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Ebers MR, Rosenberg MC, Kutz JN, Steele KM. A machine learning approach to quantify individual gait responses to ankle exoskeletons. J Biomech 2023; 157:111695. [PMID: 37406604 DOI: 10.1016/j.jbiomech.2023.111695] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 06/14/2023] [Accepted: 06/19/2023] [Indexed: 07/07/2023]
Abstract
Predicting an individual's response to an exoskeleton and understanding what data are needed to characterize responses remains challenging. Specifically, we lack a theoretical framework capable of quantifying heterogeneous responses to exoskeleton interventions. We leverage a neural network-based discrepancy modeling framework to quantify complex changes in gait in response to passive ankle exoskeletons in nondisabled adults. Discrepancy modeling aims to resolve dynamical inconsistencies between model predictions and real-world measurements. Neural networks identified models of (i) Nominal gait, (ii) Exoskeleton (Exo) gait, and (iii) the Discrepancy (i.e., response) between them. If an Augmented (Nominal+Discrepancy) model captured exoskeleton responses, its predictions should account for comparable amounts of variance in Exo gait data as the Exo model. Discrepancy modeling successfully quantified individuals' exoskeleton responses without requiring knowledge about physiological structure or motor control: a model of Nominal gait augmented with a Discrepancy model of response accounted for significantly more variance in Exo gait (median R2 for kinematics (0.928-0.963) and electromyography (0.665-0.788), (p<0.042)) than the Nominal model (median R2 for kinematics (0.863-0.939) and electromyography (0.516-0.664)). However, additional measurement modalities and/or improved resolution are needed to characterize Exo gait, as the discrepancy may not comprehensively capture response due to unexplained variance in Exo gait (median R2 for kinematics (0.954-0.977) and electromyography (0.724-0.815)). These techniques can be used to accelerate the discovery of individual-specific mechanisms driving exoskeleton responses, thus enabling personalized rehabilitation.
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Affiliation(s)
- Megan R Ebers
- Department of Mechanical Engineering, University of Washington, Seattle, WA, 98195, USA.
| | - Michael C Rosenberg
- Department of Mechanical Engineering, University of Washington, Seattle, WA, 98195, USA; Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, GA, 30322, USA
| | - J Nathan Kutz
- Department of Applied Mathematics, University of Washington, Seattle, WA, 98195, USA
| | - Katherine M Steele
- Department of Mechanical Engineering, University of Washington, Seattle, WA, 98195, USA
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Grosse L, Späh MA, Börner C, Schnabel JF, Meuche AC, Parzefall B, Breuer U, Warken B, Sitzberger A, Hösl M, Heinen F, Berweck S, Schröder SA, Bonfert MV. Addressing gross motor function by functional repetitive neuromuscular magnetic stimulation targeting to the gluteal muscles in children with bilateral spastic cerebral palsy: benefits of functional repetitive neuromuscular magnetic stimulation targeting the gluteal muscles. Front Neurol 2023; 14:1161532. [PMID: 37564737 PMCID: PMC10410564 DOI: 10.3389/fneur.2023.1161532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 06/20/2023] [Indexed: 08/12/2023] Open
Abstract
Background Impaired selective motor control, weakness and spasticity represent the key characteristics of motor disability in the context of bilateral spastic cerebral palsy. Independent walking ability is an important goal and training of the gluteal muscles can improve endurance and gait stability. Combining conventional physical excercises with a neuromodulatory, non-invasive technique like repetitive neuromuscular magnetic stimulation probably enhances effects of the treatment. This prospective study aimed to assess the clinical effects of repetitive neuromuscular magnetic stimulation in combination with a personalized functional physical training offered to children and adolescents with bilateral spastic cerebral palsy. Methods Eight participants Gross Motor Function Classification System level II and III (10.4 ± 2y5m; 50% Gross Motor Function Classification System level II) received a personalized intervention applying functional repetitive neuromuscular magnetic stimulation (12 sessions within 3 weeks; 12,600 total stimuli during each session). At baseline and follow up the following assessments were performed: 10-m-walking-test, 6-min-walking-test, GMFM-66. Six weeks after the end of treatment the patient-reported outcome measure Gait Outcome Assessment List was completed. Results GMFM-66 total score improved by 1.4% (p = 0.002), as did scoring in domain D for standing (1.9%, p = 0.109) and domain E for walking, jumping and running (2.6%, p = 0.021). Gait speed or distance walked during 6 min did not improve from baseline to follow up. Patient-reported outcome showed improvement in 4 patients in altogether 14 ratings. Caregiver-reported outcome reported benefits in 3 participants in altogether 10 ratings. Conclusion Repetitive neuromuscular magnetic stimulation promises to be a meaningful, non-invasive treatment approach for children and adolescents with bilateral spastic cerebral palsy that could be offered in a resource-efficient manner to a broad number of patients. To further investigate the promising effects of repetitive neuromuscular magnetic stimulation and its mechanisms of action, larger-scaled, controlled trials are needed as well as comprehensive neurophysiological investigations.
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Affiliation(s)
- Leonie Grosse
- LMU Hospital, Department of Pediatrics – Dr. von Hauner Children’s Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Malina A. Späh
- LMU Hospital, Department of Pediatrics – Dr. von Hauner Children’s Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
- LMU Center for Children with Medical Complexity – iSPZ Hauner, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Corinna Börner
- LMU Hospital, Department of Pediatrics – Dr. von Hauner Children’s Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
- LMU Center for Children with Medical Complexity – iSPZ Hauner, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Julian F. Schnabel
- LMU Hospital, Department of Pediatrics – Dr. von Hauner Children’s Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
- LMU Center for Children with Medical Complexity – iSPZ Hauner, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Anne C. Meuche
- LMU Hospital, Department of Pediatrics – Dr. von Hauner Children’s Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
- LMU Center for Children with Medical Complexity – iSPZ Hauner, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Barbara Parzefall
- LMU Hospital, Department of Pediatrics – Dr. von Hauner Children’s Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
- LMU Center for Children with Medical Complexity – iSPZ Hauner, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Ute Breuer
- LMU Center for Children with Medical Complexity – iSPZ Hauner, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Birgit Warken
- LMU Center for Children with Medical Complexity – iSPZ Hauner, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Alexandra Sitzberger
- LMU Hospital, Department of Pediatrics – Dr. von Hauner Children’s Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
- LMU Center for Children with Medical Complexity – iSPZ Hauner, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Matthias Hösl
- Gait and Motion Analysis Laboratory, Schoen Clinic Vogtareuth, Vogtareuth, Germany
| | - Florian Heinen
- LMU Hospital, Department of Pediatrics – Dr. von Hauner Children’s Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
- LMU Center for Children with Medical Complexity – iSPZ Hauner, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Steffen Berweck
- LMU Hospital, Department of Pediatrics – Dr. von Hauner Children’s Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
- Specialist Center for Pediatric Neurology, Neurorehabilitation and Epileptology, Schoen Clinic Vogtareuth, Vogtareuth, Germany
| | - Sebastian A. Schröder
- LMU Hospital, Department of Pediatrics – Dr. von Hauner Children’s Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
- LMU Center for Children with Medical Complexity – iSPZ Hauner, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Michaela V. Bonfert
- LMU Hospital, Department of Pediatrics – Dr. von Hauner Children’s Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
- LMU Center for Children with Medical Complexity – iSPZ Hauner, Ludwig-Maximilians-Universität München, Munich, Germany
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Fundarò C, Casale R, Maestri R, Traversoni S, Colombo R, Salvini S, Ferretti C, Bartolo M, Buonocore M, Giardini A. Technology Assisted Rehabilitation Patient Perception Questionnaire (TARPP-Q): development and implementation of an instrument to evaluate patients' perception during training. J Neuroeng Rehabil 2023; 20:35. [PMID: 36964543 PMCID: PMC10037786 DOI: 10.1186/s12984-023-01146-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 01/27/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND The introduction of technology-assisted rehabilitation (TAR) uncovers promising challenges for the treatment of motor disorders, particularly if combined with exergaming. Patients with neurological diseases have proved to benefit from TAR, improving their performance in several activities. However, the subjective perception of the device has never been fully addressed, being a conditioning factor for its use. The aims of the study were: (a) to develop a questionnaire on patients' personal experience with TAR and exergames in a real-world clinical setting; (b) to administer the questionnaire to a pilot group of neurologic patients to assess its feasibility and statistical properties. METHODS A self-administrable and close-ended questionnaire, Technology Assisted Rehabilitation Patient Perception Questionnaire (TARPP-Q), designed by a multidisciplinary team, was developed in Italian through a Delphi procedure. An English translation has been developed with consensus, for understandability purposes. The ultimate version of the questionnaire was constituted of 10 questions (5 with multiple answers), totalling 29 items, exploring the patient's performance and personal experience with TAR with Augmented Performance Feedback. TARPP-Q was then administered pre-post training in an observational, feasible, multi-centric study. The study involved in-patients aged between 18 and 85 with neurological diseases, admitted for rehabilitation with TAR (upper limb or gait). FIM scale was run to control functional performance. RESULTS Forty-four patients were included in the study. All patients answered the TARPP-Q autonomously. There were no unaccounted answers. Exploratory factor analyses identified 4 factors: Positive attitude, Usability, Hindrance perception, and Distress. Internal consistency was measured at T0. The values of Cronbach's alpha ranged from 0.72 (Distress) to 0.92 (Positive attitude). Functional Independence Measure (FIM®) scores and all TARPP-Q factors (Positive attitude, Usability, Hindrance perception, except for Distress (p = 0.11), significantly improved at the end of the treatment. A significant positive correlation between Positive attitude and Usability was also recorded. CONCLUSIONS The TARPP-Q highlights the importance of patients' personal experience with TAR and exergaming. Large-scale applications of this questionnaire may clarify the role of patients' perception of training effectiveness, helping to customize devices and interventions.
