NAO Robot in Pediatric Occupational Therapy (NAO Robot)

Using a NAO Robot to Enhance Occupational Therapy for Children With Cerebral Palsy

Cerebral Palsy (CP) is a non-progressive neurological disorder that affects movement and posture, often impairing upper extremity function and daily activity performance. Technological tools, such as social robots, have shown promise in supporting rehabilitation. This study investigated the effects of NAO robot-assisted therapy on functional performance, motivation, and emotional states in children with unilateral CP.

Sixteen children participated in a 14-week intervention, which included 12 weeks of task-oriented therapy. In six of those weeks, sessions incorporated the NAO robot, which simulated three daily activities identified using the Canadian Occupational Performance Measure (COPM) and offered motivational feedback. Emotional responses were tracked using the Empatica E4 wristband, measuring blood volume pulse (BVP), electrodermal activity (EDA), and skin temperature (ST).

Study Overview

• Status: Completed
• Conditions: Cerebral Palsy (CP); Activities of Daily Living
• Intervention / Treatment: Other: Occupational Therapy Intervention; Other: NAO Robot-Assisted Occupational Therapy

Detailed Description

This single-group interventional study investigated the effect of adding the social humanoid robot NAO to occupational therapy sessions on upper extremity function, hand skills, and motivation in children with unilateral spastic cerebral palsy (CP). Sixteen children aged 5-15 years, classified as GMFCS I-III, MACS 1-3, CFCS 1-2, and MAS 0-2, participated.

The study consisted of two sequential 6-week phases:

Phase 1: Routine occupational therapy sessions (40 minutes each).

Phase 2: Routine occupational therapy supplemented with NAO robot-assisted activities (same duration).

Sessions targeted functional tasks identified using the Canadian Occupational Performance Measure (COPM), such as eating, throwing a ball, and brushing teeth. Upper extremity function was assessed with the Quality of Upper Extremity Skills Test (QUEST); functional abilities with PEDI; activity limitations and bimanual hand use with GMFCS and BFMF; and occupational performance and satisfaction with COPM.

Physiological signals (blood volume pulse, electrodermal activity, and skin temperature) were recorded using the Empatica E4 wristband to assess children's motivation and emotional responses during sessions. Data were analyzed using appropriate statistical methods, including t-tests, Mann-Whitney U, Friedman test, and Wilcoxon signed-rank tests with Bonferroni correction.

• Study Type: Interventional
• Enrollment (Actual): 15
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Ankara
    • Altindağ, Ankara, Turkey (Türkiye), 06050
      • Ankara Medipol University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Children aged 5-15 years
• Diagnosis of unilateral spastic cerebral palsy
• Classified as Level I-III according to the Gross Motor Function Classification System (GMFCS)
• Classified as Level 1-3 on the Manual Ability Classification System (MACS)
• Level 0-2 on the Modified Ashworth Scale, indicating mild to moderate spasticity

Exclusion Criteria:

• History of upper extremity orthopedic surgery within the past year
• Presence of epileptic symptoms
• Receipt of botulinum toxin treatment within the last six months

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Sequential Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: Single Group - Occupational Therapy With and Without Social Robot Support; This single-group arm includes all participants, who receive two sequential phases of occupational therapy. In Phase 1, children receive routine occupational therapy sessions delivered by a licensed occupational therapist. After a 2-week interval, participants enter Phase 2, during which they receive the same occupational therapy activities supplemented with robot-assisted interaction using the NAO humanoid robot. All participants experience both phases in the same order, and no randomization or group allocation is performed.

Other: Occupational Therapy Intervention; Routine Occupational Therapy. Participants receive standard occupational therapy sessions delivered by a licensed pediatric occupational therapist. Sessions include individualized therapeutic activities targeting fine motor skills, bilateral coordination, sensory processing, activities of daily living (ADL) training, and play-based functional tasks.; Other: NAO Robot-Assisted Occupational Therapy; NAO Robot-Assisted Occupational Therapy. Participants receive the same core occupational therapy program as in Phase 1, supplemented with robot-mediated interaction using the NAO humanoid robot (SoftBank Robotics).

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Quality of Upper Extremity Skills Test (QUEST)	20 minutes
Pediatric Evaluation of Disability Inventory (PEDI)	10 minutes
Bimanual Fine Motor Function	10 minutes
Canadian Occupational Performance Measure	10 minutes

Collaborators and Investigators

• Sponsor: Ankara Medipol University
• Collaborators: Medipol University; Yeditepe University

Study record dates

Study Major Dates

• Study Start (Actual): January 2, 2024
• Primary Completion (Actual): July 2, 2024
• Study Completion (Actual): June 2, 2025

Study Registration Dates

• First Submitted: December 2, 2025
• First Submitted That Met QC Criteria: December 2, 2025
• First Posted (Actual): December 15, 2025

Study Record Updates

• Last Update Posted (Actual): January 23, 2026
• Last Update Submitted That Met QC Criteria: January 22, 2026
• Last Verified: November 1, 2025

More Information

Terms related to this study

• Keywords: occupational therapy; cerebral palsy; social robots
• Additional Relevant MeSH Terms: Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Brain Damage, Chronic; Cerebral Palsy
• Other Study ID Numbers: E-10840098-772.02-30; 123E355 (Other Grant/Funding Number: The Scientific and Technological Research Council of Turkey (TUBITAK 1002))

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Due to the inclusion of pediatric participants and the sensitive nature of the clinical data, individual participant data will not be shared.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No