An Accessible Training Device for Children With Cerebral Palsy

Abstract

Walking and balance capabilities can be improved upon using repetitive ankle dorsiflexion exercises. Here we developed two types of pedal switches incorporated with training devices to improve their walking and balance performance of children with cerebral palsy. The first type of pedal switch can be used to operate a home appliance, while the second type of pedal switch can connect them to web games. Pedal switches can be used for home rehabilitation. This randomized controlled trial included patients in the intervention (n = 24) and control (n = 24) groups who completed 15 weeks of ankle training. The experimental group performed ankle dorsiflexion using a pressure-activated pedal switch connected to the web games. The control group performed ankle dorsiflexion exercises using a pedal switch that operated a home appliance (a fan). Standing balance and walking performance were estimated using the Zebris FDM system, a pressure force platform, the Pediatric Balance Scale score, and the 1-minute walk test. The pre-and posttest data were analyzed using analysis of variance and analysis of covariance, which revealed that the intervention group had more significant improvements in sway patterns and balance and walking. The developed facility of a modified pedal switch integrated with web games can achieve better exercise adherence to promote balance and walking performance than that with home appliances. Maintaining motivation in children with cerebral palsy plays a very important role in the rehabilitation process.

System Comparison for Gait and Balance Monitoring Used for the Evaluation of a Home-Based Training

“…In contrast to the gait tasks, where small improvements in performance were observed for all variables (even though not always reaching statistical significance), the pattern of observed changes in stance tasks was more heterogeneous (see Table A1, Appendix A). In contrast, an improvement was reported in the literature for different patient groups, e.g., for PD patients [65] or for children with cerebral palsy [21,27] and healthy older adults [66], and for younger adults [67] after a training intervention. Cadore et al [68] also summarized in their review that most balance trainings in older adults with physical frailty led to enhancements in balance.…”

“…For the balance tasks, the center of mass (COM) sway area (area of an ellipse enclosing all data points in the x-and y-direction) and the velocity of the COM (average distance in millimeters that the participant traveled per second) were chosen. These two variables showed good reliability in previous studies (e.g., [38,39]) and are commonly used for examining balance performance [20,21,40]. Both variables were available for all three gait analysis systems.…”

“…The most commonly used instrument is a force plate (similar to gait analysis), however, an increasing number of technologies, whose reliability and validity was described in Baker et al [19], are being used on a regular basis (e.g., inertial sensors). For balance tasks, center of mass or center of pressure data are commonly used to determine the area of postural sway, path length and mean velocity [20,21]. Morenilla et al [22] described altered sway areas and velocities in PD patients when examining normal stance on a tri-axis force plate (Kistler).…”