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Affiliation(s)
- Cira Fundarò
- Istituti Clinici Scientifici Maugeri Spa SB IRCCS Neurophysiopathology Unit of Montescano Institute, Pavia, PV, Italy.
| | - Roberto Casale
- OPUSMedica PC&R, Persons, Care & Research, Piacenza, Italy
| | - Roberto Maestri
- Istituti Clinici Scientifici Maugeri, IRCCS Department of Biomedical Engineering of Montescano Institute, Pavia, PV, Italy
| | - Silvia Traversoni
- Istituti Clinici Scientifici Maugeri IT Department, IRCCS Pavia, Pavia, PV, Italy
| | - Roberto Colombo
- Istituti Clinici Scientifici Maugeri IRCCS Veruno, Veruno, NO, Italy
| | - Silvana Salvini
- Istituti Clinici Scientifici Maugeri Spa SB IRCCS Neurophysiopathology Unit of Montescano Institute, Pavia, PV, Italy
| | - Chiara Ferretti
- Istituti Clinici Scientifici Maugeri IRCSS Neuromotor Rehabilitation Unit of Montescano Institute, Pavia, PV, Italy
| | - Michelangelo Bartolo
- Habilita Department of Rehabilitation, Neurorehabilitation Unit, HABILITA Zingonia, Ciserano, Bergamo, Italy
| | - Michelangelo Buonocore
- Istituti Clinici Scientifici Maugeri Spa SB IRCCS Neurophysiopathology Unit of Montescano Institute, Pavia, PV, Italy
| | - Anna Giardini
- Istituti Clinici Scientifici Maugeri IT Department, IRCCS Pavia, Pavia, PV, Italy
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Ebers MR, Rosenberg MC, Kutz JN, Steele KM. A machine learning approach to quantify individual gait responses to ankle exoskeletons. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.01.20.524757. [PMID: 36711530 PMCID: PMC9882260 DOI: 10.1101/2023.01.20.524757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
We currently lack a theoretical framework capable of characterizing heterogeneous responses to exoskeleton interventions. Predicting an individual's response to an exoskeleton and understanding what data are needed to characterize responses has been a persistent challenge. In this study, we leverage a neural network-based discrepancy modeling framework to quantify complex changes in gait in response to passive ankle exoskeletons in nondisabled adults. Discrepancy modeling aims to resolve dynamical inconsistencies between model predictions and real-world measurements. Neural networks identified models of (i) Nominal gait, (ii) Exoskeleton ( Exo ) gait, and (iii) the Discrepancy ( i.e. , response) between them. If an Augmented (Nominal+Discrepancy) model captured exoskeleton responses, its predictions should account for comparable amounts of variance in Exo gait data as the Exo model. Discrepancy modeling successfully quantified individuals' exoskeleton responses without requiring knowledge about physiological structure or motor control: a model of Nominal gait augmented with a Discrepancy model of response accounted for significantly more variance in Exo gait (median R 2 for kinematics (0.928 - 0.963) and electromyography (0.665 - 0.788), ( p < 0.042)) than the Nominal model (median R 2 for kinematics (0.863 - 0.939) and electromyography (0.516 - 0.664)). However, additional measurement modalities and/or improved resolution are needed to characterize Exo gait, as the discrepancy may not comprehensively capture response due to unexplained variance in Exo gait (median R 2 for kinematics (0.954 - 0.977) and electromyography (0.724 - 0.815)). These techniques can be used to accelerate the discovery of individual-specific mechanisms driving exoskeleton responses, thus enabling personalized rehabilitation.
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Affiliation(s)
- Megan R Ebers
- Department of Mechanical Engineering, University of Washington, Seattle, WA, 98195, USA
| | - Michael C Rosenberg
- Department of Mechanical Engineering, University of Washington, Seattle, WA, 98195, USA
- Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, GA, 30322, USA
| | - J Nathan Kutz
- Department of Applied Mathematics, University of Washington, Seattle, WA, 98195, USA
| | - Katherine M Steele
- Department of Mechanical Engineering, University of Washington, Seattle, WA, 98195, USA
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van Dellen F, Labruyère R. Settings matter: a scoping review on parameters in robot-assisted gait therapy identifies the importance of reporting standards. J Neuroeng Rehabil 2022; 19:40. [PMID: 35459246 PMCID: PMC9034544 DOI: 10.1186/s12984-022-01017-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 04/04/2022] [Indexed: 12/02/2022] Open
Abstract
Background Lokomat therapy for gait rehabilitation has become increasingly popular. Most evidence suggests that Lokomat therapy is equally effective as but not superior to standard therapy approaches. One reason might be that the Lokomat parameters to personalize therapy, such as gait speed, body weight support and Guidance Force, are not optimally used. However, there is little evidence available about the influence of Lokomat parameters on the effectiveness of the therapy. Nevertheless, an appropriate reporting of the applied therapy parameters is key to the successful clinical transfer of study results. The aim of this scoping review was therefore to evaluate how the currently available clinical studies report Lokomat parameter settings and map the current literature on Lokomat therapy parameters. Methods and results A systematic literature search was performed in three databases: Pubmed, Scopus and Embase. All primary research articles performing therapy with the Lokomat in neurologic populations in English or German were included. The quality of reporting of all clinical studies was assessed with a framework developed for this particular purpose. We identified 208 studies investigating Lokomat therapy in patients with neurologic diseases. The reporting quality was generally poor. Less than a third of the studies indicate which parameter settings have been applied. The usability of the reporting for a clinical transfer of promising results is therefore limited. Conclusion Although the currently available evidence on Lokomat parameters suggests that therapy parameters might have an influence on the effectiveness, there is currently not enough evidence available to provide detailed recommendations. Nevertheless, clinicians should pay close attention to the reported therapy parameters when translating research findings to their own clinical practice. To this end, we propose that the quality of reporting should be improved and we provide a reporting framework for authors as a quality control before submitting a Lokomat-related article. Supplementary Information The online version contains supplementary material available at 10.1186/s12984-022-01017-3.
