Case Example of using Robotics in Pediatrics to Improve Function

Dr. Jennifer Martinc OTD, CTR/L

Robotic-assistive technology is a therapeutic approach that is becoming more accessible to various populations with neurological conditions in diverse settings. Populations with diagnoses that affect the nervous system, such as stroke, traumatic brain, spinal cord injury, and cerebral palsy, may benefit from these devices. Robotic-assistive devices have the potential to allow individuals to work on their upper extremity, active range of motion (AROM), and strength in a more meaningful way while engaging in occupations or task training through games or functional activities (Aprile et. al., 2022; Chen et al., 2022). This article describes a case example of a child with a neurologically based movement disorder who has used robotics to improve function. 

Case Study

Samantha is an energetic, sweet, 10-year-old female who had a left basal ganglia embolic stroke. Her parents remembered getting the fateful call that their daughter was screaming from pain and appeared confused while at school. Her teacher called 911, and little Samantha was transported to the emergency department. Samantha’s stroke was caused by blood clots due to a blood disorder and two congenital holes in her heart. She spent over seven weeks in the hospital and underwent surgery to repair her heart. She was paralyzed, unable to walk or talk. Samantha cried from frustration. It was not until she saw her older sister in her hospital room that Samantha spoke for the first time since her stroke and said her sister’s name. That single word set her on the path to regaining her verbal skills. Samantha has progressed mainly because of the support of her family and intense therapy. Her grandfather brought her to outpatient occupational therapy sessions three times a week for over a year. He also built a workout room for Samantha at home to supplement the lessons learned with her occupational therapist. 

Currently, Samantha wears a brace on her right leg and presents with some weakness in her right extremities but has made considerable progress. She now enjoys riding her bike, swimming, and playing basketball. Samantha uses two distinct types of robotics in the home environment to increase functional movement and independence in her daily activities. She has been using the Motus Nova Hand for the past two years to increase active range of motion and function in her right hand. When implementing the Motus Nova hand in her daily routines, Samantha demonstrates more functional movement in her wrist and is more independent with her daily activities. She now is able to open doors using her right hand. She has also been using the Bionesis H200 on her right hand to increase hand function. Samantha is able to use her right hand to stabilize paper when writing and bears weight on her right hand during dynamic standing activities and yoga positions. She continues to show gains in functional movement of her right upper extremity.  With the Bionesis H200, Samantha now is able to use her two hands to brush her hair, tie her shoes and assist with cooking in the kitchen. Samantha continues to use these two robotics in the home environment after discharge and demonstrates great carry over into the home environment. 

Conclusion

Research on robotic technology suggests that this technology may help improve functional performance (Chen et, al., 2022). As there are a wide variety of devices available for a range of conditions, more research is needed to generalize across populations. There is limited knowledge on how these innovative technologies can assist the pediatric population as most research is conducted on adults. However, a recent systematic review found that robotic hand rehabilitation improved motor function, manual dexterity, and quality of life and decreased spasticity in children with cerebral palsy; it was not found to be more effective than conventional rehabilitation (Adar et al., 2024). There is a need for more research using these devices with children who have had a stroke, brain injury or cerebral palsy or other neurologically based movement condition (Sung et al., 2021). 

References

Adar, S., Keskin, D., Dündar, Ü., Toktaş, H., Yeşil, H., Eroğlu, S., ... & Demircan, A. (2024). The Effect of Robotic Rehabilitation on Hand Functions and Quality of Life in Children with Cerebral Palsy: A Prospective Randomized Controlled Study. American Journal of Physical Medicine & Rehabilitation, 10-1097. DOI: 10.1097/PHM.0000000000002430

Aprile, I., Germanotta, M., Cruciani, A., Loreti, S., Pecchioli, C., Cecchi, F.,... & Carrozza, M. C. (2020). Upper limb robotic rehabilitation after stroke: A multicenter, randomized clinical trial. Journal of Neurologic Physical Therapy, 44(1), 3-14. https://doi.org/10.1097/NPT.0000000000000295

Bionesis: A Bioventus Rehab Company (2022). Retrieved from https://www.bioventus.com/bioness/.

Chen, Y. W., Chiang, W. C., Chang, C. L., Lo, S. M., & Wu, C. Y. (2022). Comparative effects of EMG-driven robot-assisted therapy versus task-oriented training on motor and daily function in patients with stroke: A randomized cross-over trial. Journal of NeuroEngineering and Rehabilitation, 19(1), 6. https://doi-org.ezproxylocal.library.nova.edu/10.1186/s12984-021-00961-W

Motus Nova. (2022). Retrieved from: https://motusnova.com/how-it-works/

Sung-U, S., Nisa, B. U., Yotsumoto, K., & Tanemura, R. (2021). Protocol: Effectiveness of robotic-assisted therapy for upper extremity function in children and adolescents with cerebral palsy: A systematic review protocol. British Medical Journal Open, 11(5), e04505. https://doi.org/10.1136/bmjopen-2020-045051