Improving seated postural control and upper extremity function in bilateral CP with a robotic Trunk-Support-Trainer (TruST)

中至重度双侧脑性瘫痪儿童上肢功能较差， 节段性躯干控制缺陷。他们的独立功能坐功能受损，减少了 参与休闲活动，参与教育。因此，推动独立会议 而改善姿势和上肢能力对健康和功能至关重要 中至重度双侧脑性瘫痪儿童的独立性(GMFCS III-IV)。尽管 轻度(单侧)CP儿童的上肢治疗有显著进步 支持以双侧坐姿控制为目标的治疗效果的证据有限 CP。最新的机器人设备使临床医生能够解决参与、重复和强度问题 练习以任务为导向的动作。在这种背景下，我们假设机器人技术可以提供一种 通过以下方式为患有双边脑瘫的儿童提供基于运动学习的有效训练的独特平台 实施体位技能进步。我们的团队开发了一种独特的电动后备箱- 支持-培训者(信任)，让孩子们参与以游戏为导向的练习，并取得技能进步。信任 在躯干失去平衡的区域创建自定义的类似圆环的力场 通过安全带提供超出坐姿稳定极限的主动帮助。培训的基础是 关于运动学习的原则，包括技能进步。 这项工作的总体目标是制定以证据为基础的战略，以促进 独立坐着，最大限度地提高坐姿和上肢能力，改善坐- 相关ADL。我们的中心假设是，在以下情况下，坐着并达到好处 基于运动学习的体位干预与体位技能进步相结合 通过信任，而不是静态的干线支持。这一提议的创新之处在于(RFA-HD-20- 005，《儿科康复》)在于循证临床实践与创新的融合 信任的机器人技术。结果是一种训练模式，患有双边CP的儿童可以接受 除了姿势技能进步外，还可以进行基于运动学习的姿势训练，以 孩子坐着时姿势的稳定性。如果我们的假设得到支持，信任干预将 是儿童慢性阻塞性肺疾病GMFCS III-IV获得和改善的唯一治疗方案 独立功能会议。

Children with moderate to severe bilateral CP have poor upper extremity abilities and segmental trunk control deficits. Their independent functional sitting is impaired with decreased participation in leisure activities, education involvement. Therefore, promoting independent sitting and improving postural and upper extremity abilities are critical to the health and functional independence of children with moderate-to-severe bilateral CP (GMFCS III-IV). Despite significant strides in upper extremity treatments of children with milder (unilateral) CP, there is limited evidence supporting efficacy of treatments targeting seated postural control in bilateral CP. Recent robotic equipment allows clinicians to address engagement, repetition, and intensity to practice task-oriented movements in CP. In this vein, we postulate that robotics can offer a unique platform to provide efficient motor learning-based training in children with bilateral CP by implementing postural skill progression. Our team has developed a unique motorized Trunk- Support-Trainer (TruST) to engage children in play-oriented practice with skill progression. TruST creates a customized donut-like force field at the region of the torso where balance is lost to provide active assistance beyond the sitting stability limits through a belt. The training is based on principles of motor learning, including skill progression. The overall goal of this work is to develop an evidence-based strategy to promote functional independent sitting, maximize seated postural and upper extremity abilities, and improve sitting- related ADLs. Our central hypothesis is that sitting and reaching benefits can be achieved when a motor learning-based postural intervention is combined with postural-skill progression delivered via TruST in comparison to a static trunk support. The innovation of this proposal, (RFA-HD-20- 005, ‘Pediatric Rehabilitation’) lies in the fusion of evidence-based clinical practice and novel robotics with TruST. The result is a training paradigm where children with bilateral CP can receive motor learning-based postural training in addition to postural skill progression that is tailored to the child’s postural stability in sitting. If our hypotheses are supported, the TruST-intervention will be a unique therapeutic solution for children with CP GMFCS III-IV to acquire and improve independent functional sitting.