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Affiliation(s)
- Florian van Dellen
- Sensory-Motor Systems Lab, Department of Health Sciences and Technology, ETH Zurich, Tannenstrasse 1, 8092, Zurich, Switzerland. .,Swiss Children's Rehab, University Children's Hospital Zurich, Mühlebergstrasse 104, 8910, Affoltern am Albis, Switzerland. .,Children's Research Center, University Children's Hospital of Zurich, University of Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland.
| | - Rob Labruyère
- Swiss Children's Rehab, University Children's Hospital Zurich, Mühlebergstrasse 104, 8910, Affoltern am Albis, Switzerland.,Children's Research Center, University Children's Hospital of Zurich, University of Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
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Manikowska F, Brazevic S, Krzyżańska A, Jóźwiak M. Effects of Robot-Assisted Therapy on Gait Parameters in Pediatric Patients With Spastic Cerebral Palsy. Front Neurol 2022; 12:724009. [PMID: 35002911 PMCID: PMC8732368 DOI: 10.3389/fneur.2021.724009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 11/11/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Gait dysfunction is a crucial factor that restricts independence and quality of life in children with cerebral palsy (CP). Gait training based on robotic-assisted therapy (RAT) is widely used, but information about effectiveness and ideal patient profile is not sufficient. Aim of this study was to assess the effect of RAT on gait parameters in spastic children with CP, and to determine whether changes in gait parameters are different among patients on different ambulatory levels. Method: A total of 26 children with bilateral spastic CP were divided into two groups based on their functional ability: non-assisted ambulator (NAS) or assisted ambulator (AS); and underwent a RAT program (30 training sessions of RAT during 10 weeks). Gait analysis was performed: before the therapy (t1), right after (t2), and 6 weeks later (t3). Results: No significant changes in spatiotemporal parameters or gait deviation index at t2 or t3. Double support symmetry significantly improved (t1 vs. t3, p = 0.03) for the whole group (NAS + AS). Walking speed symmetry significantly improved (t2 vs. t3, p = 0.02) for group AS. Conclusion: RAT based on our protocol did not change spatiotemporal parameters and kinematics of walking except limited improvement in some aspects of gait symmetry. We did not find differences in changes in selected objective gait parameters among children with CP in different ambulatory levels.
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Affiliation(s)
- Faustyna Manikowska
- Gait and Motion Analysis Laboratory, Poznań University of Medical Sciences, Poznań, Poland
| | - Sabina Brazevic
- Gait and Motion Analysis Laboratory, Poznań University of Medical Sciences, Poznań, Poland
| | | | - Marek Jóźwiak
- Gait and Motion Analysis Laboratory, Poznań University of Medical Sciences, Poznań, Poland
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Green MM, Kim H, Gauden R, Scheinberg A, Schroeder AS, Heinen F, Berweck S, Hong BY, Gormley M. Needlepoints: Clinical approach to child living with cerebral palsy. J Pediatr Rehabil Med 2022; 15:91-106. [PMID: 35275576 DOI: 10.3233/prm-220006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
| | - Heakyung Kim
- NewYork-Presbyterian Hospital, New York, NY, USA
| | - Ruth Gauden
- The Royal Children's Hospital Melbourne, Parkville, Australia
| | - Adam Scheinberg
- The Royal Children's Hospital Melbourne, Parkville, Australia.,Murdoch Children's Research Institute, Parkville, Australia
| | | | | | | | - Bo Young Hong
- St. Vincent's Hospital, Catholic University of Korea, College of Medicine, Seoul, Republic of Korea
| | - Mark Gormley
- Gillette Children's Specialty Healthcare, St.Paul, MN, USA
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Electromechanical and Robotic Devices for Gait and Balance Rehabilitation of Children with Neurological Disability: A Systematic Review. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app112412061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In the last two decades, a growing interest has been focused on gait and balance robot-assisted rehabilitation in children with neurological disabilities. Robotic devices allow the implementation of intensive, task-specific training fostering functional recovery and neuroplasticity phenomena. However, limited attention has been paid to the protocols used in this research framework. This systematic review aims to provide an overview of the existing literature on robotic systems for the rehabilitation of gait and balance in children with neurological disabilities and their rehabilitation applications. The literature search was carried out independently and synchronously by three authors on the following databases: MEDLINE, Cochrane Library, PeDro, Institute of Electrical and Electronics Engineers, ScienceDirect, and Google Scholar. The data collected included three subsections referring to clinical, technical, and regulatory aspects. Thirty-one articles out of 81 found on the primary literature search were included in the systematic review. Most studies involved children with cerebral palsy. Only one-third of the studies were randomized controlled trials. Overall, 17 devices (nine end-effector systems and eight exoskeletons) were investigated, among which only 4 (24%) were bore the CE mark. Studies differ on rehabilitation protocols duration, intensity, and outcome measures. Future research should improve both rehabilitation protocols’ and devices’ descriptions.
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Baseline Gross Motor Function Affects the Outcome of Robot-Assisted Therapy in Ambulatory Individuals with Spastic Cerebral Palsy. Brain Sci 2021; 11:brainsci11121563. [PMID: 34942865 PMCID: PMC8699417 DOI: 10.3390/brainsci11121563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/18/2021] [Accepted: 11/21/2021] [Indexed: 11/21/2022] Open
Abstract
Robotic-assisted therapy (RAT) is a task-specific approach for treating gait disorders in individuals with neurological impairments. However, the effectiveness of RAT is not clear for different severities of involvement, pathologies, and ages. This study aimed to assess the functional and clinical status outcomes after RAT in individuals with cerebral palsy (CP). Twenty-eight individuals with bilateral spastic CP were enrolled (female = 10; male = 18; age = 15.2 ± 2.0 years). The RAT program consisted of 30 sessions: five sessions weekly for six weeks. Gross Motor Function Measure (GMFM) and clinical physical examinations were evaluated before and after RAT. Our results suggested that the RAT program with the described protocol can improve the general gross motor functions of individuals with CP in Gross Motor Function Classification System (GMFCS) levels I and II, and primarily improves performance on less complex GMFM items for those in GMFCS levels III and IV. The lower baseline functional level was related to a greater functional improvement. Older individuals were noticed to improve more in GMFM dimension D. Regarding impairments evaluated by clinical examinations, no change was found after RAT intervention. It is worth mentioning that the strength of knee muscles was not affected either.
