Constraint induced movement therapy with armeospring pediatric training for children with hemiplegic cerebral palsy

Abstract

Constraint Induced Movement Therapy (CIMT) is a therapeutic intervention using constraint of the non-involved limb while a child engages in intense training with hemiplegic extremity. No studies to date have examined the effectiveness of CIMT combined with the Armeo®Spring Pediatric, a robotic device, in the pediatric hemiplegic cerebral palsy (hCP) population. The Armeo®Spring combines virtual reality games with repetitive upper limb movements. The games aim to increase motivation to complete repetitive tasks required to improve function. The purpose of this study was to examine the effectiveness of hand function of CIMT compared to CIMT with Armeo®Spring and the perceived experience of using the Armeo®Spring compared to fine motor tasks. </DISS_para> <DISS_para>Twelve children with hCP (age 6-11yr, 8 M, MACS Level I= 2, II= 9, III= 1, right hCP= 7) were recruited at a pediatric hospital. Eight subjects completed CIMT camp 6 hours for 10 days; 4 subjects completed CIMT camp with Armeo®Spring daily for 30 minutes. Primary outcome measure, Assisting Hand Assessment (AHA), and secondary outcome measures, Melbourne Assessment of Unilateral Upper Limb Function (MUUL), Canadian Occupational Performance Measure (COPM), Tone (MAS and Tardieu), Range of Motion, grip strength, proprioception, and stereognosis were compared before and post intervention. Perceived observations on motivation, engagement, enjoyment and frustration were recorded during Armeo®Spring and fine motor activities.</DISS_para> <DISS_para>Clinically significant gains were observed in the augmented CIMT group on the AHA, COPM, and grip strength. The CIMT group demonstrated improvements on the AHA, MUUL, COPM, and grip strength. The augmented group demonstrated significant improvement on the AHA. Mean scores for motivation, engagement, and enjoyment were higher on the Armeo®Spring than fine motor tasks. The Armeo®Spring is a novel therapy that improves functional outcomes for children with hCP. Compared to CIMT alone, CIMT with Armeo®Spring appears to provide more intensive training. Based on particpant comments, its robotic features and videogame interface also appeal to the children leading to increased motivation, engagement and enjoyment while providing the just right challenge of the affected limb. This study provides a framework supported by evidence-based data for non-invasive treatment of children with hCP.