Rehabilitation of Upper Limb in Children with Acquired Brain Injury: A Preliminary Comparative Study

Abstract

Acquired brain injuries (ABIs) can lead to a wide range of impairments, including weakness or paralysis on one side of the body known as hemiplegia. In hemiplegic patients, the rehabilitation of the upper limb skills is crucial, because the recovery has an immediate impact on patient quality of life. For this reason, several treatments were developed to flank physical therapy (PT) and improve functional recovery of the upper limbs. Among them, Constraint-Induced Movement Therapy (CIMT) and robot-aided therapy have shown interesting potentialities in the rehabilitation of the hemiplegic upper limb. Nevertheless, there is a lack of quantitative evaluations of effectiveness in a standard clinical setting, especially in children, as well as a lack of direct comparative studies between these therapeutic techniques. In this study, a group of 18 children and adolescents with hemiplegia was enrolled and underwent intensive rehabilitation treatment including PT and CIMT or Armeo®Spring therapy. The effects of the treatments were assessed using clinical functional scales and upper limb kinematic analysis during horizontal and vertical motor tasks. Results showed CIMT to be the most effective in terms of improved functional scales, while PT seemed to be the most significant in terms of kinematic variations. Specifically, PT resulted to have positive influence on distal movements while CIMT conveyed more changes in the proximal kinematics. Armeo treatment delivered improvements mainly in the vertical motor task, showing trends of progresses of the movement efficiency and reduction of compensatory movements of the shoulder with respect to other treatments. Therefore, every treatment gave advantages in a specific and different upper limb district. Therefore, results of this preliminary study may be of help to define the best rehabilitation treatment for each patient, depending on the goal, and may thus support clinical decision.

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

“…Patients were evaluated before (T0) and after (T1) the intervention with the Quality of Upper Extremities Skills Test (QUEST) and the Melbourne Assessment of Unilateral Upper Limb Function [5, 16, 25], according to the evaluation protocol defined at the IRCCS E. Medea.…”

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

“…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].…”

“…Due to this different responses to the same treatment, authors suggested the need to differentiate the rehabilitative protocol according to the neurological disorders. In another study, Beretta et al [86] trained children with ABI with different approaches: CIMT (Constraint-Induced Movement Therapy), PT (physical therapy), Armeo Spring with the purpose to characterize the possible different outcomes. It turned out that CIMT treatment emerged as the most effective in improving the proximal movements, specifically at the shoulder joints, PT promoted an improvement in the distal movements and increased the speed and fluidity of fingers, while the Armeo Spring therapy elicited improvements in shoulder RoM in abduction/adduction but it worsened performance in flexion/extension.…”

A Multiparameter Approach to Evaluate Post-Stroke Patients: An Application on Robotic Rehabilitation

“…The effects of robotic therapies were observed as well, in terms of smoothness, accuracy, and velocity of motor performance, suggesting the possibility of promoting neuroplasticity at both shoulder and elbow level [14]. In a recent study [15] combined constrained induced therapy and robotic therapy demonstrating therapeutic effects on proximal and distal kinematics on children. Kinematics is also used to evaluate motor control capability and smoothness, often coupled with standard clinical tests [16].…”