Promoting Functional and Independent Sitting in Children With Cerebral Palsy Using the Robotic Trunk Support Trainer.
Promoting Functional and Independent Sitting in Children With Cerebral Palsy Using the Robotic Trunk Support Trainer.
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DOI：
10.1109/tnsre.2020.3031580
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发表时间：
2020-12
期刊：
影响因子：
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通讯作者：
Agrawal SK
中科院分区：
文献类型：
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作者：
Santamaria V;Khan M;Luna T;Kang J;Dutkowsky J;Gordon AM;Agrawal SK
坐姿能力对脑瘫儿童的功能独立和参与至关重要，粗大运动功能分类系统（GMFCS）III-IV级。在这项概念验证研究中，我们研究了在纵向单一受试者设计（13岁，GMFCS IV）中使用机器人躯干支持训练器（TruST）进行基于运动学习的坐姿训练的可行性，以及其在3名儿童（6- 14岁，GMFCS III-IV）中的潜在有效性。TRUST是一个电动电缆驱动带放置在孩子的躯干施加积极的辅助力量时，躯干移动超过稳定性限制。信任干预解决姿势任务进展量身定制的辅助力场，以儿童的坐姿平衡，训练躯干控制在独立的短坐姿。信任干预包括2个训练模块，每个模块6次，每次2小时（每周3次）。在第1个街区需要使用骨盆捆扎带，以防止福尔斯跌倒。作为主要结果，我们使用了改良的功能性前伸测试、粗大运动功能测量项目集（GMFM-IS）、Box & Blocks和姿势运动学。在信任干预后，儿童不需要骨盆捆绑来防止跌倒，在伸手时改善了躯干稳定性（基线= 5.49cm，训练后1周= 16.38cm，3个月随访= 14.63cm，P < 0.001），增加了他们的坐姿工作空间（基线= 127.55cm 2，训练后1周= 409.92cm 2，3个月随访= 270.03cm 2，p < 0.001）。三名儿童在GMFM-IS中也有所改善。总之，我们的新型机器人信任干预是可行的，可以有效地最大限度地提高CP GMFCS III-IV儿童的功能独立坐。
Seated postural abilities are critical to functional independence and participation in children with cerebral palsy, Gross Motor Functional Classification System (GMFCS) levels III-IV. In this proof-of-concept study, we investigated the feasibility of a motor learning–based seated postural training with a robotic Trunk-Support-Trainer (TruST) in a longitudinal single-subject-design (13y, GMFCS IV), and its potential effectiveness in a group of 3 children (6-14y, GMFCS III-IV). TruST is a motorized-cable driven belt placed on the child’s trunk to exert active-assistive forces when the trunk moves beyond stability limits. TruST-intervention addresses postural-task progression by tailoring the assistive-force fields to the child’s sitting balance to train trunk control during independent short-sitting posture. TruST-intervention consisted of 2 training blocks of 6 2hour-sessions per block (3 sessions per week). Pelvic strapping was required in the 1st block to prevent falls. As primary outcomes, we used the modified functional reach test, gross motor function measure-item set (GMFM-IS), Box & Blocks, and postural kinematics. After TruST-intervention children did not require pelvic strapping to prevent a fall, improved trunk stability during reaching (baseline = 5.49cm, 1week post-training = 16.38cm, 3mos follow-up = 14.63cm, p < 0.001) and increased their sitting workspace (baseline = 127.55cm2, 1week post-training, = 409.92cm2, 3mos follow-up = 270.03cm2, p < 0.001). Three children also improved in the GMFM-IS. In summary, our novel robotic TruST-intervention is feasible and can effectively maximize functional independent sitting in children with CP GMFCS III-IV.