Background & Objective: Upper limb dysfunction is a common neuromotor impairment in children with cerebral palsy (CP). The recent robot assisted rehabilitation may complement conventional rehabilitation. This study aimed to explore effective training protocol of the hand robot on upper limb function and daily living capability in children with CP.
Methods: Twenty-four children aged 4 to 13 years with CP who are able to maintain sitting position, manual ability classification system (MACS) level II to IV, gross motor function classification system (GMFCS) level I to IV were recruited. Participants were randomly assigned to robot-assisted training with different training protocol; Group 1 (active, active assisted, and task-oriented training using hand robotic device) and Group 2 (passive range of motion exercise using same device). Both groups were provided intensive robotic training of the affected hand using AmadeoTM which is an end-effector device that covers the hand fingers workspace. Both groups took the same dose of intervention of 18 sessions of 30 min each, three days a week for six weeks. The outcome measures were obtained before and after the intervention, and at the 6-week follow-up. The Shriners Hospital Upper Extremity Evaluation (SHUEE), nine-hole pegboard test, box and block test, grasp and pinch power test, Daily living capability using Pediatric Motor Activity Log (PMAL) and visuomotor coordination function using Developmental Test of Visual Perception-4 (DTVP-4) were conducted. To avoid assessment bias, all assessments were completed by occupational therapists blinded to group assignment.
Results: Overall, 23 children (11, active group; 12, passive group) completed the protocol. Active group showed significant improvements in positional dynamic analysis (PDA) of SHUEE and lateral and palmar pinch power, compared with the passive group (p<0.05). The amount of use of the affected arm measured by PMAL improved in both groups after treatment. As for passive group, dexterity function measured by Box & block test and Quality of movement measured by PMAL improved after intervention but did not reach a statistically significant level in terms of group by time.
Conclusions: Robot assisted hand training with active training protocol showed improvement in motor outcomes in children with CP. Robot assisted active and task-oriented hand training can offer intensive, interactive, and repetitive training, providing motivation and enhancing motor learning in children with CP. |
