Technology and Disability - Volume 22, issue 4

Authors: Soede, Thijs

Article Type: Editorial

DOI: 10.3233/TAD-2010-0309

Citation: Technology and Disability, vol. 22, no. 4, pp. 159-160, 2010

Authors: Foulds, Richard | Adamovich, Sergei

Article Type: Editorial

DOI: 10.3233/TAD-2010-0307

Citation: Technology and Disability, vol. 22, no. 4, pp. 161-165, 2010

Authors: Martin, John H. | Friel, Kathleen M. | Chakrabarty, Samit | Salimi, Iran

Article Type: Research Article

Abstract: The corticospinal tract (CST) is the principal motor control pathway for skilled movements. The CST, as well as the motor behaviors that it is important for controlling, has a protracted postnatal development in humans and many animals. We first discuss our experiments in the cat, showing that CST neuronal activity is important for normal development of the tract; especially for development of the proper pattern of connections between CST axons and neurons in spinal cord motor circuits. We compare our results in the cat using neural pathway tracing techniques with research on development of the CST in humans using transcranial …magnetic stimulation, showing that the cat model captures key features of normal human CST development. In the human, damage to the CST during development produces cerebral palsy, a debilitating motor control disorder. Cerebral palsy research suggests that the motor signs of this condition reflect both the loss of development of a strong contralateral CST, together with development of aberrant dense ipsilateral connections between the CST and spinal motor circuits. We have developed a cat model of unilateral (i.e., hemiplegic) cerebral palsy that both captures these key defects in CST connections and exhibits motor control impairments. We discuss our work, showing that harnessing activity-dependent processes later in development is capable of both restoring the proper connections of the CST in this model and restoring normal motor function. Show more

DOI: 10.3233/TAD-2010-0301

Citation: Technology and Disability, vol. 22, no. 4, pp. 167-177, 2010

Authors: Gordon, Andrew M. | Okita, Sandra Y.

Article Type: Research Article

Abstract: Cerebral palsy (CP) is the most common cause of physical disability in childhood. Hemiplegia is among the most common forms of CP and the resulting impaired hand function is one of the most disabling symptoms, affecting self-care activities such as feeding, dressing, and grooming. To date, evidence-based treatments are limited. Recent approaches, however, have capitalized on findings that show children with hemiplegia have residual motor capabilities and neuroplastic changes in nervous system function that emerge and improve with practice. Here the etiology and neural basis of hemiplegic CP is first briefly reviewed, followed by a description of the residual motor …capabilities in the involved upper extremity and the potential role of intensive practice. Two promising approaches that target residual motor function, constraint-induced movement therapy (CIMT) and bimanual training, are then described. Recent evidence suggests that such task-oriented training approaches to rehabilitation are enhanced when the tasks are meaningful to the performer. Increasingly, this means use of current technology, specifically video gaming, to maintain salience and motivation and target specific motor impairments. Thus a method for using commercially available video gaming, including the Nintendo Wii to augment such intensive treatment approaches is described. It is suggested that with such intensive treatment programs, gaming can be an important compliment to, but not a replacement for, salient task-oriented activities in the real world and that video gaming and virtual reality training will be an important part of future rehabilitation efforts. Show more

Keywords: video game console, Nintendo Wii, computer game, virtual reality, virtual environment, rehabilitation, cerebral palsy, task-oriented training, upper extremity, hand, bimanual training, constraint-induced movement therapy

DOI: 10.3233/TAD-2010-0302

Citation: Technology and Disability, vol. 22, no. 4, pp. 179-191, 2010

Authors: Fasoli, Susan E. | Fragala-Pinkham, Maria | Hughes, Richard | Hogan, Neville | Stein, Joel | Krebs, Hermano Igo

Article Type: Research Article

Abstract: Although a number of research studies have examined the effects of robot-assisted movement therapy for adults with motor impairments following stroke, use of this technology for children with neurologically-based movement disorders is just beginning. Conventional rehabilitation methods are insufficient in meeting children's needs for intensive motor learning experiences. Therapy for children with moderate to severe upper limb motor impairments is particularly challenging, because of their reluctance to engage in challenging and repetitive upper limb exercise and frequent developmental disregard for using the paretic arm during functional tasks. In an effort to adapt robot-assisted movement therapy for children with …moderate to severe hemiplegia due to cerebral palsy (CP), we developed robotic therapy that was engaging and cognitively challenging for children, and that provided intensive sensorimotor practice during goal directed reaching activities. This is a review of how we adapted robotic therapy for children with hemiplegia, our selection of outcome measures, and a brief summary of study findings. Our initial work suggests that robot-assisted therapy can be readily adapted and has good potential for improving motor performance of children with hemiplegic cerebral palsy. Show more

DOI: 10.3233/TAD-2010-0303

Citation: Technology and Disability, vol. 22, no. 4, pp. 193-198, 2010

Authors: Long, Jason T. | Harris, Gerald F.