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Klobucká S, Klobucký R, Kollár B. The effect of patient-specific factors on responsiveness to robot-assisted gait training in patients with bilateral spastic cerebral palsy. NeuroRehabilitation 2021; 49:375-389. [PMID: 34776432 DOI: 10.3233/nre-210130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND No general recommendations are yet available for the application of robot-assisted treadmill therapy for children with cerebral palsy regarding the length and intensity of the intervention. OBJECTIVE The aim of the study was to evaluate patient-specific determinants of responsiveness to robot-assisted gait training (RAGT) in patients with bilateral spastic cerebral palsy. METHOD During 12 months, the patients underwent 1-4 blocks of RAGT, representing 16-82 TUs. The following parameters were evaluated before (V0) and after each therapeutic block (V1-V4): dimension A (lying and rolling), B (sitting), C (crawling and kneeling), D (standing), E (walking, running and jumping) of the Gross Motor Function Measure (GMFM-88). We evaluated the change in motor functions in relation to the severity of disability, age, gender and number of therapeutic units. RESULTS Ninety-seven patients aged between 3.7 and 27 years (mean age 10.02 years (SD±5.29); Gross Motor Function Classification System level I [n = 5], II [n = 25], III [n = 48], IV [n = 19]) underwent 16-82 TUs (overall average number 34.06 TUs, SD±16.41) of RAGT. In the patient group, we recorded clinically meaningful improvement and statistically significant improvement (p < 0.001) in gross motor functions with gradual increase in the effect size after each therapeutic block. Using correlation and regression analysis, we found a statistically significant associations between the number of therapeutic units, severity of disability, and improvement in motor functions after RAGT. CONCLUSION We have identified two determinants -the severity of disability and the number of therapeutic units -which could have a decisive and predictive character in setting rehabilitation/designing programmes. The duration of the applied RAGT period, frequency and intensity could be a crucial factor for the potential of improvement in children with BS-CP.
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Affiliation(s)
| | - Robert Klobucký
- Institute for Sociology, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Branislav Kollár
- 1st Department of Neurology, Faculty of Medicine, Comenius University Bratislava, Bratislava, Slovakia
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Effect of the Hybrid Assistive Limb on the Gait Pattern for Cerebral Palsy. ACTA ACUST UNITED AC 2020; 56:medicina56120673. [PMID: 33297300 PMCID: PMC7762323 DOI: 10.3390/medicina56120673] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/03/2020] [Accepted: 12/04/2020] [Indexed: 01/06/2023]
Abstract
Background and objectives: Cerebral palsy (CP) is the most frequent childhood motor disability. Achieving ambulation or standing in children with CP has been a major goal of physical therapy. Recently, robot-assisted gait training using the Hybrid Assistive Limb® (HAL) has been effective in improving walking ability in patients with CP. However, previous studies have not examined in detail the changes in gait pattern after HAL training for patients with spastic CP, including gait symmetry. This study aimed to evaluate the immediate effect of HAL training on the walking ability and the changes in gait pattern and gait symmetry in patients with spastic CP. Materials and Methods: We recruited 19 patients with spastic CP (13 male and six female; mean age, 15.7 years). Functional ambulation was assessed using the 10-Meter Walk Test and gait analysis in the sagittal plane before and after a single 20-min HAL intervention session. Results: The walking speed and stride length significantly increased after HAL intervention compared to the pre-intervention values. Two-dimensional gait analysis showed improvement in equinus gait, increase in the flexion angle of the swing phase in the knee and hip joints, and improvement in gait symmetry. Immediate improvements in the walking ability and gait pattern were noted after HAL training in patients with spastic CP. Conclusions: The symmetry of the joint angle of the lower limb, including the trunk, accounts for the improvement in walking ability after HAL therapy.
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Colomera JA, Nahuelhual P. [Effectiveness of robotic assistance for gait training in children with cerebral palsy. a systematic review]. Rehabilitacion (Madr) 2020; 54:107-115. [PMID: 32370825 DOI: 10.1016/j.rh.2019.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 12/10/2019] [Accepted: 12/17/2019] [Indexed: 06/11/2023]
Abstract
INTRODUCTION In recent years, the use of gait training using robotic assistance systems has progressively increased in the paediatric population with cerebral palsy. OBJECTIVE To systematically assess the effects of robotic assistance for gait training compared with physical rehabilitation therapy in children with cerebral palsy (CP), based on the International Classification of Functioning, Health and Disability (ICF). MATERIALS AND METHODS A systematic review was carried out according to the recommendations of the Cochrane Collaboration. We included randomised or quasi-randomised clinical trials that analysed children with CP classified according to The Gross Motor Function Classification System (GMFCS) I-III. The search was carried out in PubMed, PEDro, CENTRAL, CINALH, Cochrane, Embase, Europe PMC, LILACS and Science Direct. The selection and extraction of data from the studies was carried out by two independent researchers. Disagreements were resolved by consensus. A descriptive analysis of the selected studies was performed. Assessment of risk of bias was performed with the Cochrane Collaboration tool. RESULTS Four studies met the eligibility criteria. Most of the temporal-spatial, kinetic and kinematic parameters of gait were evaluated, all corresponding to the activity component of the ICF. CONCLUSIONS Due to the methodological variability of the studies, it is not possible to determine whether robot-assisted gait training is effective for treatment in children with CP.
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Affiliation(s)
- J A Colomera
- Unidad de Kinesiología, Instituto Teletón Temuco, Temuco, Chile.
| | - P Nahuelhual
- Subdirección de investigación Teletón Santiago, Chile; Facultad de Medicina CAS UDD, Santiago, Chile
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Abstract
The effectiveness of exercise and physical therapy for children with ataxia is poorly understood. The aim of this systematic review was to critically evaluate the range, scope and methodological quality of studies investigating the effectiveness of exercise and physical therapy interventions for children with ataxia. The following databases were searched: AMED, CENTRAL, CDSR, CINAHL, ClinicalTrials.gov, EMBASE, Ovid MEDLINE, PEDro and Web of Science. No limits were placed on language, type of study or year of publication. Two reviewers independently determined whether the studies met the inclusion criteria, extracted all relevant outcomes, and conducted methodological quality assessments. A total of 1988 studies were identified, and 124 full texts were screened. Twenty studies were included in the review. A total of 40 children (aged 5-18 years) with ataxia as a primary impairment participated in the included studies. Data were able to be extracted from eleven studies with a total of 21 children (aged 5-18 years), with a range of cerebellar pathology. The studies reported promising results but were of low methodological quality (no RCTs), used small sample sizes and were heterogeneous in terms of interventions, participants and outcomes. No firm conclusions can be made about the effectiveness of exercise and physical therapy for children with ataxia. There is a need for further high-quality child-centred research.
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Ammann-Reiffer C, Bastiaenen CHG, Meyer-Heim AD, van Hedel HJA. Lessons learned from conducting a pragmatic, randomized, crossover trial on robot-assisted gait training in children with cerebral palsy (PeLoGAIT). J Pediatr Rehabil Med 2020; 13:137-148. [PMID: 32444573 PMCID: PMC7458505 DOI: 10.3233/prm-190614] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To investigate the effectiveness of outpatient robot-assisted gait training (RAGT) in ambulatory children with spastic cerebral palsy. METHODS Children were randomized to two different intervention sequences within a pragmatic crossover design. They performed five weeks of RAGT (3 sessions per week) and five weeks of usual care (UC). Dimension E of the Gross Motor Function Measure-88 (GMFM E) as the primary outcome as well as Dimension D (GMFM D), and timed walking tests were assessed before and after each treatment sequence and after a 5-week follow-up. RESULTS The trial was stopped early because of recruitment problems. We included 16 children with a mean age of 11.3 years (6.0-15.3 years). GMFM E median (IQR) change scores were -0.7 (-2.8 to 3.5) after RAGT and 0 (-2.4 to 2.4) after UC. Neither GMFM E nor any secondary outcome measure changed significantly after RAGT or UC, nor were any period, follow-up, or carry-over effects observable. CONCLUSIONS RAGT as a single intervention was not effective in improving walking abilities in the included children. It should be embedded in a holistic treatment approach, as it cannot cover all aspects relevant to gait. Furthermore, children's personalized rehabilitation goals should be carefully monitored with individualized measurement instruments.
