Feasibility of gestural feedback treatment for upper extremity movement in children with cerebral palsy.
Feasibility of gestural feedback treatment for upper extremity movement in children with cerebral palsy.
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DOI：
10.1109/tnsre.2012.2227804
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发表时间：
2013-03
期刊：
影响因子：
--
通讯作者：
Kaufman KR
中科院分区：
文献类型：
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作者：
Wood KC;Lathan CE;Kaufman KR
表现的外部反馈是治疗的一个重要组成部分，特别是对于由于脑瘫而受损的儿童，因为他们缺乏“良好运动”的内在经验来比较努力和确定表现结果。开发了一种机器人治疗系统，为治疗所需的特定上肢运动（手势）提供反馈。本研究的目的是比较常规治疗和手势机器人反馈治疗干预后前臂旋/旋前或手腕伸/屈运动的变化。6名脑瘫患者（5-18岁，GMFCS等级iv - 3、iii - 1和i - 2）参与了一项针对前臂旋后或手腕伸展的传统和机器人反馈治疗的盲法交叉设计研究。在基线和常规和机器人反馈治疗干预后，由不知道干预顺序的人员使用动作捕捉系统获得功能性上肢运动。所有活动均经IRB批准。机器人反馈系统的使用确实导致目标手势的运动略有增加，而非目标动作没有变化。数据还表明，在常规治疗干预后，激动剂和拮抗剂的运动均有所减少。结果表明，机器人反馈治疗干预在常规治疗干预之前改善了运动。机器人反馈疗法与常规疗法在改善脑瘫患儿上肢旋后或腕关节伸展功能方面没有什么不同。在这一小群不同的患者中，个体受试者的结果表明，干预顺序可能是模糊干预类型差异的原因。几个个体受试者的结果表明，在一个更均匀的受试者群体中，结果可能会有所不同，未来的研究应该被考虑，以最终确定机器人反馈疗法的疗效。未来的研究还应探讨其他神经肌肉患者群体的疗效。
External feedback of performance is an important component of therapy, especially for children with impairments due to cerebral palsy because they lack intrinsic experience of “good movements” to compare effort and determine performance outcomes. A robotic therapy system was developed to provide feedback for specific upper extremity movements (gestures) which are therapeutically desirable. The purpose of this study was to compare changes in forearm supination/pronation or wrist extension/flexion motion following conventional therapy and gestural robotic feedback therapy intervention. Six subjects with cerebral palsy (ages 5–18, GMFCS level IV—three subjects, level III—one subject, and level I—two subjects) participated in a blinded crossover design study of conventional and robotic feedback therapy targeting either forearm supination or wrist extension. Functional upper extremity motion at baseline and following conventional and robotic feedback therapy interventions were obtained using a motion capture system by personnel blinded to the intervention order. All activities were approved by IRB. Use of the robotic feedback system did result in slightly increased movement in the targeted gesture without change in un-targeted motions. Data also suggest a decrease in both agonist and antagonist motion following conventional therapy intervention. Results suggest improved motion when robotic feedback therapy intervention precedes conventional therapy intervention. Robotic feedback therapy is no different than conventional therapy to improve supination or wrist extension function in upper extremity impairments of children with cerebral palsy when changes were considered as aggregate data. In this very small group of diverse patients, individual subject results suggested that intervention order could be responsible for obscuring differences due to intervention type. Outcomes from several individual subjects suggest that results could be different given a more homogeneous group of subjects which future studies should be considered to ultimately determine efficacy of the robotic feedback therapy. Future studies should also address efficacy in other neuromuscular patient populations.