Validation of a robot serious game assessment protocol for upper limb motor impairment in children with cerebral palsy

Abstract

BACKGROUND:The ROBiGAME project aims to implement serious games on robots to rehabilitate upper limb (UL) motor function in children with cerebral palsy (CP). Serious game characteristics (target position, level of assistance/resistance, level of force) are typically adapted based on the child's assessment before and continuously during the game (measuring UL working area, kinematics and muscle strength). OBJECTIVE: This study developed an UL robotic motor assessment protocol to configure the serious game. METHODS: Forty-nine healthy children and 20 CP children participated in the study. The clinical assessment consisted of the child's UL length and isometric force. The robot assessment consisted of the child's UL working area (WA), the UL isometric and isokinetic force in three directions and the UL kinematics during a pointing task toward targets placed at different distances. RESULTS: Results showed that WA and UL isometric force were moderately to highly correlated with clinical measures. Ratios between the UL isokinetic force generated on three directions were established. The velocity and straightness indexes of all children increased when they had to reach to targets placed more distant. CONCLUSIONS: This protocol can be integrated into different serious games in order to continuously configure the game characteristics to a child's performance. Trial registration: The study was registered at ClinicalTrials.gov (NCT02543424), 12 August 2015.

Tools and Techniques Used With Robotic Devices to Quantify Upper-Limb Function in Typically Developing Children: A Systematic Review

“…Thirteen articles compared robotic measures of performance to clinical outcome measures. 10,11,[13][14][15][16][17][18][19][20][21][22]27 The definitions and descriptions of each robotic and clinical outcome measure can be found in their respective articles.…”

“…10,12,15,16,21,24 Point-to-point reaching tasks (without perturbations) were the most common task type, appearing in 10 articles. [10][11][12][13][14]16,20,21,23,26 The point-to-point reaching task was the only task that had a similar experimental paradigm among different laboratory groups and robots. Generally, a virtual target would appear, and the participant would reach toward the target.…”

“…Two 9,25 REAPlan Axinesis Rehabilitation Technologies 2D workspace with 2 DOF. Two 11,14 Abbreviations: 2/3D, 2/3-dimensional; DOF, Degrees of freedom. Action planning Target interception 9 Path length ratio 9 None 9…”

“…Directional effects 22 Path length ratio 9 Movement duration 9 Distance between gaze and end-effector position 9 Time on target 9 Normalized velocity 9 Movement smoothness (calculated as normalized jerk) 9 Overall motor performance Point to point reaching (without perturbations) [10][11][12][13][14]16,20,21,23,26 Postural speed 10,20,21,26 Assisting Hand Assessment (AHA) 15,16,19,20,21,29 Object interception (bimanual task) 10,16 Reaction time 10,12,16,20,21,24,26 Melbourne Assessment of Unilateral Upper Limb Function (MA) 15,16,19,20,21,22,30 Object interception and avoidance (bimanual task) 15 Initial direction error 10,13,16,20,…”

“…Strength Isometric and isokinetic maximum voluntary contraction force measurements 11 Isometric and isokinetic pushing forward and pulling backward force measurements 11 Isometric maximum voluntary contraction measurements using a hand-held dynamometer 11 A potential recruitment bias existed as a "convenience sample" was taken for participants in the study. Limitations included: not justifying sample size, small sample size, and not performing a power analysis.…”