Clinical application of a robotic ankle training program for cerebral palsy compared to the research laboratory application: does it translate to practice?

Abstract

Objective: To determine the clinical efficacy of an ankle robotic rehabilitation protocol for patients with cerebral palsy.

Design: The clinic cohort was identified from a retrospective chart review in a before-after intervention trial design and compared with a previously published prospective research cohort.

Setting: Rehabilitation hospital.

Participants: Children (N=28; mean age, 8.2±3.62 y) with Gross Motor Function Classification System levels I, II, or III who were referred for ankle stretching and strengthening used a robotic ankle device in a clinic setting. Clinic results were compared with a previously published cohort of participants (N=12; mean age, 7.8±2.91 y) seen in a research laboratory-based intervention protocol.

Interventions: Patients in the clinic cohort were seen 2 times per week for 75-minute sessions for a total of 6 weeks. The first 30 minutes of the session were spent using the robotic ankle device for ankle stretching and strengthening, and the remaining 45 minutes were spent on functional movement activities. There was no control group.

Main outcome measures: We compared pre- and postintervention measures of plantarflexor and dorsiflexor range of motion, strength, spasticity, mobility (Timed Up and Go test, 6-minute walk test, 10-m walk test), balance (Pediatric Balance Scale), Selective Control Assessment of the Lower Extremity (SCALE), and gross motor function measure (GMFM).

Results: Significant improvements were found for the clinic cohort in all main outcome measures except for the GMFM. These improvements were equivalent to those reported in the research cohort, except for larger SCALE test changes in the research cohort.

Conclusions: These findings suggest that translation of repetitive, goal-directed biofeedback training into the clinic setting is both feasible and beneficial for patients with cerebral palsy.

Keywords: Ankle; Cerebral palsy; Exercise; Rehabilitation; Resistance training; Robotics.

Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1

Comparison of clinic (A) and laboratory (B) protocols, with description of time spent for each activity using the IntelliStretch (PS = passive stretching, AA = active assist, A/AR = active/active resist) and outside of the IntelliStretch (FA = functional activities). Each gray bar indicates a treatment session, and arrows indication time of the evaluations. (C) Device setup, showing patient in a seated position with the tested knee in extension and tested ankle strapped to the IntelliStretch footplate. The screen (rotated for photo) shows the feedback the participant would receive during the passive stretching portion of the treatment.

Figure 2

Results from clinical outcome measures, with comparisons to research cohort where available. Average measures with standard deviation error bars are shown for the Pre and Post evaluations both cohorts. Significant changes in the Wilcoxon Signed Rank test (*) were found in all measures in the clinic cohort and all but the TUG in the research cohort. There were no differences between the two cohorts’ change in any test but the SCALE, where the research cohort improved more than the clinic cohort, identified by the Kruskal-Wallis test (†). Note that not all y-axes start with zero.