Non-ambulatory children with cerebral palsy: effects of four months of static and dynamic standing exercise on passive range of motion and spasticity in the hip
Abstract:Purpose
The aim of this study was to compare the effects of four months of two types of structured training regimes, static standing (StS) versus dynamic standing (DyS), on passive range of motion (PROM) and spasticity in the hip among non-ambulatory children with cerebral palsy.
Method
Twenty non-ambulatory children with cerebral palsy participated in an exercise intervention study with a crossover design. During StS, the Non-ambulatory ch… Show more
“…3 Picture of upper limb exoskeletons rehabilitation robots a KINARM [ 82 ], b GLOREHA [ 83 ], c HAL single joint [ 84 ], and d PneuGlove [ 85 ] Fig. 4 Picture of lower limb end-effectors rehabilitation robots: a Innowalk [ 86 ], b UFMG [ 87 ], c 3DCaLT [ 88 ], d Leg Press [ 89 ]. Reprinted from Biomedical Signal Processing and Control, Vol.…”
Section: Methodsmentioning
confidence: 99%
“… Picture of lower limb end-effectors rehabilitation robots: a Innowalk [ 86 ], b UFMG [ 87 ], c 3DCaLT [ 88 ], d Leg Press [ 89 ]. …”
Children with physical disabilities often have limited performance in daily activities, hindering their physical development, social development and mental health. Therefore, rehabilitation is essential to mitigate the adverse effects of the different causes of physical disabilities and improve independence and quality of life. In the last decade, robotic rehabilitation has shown the potential to augment traditional physical rehabilitation. However, to date, most robotic rehabilitation devices are designed for adult patients who differ in their needs compared to paediatric patients, limiting the devices’ potential because the paediatric patients’ needs are not adequately considered. With this in mind, the current work reviews the existing literature on robotic rehabilitation for children with physical disabilities, intending to summarise how the rehabilitation robots could fulfil children’s needs and inspire researchers to develop new devices. A literature search was conducted utilising the Web of Science, PubMed and Scopus databases. Based on the inclusion–exclusion criteria, 206 publications were included, and 58 robotic devices used by children with a physical disability were identified. Different design factors and the treated conditions using robotic technology were compared. Through the analyses, it was identified that weight, safety, operability and motivation were crucial factors to the successful design of devices for children. The majority of the current devices were used for lower limb rehabilitation. Neurological disorders, in particular cerebral palsy, were the most common conditions for which devices were designed. By far, the most common actuator was the electric motor. Usually, the devices present more than one training strategy being the assistive strategy the most used. The admittance/impedance method is the most popular to interface the robot with the children. Currently, there is a trend on developing exoskeletons, as they can assist children with daily life activities outside of the rehabilitation setting, propitiating a wider adoption of the technology. With this shift in focus, it appears likely that new technologies to actuate the system (e.g. serial elastic actuators) and to detect the intention (e.g. physiological signals) of children as they go about their daily activities will be required.
“…3 Picture of upper limb exoskeletons rehabilitation robots a KINARM [ 82 ], b GLOREHA [ 83 ], c HAL single joint [ 84 ], and d PneuGlove [ 85 ] Fig. 4 Picture of lower limb end-effectors rehabilitation robots: a Innowalk [ 86 ], b UFMG [ 87 ], c 3DCaLT [ 88 ], d Leg Press [ 89 ]. Reprinted from Biomedical Signal Processing and Control, Vol.…”
Section: Methodsmentioning
confidence: 99%
“… Picture of lower limb end-effectors rehabilitation robots: a Innowalk [ 86 ], b UFMG [ 87 ], c 3DCaLT [ 88 ], d Leg Press [ 89 ]. …”
Children with physical disabilities often have limited performance in daily activities, hindering their physical development, social development and mental health. Therefore, rehabilitation is essential to mitigate the adverse effects of the different causes of physical disabilities and improve independence and quality of life. In the last decade, robotic rehabilitation has shown the potential to augment traditional physical rehabilitation. However, to date, most robotic rehabilitation devices are designed for adult patients who differ in their needs compared to paediatric patients, limiting the devices’ potential because the paediatric patients’ needs are not adequately considered. With this in mind, the current work reviews the existing literature on robotic rehabilitation for children with physical disabilities, intending to summarise how the rehabilitation robots could fulfil children’s needs and inspire researchers to develop new devices. A literature search was conducted utilising the Web of Science, PubMed and Scopus databases. Based on the inclusion–exclusion criteria, 206 publications were included, and 58 robotic devices used by children with a physical disability were identified. Different design factors and the treated conditions using robotic technology were compared. Through the analyses, it was identified that weight, safety, operability and motivation were crucial factors to the successful design of devices for children. The majority of the current devices were used for lower limb rehabilitation. Neurological disorders, in particular cerebral palsy, were the most common conditions for which devices were designed. By far, the most common actuator was the electric motor. Usually, the devices present more than one training strategy being the assistive strategy the most used. The admittance/impedance method is the most popular to interface the robot with the children. Currently, there is a trend on developing exoskeletons, as they can assist children with daily life activities outside of the rehabilitation setting, propitiating a wider adoption of the technology. With this shift in focus, it appears likely that new technologies to actuate the system (e.g. serial elastic actuators) and to detect the intention (e.g. physiological signals) of children as they go about their daily activities will be required.
