Harnessing the Power of Movement: A Body-Weight Support System & Assistive Robot Case Study.

Young children with motor disabilities face extra obstacles to engaging in movement and initiating social interaction. A body-weight support harness system (BWSS) allows a child to take steps, explore the environment, and interact with people and objects, but further research is needed to understand how this type of system can help children with motor disabilities. Assistive robots have the potential to keep a child engaged and motivated during physical therapy sessions with a BWSS. We conducted a case study over three and a half months to understand if the BWSS alone and if the BWSS with an assistive robot could promote child movement and engagement. Our results show that the child tended to increase their amount of movement over each session with the BWSS. The assistive robots used in this study also tended to keep the child engaged. The products of this work can benefit clinicians and researchers interested in early mobility intervention technologies, as well as roboticists working in the child mobility domain.

Reliability and validity of the five-repetition sit-to-stand test for children with cerebral palsy.

UNLABELLED: OBJECTIVE To investigate the psychometric properties of the five-repetition sit-to-stand test, a functional strength test, in children with spastic diplegia. DESIGN: Methodology study. SETTINGS: Hospital, laboratory or home. PARTICIPANTS: In total, 108 children with spastic diplegia and 62 with typical development aged from five to 12 years were tested. For test-retest reliability, 22 children with spastic diplegia were tested twice within one week. INTERVENTIONS: Not applicable. MAIN MEASURES: The five-repetition sit-to-stand test measures time needed to complete five consecutive sit-to-stand cycles as quickly as possible. The higher the rate of five-repetition sit-to-stand (repetitions per second), the more strength a person has. RESULTS: The intraclass correlation coefficients of intra-session reliability and test-retest reliability were 0.95 and 0.99 respectively. The minimal detectable difference was 0.06 rep/sec. The convergent validity of the five-repetition sit-to-stand test was supported by significant correlation with one-repetition maximum of the loaded sit-to-stand test, isometric muscle strength, scores of Gross Motor Function Measure, and gait function (r or rho = 0.40-0.78). For known group validity, children with typical development and children classified as Gross Motor Function Classification System level I performed higher rates of five-repetition sit-to-stand than children classified as level II, and children classified as level II performed higher rates than level III. CONCLUSION: The five-repetition sit-to-stand test was a reliable and valid test to measure functional muscle strength in children with spastic diplegia in clinics.

Structural Validity of an ICF-Based Measure of Activity and Participation for Children in Taiwan's Disability Eligibility Determination System.

To assess activity and participation for children in Taiwan's Disability Eligibility Determination System (DEDS), we developed a questionnaire, the Functioning Disability Evaluation Scale (FUNDES-Child), based on the Child and Adolescent Scale of Participation (CASP). The study follows a methodology research design to investigate the construct validity of the frequency and independence dimensions of FUNDES-Child 7.0. Two samples were randomly stratified from the databank of 13,835 children and youth with disabilities aged 6.0-17.9 years to examine structural validity by exploratory factor analysis (EFA, n = 4111, mean age of 11.3 ± 3.5) and confirmatory factor analysis (CFA, n = 4823, mean age of 11.4 ± 3.5)). EFA indicated a 4-factor structure for the frequency dimension (51.3% variance explained) and a 2-factor structure for the independence dimension (53.6% variance explained). The CFA indicated that the second-order factor structures of both dimensions were more parsimonious with adequate fit indices (Goodness fit Index, GFI; Normed Fit Index, NFI; Comparative Fit Index, CFI; and Tucker-Lewis Index, TLI ≥ 0.95, Root Mean Square Error of Approximation, RMSEA < 0.06). Results provide evidence that the participation part of FUNDES-Child 7.0 has acceptable structural validity for use in Taiwan's DEDS. Utility of FUNDES-Child 7.0 in rehabilitation, welfare, and educational services needs further study.

Effects of hippotherapy on body functions, activities and participation in children with cerebral palsy based on ICF-CY assessments.

