Robotic-assisted therapy to improve manual dexterity in children with cerebral palsy
Jean-Francois Daneault, PhD
Backgroung: Cerebral palsy (CP) is the most common motor disorder in children (1.5 to 4 per 1 000 live births) and a prevalence of 500 000 in the US. CP is a group of permanent disorders affecting movement and posture. Symptoms usually include weakness, spasticity, and loss of selective motor control. This leads to activity limitations and impaired quality of life (QoL) for the child and family members. Lifelong therapy is required to minimize symptoms and improve QoL; putting a financial burden the family and healthcare system.
Gap: Recent small studies have demonstrated beneficial effect of using robotic-assisted therapy for upper-limb impairments in CP. However, as for robotic-assisted gait training in CP, there is much variability in response to the intervention. Furthermore, these interventions usually focus on large movements (e.g. gait and reaching) without addressing fine motor control (e.g. grasping and releasing) that will enable children to better interact with their environment, reduce their functional impairments, and consequently improve QoL. Consequently, we propose to conduct the first study to assess the use of robot-assisted therapy aimed at improving grasping movements in children with CP and simultaneously identify a possible predictor of intervention response.
Hypotheses: Extensive data from our laboratory has demonstrated the effectiveness of robotic-assisted therapy in improving functional outcomes in children with CP. Furthermore, using sophisticated analytical techniques, we are able to identify specific properties of muscle activation and show a relationship between them, clinical characteristics of the children with CP, and outcome of robotic-assisted therapy. We hypothesize that robotic-assisted therapy will lead to significant improvements in manual dexterity in children with CP. We also hypothesize that this will lead to significant improvements in QoL in children with CP. Finally, we hypothesize that the improvements in motor function will be associated with specific properties of muscle activity.
Methodology: To address our first hypothesis, we will assess functional measures (e.g. Melbourne Assessment of Unilateral Limb Function, Modified Ashworth Scale, etc.) before, after 18 sessions of robotic-assisted therapy using the Amadeo®, and 1 month post-treatment. To address our second hypothesis, we will assess QoL using the cerebral palsy QoL questionnaire at baseline, after the intervention, and at 1 month post-intervention. Finally, to address our third hypothesis, we will assess muscle activity during grasping movements at baseline. A total of 10 children with CP exhibiting upper-limb paresis will be recruited. The primary outcome will be functional and QoL measures. The number of muscle synergies, their similarity, and shared subspace will also be primary outcomes.
Potential Impact: This research will identify whether using robotic-assisted therapy can provide significant functional improvements in manual dexterity in children with CP. Furthermore, we will be able to identify whether characteristics of muscle activity could help in screening children that would benefit most from such an approach. This could have major impact on the rehabilitation protocols implemented in children with CP. Finally, this research will enable us to compute the required sample size of a large-scale controlled clinical trial examining the impact of robotic-assisted therapy on impaired hand function and QoL in children with CP.