The Effectiveness of Robot-Assisted, Task-Specific Ankle Training in Improving Deficits Across the Three Domains of the ICF in Children with Cerebral Palsy (CP)

Abstract

Cerebral Palsy (CP) is considered to be the leading cause of motor disability among children. Children with CP present with multiple physical impairments including decreased strength and range of motion (ROM), increased spasticity, and poor balance and coordination. These impairments often lead to limitations in ankle motor control that impacts balance and gait function, which puts children at a higher risk for developing other problems. In recent studies, robotic devices have been developed to address poor motor control of the upper and lower extremities. Aim: The aim of this study is to investigate the extent to which the robot-assisted, taskspecific ankle trainer improve deficits across the three domains of the International Classification of Functioning, Disability and Health (ICF) in children with CP. Method: This is a quasi-experimental, single group, repeated measure design with four time-testing points through a set training session/protocol. A convenience sample of 5 children with CP were enrolled in the study. All children received 6-weeks of ankle robot training that included two 45-60 minute sessions per week, for a total of 12 sessions. Data from Tardieu Scale of spasticity, Boyd and Graham selective motor control, Pediatric Balance Scale, goniometer, hand held dynamometer, gait mat analysis, accelerometer, LIFE-H for children questionnaires, ultrasound, and robotic evaluation were collected at the different time points (1 week and 1 month pre training and 1 week and 1 month post training). Descriptive statistics and repeated measure (ANOVA) were used with SPSS software for data analysis. Results: All participants showed improvement in 1. Body Function and Structures (ROM, tone, strength, balance, ankle control and performance, and muscle architecture), 2. Activity (gait and activity counts) and 3. Participations over the course of the study. Conclusion: The results revealed the potential of robot-assisted, task-specific ankle training to improve motor performance and capacity at the body function, activity and participation level. Training appeared to have a lasting impact as most gains were maintained one month following training.