Feasibility and Effectiveness of a Novel Exoskeleton for an Infant With Arm Movement Impairments

Abstract

Purpose To determine whether a novel exoskeletal device (Pediatric Wilmington Robotic Exoskeleton, P-WREX) is feasible and effective for intervention to improve reaching and object interaction for an infant with arm movement impairments. Methods An 8-month old with arthrogryposis was followed every two weeks during a 1-month baseline, 3-month intervention, and 1-month post-intervention. At each visit, reaching and looking behaviors were assessed. Results Within sessions, the infant spent more time contacting objects across a larger space, contacting objects with both hands, and looking at objects when wearing the P-WREX. Throughout intervention, the infant increased time contacting objects both with and without the device and increased bilateral active shoulder flexion. Conclusions 1) It may be feasible for families to use exoskeletons for daily intervention, 2) Exoskeletons facilitate immediate improvements in function for infants with impaired upper extremity mobility, and 3) Interventions using exoskeletons can improve independent upper extremity function across time.

Rehabilitation across the lifespan for individuals with arthrogryposis

“…These children may discover, on their own, alternative leverage techniques that do not require assistive devices. They may find the use of overhead slings or upper extremity exoskeletons (Figure ) helpful in gaining antigravity use of the upper body and subsequently promoting fine motor skills (Babik et al, ).…”

Development of self‐feeding behavior in children with typical development and those with arm movement impairments

“…AMC 2 is a non-progressive neuromuscular congenital condition with muscle contractures and weakness across multiple joints, often resulting in significant movement impairments (Bamshad, Van Heest, & Pleasure, 2009;Staheli, Hall, Jaffe, & Paholke, 1998). Many children and adults with AMC have difficulty lifting both arms against gravity and bending the elbow (Babik et al, 2016). This often limits fine-motor skills, reaching, and object manipulation (Babik et al, 2016).…”

“…Moreover, as children with AMC have limited opportunities to grasp and manipulate food, utensils, and other tools, their haptic learning opportunities become diminished, placing them at risk for delays in problem-solving and cognition (Corbetta & Snapp-Childs, 2009;Gibson, 1988;Jouen & Molina, 2005;Needham, Barrett, & Peterman, 2002). Although motor development in children with AMC has received some attention (Babik, Cunha, & Lobo, under review;Babik et al, 2016), little research has been conducted on the effects of motor impairments on the motor and cognitive aspects of self-feeding. Such research would highlight the role of motor ability in learning to perform daily self-care activities.…”

Play with objects in children with arthrogryposis: Effects of intervention with the Playskin Lift™ exoskeletal garment

“…Arthrogryposis multiplex congenita (AMC) is a nonprogressive congenital condition characterized by multiple joint contractures, significant muscle weakness, and reduced range of motion beginning in utero (Bamshad, Van Heest, & Pleasure, ; Staheli, Hall, Jaffe, & Paholke, ; Wallach et al, ). Children with AMC are often delayed in the development of antigravity arm movement, reaching, visual–manual coordination, object exploration, and bimanual engagement with objects (Babik et al, ; Babik, Cunha, & Lobo, under review), which might negatively impact motor and cognitive development, self‐care, and quality of life (Cohen, Parmelee, Beckwith, & Sigman, ; Lawson & Ruff, ; Ruff, McCarton, Kurtzberg, & Vaughan, ). Commonly, children with AMC develop alternative strategies to interact with objects by using the mouth or feet.…”

“…As AMC typically affects the limbs in a symmetrical manner (Oishi et al, ; Wallach et al, ), many children with AMC initially have difficulty lifting both arms against gravity and bending them at the elbow (Babik et al, ). However, at an early age, these children may develop a strong hand preference (Babik, Movva, Cunha, & Lobo, under review), likely because it is adaptive to concentrate on learning to control the movement of only one arm, rather than attempting to manage both arms.…”