“…In addition, their parents reported warmer feet, improvements in bowel function, gross motor function, satisfaction, alertness, fatigability, and the ability to focus compared with StS [8]. When comparing four months of DyS with four months of StS, passive range of motion in the hip improved more with DyS and the spasticity in the hip decreased after one bout (30 min) of DyS, whereas StS had no such effects [5]. These positive effects of DyS compared with StS raise the question of whether or not DyS is a cost-effective treatment.…”
Section: Introductionmentioning
confidence: 96%
“…A variety of structural and functional effects of StS have been described, including improved bone mineral density, improved hip stability, a larger passive range of motion in the hip, knee and ankle joints, and enhanced activity and participation [3,4]. In addition, StS enables light physical activity [5,6]. However, StS is time-consuming and costly, and while it may benefit the well-being of many children, it is inconvenient for others.…”
Children with cerebral palsy who are non-ambulant cannot stand or walk independently. In Sweden, daily static standing is part of standard care for these children even though it is time-consuming and costly, and while it may benefit the well-being of many children, it is inconvenient for others. A novel stander enables dynamic standing through walking movements. The aim of this study was to compare dynamic and static standing regarding quality of life and cost-effectiveness. Twenty children who were non-ambulant with cerebral palsy were included in this randomized controlled study with a cross-over design. Mean age of the participants was 11.6 ± 3.6 years, nine were female. They participated in four months of static and four months of dynamic standing. Quality of life was assessed with the Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD), which has been shown to be valid and reliable, and is tailored to children with severe cerebral palsy. Information about other aspects of quality of life and about cost-effectiveness was collected by study-specific questionnaires. Dynamic standing was the preferred alternative from the family perspective, as it cost less (€64, p < 0.01) and had greater benefits than standard (static standing) care. From societal and healthcare provider perspectives, dynamic standing had benefits but higher costs than static standing (€290 and €354 respectively, p < 0.01). These findings may contribute to the development of individualized standing recommendations.
“…Maintaining the standing position has been reported to have various benefits in children and adults with CP, including increased bone mineral density of the spine 21 ) , decreased modified Ashworth scale, improved passive range of motion with dynamic standing posture maintenance using a posture-holding device called the Innowalk 22 ) , increased hamstring muscle length, and reduced caregiver assistance 23 ) . In addition to these benefits reported in previous studies, the possibility of muscle qualitative changes caused by standing as suggested in the present study must be taken into account when making decisions on whether or not to provide standing intervention for individuals with severe CP.…”
[Purpose] To observe the effect of daily standing, as indicated by gross motor function,
on the quantity and quality of the thigh muscles in adults with severe cerebral palsy and
to obtain data to determine an appropriate intervention that will improve their quality of
life. [Participants and Methods] Thirty-three adults with severe cerebral palsy
participated in the study. We assessed the gross motor function using the GMFM-66-IS. We
then evaluated the quadriceps muscle thickness and the rectus femoris muscle echo
intensity using ultrasonography. We divided the participants into the standing and
non-standing groups and then examined the correlations of the GMFM-66-IS score to muscle
thickness and echo intensity. We calculated the difference in mean muscle thickness and
echo intensity between the two groups using an independent t-test. [Results] Significant
positive correlations were found between the GMFM-66-IS score and muscle thickness and
echo intensity. In the group-specific analysis, no significant correlation was found
between echo intensity and the GMFM-66-IS score in either group. Muscle thickness and echo
intensity were greater in the participants of the standing group. [Conclusion] Daily
standing, as indicated by gross motor function, affected muscle thickness and echo
intensity. Quantitative and qualitative data might need to be evaluated when assessing the
muscles of adults with severe cerebral palsy using ultrasonography.
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