Robotic Hand Therapy for Children With Cerebral Palsy
Condition: Cerebral Palsy; Hand Functions; Rehabilitation; Robotic Rehabilitation
MeSH terms: Cerebral Palsy
Study type: Interventional

Summary: 
      Cerebral palsy (CP) is the most common physical disability in childhood. The term CP is
      defined as a group of persistent but non-progressive movement and posture disorders resulting
      from a defect or lesion of the immature brain. The overall prevalence of CP worldwide is 2.11
      per 1000 live births.

      There is evidence that 80% of children with CP have upper extremity involvement. In general,
      the acquisition of effective arm and hand skills for use in daily life is a complex process
      that not only requires neuromusculoskeletal integrity, but also includes various aspects of
      the child's abilities. Thus, in addition to the positive symptoms that typically present
      patterns of spasticity, children and adolescents with CP often have a poor ability to reach,
      grasp, release, and manipulate objects. They also have difficulty using their upper
      extremities to perform self-care and other activities.

      Robot-assisted and computer-assisted methods may be valuable new strategies for improving the
      sensory-motor learning process in children with central motor impairment. These new
      technologies represent an attractive complement to existing physiotherapeutic and
      occupational therapy concepts.

      In patients with difficulty in individual finger and hand movements, the AMADEO device
      (Tyromotion, Austria) can be used for unilateral distal training of the upper extremity. With
      this device, patients with little or no voluntary control of the hand and fingers can receive
      more or less passive training, while those with better distal function of the upper extremity
      can strength train by following the device or even against the device to a certain extent.

      Implementation of robot-assisted therapy provides intense repetitive training, sensorimotor
      integration and cognitive engagement through targeted tasks; focuses primarily on functional
      motor performance. From previous studies, the use of robotic devices has been found to
      improve the kinematics, range of motion, muscle tone, postural control, and functionality of
      the upper and lower extremities in individuals with CP. Robotic hand therapy has started to
      take place in routine rehabilitation protocols today. Considering the scarcity of studies on
      robotic hand therapy in the pediatric group, larger-scale studies are needed. In this study,
      our aim is to investigate the effect of robotic hand therapy on hand functions and quality of
      life in children with CP.
    

Detailed description: 
      Cerebral palsy (CP) is the most common physical disability in childhood. The term CP is
      defined as a group of persistent but non-progressive movement and posture disorders resulting
      from a defect or lesion of the immature brain. The overall prevalence of CP worldwide is 2.11
      per 1000 live births.

      There is evidence that 80% of children with CP have upper extremity involvement. In general,
      the acquisition of effective arm and hand skills for use in daily life is a complex process
      that not only requires neuromusculoskeletal integrity, but also includes various aspects of
      the child's abilities. Thus, in addition to the positive symptoms that typically present
      patterns of spasticity, children and adolescents with CP often have a poor ability to reach,
      grasp, release, and manipulate objects. They also have difficulty using their upper
      extremities to perform self-care and other activities.

      Robot-assisted and computer-assisted methods may be valuable new strategies for improving the
      sensory-motor learning process in children with central motor impairment. These new
      technologies represent an attractive complement to existing physiotherapeutic and
      occupational therapy concepts.

      In patients with difficulty in individual finger and hand movements, the AMADEO device
      (Tyromotion, Austria) can be used for unilateral distal training of the upper extremity. With
      this device, patients with little or no voluntary control of the hand and fingers can receive
      more or less passive training, while those with better distal function of the upper extremity
      can strength train by following the device or even against the device to a certain extent.

      Implementation of robot-assisted therapy provides intense repetitive training, sensorimotor
      integration and cognitive engagement through targeted tasks; focuses primarily on functional
      motor performance. From previous studies, the use of robotic devices has been found to
      improve the kinematics, range of motion, muscle tone, postural control, and functionality of
      the upper and lower extremities in individuals with CP.

      In a case series of 7 children with CP presenting the results of robotic therapy, it showed
      beneficial effects on body structure and function, including motor function, coordination,
      and brachioradial muscle recruitment, but no improvement in activity and participation
      skills. It has been stated that there is a need for new studies to be carried out with longer
      training periods and with the measurement of grip strength, daily living activity evaluation
      scales covering a wide variety of tasks.

      In the first randomized controlled study with 16 children with CP, the results of upper
      extremity robot-assisted therapy were evaluated with body functions, structure and activity
      participation scales, and it was found that robotic therapy improved upper extremity
      kinematics and manual dexterity, but not functional activities and social participation.

      Most robotic studies in children and adolescents with CP have relatively small sample sizes
      and few randomized controlled trials.

      Robotic hand therapy has started to take place in routine rehabilitation protocols today.
      Considering the scarcity of studies on robotic hand therapy in the pediatric group,
      larger-scale studies are needed. In this study, our aim is to investigate the effect of
      robotic hand therapy on hand functions and quality of life in children with CP.
    

Intervention name(s): Robotic rehabilitation; Conventional rehabilitation
Intervention type(s): Other; Other
Intervention description(s): In robot-assisted therapy, the therapist selects different programs with personalized environments to train patients to strengthen limb muscles that have previously had difficulty with movements or are relatively weak. Active (individual finger movement, memory, motility, apple tree, target board, recycling bins, balloons, firefighter), auxiliary, and passive (cpm, cpm plus) treatment options are available in the system.; Conventional therapy group In the pediatric rehabilitation of the children's hands on the affected side, an exercise program consisting of 40 minutes of hand finger joint range of motion exercises (passive, active assistive), strengthening exercises, and coarse and fine dexterity exercises was planned, accompanied by a physiotherapist experienced for at least 5 years.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Investigator, Outcomes Assessor)
Primary purpose: Treatment