Use of Robotics in a Pediatric Constraint-Induced Movement Therapy Program
Teressa Garcia Reidy MS, OTR/L; Frank Pidcock, MD; Joan Carney, EdD; Erin Naber, PT, DPT; Patricia Turlington, MS, PT Kennedy Krieger Institute, Baltimore, MD
Background: Pediatric Constraint-Induced Movement Therapy (CIMT) is an effective intervention for children with both congenital and acquired hemiparesis (Brady & Garcia, 2009; Reidy et al, 2012). Virtual reality (VR) and robotic therapies (RT) are emerging modalities in occupational and physical therapy that provide means for repetitive practice of target movements, such as reaching in space (Fasoli et al, 2008) or grasp and release (Carmeli et al, 2010). These modalities typically employ robotic arms, joysticks, or other controllers to measure the patient’s performance of the targeted movement. Early studies demonstrate that patients using robotic devices in therapy sessions are motivated and make positive gains after intervention with both stationary (Fasoli et al, 2008; Frascarelli, 2009) and glove-based devices (Carmeli et al, 2010). To date, only one study (Fluet et al, 2010) reported use of VR combined with a robotic device in a pediatric CIMT setting.
Purpose: Clinicians in an established, intensive CIMT program found robotic therapies to be a natural complementary modality to incorporate during a group-based CIMT program. This poster reports on the use of a sling style device, a wireless motion feedback device, and a glove-based robotic device in this program.
Objectives: Participants who view this poster will be able to identify ways to increase patient motivation with effective and engaging clinic-based robotic activities, and identify the potential risks and benefits of using complementary robotic modalities during CIMT. Robotics Intervention
Description: Patients enrolled in the program received intensive PT and OT services six hours a day, five days a week, for 21 days. Participants wore a cast on the stronger upper extremity for 24 hours a day for the first 16 days of the program, and received bimanual treatment the last five days. Immediately prior to and after intervention, children were assessed using standardized measures. During those six hours, the patients used a UE glove (HandTutorTM by MediTouch), a wireless motion feedback device on a Velcro strap (3D TutorTM), or a sling-based robotic device (Armeo® Boom by Hocoma) for at least one hour a day, three days a week.
Conclusions: When implementing pediatric CIMT programs, therapists should consider complementary therapies such as virtual reality and robotic therapy to potentially augment the gains associated with this approach. This poster provides a framework for incorporating robotics into a group-based, camp-like program that can be replicated in clinics. Further research should analyze the effects of treatment using pre/post and follow-up outcome measures. Comparisons of various robotic devices and the most effective dosage in collaboration with CIMT should be explored.