The impact of robotic rehabilitation in children with acquired or congenital movement disorders

Aim. The aim of this study was to evaluate if the robotmediated therapy (RMT) can yield positive outcomes in children with acquired or congenital upper extremity movement disorders. Methods. This was an uncontrolled pilot study with prepost treatment outcome comparison carried out by the Pediatric Rehabilitation Department of a Children's Hospital. The study enrolled 12 children, aged 5 to 15 years, suffering from acquired (at least 12 months postonset) or congenital upper limb motor impairment. Etiology: 4 stroke, 6 traumatic brain injuries, and 2 hémiplégie cerebral palsy. RMT was provided 3 times a week for an hour during 6 weeks for a total of 18 robot therapy sessions. The Melbourne Scale (MS) and the upperextremity subsection of the Fugl-Meyer Assessment (FMA) were used for measurement of impairment. Secondary outcome measurements were made through the Modified Ashworth Scale (MAS); the Reaching Performance Scale (RPS); Parent's Questionnaire, and robot-based evaluation measurements. Specifically, authors compared the smoothness, as measured by the jerk metric, and average speed of unconstrained reaching movements. Results. Pre-post clinical evaluation revealed statistically significant gains for all primary and secondary metrics. In addition, significant improvement of robotbased metrics was observed. The primary outcome measurement mean (SEM) gains were 6.71 (1.29) for MS and 3-33 (0.80) for the FMA. RMT led to spasticity decreases in chronic cases, as shown by the reduction of MAS. It led to improved trunk-upper extremity postural attitude as demonstrated by improved RPS, and it was well accepted by parents and children as observed in the Parent's Questionnaire. Conclusion. This study suggests that RMT may hold rehabilitative benefits in children suffering from acquired and congenital hemiparesis.