Category: Clinical Practice (assessment, diagnosis, treatment, knowledge translation/EBP, implementation science, program development); Technology (e.g. robotics, assistive technology, mHealth)
To investigate the efficacy of short-course intensive therapy using robotic mobility technology, to improve chronic motor deficits after cerebral hemispherectomy.
Design : Case series
Setting : Tertiary care rehabilitation center
Participants (or Animals, Specimens, Cadavers) :
Twelve post-hemispherectomy patients (15.9±3.7 years; age at hemispherectomy 6.0±4.9 years), zero withdrawal, volunteer sample, eligibility including age >11 years, >1 year from last brain surgery, self-report ability to walk >32 feet and to focus for >30 minutes at a time.
Interventions : Intervention delivered as two-week rehabilitation camp, with orthosis assessments, social activities, and eight days of intensive therapy, each comprising three hours/day of technology-assisted training, 15 minutes/day of range and mobilization, and three hours/day of recreational therapy. Hocoma Lokomat, ArmeoSpring and ArmeoPower, AlterG AntiGravity Treadmill, and Restorative-Therapies FES Leg System were used.
Main Outcome Measure(s) :
Six-Minute Walk Test (6MWT), 10 Meter Walk Test (10MWT), Fugl-Meyer Upper Extremity (FMUE), Canadian Occupational Performance Measure (COPM), Confidence Scale (CS) and Assisting Hand Assessment (AHA, n=6 for this measure) were assessed pre- and post-intervention on hemiparetic side.
Statistically significant improvements were seen in 6MWT (mean improvement 122.4 feet, 95%CI 65.6-179.2, p<0.001), Fast Walking Velocity (9.6 m/min, 95%CI 1.2-17.9, p=0.03), FMUE (3.3, 95%CI 0.4-6.1, p=0.03), COPM Performance (1.9, 95%CI 0.7-3.1, p=0.006), COPM Satisfaction (3.2, 95%CI 1.1-5.3, p=0.007), CS Participant, Part 2 (3.2, 95%CI 1.3-5.0, p=0.003), CS Parent, Part 2a (3.9, 95%CI 2.2-5.7, p<0.001), CS Parent, Part 2b (2.1, 95%CI 0.6-3.6, p=0.01). No statistical improvement in AHA or CS Part 1. Clinically meaningful improvement seen in 3 of 6 subjects who underwent AHA.
A short-duration, intensive regimen utilizing robotic mobility technology therapy improved walking endurance, fast walking velocity, upper extremity function, and physical activity confidence in subjects outside the acute recovery period after hemispherectomy.
Susan Shaw– Chair, Department of Neurology, Rancho Los Amigos National Rehabilitation Center, Downey, California
Julie Kasayama– Physical Therapy Supervisor, Rancho Los Amigos National Rehabilitation Center, Downey, California
Remy Chu– Occupational Therapy Supervisor, Rancho Los Amigos National Rehabilitation Center, Downey, California
Eirik Blydt-Hansen– Physical Therapy Supervisor, Rancho Los Amigos National Rehabilitation Center, Downey, California