Movement Improvement After Paediatric Armeo®Spring Rehabilitation
Condition: Acquired Brain Injury; Cerebral Palsy
MeSH terms: Brain Injuries; Cerebral Palsy
Study type: Observational

Summary: 
      Children with acquired and congenital brain lesions (namely, cerebral palsy, CP, and acquired
      brain injury, ABI) may exhibit upper limb impairment, with consequent limitations in their
      daily living activities.

      In recent years, robotic rehabilitation has become an important tool to promote functional
      recovery in patients with CP and ABI, thanks to its ability to promote high intensity,
      repetitive, engaging training. Moreover, it has additional advantages that can contribute to
      the understanding of the effectiveness of these devices in motor learning and recovery. It
      has indeed higher resolution and inter -rater and intra-rater reliability with respect to
      standard assessment methods (i.e. clinical scales). Furthermore, it is able to provide a
      quantitative evaluation of patients' movement during treatments instead of relying
      exclusively on qualitative observation. Recently, Merlo and co-workers (Sol et Salus, Rimini,
      Italy) developed and validated a tool to extract indices of accuracy, velocity and smoothness
      from the analysis of 3D trajectories of the end point of the robotic exoskeleton Armeo®Spring
      (Hocoma, CH).

      The primary aim of the study is to retrospectively investigate the effectiveness of
      robot-assisted upper limb rehabilitation in children affected by congenital and acquired
      brain damages by means of funcional scales and quantitative assessment of movement
      performance (accuracy, velocity and smoothness).

      Patients affected by acquired or congenital brain disease are enrolled. The inclusion
      criteria are: age between 5 and 18; the ability to handle objects in daily life within levels
      I, II, and III, according to the Manual Ability Classification System (MACS); the ability to
      understand and follow test instructions. Conversely, the exclusion criteria are: severe
      muscle contracture and/or spasticity, a diagnosis of severe learning disabilities or
      behavioral problems and visual or hearing difficulties that would impact on function and
      participation.

      Participants undergo the standard intervention protocol followed at the IRCCS E. Medea. It is
      composed by 20 sessions with Armeo®Spring and 20 sessions of physiotherapy, within 1 month.
      Patients are evaluated before (T0) and after (T1) the intervention with the Quality of Upper
      Extremities Skills Test (QUEST) and the Melbourne Assessment of Unilateral Upper Limb
      Function. During the first, tenth and last training session, patients executed the "Vertical
      Capture" exergame, which assess patient's functional level during a task that involves elbow
      flex-extension and shoulder flex- extension and abd-adduction. From these evaluation
      sessions, quantitative indices of movement performance (precision, velocity and smoothness)
      are extracted.
    


Intervention name(s): Upper limb robot-assisted rehabilitation; physiotherapy
Intervention type(s): Device; Other
Intervention description(s): Upper limb robot-assisted rehabilitation is performed with Armeo®Spring. It is a passive exoskeleton with five degrees of freedom that guarantees passive arm weight support with springs.
The treatment was composed by 45 minutes of robotic training (5 times a week for 4 weeks) during which patients performed a customized pull of exergames.; Patients undergo 45-minute treatment sessions 5 times a week for 4 weeks of physiotherapy, focused on gross and fine motor ability to promote independence in daily activities, and it is customized on patients' need.
Other intervention name(s): Armeo Spring
Observational model: Cohort
Time perspective: Retrospective
Sampling method: Non-Probability Sample
Study population: 
        Neurophysiatric care unit
      
Keywords: robot-assisted rehabilitation; Armeo®Spring; quantitative assessment