Feasibility and Effectiveness of a Novel Exoskeleton for an Infant With Arm Movement Impairments.
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ABSTRACT:
SUBMITTER: Babik I
PROVIDER: S-EPMC4922496 | biostudies-literature | 2016 Fall
REPOSITORIES: biostudies-literature
Publications
Feasibility and Effectiveness of a Novel Exoskeleton for an Infant With Arm Movement Impairments.
Babik Iryna I Kokkoni Elena E Cunha Andrea B AB Galloway James Cole JC Rahman Tariq T Lobo Michele A MA
Pediatric physical therapy : the official publication of the Section on Pediatrics of the American Physical Therapy Association 20160901 3
<h4>Purpose</h4>To determine whether a novel exoskeletal device (Pediatric-Wilmington Robotic Exoskeleton [P-WREX]) is feasible and effective for intervention to improve reaching and object interaction for an infant with arm movement impairments.<h4>Methods</h4>An 8-month old infant with arthrogryposis was followed up every 2 weeks during a 1-month baseline, 3-month intervention, and 1-month postintervention. At each visit, reaching and looking behaviors were assessed.<h4>Results</h4>Within sess ...[more]
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Project description:To date, the limited degrees of freedom (DOF) of most robotic training devices hinders them from providing functional training following stroke. We developed a 6-DOF exoskeleton ("BONES") that allows movement of the upper limb to assist in rehabilitation. The objectives of this pilot study were to evaluate the impact of training with BONES on function of the affected upper limb, and to assess whether multijoint functional robotic training would translate into greater gains in arm function than single joint robotic training also conducted with BONES.Twenty subjects with mild to moderate chronic stroke participated in this crossover study. Each subject experienced multijoint functional training and single joint training three sessions per week, for four weeks, with the order of presentation randomized. The primary outcome measure was the change in Box and Block Test (BBT). The secondary outcome measures were the changes in Fugl-Meyer Arm Motor Scale (FMA), Wolf Motor Function Test (WMFT), Motor Activity Log (MAL), and quantitative measures of strength and speed of reaching. These measures were assessed at baseline, after each training period, and at a 3-month follow-up evaluation session.Training with the robotic exoskeleton resulted in significant improvements in the BBT, FMA, WMFT, MAL, shoulder and elbow strength, and reaching speed (p < 0.05); these improvements were sustained at the 3 month follow-up. When comparing the effect of type of training on the gains obtained, no significant difference was noted between multijoint functional and single joint robotic training programs. However, for the BBT, WMFT and MAL, inequality of carryover effects were noted; subsequent analysis on the change in score between the baseline and first period of training again revealed no difference in the gains obtained between the types of training.Training with the 6 DOF arm exoskeleton improved motor function after chronic stroke, challenging the idea that robotic therapy is only useful for impairment reduction. The pilot results presented here also suggest that multijoint functional robotic training is not decisively superior to single joint robotic training. This challenges the idea that functionally-oriented games during training is a key element for improving behavioral outcomes.NCT01050231.
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Project description:BackgroundEarly phase research suggests that physiotherapy paired with use of robotic walking aids provides a novel opportunity for children with severe mobility challenges to experience active walking. The Trexo Plus is a pediatric lower limb exoskeleton mounted on a wheeled walker frame, and is adjustable to fit a child's positional and gait requirements. It guides and powers the child's leg movements in a way that is individualized to their movement potential and upright support needs, and can provide progressive challenges for walking within a physiotherapy-based motor learning treatment paradigm.MethodsThis protocol outlines a single group mixed-methods study that assesses the feasibility of physiotherapy-assisted overground Trexo use in school and outpatient settings during a 6-week physiotherapy block. Children ages 3-6 years (n = 10; cerebral palsy or related disorder, Gross Motor Function Classification System level IV) will be recruited by circle of care invitations to participate. Study indicators/outcomes will focus on evaluation of: (i) clinical feasibility, safety, and acceptability of intervention; (ii) pre-post intervention motor/functional outcomes; (iii) pre-post intervention brain structure characterization and resting state brain connectivity; (iv) muscle activity characterization during Trexo-assisted gait and natural assisted gait; (v) heart rate during Trexo-assisted gait and natural assisted gait; and (vi) user experience and perceptions of physiotherapists, children, and parents.DiscussionThis will be the first study to investigate feasibility indicators, outcomes, and experiences of Trexo-based physiotherapy in a school and outpatient context with children who have mobility challenges. It will explore the possibility of experience-dependent neuroplasticity in the context of gait rehabilitation, as well as associated functional and muscular outcomes. Finally, the study will address important questions about clinical utility and future adoption of the device from the physiotherapists' perspective, comfort and engagement from the children's perspective, and the impressions of parents about the value of introducing this technology as an early intervention.Clinical trial registrationhttps://clinicaltrials.gov, identifier NCT05463211.
