The Effects Of Upper Extremity Robotic Rehabilitation On Upper Extremity Functions And Gait Parameters
Condition: Cerebral Palsy
MeSH terms: Cerebral Palsy
Study type: Interventional

Summary: 
      Cerebral Palsy is defined as the cause of movement and posture disorders and activity
      limitation that develops in the fetal or infant brain that has not yet completed its
      development. When the literature is examined, although upper extremity and lower extremity
      involvements are common in individuals with hemiparetic CP, treatment programs are mostly
      aimed at the lower extremities. However, studies report that the upper extremity is more
      severely affected than the lower extremities in individuals with hemiparetic CP and that
      upper extremity functions have an effect on walking. Although different treatment methods
      have positive effects, their superiority over each other cannot be clearly reported. In this
      case, new intervention strategies based on sound methodological and scientific foundations
      are needed. At this point, virtual reality applications and robotic rehabilitation programs
      have started to play an important role in CP rehabilitation along with current developments
      in technology-assisted rehabilitation. Robotic devices provide visual, auditory and sensory
      inputs, making the process fun, while making the individual active in the treatment. It also
      enables the child to achieve goal-directed movements in children with motor disabilities.
      Various gait problems are seen in individuals with CP. Therefore, although lower extremity
      movements during walking have been well analyzed in the literature, upper extremity functions
      and especially arm movements during walking have received less attention. Although human gait
      is perceived as a situation that concerns only the lower extremities, it actually includes
      the coordinated movements of all four extremities. Individuals with hemiplegic CP usually
      have a markedly deviated arm position and reduced arm movement. This situation also affects
      the gait and balance of individuals with hemiparetic CP. Individuals change their upper
      extremity kinematics while increasing their walking speed to optimize gait and increase
      balance. In the light of this information, practices aimed at improving upper extremity
      movement and function should be included in the rehabilitation program of patients with
      hemiparetic CP, considering a holistic approach. Considering all these, we thought that if we
      increase the functions of the upper extremities, we can improve walking, and we planned this
      study.
    

Detailed description: 
      Cerebral Palsy is defined as the cause of movement and posture disorders and activity
      limitation that develops in the fetal or infant brain that has not yet completed its
      development. Although CP is the most common physical disorder in childhood, its incidence
      varies between 1.7-2 people per 1000 live births in developed countries. Although the
      impairments seen in CP are not progressive, as individuals with CP get older, their current
      motor function declines dramatically and their independence decreases or disappears as a
      result. These neurodevelopmental disorders are classified as hemiplegic, diplegic and
      quadriplegic according to the anatomically affected body parts. Along with motor damage,
      epilepsy, cognitive disorders, behavioral disorders, visual-hearing losses and sensory
      disorders can be seen in children with CP. In addition, upper extremity involvement is quite
      common in individuals with CP. Although upper extremity and lower extremity involvement are
      common in individuals with hemiparetic CP, treatment programs are mostly aimed at the lower
      extremities. However, studies report that the upper extremity is more severely affected than
      the lower extremities in individuals with hemiparetic CP and that upper extremity functions
      have an effect on walking . Although human gait is perceived as a situation that concerns
      only the lower extremities, it actually includes the coordinated movements of all four
      extremities. In a study, it was reported that it is beneficial to encourage arm movements
      during gait rehabilitation. It has been reported that although individuals with hemiparetic
      CP gain walking skills, they lag behind their peers in terms of upper extremity functions.
      This makes upper extremity rehabilitation important. There are various treatment modalities
      aimed at eliminating upper extremity dysfunction and reducing activity limitations. These;
      neurodevelopmental treatment approaches, orthoses, forced restrictive movement therapy,
      virtual reality and robotic rehabilitation applications. Although the different treatment
      methods have positive effects, their superiority to each other cannot be reported
      definitively. In this case, new intervention strategies based on sound methodological and
      scientific foundations are needed.

      With the development of technology, the interest in robotic rehabilitation has also
      increased. The first study examining upper extremity robotic rehabilitation in CP was
      conducted in 2008. In this study, it was reported that robotic rehabilitation has positive
      effects on upper extremity motor functions and the use of upper extremities in daily living
      activities. In a thesis study conducted in our country, conventional physiotherapy and
      robotic rehabilitation were compared and it was concluded that hand skills improved in both
      groups, but the increase in the group receiving robotic rehabilitation was statistically
      significant. In the literature review, it was seen that studies on upper extremity robotic
      rehabilitation were few and their effects on gait parameters were not examined. In this
      context, it is thought that in our study, the effects of upper extremity robotic
      rehabilitation on upper extremity functions and gait parameters will be examined and it will
      contribute to the literature.

      Method: This study was conducted to examine the effects of upper extremity robotic
      rehabilitation on upper extremity functions and gait parameters in individuals with
      hemiparetic CP; It is a prospective, randomized controlled, single-blind study. The study
      will be carried out in a single-blind manner, and the evaluator will not know which group the
      individual is in. 30 individuals with spastic hemiparetic CP, aged between 6-18 years, will
      be included in our study. The parents of each individual will be informed about the study and
      will read and sign the consent form stating that they voluntarily participated in the study.
    

Intervention name(s): conventional physiothrapy; robotic rehabilitation
Intervention type(s): Other; Other
Intervention description(s): Conventional physiotherapy program will be applied to the control group for 6 weeks, 3 days a week, 45 minutes a day. Strengthening, dynamic stretching, coordination and balance exercises and functional exercises for upper and lower extremities will be applied in this treatment program.; The study group will be included in the rehabilitation program with the Hocoma brand Armeo Spring pediatric upper extremity robot for 30 minutes a day, 3 days a week, for 6 weeks at hospital. Armeo spring robot enables the individual to perform active movement by carrying the weight of the upper extremity of children who have active movement in their upper extremities but do not have enough strength to overcome gravity with their upper extremities. The individual is actively involved in the study during the study. With the adjustments made, it becomes suitable for use for right and left extremities. In the process of working; The games named High Flyer, Frisbee, Balloons, Goalkepper, Save the Monster, Fishing, Helicopter Rescue, which are included in the Armeo Spring robot and created to increase shoulder, elbow and wrist movements, will be used.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Individuals with CP will be assigned to group 1 or group 2 by simple randomization using the "Research Randomizer" program (https://www.randomizer.org/) prior to treatment.
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment