Content » Vol 50, Issue 1

Original report

Ankle passive and active movement training in children with acute brain injury using a wearable robot

Kai Chen, Bo Xiong, Yupeng Ren, Assaf Y. Dvorkin, Deboah Gaebler-Spira, Charles E. Sisung, Li-Qun Zhang
Sensory-Motor Performance Prog, Rehabilitation Institute of Chicago, 60611 Chicago, USA

DOI: 10.2340/16501977-2285

Abstract

Objective: To evaluate the feasibility and effectiveness of a wearable robotic device in guiding isometric torque generation and passive-active movement training for ankle motor recovery in children with acute brain injury.
Participants/setting: Ten inpatient children with acute brain injury being treated in a rehabilitation hospital.
Design: Daily robot-guided ankle passive-active movement therapy for 15 sessions, including isometric torque generation under real-time feedback, stretch-ing, and active movement training with motivating games using a wearable ankle rehabilitation robot.
Main measures: Ankle biomechanical improvements induced by each training session including ankle range of motion (ROM), muscle strength, and clinical (Fugl-Meyer Lower-Extremity (FMLE), Pediatric Balance Scale (PBS)) and biomechanical (ankle ROM and muscle strength) outcomes over 15 training sessions.
Results: As training progressed, improvements in biomechanical performance measures followed logarithmic curves. Each training session increased median dorsiflexion active range of motion (AROM) 2.73° (standard deviation (SD) 1.14), dorsiflexion strength 0.87 Nm (SD 0.90), and plantarflexion strength 0.60 Nm (SD 1.19). After 15 training sessions the median FMLE score had increased from 14.0 (SD 10.11) to 23.0 (SD 11.4), PBS had increased from 33.0 (SD 19.99) to 50.0 (SD 23.13) (p < 0.05), median dorsiflexion and plantarflexion strength had improved from 0.21 Nm (SD 4.45) to 4.0 Nm (SD 7.63) and 8.33 Nm (SD 10.18) to 18.45 Nm (SD 14.41), respectively, median dorsiflexion AROM had improved from –10.45° (SD 12.01) to 11.87° (SD 20.69), and median dorsiflexion PROM increased from 20.0° (SD 9.04) to 25.0° (SD 8.03).
Conclusion: Isometric torque generation with real-time feedback, stretching and active movement training helped promote neuroplasticity and improve motor performance in children with acute brain injury.

Lay Abstract

We tested ten children who were hospitalized with an acute brain injury. A rehabilitation robot passively stretched their ankle as well as guided their ankle movements while playing computer games. Ankle biomechanical measures and balance and gait performance were evaluated both within each therapy session and overall during the entire therapy. We found that their biomechanical as well as balance and gait performance significantly improved as therapy progressed. It could be concluded that providing children with acute brain injury with robotic motor training and ankle stretching, as early as possible following injury, is a useful tool to improve motor performance.

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