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Project description:Developmental dyslexia is associated with vision and hearing impairments. Whether these impairments are causes or comorbidities is controversial. Because both senses are heavily involved in reading, cognitive theories argue that sensory impairments are comorbidities that result from a lack of reading practice. Sensory theories instead argue that this is sensory impairments that cause reading disabilities. Here we test a discriminant prediction: whether sensory impairments in developmental dyslexia are restrained to reading-related senses or encompass other senses. Sensory theories predict that all senses are affected, whereas, according to the lack of reading practice argument, cognitive theories predict that only reading-related senses are affected. Using a robotic ergometer and fully automatized analyses, we tested proprioceptive acuity in seventeen dyslexic children and seventeen age-matched controls on a movement detection task. Compared to controls, dyslexics had higher and more variable detection thresholds. For the weakest proprioceptive stimuli, dyslexics were twice as long and twice as variable as controls. More, proprioceptive acuity strongly correlated with reading abilities, as measured by blind cognitive evaluations. These results unravel a new sensory impairment that cannot be attributed to a lack of reading practice, providing clear support to sensory theories of developmental dyslexia. Protocol registration: This protocol is part of the following registration, ClinicalTrials.gov Identifier: NCT03364010; December 6, 2017.
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Project description:The process by which neural circuitry in the brain plans and executes movements is not well understood. Until recently, most available data were limited either to single-neuron electrophysiological recordings or to measures of aggregate field or metabolism. Neither approach reveals how individual neurons' activities are coordinated within the population, and thus inferences about how the neural circuit forms a motor plan for an upcoming movement have been indirect. Here we build on recent advances in the measurement and description of population activity to frame and test an "initial condition hypothesis" of arm movement preparation and initiation. This hypothesis leads to a model in which the timing of movements may be predicted on each trial using neurons' moment-by-moment firing rates and rates of change of those rates. Using simultaneous microelectrode array recordings from premotor cortex of monkeys performing delayed-reach movements, we compare such single-trial predictions to those of other theories. We show that our model can explain approximately 4-fold more arm-movement reaction-time variance than the best alternative method. Thus, the initial condition hypothesis elucidates a view of the relationship between single-trial preparatory neural population dynamics and single-trial behavior.
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Project description:BACKGROUND:Recent movement behaviour guidelines prescribe the optimal time spent in physical activity, screen time, and sleep across a 24-hr period. The proportion of youth with visual impairments meeting 0, 1, 2, or all 3 of these 24 movement guidelines is unknown. The primary purpose of this observational, cross-sectional analysis was to examine the proportions of youth with visual impairments in the United States who partially or fully meet the physical activity, screen time, and sleep duration guidelines. A secondary purpose of this analysis was to examine whether demographic variables were associated with the odds of youth with visual impairments meeting these guidelines. METHODS:This study included 561 youth with visual impairments from the 2016 to 2017 National Survey of Children's Health (NSCH). Accounting for the NSCH sampling plan, Complex Samples was used to estimate the prevalence of meeting 24-hr movement guidelines, and a multinomial logistic regression analysis was conducted to examine the odds ratio of guidelines met across different demographic factors. RESULTS:Of the participants in this study, 18.7%, 50.7%, and 73.2% met physical activity, sleep, and screen time guidelines, respectively. Just 5.8% of the sample met all three of the 24-hr movement guidelines, whereas 10.6% did not meet any of the three guidelines. CONCLUSIONS:The proportion of the sample meeting of all three guidelines was low, thus depriving the majority of this population of the physiological and psychological health benefits of meeting each guideline. Moreover, the study identifies physical inactivity as a key risk factor that requires attention in this population.
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Project description:BackgroundThis study aimed to address methodological limitations of the evidence that informed national and international movement behaviour guidelines for the early years. Specifically, the primary objective was to examine the longitudinal associations of infant physical activity (i.e., tummy time) and sedentary behaviour (i.e., back time, screen time, reading time, restrained time) with gross motor development. Secondary and tertiary objectives were to examine longitudinal associations of: (1) infant physical activity and sedentary behaviour with communication, fine motor, personal-social, and problem solving development, and (2) sleep time with primary and secondary outcomes.MethodsParticipants were 411 parents and their infants from the Early Movers project in Edmonton, Canada. Physical activity, sedentary behaviour, and sleep were measured with a parental questionnaire and the Ages & Stages Questionnaire (ASQ-3) developmental screening tool was administered at 2, 4, and 6 months. Parents reported the dates six major gross motor milestones (i.e., independent sitting, crawling, assisted standing, assisted walking, independent standing, independent walking) were acquired in the first 18 months of life according to World Health Organization criteria. In a subsample (n = 125), gross motor development was assessed using the Alberta Infant Motor Scale (AIMS) at 6 months.ResultsHigher tummy time across time points was significantly associated with higher ASQ-3 gross motor and personal-social development scores over time, higher total AIMS scores at 6 months, and earlier acquisition of all gross motor milestones. Higher reading time across time points was significantly associated with higher ASQ-3 fine motor, gross motor, personal-social, and total development scores over time. In contrast, higher back time across time points was significantly associated with lower total AIMS scores at 6 months and the later acquisition of assisted standing, assisted walking, and independent walking. Similarly, higher restrained time across time points was significantly associated with a later acquisition of supported walking.ConclusionsTummy time was consistently longitudinally associated with more advanced gross motor development and reading with more advanced total development. Whereas, some detrimental associations were observed for back and restrained time. Findings support the promotion of tummy time and certain sedentary behaviours (i.e., reading) in young infants to enhance overall development.
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