Movement Velocity and Fluidity Improve after Armeo®Spring Rehabilitation in Children Affected by Acquired and Congenital Brain Diseases: An Observational Study

Abstract

Background Children with cerebral palsy (CP) and acquired brain injury (ABI) often exhibit upper limb impairment, with repercussions in their daily activities. Robotic rehabilitation may promote their functional recovery, but evidence of its effectiveness is often based on qualitative functional scales. The primary aim of the present work was to assess movement precision, velocity, and smoothness using numerical indices from the endpoint trajectory of Armeo®Spring. Secondly, an investigation of the effectiveness of robotic rehabilitation in CP and ABI children was performed. Methods Upper limb functional changes were evaluated in children with CP (N=21) or ABI (N=22) treated with Armeo®Spring (20 45-minute sessions over 4 weeks) using clinical scales and numerical indices computed from the exoskeleton trajectory. Results Functional scales (i.e., QUEST and Melbourne) were sensitive to changes produced by the treatment for the whole study group and for the two etiology-based subgroups (improvements above Minimal Clinically Importance Difference). Significant improvement was also observed in terms of velocity, fluidity, and precision of the movement through the numerical indices of kinematic performance. Differences in the temporal evolution of the motor outcome were highlighted between the ABI and CP subgroups, pointing toward adopting different rehabilitative protocols in these two populations. Conclusions Robot-assisted upper limb rehabilitation seems to be a promising tool to promote and assess rehabilitation in children affected by acquired and congenital brain diseases.

Devices and Protocols for Upper Limb Robot-Assisted Rehabilitation of Children with Neuromotor Disorders

“…However, significant improvements in terms of QUEST scale after the training with Armeo has been proven by El-Shamy [85], showing that robotic-assisted therapy is more effective than conventional therapy in promoting functional improvements of upper limbs, suggesting to combine conventional and robotic therapies for the achievement of better rehabilitation gains. In support of this thesis, another study [82] has demonstrated the improvement of functionality of the upper limbs after Armeo Spring training in children with CP and ABI. However, the researchers have noticed that the recovery was different between the two groups and that children with ABI improved essentially in the first period of training whereas children with CP in the second one.…”

“…This device records movement parameters such as resistance, strength, coordination and range of motion and is adjustable according to the patient's condition. We found 7 clinical studies involving this device [81][82][83][84][85][86][87]. It has been used primarily for clinical rehabilitation protocols for children with CP, demonstrating a better quality of upper limb movements due to improvements of QUEST and MAAULF scales at the end of the training [81][82][83].…”

“…We found 7 clinical studies involving this device [81][82][83][84][85][86][87]. It has been used primarily for clinical rehabilitation protocols for children with CP, demonstrating a better quality of upper limb movements due to improvements of QUEST and MAAULF scales at the end of the training [81][82][83]. Nonetheless, we also found a study showing that the training with Armeo improved only the MAAULF scale while the QUEST scale remained unchanged, which means improvements in functional gains of the upper limbs and not in the movement characteristics [84].…”

Effectiveness of robotic-assisted therapy for upper extremity function in children and adolescents with cerebral palsy: a systematic review protocol

“…[31][32][33] Thus, the implementation of robotics primarily focuses on functional motor performance by providing intensive repetitive training, sensorimotor integration and cognitive engagement through goal-directed tasks to address the underlying symptoms and related problems due to client's neurological conditions. [34][35][36] From previous studies, the use of robotic devices has been found to improve kinematics, [37][38][39][40] range of motion, 41 42 muscle tone, 43 44 postural control 45 46 and functionality of upper 38 40 and lower extremities 47 48 among individuals with CP.…”

Robotics in physical medicine and neurorehabilitation

“…The Armeo Spring is a robotic device for hand rehabilitation which, with the help of exoskeletons with integrating springs, facilitates active movements of the upper limbs [26]. Software video games allow the patient to move his arms in different directions and perform more precise movements as well as squeeze [27].…”