RESUMEN
BACKGROUND: Robot assisted upper extremity therapy has been shown to be effective in adult stroke patients and in children with cerebral palsy (CP) and other acquired brain injuries (ABI). The patient's active involvement is a factor in its efficacy. However, this demands focused attention during training sessions, which can be a challenge for children. OBJECTIVE: To compare results of training requiring two different levels of focused attention. Differences in short term performance and retention of gains as a function of training protocol as measured by the Fugl-Meyer (FM) were predicted. METHODS: Thirty-one children with CP or ABI were randomly divided into two groups. All received 16 one hour sessions of robot-assisted therapy (twice a week for 8 weeks) where they moved a robot handle to direct a cursor on the screen toward designated targets. One group had targets presented sequentially in clockwise fashion, the other presented in random order. Thus, one group could anticipate the position of each target, the other could not. RESULTS: Both groups showed significant functional improvement after therapy, but no significant difference between groups was observed. CONCLUSIONS: Assist-as-needed robotic training is effective in children with CP or ABI with small non-significant differences attributed to attentional demand.
Asunto(s)
Atención/fisiología , Lesiones Encefálicas/rehabilitación , Parálisis Cerebral/rehabilitación , Robótica/métodos , Extremidad Superior/fisiopatología , Adolescente , Niño , Preescolar , Femenino , Humanos , Masculino , Estimulación LuminosaRESUMEN
The field of rehabilitation robotics has grown substantially during the past 15 yrs. Studies of upper limb robot-assisted therapy for adults with moderate to severe hemiparesis after stroke have shown significant gains compared with usual care in isolated control, coordination, and strength in the paretic arm (J Rehabil Res Dev 2006;43:171-84; Top Stroke Rehabil 2007;14:22-44; Neurorehabil Neural Repair 2008;22:111-21). While attempts to increase the understanding of the key active ingredients of these interventions continue, researchers have recently extended their focus to children with neurologically based movement disorders arising from cerebral palsy and acquired brain injury or stroke. This study's aim was to provide a narrative review that highlights recent pediatric studies of robot-assisted therapies for the upper and lower limbs. Potential benefits will be discussed, as well as challenges and needs for future development.
Asunto(s)
Niños con Discapacidad/rehabilitación , Modalidades de Fisioterapia/instrumentación , Robótica/tendencias , Lesiones Encefálicas/rehabilitación , Parálisis Cerebral/rehabilitación , Niño , Retroalimentación Sensorial , Humanos , Trastornos del Movimiento/rehabilitación , Aparatos Ortopédicos , Rehabilitación de Accidente Cerebrovascular , Análisis y Desempeño de TareasRESUMEN
Our goal was to examine the feasibility of applying therapeutic robotics to children and adults with severe to moderate impairment due to cerebral palsy (CP). Pilot results demonstrated significant gains for both groups. These results suggest that robot-mediated therapy may be an effective tool to ameliorate the debilitating effects of CP and provide new opportunities for reducing impairment and improving coordination.
Asunto(s)
Parálisis Cerebral/terapia , Terapia por Ejercicio/métodos , Robótica , Adulto , Niño , Humanos , Masculino , Persona de Mediana Edad , Accidente Cerebrovascular/terapia , Rehabilitación de Accidente CerebrovascularRESUMEN
In this descriptive study, we examined changes in invasive and non-invasive airway support; studied the rates of home discharge vs. long-term care or acute hospitalization; and examined the relationship between the level of airway support and discharge to home for 92 children (<3 years of age) with 104 admission-discharge episodes to a consortium of pediatric rehabilitation hospitals over a one-year period. We found a significant reduction (p < 0.001) in the level of airway support between admission and discharge. In 21 of 47 (45%) episodes, children weaned from mechanical ventilation to a less restrictive type of support. Sixty percent of the children had final discharges to home. There was a significant, though fair correlation (Spearman Rho = -0.344, p = 0.001) between home discharge and level of airway support. These outcomes data provide a multi-site baseline for understanding expected changes in airway support and home discharge rates of young children who are admitted to a post-acute inpatient program.
Asunto(s)
Alta del Paciente , Terapia Respiratoria , Preescolar , Presión de las Vías Aéreas Positiva Contínua , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Lactante , Intubación Intratraqueal , Tiempo de Internación/estadística & datos numéricos , Cuidados a Largo Plazo/estadística & datos numéricos , Masculino , Máscaras , Terapia por Inhalación de Oxígeno , Admisión del Paciente , Estudios Prospectivos , Respiración Artificial , Insuficiencia Respiratoria/terapia , Traqueostomía , Resultado del TratamientoRESUMEN
The purpose of this study was to describe mechanical ventilation weaning outcomes for children with chronic respiratory failure discharged from one of six post-acute rehabilitation facilities. Demographic, clinical and outcome data were collected from the medical record. Forty-four children were included in this prospective series; 20 (45%) were weaned off the ventilator at discharge. Children required significantly lower levels of ventilatory support at discharge than admission. Hourly use on the ventilator decreased from admission to discharge for the full cohort and for the subgroup who required a ventilator at discharge. Seventy-five percent of the children discharged with a ventilator had a portable unit. We conclude that nearly half of the children using mechanical ventilation achieve weaning during a postacute rehabilitation admission, whereas others have positive outcomes in severity, hours off the ventilator or portability of equipment.