Feasibility of motor-assisted elliptical to improve walking, fitness and balance following pediatric acquired brain injury: A case series

Abstract

PURPOSE: Walking, fitness, and balance deficits are common following acquired brain injury (ABI). This study assessed feasibility, acceptability, and usefulness of a modified motor-assisted elliptical (ICARE) in addressing walking, fitness, and balance deficits in children with chronic ABIs. METHODS: Three children (> 5 years post-ABI) completed 24 ICARE exercise sessions (exercise time, speed, and time overriding motor-assistance gradually increased) to promote mass repetition of gait-like movements and challenge cardiorespiratory fitness. Parents’ and children’s perceptions of ICARE’s safety, comfort, workout, and usability were assessed. Cardiovascular response, gait and balance outcomes were assessed. RESULTS: No adverse events occurred. Parent’s Visual Analogue Scale (VAS) scores of perceived device safety (range 80–99), workout (range 99–100), and usability (range 75–100) were high, while comfort were 76–80 given commercial harness fit and arm support. Children’s VAS scores all exceeded 89. Comfortable walking velocity, 2-Minute Walk Test, fitness, and Pediatric Balance Scale scores improved post-training, with many outcomes surpassing established minimal clinically important differences. CONCLUSION: Following engagement in moderate- to vigorous-intensity exercise promoting repetitive step-like movements on a specially adapted motor-assisted elliptical, three children with chronic ABI demonstrated improvements in walking, fitness and balance. Future research in community-based environments with a larger cohort of children with ABI is needed.

Combining a non-immersive virtual reality gaming with motor-assisted elliptical exercise increases engagement and physiologic effort in children

“…Training faster than the speed set on the console causes the motor to disengage and promotes greater physiologic challenge for lower extremity muscles and the heart (Burnfield et al, 2017;Burnfield et al, 2019). The device has recently been adapted to train children as young as three years of age with physical disabilities and special healthcare needs (Nelson et al, 2015;Burnfield et al, 2017;Burnfield et al 2018;Burnfield et al 2019;Burnfield et al 2021). However, one practical challenge is encouraging children to exert the greater effort required to override the motor's assistance without external cueing from a clinician, educator, or caregiver.…”