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

中度至重度双侧CP的儿童上肢功能较差， 节段性躯干控制缺陷。他们的独立功能性坐姿受损， 参与休闲活动，教育参与。因此，促进独立坐 改善姿势和上肢能力对健康和功能至关重要 中度至重度双侧CP儿童的独立性（GMFCS III-IV）。尽管 在轻度（单侧）CP儿童的上肢治疗方面取得了重大进展， 有限的证据支持针对双侧坐姿控制的治疗有效性 CP.最近的机器人设备允许临床医生解决参与，重复和强度 在CP中练习以任务为导向的动作。在这种情况下，我们假设机器人可以提供一个 一个独特的平台，为双侧CP儿童提供有效的基于运动学习的训练， 实施姿势技能进展。我们的团队开发了一种独特的机动行李箱- 支持培训师（信任），让孩子们在游戏为导向的实践与技能进步。信任 在失去平衡的躯干区域创建定制的甜甜圈状力场， 通过安全带提供超过坐姿稳定极限的主动辅助。培训是基于 运动学习的原则，包括技能的进步。 这项工作的总体目标是制定一项以证据为基础的战略， 独立坐姿，最大限度地提高坐姿和上肢能力，并改善坐姿- 相关的ADLs我们的中心假设是，坐着和伸手可及的好处可以实现， 基于运动学习的姿势干预与姿势技能进展相结合， 与静态干线支持相比，本提案的创新之处在于，（RFA-HD-20- 005，“儿科康复”）在于融合循证临床实践和新颖的 机器人与信任结果是一个训练范例，双侧CP儿童可以接受 运动学习为基础的姿势训练，除了姿势技能的进展，是量身定制的， 孩子坐姿的稳定性。如果我们的假设得到支持，信任干预将 是一个独特的治疗方案，为儿童CP GMFCS III-IV获得和改善 独立的功能性坐姿。

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.