Article Type: Research Article

Abstract: Studies of human locomotion have historically paralleled developments in photographic technology. Early works of the late 19th century by Muybridge and Marey employed sequential photography. Later works by Braun and Fischer introduced illuminated tubes on limb segments, and multiple cameras. With these early contributions began the maturation of gait analysis from a research-based activity to a more clinically relevant assessment tool. Significant clinical advances began in the 1960's and have continued to the current time. Recognized clinical contributors include David Sutherland, Jacqueline Perry, Sheldon Simon, Freeman Miller, and James Gage. Today, the majority of pediatric clinical applications focus on the …lower extremities (LE) with segmental motions distal to the ankle seldom considered. Methods for expanding current LE analysis methods are presented. These include functional means of assessing hip joint center location and refinement of a biomechanical foot model to include segmental (heel, forefoot, hallux) motion. Emerging opportunities for clinically relevant pediatric assessment, pre-treatment decision making, and post-treatment rehabilitative follow-up are included. Show more

Keywords: Gait, motion analysis, pediatric gait, foot and ankle motion, hip joint center

DOI: 10.3233/TAD-2010-0304

Citation: Technology and Disability, vol. 22, no. 4, pp. 199-205, 2010

Authors: Fowler, Eileen G.

Article Type: Research Article

Abstract: Multiple impairments contribute to motor deficits seen in children with spastic cerebral palsy (CP). Impairments should be identified and quantified to individualize treatment plans. Spasticity and reduced selective voluntary motor control (SVMC) are two primary impairments. Spasticity is one of the most obvious and is the focus of many current interventions. The pendulum test is a sensitive measure of quadriceps spasticity than can be easily used with children. Our research has shown that the most sensitive pendulum test outcome is the first swing excursion. Using the pendulum test, the clinical premise that effortful exercise increases spasticity was disproven. Standardized tools …have been available for evaluating spasticity, balance, strength and contractures, but not for the assessment of SVMC for patients with CP. We developed a new comprehensive assessment for lower extremity SVMC. Its validity and reliability have been established. The relationships between SVMC and gait as well as the clinical applications of SVMC assessment are presented. Show more

Keywords: Spasticity, selective motor control, lower extremity, cerebral palsy

DOI: 10.3233/TAD-2010-0305

Citation: Technology and Disability, vol. 22, no. 4, pp. 207-214, 2010

Authors: Patritti, Benjamin L. | Sicari, Monica | Deming, Lynn C. | Romaguera, Fernanda | Pelliccio, Marlena M. | Kasi, Patrick | Benedetti, Maria Grazia | Nimec, Donna L. | Bonato, Paolo

Article Type: Research Article

Abstract: Recent work has examined the feasibility of robotic-assisted gait training in pediatric patients, including children with cerebral palsy (CP). Herein we present a case series describing clinical outcomes in four children diagnosed with spastic diplegia due to CP who underwent gait training using a robotic driven gait orthosis (DGO) (Pediatric Lokoma©). The children were paired based on functional abilities and observed gait characteristics. Two children were classified as Gross Motor Function Classification System (GMFCS) level II and displayed a crouch gait pattern. The other two children were classified as GMFCS level III and exhibited a toe-walking gait pattern. Each child …participated in a 6-week intervention of robotic-assisted gait training that involved three 30-minute sessions per week. One child of each GMFCS level underwent training using the augmented feedback module of the Pediatric Lokomat© system, while the other child of each pair underwent training without using the augmented feedback module. Pre-training, post-training, and 3-month follow-up evaluations were performed including clinical tests of standing and walking function (Gross Motor Function Measure, GMFM, sections D and E, respectively), walking speed, and walking endurance. Clinical gait analysis was also performed during each evaluation using a motion capture system to assess changes in gait biomechanics. All children showed an improvement in gait speed. For the lower functioning children (i.e. GMFCS level III), this may be mediated by improved trunk control suggested by concomitantly large increases in standing function (i.e. GMFM section D). Conversely, for the higher functioning children (i.e. GMFCS level II), large changes were observed in walking function assessed by the GMFM section E. The use of augmented feedback was associated with larger improvements in walking function (i.e. GMFM section E) and in walking speed. Furthermore, subjects who received robotic-assisted gait training in combination with augmented feedback showed a large increase in endurance while subjects who received robotic-assisted gait training without augmented feedback showed limited or no improvements in endurance. Overall, these results suggest that the use of an augmented feedback module in combination with robotic-assisted gait training leads to better outcomes than robotic-assisted gait training without augmented feedback. Show more

Keywords: Augmented feedback, body weight supported treadmill training, cerebral palsy, gait, virtual reality

DOI: 10.3233/TAD-2010-0306

Citation: Technology and Disability, vol. 22, no. 4, pp. 215-227, 2010