PURPOSE: To evaluate the effects of hippotherapy on body functions, activities, and participation in children with CP of various functional levels by using the International Classification of Functioning, Disability and Health-Children and Youth (ICF-CY) checklist. METHODS: Fourteen children with cerebral palsy (CP) (3-8 years of age) were recruited for a 36-week study composed of baseline, intervention, and withdrawal phases (12 weeks for each phase, ABA design). Hippotherapy was implemented for 30 min once weekly for 12 consecutive weeks during the intervention phase. Body Functions (b) and Activities and Participation (d) components of the ICF-CY checklist were used as outcome measures at the initial interview and at the end of each phase. RESULTS: Over the 12 weeks of hippotherapy, significant improvements in ICF-CY qualifiers were found in neuromusculoskeletal and movement-related functions (b7), mobility (d4) and major life areas (d8) and, in particular, mobility of joint functions (b710), muscle tone functions (b735), involuntary movement reaction functions (b755), involuntary movement functions (b765), and play (d811) (all p < 0.05) when compared with baseline. CONCLUSION: This study demonstrated the beneficial effects of hippotherapy on body functions, activities, and participation in children with CP. Implications for Rehabilitation ICF-CY provides a comprehensive overview of functioning and disability and constitutes a universal language for identifying the benefits of hippotherapy in areas of functioning and disability in children with CP. In children with CP, hippotherapy encourages a more complementary approach that extends beyond their impairments and limitations in body functions, activities, and participation. The effect of hippotherapy was distinct from GMFCS levels and the majority of improvements were present in children with GMFCS levels I-III.

A home-based program using patterned sensory enhancement improves resistance exercise effects for children with cerebral palsy: a randomized controlled trial.

BACKGROUND: Neurologic music therapy has demonstrated improved walking performance in persons with neurologic disease; however, little evidence supports the use of music with functional resistance exercise to improve motor capacity and daily functions for children with cerebral palsy. OBJECTIVE: To investigate the effect of additional patterned sensory enhancement (PSE) music combined with exercise for children with spastic diplegia. METHODS: An assessor-blind, randomized controlled trial with 6- and 12-week follow-ups was carried out. Thirty-six children with spastic diplegia, aged 5 to 13 years, were assigned to a PSE group (n = 18) or a no-music group (n = 18). Both groups received 6-week, home-based, loaded sit-to-stand exercise, but only the PSE group exercised with prerecorded PSE music. The primary outcome was Gross Motor Function Measure (GMFM). Secondary outcomes included Pediatric Evaluation of Disability Inventory (PEDI) mobility and self-care domains, 1-repetition maximum of sit-to-stand, and walking speeds. RESULTS: Three children did not complete the program. Intention-to-treat analysis showed both groups improved in GMFM D, E, and Goal dimensions; Functional Skills Scales of PEDI mobility domain; and 1-repetition maximum of sit-to-stand at posttest and follow-ups (P ≤ .005). The PSE group improved significantly greater than the no-music group in the GMFM D and Goal dimensions (P < .005) after training, and the improvement persisted for at least 6 or 12 weeks (P ≤ .013). No significant improvements in the rest PEDI scales and walking speeds were found. CONCLUSIONS: Adding neurologic music therapy to functional resistance exercise could induce greater improvements in gross motor capacity for children with cerebral palsy.

Immediate effects of therapeutic music on loaded sit-to-stand movement in children with spastic diplegia.

The effects of patterned sensory enhancement (PSE) music on muscle power and movement control in children with spastic diplegia (SD) during loaded sit-to-stand (LSTS) were investigated. Twenty-three children with SD aged 5 to 12 years were recruited. Individualized PSE was composed by a music therapist based on each subject's sit-to-stand (STS) movement with 50% 1-repetition maximum load. Each subject performed LSTS continuously for eight repetitions under randomly assigned music or no-music (Control) conditions while the kinematic and kinetic data were measured simultaneously. For the music condition, PSE music was played only during the first five repetitions (PSE condition), and the following three repetitions were referred to as the Continuation condition. Paired t- or Wilcoxon signed rank tests were used to compare the variables between the PSE and Control conditions, and between the Continuation and Control conditions. Compared to the Control condition, greater peak knee extensor power (P=0.009), greater total extensor power (P=0.015), and better center-of-mass smoothness (P=0.01), but less movement time (P=0.003) were found in the PSE condition. Significant effects of the PSE music on the above variables were also found for Continuation condition. The current results showed that individualized PSE music helped improve the performance of LSTS in children with SD. The associated biomechanical features also continued to exist in subsequent movement cycles after the music had ceased. These findings suggest that therapy using LSTS combined with PSE music may be beneficial for rehabilitating children with SD.