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Affiliation(s)
- Corinne Ammann-Reiffer
- Swiss Children's Rehab, Research Department, University Children's Hospital Zurich, Eleonore Foundation, Affoltern am Albis, Switzerland.,Functioning and Rehabilitation, CAPHRI, Department of Epidemiology, Maastricht University, Maastricht, The Netherlands.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Caroline H G Bastiaenen
- Functioning and Rehabilitation, CAPHRI, Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
| | - Andreas D Meyer-Heim
- Swiss Children's Rehab, Research Department, University Children's Hospital Zurich, Eleonore Foundation, Affoltern am Albis, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Hubertus J A van Hedel
- Swiss Children's Rehab, Research Department, University Children's Hospital Zurich, Eleonore Foundation, Affoltern am Albis, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
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Sucuoglu H. Effects of robot-assisted gait training alongside conventional therapy on the development of walking in children with cerebral palsy. J Pediatr Rehabil Med 2020; 13:127-135. [PMID: 32444570 DOI: 10.3233/prm-180541] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To investigate the effects of robot-assisted gait training (RAGT) alongside conventional therapy on the standing and walking abilities of children with cerebral palsy (CP). METHODS The study sample consisted of children (aged 4-18 years) with CP whose gross motor function classification system (GMFCS) was at levels I-V. In total, 75 children with CP were evaluated and 38 patients completed the study. Patients were divided into two groups as GMFCS levels I-III (Group 1) and levels IV-V (Group 2). RAGT (30 min/session) and conventional physiotherapy (30 min/session) were applied together in the treatment. The treatment duration was 60 min per session, 3 or 4 sessions per week, for a total of 30 sessions over 8-10 weeks. 10-meter walk test (10MWT), 6-min walk test (6MinWT), gross motor functional measurement 66 (GMFM66) -D, and -E tests were performed. RESULTS We showed that in both groups of CP patients (mild-moderate and severe), meaningful improvements were seen in the standing (D) and walking (E) sections of GMFM-66 after treatment. When we compared the post-treatment changes in 10-m walk test, 6-min walk test, GMFM66-D, and -E between Groups 1 and 2, we noted that the improvements were statistically significant in favor of Group 1 (p< 0.01). CONCLUSION RAGT in combination with a conventional treatment program was significantly associated with improvements in the standing and walking abilities of children with mild to moderate CP (GMFCS levels I-III).
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Comparison of the effectiveness of partial body weight-supported treadmill exercises, robotic-assisted treadmill exercises, and anti-gravity treadmill exercises in spastic cerebral palsy. Turk J Phys Med Rehabil 2019; 65:361-370. [PMID: 31893273 DOI: 10.5606/tftrd.2019.3078] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 10/17/2018] [Indexed: 11/21/2022] Open
Abstract
Objectives This study aims to compare the effectiveness of the partial body weight-supported treadmill exercise (PBWSTE), robotic-assisted treadmill exercise (RATE), and anti-gravity treadmill exercise (ATE) in children with spastic cerebral palsy (CP). Patients and methods Between December 01, 2015 and May 01, 2016, a total of 29 children (18 males, 11 females; mean age 9.3±2.3 years; range, 6 to 14 years) with spastic CP were included in the study. The patients were randomly divided into three groups as the PBWSTE group (n=10), RATE group (n=10), and ATE group (n=9). Each group underwent a total of 20 treadmill exercise sessions for 45 min for five days a week for a total of four weeks. The patients were assessed using three-dimensional gait analysis, open-circle indirect calorimeter, six-minute walking test, and Gross Motor Functional Measurement (GMFM) scale before and after treatment and at two months of follow-up. Results No significant change compared to baseline was found in the walking speed on gait analysis among the groups after the treatment. There was no statistically significant difference among the groups in terms of the GFMF-D, GMFM-E and six-minute walking test (p>0.05). There was a significant improvement in the oxygen consumption in the ATE group (p>0.05) and RATE group (p>0.05), but not in the PBWSTE group (p<0.05). Conclusion Our study findings indicate that all three treadmill exercises have a positive impact on walking, and RATE and ATE can be used more actively in patients with spastic CP.
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Weinberger R, Warken B, König H, Vill K, Gerstl L, Borggraefe I, Heinen F, von Kries R, Schroeder AS. Three by three weeks of robot-enhanced repetitive gait therapy within a global rehabilitation plan improves gross motor development in children with cerebral palsy - a retrospective cohort study. Eur J Paediatr Neurol 2019; 23:581-588. [PMID: 31155454 DOI: 10.1016/j.ejpn.2019.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 04/08/2019] [Accepted: 05/06/2019] [Indexed: 10/26/2022]
Abstract
AIM To assess the improvement in gross motor function following three blocks of a three-week, intensive robot-enhanced treadmill therapy (ROBERT-Program). METHOD retrospective chart review in a before-after interventional trial in children with cerebral palsy attending a university hospital outpatient rehabilitation centre. Patients received three blocks of a three-week, 12 sessions ROBERT-Program over a mean period of 24 months. Outcome measures were block specific and cumulative improvement in GMFM 66, D and E. Longterm GMFM 66 improvements were compared to the individuals' expected increment as derived from previously published GMFM-66 percentiles. 95% confidence intervals (CI) and paired t-test were calculated. RESULTS 20 children (8 GMFCS Level II; 12 GMFCS Level III, mean age 5.9 years (CI: [5.0; 6.7])) were treated. For each block a significant increase in motor performance in similar size could be observed without deterioration between blocks. The cumulative improvement during 21 months observation period was: 6.5 (CI: [4.8; 8.2]) in GMFM 66, which represents a clinically meaningful effect size of 3.6 (CI: [1.4; 5.8]) above the expected improvement. INTERPRETATION Progressive clinically meaningful improvement in motor performance for three blocks of ROBERT-Program was observed. Cumulative GMFM 66 improvements exceeded the individuals' age-specific expected course.
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Affiliation(s)
- R Weinberger
- Ludwig Maximilian University of Munich (LMU), Hauner Children's Hospital, Department of Paediatric Neurology and Developmental Medicine, Lindwurmstr. 4, D-80337 Munich, Germany; Ludwig Maximilian University of Munich (LMU), Department of Epidemiology, Institute of Social Paediatrics and Adolescent Medicine, Haydnstraße 5/IV. Stock, D-80336 Munich, Germany
| | - B Warken
- Ludwig Maximilian University of Munich (LMU), Hauner Children's Hospital, Department of Paediatric Neurology and Developmental Medicine, Lindwurmstr. 4, D-80337 Munich, Germany
| | - H König
- Ludwig Maximilian University of Munich (LMU), Hauner Children's Hospital, Department of Paediatric Neurology and Developmental Medicine, Lindwurmstr. 4, D-80337 Munich, Germany
| | - K Vill
- Ludwig Maximilian University of Munich (LMU), Hauner Children's Hospital, Department of Paediatric Neurology and Developmental Medicine, Lindwurmstr. 4, D-80337 Munich, Germany
| | - L Gerstl
- Ludwig Maximilian University of Munich (LMU), Hauner Children's Hospital, Department of Paediatric Neurology and Developmental Medicine, Lindwurmstr. 4, D-80337 Munich, Germany
| | - I Borggraefe
- Ludwig Maximilian University of Munich (LMU), Hauner Children's Hospital, Department of Paediatric Neurology and Developmental Medicine, Lindwurmstr. 4, D-80337 Munich, Germany
| | - F Heinen
- Ludwig Maximilian University of Munich (LMU), Hauner Children's Hospital, Department of Paediatric Neurology and Developmental Medicine, Lindwurmstr. 4, D-80337 Munich, Germany
| | - R von Kries
- Ludwig Maximilian University of Munich (LMU), Department of Epidemiology, Institute of Social Paediatrics and Adolescent Medicine, Haydnstraße 5/IV. Stock, D-80336 Munich, Germany
| | - A S Schroeder
- Ludwig Maximilian University of Munich (LMU), Hauner Children's Hospital, Department of Paediatric Neurology and Developmental Medicine, Lindwurmstr. 4, D-80337 Munich, Germany.
