Feasibility of school-based computer-assisted robotic gaming technology for upper limb rehabilitation of children with cerebral palsy.

INTRODUCTION: We investigated the feasibility of using computer-assisted arm rehabilitation (CAAR) computer games in schools. Outcomes were children's preference for single player or dual player mode, and changes in arm activity and kinematics. METHOD: Nine boys and two girls with cerebral palsy (6-12 years, mean 9 years) played assistive technology computer games in single-user mode or with school friends in an AB-BA design. Preference was determined by recording the time spent playing each mode and by qualitative feedback. We used the ABILHAND-kids and Canadian Occupational Performance Measure to evaluate activity limitation, and a portable laptop-based device to capture arm kinematics. RESULTS: No difference was recorded between single-user and dual-user modes (median daily use 9.27 versus 11.2 min, p = 0.214). Children reported dual-user mode was preferable. There were no changes in activity limitation (ABILHAND-kids, p = 0.424; COPM, p = 0.484) but we found significant improvements in hand speed (p = 0.028), smoothness (p = 0.005) and accuracy (p = 0.007). CONCLUSION: School timetables prohibit extensive use of rehabilitation technology but there is potential for its short-term use to supplement a rehabilitation program. The restricted access to the rehabilitation games was sufficient to improve arm kinematics but not arm activity. Implications for Rehabilitation School premises and teaching staff present no obstacles to the installation of rehabilitation gaming technology. Twelve minutes per day is the average amount of time that the school time table permits children to use rehabilitation gaming equipment (without disruption to academic attendance). The use of rehabilitation gaming technology for an average of 12 minutes daily does not appear to benefit children's functional performance, but there are improvements in the kinematics of children's upper limb.

Systematic review of outcome measures used in the evaluation of robot-assisted upper limb exercise in stroke.

OBJECTIVE: To classify and evaluate outcome measures currently used in robot-assisted exercise trials (RAET) in stroke, and to determine selection criteria for outcome measures in future trials. METHODS: Outcome measures used in RAET were identified from MEDLINE, EMBASE, CINAHL, PubMed and PsychINFO databases. The scale items were categorized into International Classification of Functioning Disability and Health (ICF) domains. The psychometric properties of scale were rated using a standardized pro forma. RESULTS: Thirty outcome measures were identified from 28 published RAET. Commonly used ICF body function scales were: Fugl-Meyer (FM) (24 studies), Modified Ashworth Scale (13 studies), Medical Research Council (11 studies), Kinematic measures (8 studies) and Motor Status Score (6 studies); ICF activity scale was Functional Independence Measure (FIMTM) (9 studies); ICF participation, personal and environmental factors scales were rarely used. Standard-ized rating identified that FM, kinematic measures, Action Research Arm Test, Wolf Motor Function Test, FIMTM, and ABILHAND have adequate measurement properties for use in RAET. CONCLUSION: Some of the currently used outcome measures seem appropriate for RAET. The use of the ICF framework enables selection of an appropriate combination of outcome measures depending on patient characteristics, such as severity of weakness and chronicity of stroke impairments.

Pharmacotherapy for treatment of attention deficits after non-progressive acquired brain injury. A systematic review.

OBJECTIVE: To systematically review the effectiveness of medications used to improve attention in people with non-progressive acquired brain injury. DESIGN: A systematic review. METHODS: MEDLINE, EMBASE, CINALH, PUBMED and PsychINFO databases were used to identify studies published between 1987 and 2008 meeting the following criteria: studies with subjects older than 18 years; diagnosis of new onset or previous acquired brain injury; medication given to improve attention and use of outcome to measure attention. Studies involving subjects in low arousal states or with neurogenerative conditions were excluded. The studies were categorized into three evidence levels: I - Randomized controlled trials; II - Prospective studies, controlled trials with methodological limitations; and III - Retrospective studies, clinical case series. RESULTS: Forty-seven articles were identified on initial search. Twenty-six met the pre-specified criteria. Five articles were assessed as meeting the level I evidence criteria, 12 were level II studies and 9 were level III studies. Methylphenidate can improve information processing speed but not all attention aspects in some people after traumatic brain injury. There is weak evidence for use of dopamine agonists to improve neglect/inattention after stroke. There is little evidence on the frequency of adverse effects and long-term functional benefits. CONCLUSION: Although there is lack of robust evidence to recommend the routine use of medication to improve attention after traumatic brain injury and stroke, the existing evidence indicates potential for benefit in some patents and therefore further research is warranted.

The engagement of children with disabilities in health-related technology design processes: identifying methodology.

PURPOSE: This review aims to identify research methodology that is suitable for involving children with disabilities in the design of healthcare technology, such as assistive technology and rehabilitation equipment. METHOD: A review of the literature included the identification of methodology that is available from domains outside of healthcare and suggested a selection of available methods. RESULTS: The need to involve end users within the design of healthcare technology was highlighted, with particular attention to the need for greater levels of participation from children with disabilities within all healthcare research. Issues that may arise when trying to increase such involvement included the need to consider communication via feedback and tailored information, the need to measure levels of participation occurring in current research, and caution regarding the use of proxy information. Additionally, five suitable methods were highlighted that are available for use with children with disabilities in the design of healthcare technology. CONCLUSION: The methods identified in the review need to be put into practice to establish effective and, if necessary, novel ways of designing healthcare technology when end users are children with disabilities.