Objective To investigate the feasibility of game-based robotic training of the ankle in children with cerebral palsy (CP). Design Case study, 12 weeks intervention, with no follow-up. Setting University research laboratory. Participants A referred sample of 3 children with cerebral palsy, age 7 to 12, all male were enrolled. Three completed the intervention. Interventions Participants trained on the RA CP system for 36 rehabilitation sessions (12 weeks, 3 times/week), playing two custom virtual reality games. The games were played while participants were seated, and trained one ankle at-a-time for strength, motor control, and coordination. Main Outcome Measures The primary study outcome measures were for impairment (DF/PF torques, DF initial contact angle and gait speed), function (GMFM) and quality of life (Peds QL). Secondary outcome measures relate to game performance (game scores as reflective of ankle motor control and endurance). Results Gait function improved substantially in ankle kinematics, speed and endurance. Overall function (GMFM) indicated improvements that were typical of other ankle strength training programs. Quality of life increased beyond what would be considered a minimal clinical important difference. Game performance improved in both games during the intervention. Conclusions This feasibility study supports the assumption that game-based robotic training of the ankle benefits gait in children with CP. Game technology is appropriate for the age group and was well accepted by the participants. Additional studies are needed however, to quantify the level of benefit and compare the approach presented here to traditional methods of therapy.
The purpose of the study described here was to develop and feasibility test the Rutgers Ankle CP, aimed at ankle strengthening and improved control for children with cerebral palsy (CP). The system was an upgrade in hardware (new foot attachment, new robot controller) and software (new games and programming language) of the earlier Rutgers Ankle in order to permit training of children with CP. The new Rutgers Ankle CP was used to train ankle strength and motor control in a 7 year old boy with CP during 36 rehabilitation sessions (12 weeks, 3 times/week). Assessments for impairment, function and quality of life were taken before and after training. Results indicated improvements in both strength and motor control. Gait function improved substantially in ankle kinematics, speed and endurance. Overall function (GMFM) indicated improvements that were typical of other ankle strength training programs. Quality of life increased beyond what would be considered a minimal clinical important difference. While these results are only for a single participant, they are very encouraging toward improving the function and quality of life of children with cerebral palsy. Further research with a larger number of participants is planned.
Background The current jig standard for measuring scapulohumeral movement of the shoulder complex only allows for static measurements of scapular positioning. Methods We compared scapular positioning as determined by a scapular jig with that projected from a marker triad placed on the acromion process of the scapula using an infrared motion capture system. Nine individuals performed abduction and scaption shoulder movements while arm and shoulder positioning were recorded during static and dynamic trials. Virtual scapulae were projected from surface marker triads on participants' acromia and compared with the position of three scapular landmarks identified by placement of a customized plastic jig. Static and dynamic positioning at a series of angles was compared to the jig standard to determine validity of the technique. Results There were no statistically significant differences between the virtual projections and jig standard for scapular external rotation, upward rotation, and anterior‐posterior tilt planar measurements. Dynamic positioning correlated well with static projections, but virtual scapular projections generally overestimated upward rotation of the scapulae, as compared to the jig. This could potentially be corrected through the development of a linear correction factor. Conclusion Acromial projection allows for reproducible, non‐invasive dynamic video motion capture of the scapula.
Background Scapula mobility complicates upper extremity kinematics assessment. Existing methods are diverse, providing inconsistent results. The current gold standard (bone pins) is prohibitively invasive. The purposes of the current study are to describe a virtual projection alternative to surface markers for video motion capture (VMC) of the scapula and to compare the results of the projection and surface marker methods to the results of similar existing methods. Methods Ten participants were evaluated using VMC. Surface markers were applied to the trunk and arm in accordance with existing guidelines. Three markers were affixed to plastic base on the skin over the acromion process. Other scapular landmarks were digitized in a neutral position. These landmarks' locations were defined in reference to the acromion cluster and used to generate the projection. Humerothoracic, glenohumeral, and scapulothoracic kinematics were evaluated during shoulder abduction, flexion, and scaption. Joint angles produced by the surface markers and the projection were compared by Bonferroni-adjusted t tests. The results were compared to prior findings in the literature. Results The projection resulted in greater scapulothoracic upward rotation, internal rotation, and anterior-posterior tilt and less glenohumeral elevation (p<.0055) than did surface markers. The virtual scapula produced greater estimates of scapular mobility than did surface markers, corresponding to pre-existing results from similar methodologies. Conclusions The result is a noninvasive measurement tool that produces different and superior results than do scapula surface markers. Measuring scapula kinematics via VMC without bone pins will facilitate future investigations into interactions between upper extremity injury, kinematics, and activity performance.
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