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Beresford B, Clarke S, Maddison J. Therapy interventions for children with neurodisabilities: a qualitative scoping study. Health Technol Assess 2019; 22:1-150. [PMID: 29345224 DOI: 10.3310/hta22030] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Therapy interventions emerged four times in the top 10 research priorities in a James Lind Alliance research prioritisation exercise for children with neurodisabilities (Morris C, Simkiss D, Busk M, Morris M, Allard A, Denness J, et al. Setting research priorities to improve the health of children and young people with neurodisability: a British Academy of Childhood Disability-James Lind Alliance Research Priority Setting Partnership. BMJ Open 2015;5:e006233). The National Institute for Health Research (NIHR) commissioned this study as part of an information-gathering exercise in response to this. OBJECTIVES The objectives were to (1) describe the current practice, approaches and schools of thought in relation to physiotherapy, occupational therapy and speech and language therapy for children with neurodisability; (2) explore clinical decision-making; (3) investigate views on outcomes and their measurement, particularly participation as an outcome, that is, the child's ability to have the opportunity to be involved in life situations and activities (e.g. communication, mobility, interpersonal interactions, self-care, learning and applying knowledge); (4) seek views on the aspects of therapy interventions that have an impact on outcomes; and (5) elicit stakeholder views on research needs and priorities. DESIGN, SETTING AND PARTICIPANTS More than 70 professionals (therapists, service leads, paediatricians and education staff) and 25 parents participated in a qualitative interview (either individually or as part of a focus group). RESULTS Professional thinking and models of service delivery are in a state of flux and development. There is a move towards goals-focused, family-centred approaches. Work tends to be highly individualised, with few protocols. Parents are certain of the value of therapies, although they may experience difficulties with provision and may seek (additional) private provision. Therapy interventions are conceived as three components: the therapist, the procedures/equipment, etc., and the wider therapeutic environment. They are believed to be highly complex and poorly understood. Although participation is widely endorsed as a core intervention objective of therapy interventions, its suitability, or appropriateness, as an outcome measure was questioned. Other child and/or parent outcomes were identified as more or equally important. Notions of intermediate outcomes - in terms of body structure/function, and the achievement of activities - were regarded as important and not counter to participation-focused approaches. Among therapists, research on intervention effectiveness was (cautiously) welcomed. A number of methodological challenges were identified. A portfolio of study designs - quantitative and qualitative, experimental and observational - was called for, and which included economic evaluation and clear pathways to impact. LIMITATIONS The study was not successful in recruiting children and young people. Further work is required to elucidate the views of this key stakeholder group. CONCLUSIONS Therapy interventions are poorly understood. There was strong support, tempered a little by concerns among some about the feasibility of demonstrating impact, for investment in research. FUTURE WORK The identification of research priorities was a core study objective, and a wide-ranging research agenda was identified. It included 'foundational' research into neurodisability, the active components of therapy interventions and the concept of participation. Three areas of evaluation were identified: overall approaches to therapy, service organisation and delivery issues, and the evaluation of specific techniques. Parents regarded evaluations of approaches to therapy (e.g. goals-focused; supporting family-self management) as priorities, along with evaluations of models of service provision. Professionals' views were broadly similar, with an additional emphasis on methodological research. In terms of specific techniques, there was no shared agreement regarding priorities, with views informed by personal interests and experiences. FUNDING The NIHR Health Technology Assessment programme.
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A Systematic Review on Existing Measures for the Subjective Assessment of Rehabilitation and Assistive Robot Devices. JOURNAL OF HEALTHCARE ENGINEERING 2018; 2016:1048964. [PMID: 27196802 PMCID: PMC5058569 DOI: 10.1155/2016/1048964] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 04/06/2016] [Indexed: 11/29/2022]
Abstract
The objective of the current study is to identify and classify outcome measures currently used for the assessment of rehabilitation or assistive robot devices. We conducted a systematic review of the literature using PubMed, MEDLINE, CIRRIE, and Scopus databases for studies that assessed rehabilitation or assistive robot devices from 1980 through January 2016. In all, 31 articles met all inclusion criteria. Tailor-made questionnaires were the most commonly used tool at 66.7%, while the great majority (93.9%) of the studies used nonvalidated instruments. The study reveals the absence of a standard scale which makes it difficult to compare the results from different researchers. There is a great need, therefore, for a valid and reliable instrument to be available for use by the intended end users for the subjective assessment of robot devices. The study concludes by identifying two scales that have been validated in general assistive technology devices and could support the scope of subjective assessment in rehabilitation or assistive robots (however, with limited coverage) and a new one called PYTHEIA, recently published. The latter intends to close the gap and help researchers and developers to evaluate, assess, and produce products that satisfy the real needs of the end users.
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Corrigendum. Dev Med Child Neurol 2018; 60:324. [PMID: 29464709 DOI: 10.1111/dmcn.13657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Matsuda M, Mataki Y, Mutsuzaki H, Yoshikawa K, Takahashi K, Enomoto K, Sano K, Mizukami M, Tomita K, Ohguro H, Iwasaki N. Immediate effects of a single session of robot-assisted gait training using Hybrid Assistive Limb (HAL) for cerebral palsy. J Phys Ther Sci 2018; 30:207-212. [PMID: 29545679 PMCID: PMC5851348 DOI: 10.1589/jpts.30.207] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 11/02/2017] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Robot-assisted gait training (RAGT) using Hybrid Assistive Limb (HAL,
CYBERDYNE) was previously reported beneficial for stroke and spinal cord injury patients.
Here, we investigate the immediate effect of a single session of RAGT using HAL on gait
function for cerebral palsy (CP) patients. [Subjects and Methods] Twelve patients (average
age: 16.2 ± 7.3 years) with CP received a single session of RAGT using HAL. Gait speed,
step length, cadence, single-leg support per gait cycle, hip and knee joint angle in
stance, and swing phase per gait cycle were assessed before, during, and immediately after
HAL intervention. [Results] Compared to baseline values, single-leg support per gait cycle
(64.5 ± 15.8% to 69.3 ± 12.1%), hip extension angle in mid-stance (149.2 ± 19.0° to 155.5
± 20.1°), and knee extension angle in mid-stance (137.6 ± 20.2° to 143.1 ± 19.5°) were
significantly increased immediately after intervention. Further, the knee flexion angle in
mid-swing was significantly decreased immediately after treatment (112.0 ± 15.5° to 105.2
± 17.1°). Hip flexion angle in mid-swing also decreased following intervention (137.2 ±
14.6° to 129.7 ± 16.6°), but not significantly. Conversely, gait speed, step length, and
cadence were unchanged after intervention. [Conclusion] A single-time RAGT with HAL
improved single-leg support per gait cycle and hip and knee joint angle during gait,
therapeutically improving gait function in CP patients.
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Affiliation(s)
- Mayumi Matsuda
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital:4733 Ami, Ibaraki 300-0331, Japan.,Graduate School of Health Science, Ibaraki Prefectural University of Health Sciences, Japan
| | - Yuki Mataki
- Department of Orthopaedic Surgery, Ibaraki Prefectural University of Health Sciences Hospital, Japan
| | - Hirotaka Mutsuzaki
- Graduate School of Health Science, Ibaraki Prefectural University of Health Sciences, Japan.,Center for Medical Science, Ibaraki Prefectural University of Health Sciences, Japan
| | - Kenichi Yoshikawa
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital:4733 Ami, Ibaraki 300-0331, Japan
| | - Kazushi Takahashi
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital:4733 Ami, Ibaraki 300-0331, Japan
| | - Keiko Enomoto
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital:4733 Ami, Ibaraki 300-0331, Japan
| | - Kumiko Sano
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital:4733 Ami, Ibaraki 300-0331, Japan
| | - Masafumi Mizukami
- Graduate School of Health Science, Ibaraki Prefectural University of Health Sciences, Japan.,Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Japan
| | - Kazuhide Tomita
- Graduate School of Health Science, Ibaraki Prefectural University of Health Sciences, Japan.,Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Japan
| | - Haruka Ohguro
- Department of Pediatrics, Ibaraki Prefectural University of Health Sciences Hospital, Japan
| | - Nobuaki Iwasaki
- Graduate School of Health Science, Ibaraki Prefectural University of Health Sciences, Japan.,Center for Medical Science, Ibaraki Prefectural University of Health Sciences, Japan.,Department of Pediatrics, Ibaraki Prefectural University of Health Sciences Hospital, Japan
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Peri E, Turconi AC, Biffi E, Maghini C, Panzeri D, Morganti R, Pedrocchi A, Gagliardi C. Effects of dose and duration of Robot-Assisted Gait Training on walking ability of children affected by cerebral palsy. Technol Health Care 2017; 25:671-681. [DOI: 10.3233/thc-160668] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Elisabetta Peri
- Neuroengineering and Medical Robotic Laboratory, Electronics, Information and Bioengineering Department, Politecnico di Milano, Milan, Italy
- Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Italy
| | | | - Emilia Biffi
- Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Italy
| | - Cristina Maghini
- Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Italy
| | - Daniele Panzeri
- Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Italy
| | - Roberta Morganti
- Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Italy
| | - Alessandra Pedrocchi
- Neuroengineering and Medical Robotic Laboratory, Electronics, Information and Bioengineering Department, Politecnico di Milano, Milan, Italy
| | - Chiara Gagliardi
- Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Italy
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Valentín‐Gudiol M, Mattern‐Baxter K, Girabent‐Farrés M, Bagur‐Calafat C, Hadders‐Algra M, Angulo‐Barroso RM. Treadmill interventions in children under six years of age at risk of neuromotor delay. Cochrane Database Syst Rev 2017; 7:CD009242. [PMID: 28755534 PMCID: PMC6483121 DOI: 10.1002/14651858.cd009242.pub3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Delayed motor development may occur in children with Down syndrome, cerebral palsy, general developmental delay or children born preterm. It limits the child's exploration of the environment and can hinder cognitive and social-emotional development. Literature suggests that task-specific training, such as locomotor treadmill training, facilitates motor development. OBJECTIVES To assess the effectiveness of treadmill interventions on locomotor development in children with delayed ambulation or in pre-ambulatory children (or both), who are under six years of age and who are at risk for neuromotor delay. SEARCH METHODS In May 2017, we searched CENTRAL, MEDLINE, Embase, six other databases and a number of trials registers. We also searched the reference lists of relevant studies and systematic reviews. SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-RCTs that evaluated the effect of treadmill intervention in the target population. DATA COLLECTION AND ANALYSIS Four authors independently extracted the data. Outcome parameters were structured according to the International Classification of Functioning, Disability and Health model. MAIN RESULTS This is an update of a Cochrane review from 2011, which included five trials. This update includes seven studies on treadmill intervention in 175 children: 104 were allocated to treadmill groups, and 71 were controls. The studies varied in population (children with Down syndrome, cerebral palsy, developmental delay or at moderate risk for neuromotor delay); comparison type (treadmill versus no treadmill; treadmill with versus without orthoses; high- versus low-intensity training); study duration, and assessed outcomes. Due to the diversity of the studies, only data from five studies were used in meta-analyses for five outcomes: age of independent walking onset, overall gross motor function, gross motor function related to standing and walking, and gait velocity. GRADE assessments of quality of the evidence ranged from high to very low.The effects of treadmill intervention on independent walking onset compared to no treadmill intervention was population dependent, but showed no overall effect (mean difference (MD) -2.08, 95% confidence intervals (CI) -5.38 to 1.22, 2 studies, 58 children; moderate-quality evidence): 30 children with Down syndrome benefited from treadmill training (MD -4.00, 95% CI -6.96 to -1.04), but 28 children at moderate risk of developmental delay did not (MD -0.60, 95% CI -2.34 to 1.14). We found no evidence regarding walking onset in two studies that compared treadmill intervention with and without orthotics in 17 children (MD 0.10, 95% CI -5.96 to 6.16), and high- versus low-intensity treadmill interventions in 30 children with Down syndrome (MD -2.13, 95% -4.96 to 0.70).Treadmill intervention did not improve overall gross motor function (MD 0.88, 95% CI -4.54 to 6.30, 2 studies, 36 children; moderate-quality evidence) or gross motor skills related to standing (MD 5.41, 95% CI -1.64 to 12.43, 2 studies, 32 children; low-quality evidence), and had a negligible improvement in gross motor skills related to walking (MD 4.51, 95% CI 0.29 to 8.73, 2 studies, 32 children; low-quality evidence). It led to improved walking skills in 20 ambulatory children with developmental delay (MD 7.60, 95% CI 0.88 to 14.32, 1 study) and favourable gross motor skills in 12 children with cerebral palsy (MD 8.00, 95% CI 3.18 to 12.82). A study which compared treadmill intervention with and without orthotics in 17 children with Down syndrome suggested that adding orthotics might hinder overall gross motor progress (MD -8.40, 95% CI -14.55 to -2.25).Overall, treadmill intervention showed a very small increase in walking speed compared to no treadmill intervention (MD 0.23, 95% CI 0.08 to 0.37, 2 studies, 32 children; high-quality evidence). Treadmill intervention increased walking speed in 20 ambulatory children with developmental delay (MD 0.25, 95% CI 0.08 to 0.42), but not in 12 children with cerebral palsy (MD 0.18, 95% CI -0.09 to 0.45). AUTHORS' CONCLUSIONS This update of the review from 2011 provides additional evidence of the efficacy of treadmill intervention for certain groups of children up to six years of age, but power to find significant results still remains limited. The current findings indicate that treadmill intervention may accelerate the development of independent walking in children with Down syndrome and may accelerate motor skill attainment in children with cerebral palsy and general developmental delay. Future research should first confirm these findings with larger and better designed studies, especially for infants with cerebral palsy and developmental delay. Once efficacy is established, research should examine the optimal dosage of treadmill intervention in these populations.
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Affiliation(s)
- Marta Valentín‐Gudiol
- Universitat Internacional de CatalunyaDepartment of Physical TherapyBarcelonaSpain
- Ramon Llull UniversityBlanquerna School of Health SciencesBarcelonaSpain
| | - Katrin Mattern‐Baxter
- California State UniversityDepartment of Physical Therapy6000 J StSacramentoCaliforniaUSA95819
| | - Montserrat Girabent‐Farrés
- Universitat Internacional de CatalunyaDepartment of Physical Therapy, Biostatistics UnitC/ Josep trueta, s/nSant Cugat del VallèsBarcelonaSpain08195
| | | | - Mijna Hadders‐Algra
- University of Groningen, University Medical Center Groningen, Department of PaediatricsHanzeplein 1GroningenNetherlands9713 GZ
| | - Rosa Maria Angulo‐Barroso
- University of BarcelonaDepartment of Health and Applied Sciences, National Institute of Physical EducationAve. de L'Estadi 12‐22BarcelonaBarcelonaSpain08036
- California State UniversityDepartment of KinesiologyNorthridgeCaliforniaUSA
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Grecco LAC, Oliveira CS, Duarte NDAC, Lima VLCC, Zanon N, Fregni F. Cerebellar transcranial direct current stimulation in children with ataxic cerebral palsy: A sham-controlled, crossover, pilot study. Dev Neurorehabil 2017; 20:142-148. [PMID: 27003795 DOI: 10.3109/17518423.2016.1139639] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of the present study was to analyze the use of anodal tDCS of the cerebellar region combined with treadmill training to improve balance and functional performance in children with ataxic cerebral palsy. DESIGN Single-blind, sham-controlled, crossover, pilot study. SETTING Rehabilitation center and research motion analysis laboratory. PARTICIPANTS Children (N = 6) with ataxic cerebral palsy and balance deficit. MAIN OUTCOME MEASURES Static balance (oscillations of the center of pressure), functional balance (Pediatric Balance Scale) and functional performance (Pediatric Evaluation of Disability Inventory) were evaluated. RESULTS Significant reductions occurred in oscillations of the center of pressure with eyes closed after active anodal tDCS only. The effects of treadmill training on functional balance and functional performance in mobility were maintained in the active tDCS group only. CONCLUSION These preliminary data support the notion that anodal tDCS of the cerebellar region combined with treadmill training improves balance in children with ataxic cerebral palsy.
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Affiliation(s)
- Luanda André Collange Grecco
- a Postgraduate in Rehabilitation Sciences , Universidade Nove de Julho , São Paulo , SP , Brazil.,b Pediatric Neurosurgical, Center (CENEPE) , São Paulo , SP , Brazil.,c Department of Physical Medicine & Rehabilitation , Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School , Boston , MA , USA
| | - Claudia Santos Oliveira
- a Postgraduate in Rehabilitation Sciences , Universidade Nove de Julho , São Paulo , SP , Brazil
| | | | - Vânia L C Carvalho Lima
- d Communication Disorders Department , Federal University of São Paulo , São Paulo , SP , Brazil
| | - Nelci Zanon
- b Pediatric Neurosurgical, Center (CENEPE) , São Paulo , SP , Brazil
| | - Felipe Fregni
- c Department of Physical Medicine & Rehabilitation , Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School , Boston , MA , USA
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Lefmann S, Russo R, Hillier S. The effectiveness of robotic-assisted gait training for paediatric gait disorders: systematic review. J Neuroeng Rehabil 2017; 14:1. [PMID: 28057016 PMCID: PMC5217646 DOI: 10.1186/s12984-016-0214-x] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 12/14/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Robotic-assisted gait training (RAGT) affords an opportunity to increase walking practice with mechanical assistance from robotic devices, rather than therapists, where the child may not be able to generate a sufficient or correct motion with enough repetitions to promote improvement. However the devices are expensive and clinicians and families need to understand if the approach is worthwhile for their children, and how it may be best delivered. METHODS The objective of this review was to identify and appraise the existing evidence for the effectiveness of RAGT for paediatric gait disorders, including modes of delivery and potential benefit. Six databases were searched from 1980 to October 2016, using relevant search terms. Any clinical trial that evaluated a clinical aspect of RAGT for children/adolescents with altered gait was selected for inclusion. Data were extracted following the PRISMA approach. Seventeen trials were identified, assessed for level of evidence and risk of bias, and appropriate data extracted for reporting. RESULTS Three randomized controlled trials were identified, with the remainder of lower level design. Most individual trials reported some positive benefits for RAGT with children with cerebral palsy (CP), on activity parameters such as standing ability, walking speed and distance. However a meta-analysis of the two eligible RCTs did not confirm this finding (p = 0.72). Training schedules were highly variable in duration and frequency and adverse events were either not reported or were minimal. There was a paucity of evidence for diagnoses other than CP. CONCLUSION There is weak and inconsistent evidence regarding the use of RAGT for children with gait disorders. If clinicians (and their clients) choose to use RAGT, they should monitor individual progress closely with appropriate outcome measures including monitoring of adverse events. Further research is required using higher level trial design, increased numbers, in specific populations and with relevant outcome measures to both confirm effectiveness and clarify training schedules.
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Affiliation(s)
- Sophie Lefmann
- Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide, SA 5001 Australia
| | - Remo Russo
- Paediatric Rehabilitation Department, Women’s and Children’s Health Network, Women’s and Children’s Hospital Campus, 72 King William Road, North Adelaide, SA 5006 Australia
| | - Susan Hillier
- Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide, SA 5001 Australia
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Comparison of a robotic-assisted gait training program with a program of functional gait training for children with cerebral palsy: design and methods of a two group randomized controlled cross-over trial. SPRINGERPLUS 2016; 5:1886. [PMID: 27843743 PMCID: PMC5084143 DOI: 10.1186/s40064-016-3535-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 10/13/2016] [Indexed: 01/21/2023]
Abstract
Background Enhancement of functional ambulation is a key goal of rehabilitation for children with cerebral palsy (CP) who experience gross motor impairment. Physiotherapy (PT) approaches often involve overground and treadmill-based gait training to promote motor learning, typically as free walking or with body-weight support. Robotic-assisted gait training (RAGT), using a device such as the Lokomat®Pro, may permit longer training duration, faster and more variable gait speeds, and support walking pattern guidance more than overground/treadmill training to further capitalize on motor learning principles. Single group pre-/post-test studies have demonstrated an association between RAGT and moderate to large improvements in gross motor skills, gait velocity and endurance. A single published randomized controlled trial (RCT) comparing RAGT to a PT-only intervention showed no difference in gait kinematics. However, gross motor function and walking endurance were not evaluated and conclusions were limited by a large PT group drop-out rate. Methods/design In this two-group cross-over RCT, children are randomly allocated to the RAGT or PT arm (each with twice weekly sessions for eight weeks), with cross-over to the other intervention arm following a six-week break. Both interventions are grounded in motor learning principles with incorporation of individualized mobility-based goals. Sessions are fully operationalized through manualized, menu-based protocols and post-session documentation to enhance internal and external validity. Assessments occur pre/post each intervention arm (four time points total) by an independent assessor. The co-primary outcomes are gross motor functional ability (Gross Motor Function Measure (GMFM-66) and 6-minute walk test), with secondary outcome measures assessing: (a) individualized goals; (b) gait variables and daily walking amounts; and (c) functional abilities, participation and quality of life. Investigators and statisticians are blinded to study group allocation in the analyses, and assessors are blinded to treatment group. The primary analysis will be the pre- to post-test differences (change scores) of the GMFM-66 and 6MWT between RAGT and PT groups. Discussion This study is the first RCT comparing RAGT to an active gait-related PT intervention in paediatric CP that addresses gait-related gross motor, participation and individualized outcomes, and as such, is expected to provide comprehensive information as to the potential role of RAGT in clinical practice. Trial registration ClinicalTrials.gov NCT02196298 Electronic supplementary material The online version of this article (doi:10.1186/s40064-016-3535-0) contains supplementary material, which is available to authorized users.
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Kurz MJ, Reelfs H. Taking steps towards improving the mobility of children with cerebral palsy. Dev Med Child Neurol 2014; 56:1137-1138. [PMID: 25174951 DOI: 10.1111/dmcn.12572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Max J Kurz
- Department of Physical Therapy, Munroe-Myer Institute, University of Nebraska Medical Center, Omaha, NE, USA
| | - Heidi Reelfs
- Department of Physical Therapy, Munroe-Myer Institute, University of Nebraska Medical Center, Omaha, NE, USA
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