A gaming system with haptic feedback to improve upper extremity function: A prospective case series

BACKGROUND: Video games can be used to motivate repetitive movements in paediatric rehabilitation. Most upper limb videogaming therapies do not however include haptic feedback which can limit their impact. OBJECTIVE: To explore the effectiveness of interactive computer play with haptic feedback for improving arm function in children with cerebral palsy (CP). METHODS: Eleven children with hemiplegic CP attended 12 therapist-guided sessions in which they used a gaming station composed of the Novint Falcon, custom-built handles, physical supports for the child’s arm, games, and an application to manage and calibrate therapeutic settings. Outcome measures included Quality of Upper Extremity Skills Test (QUEST) and Canadian Occupational Performance Measure (COPM). The study protocol is registered on clinicaltrials.gov (NCT04298411). RESULTS: Participants completed a mean of 3858 wrist extensions and 6665 elbow/shoulder movements during the therapist-guided sessions. Clinically important improvements were observed on the dissociated and grasp dimensions on the QUEST and the performance and satisfaction scales of the COPM (all p< 0.05). CONCLUSION: This study suggests that computer play with haptic feedback could be a useful and playful option to help improve the hand/arm capacities of children with CP and warrants further study. The opportunities and challenges of using low-cost, mainstream gaming software and hardware for therapeutic applications are discussed.

Living labs for patient engagement and knowledge exchange: an exploratory sequential mixed methods study to develop a living lab in paediatric rehabilitation

IntroductionDespite recognition of the importance of patient engagement in research and knowledge translation, systematic approaches to engagement and co-ideation remain limited. Living labs are collaborative knowledge sharing systems that use multimethod, user-centred approaches that hold potential to catalyse these aims. However, their use in healthcare is limited, and no living lab has been developed in paediatric rehabilitation. In response to this gap and to propel innovative knowledge exchange, we propose a mixed methods study to co-develop a living lab prototype (ie, preliminary infrastructure with opportunity for scale up) in paediatric rehabilitation, with relevance to other healthcare contexts.MethodsAn exploratory sequential mixed methods study will be undertaken to determine research and knowledge exchange priorities and to inform the development of the living lab prototype. Stage 1: we will use a multipronged approach to sample 18–21 youth with developmental differences or rehabilitation needs, their youth siblings and parents/guardians from a provincial paediatric rehabilitation centre, to participate in qualitative and arts-based data collection. Data will provide insight into desirable features of the living lab. Stage 2: E-surveys to youth, siblings, parents/guardians and clinicians who receive or provide services at this same centre will expand on priorities and living lab features. Stage 3: integrated analysis will inform the living lab prototype development.AnalysisInductive thematic analysis using interpretive description, integrated analysis of visual data and descriptive and content analysis of e-survey data will be undertaken. Joint displays will facilitate data integration. Priorities will be identified using a modified rank-order method for each key living lab domain.Ethics and disseminationInstitutional ethics and site approval have been granted. A parent advisory group and rehabilitation engineering partners will confer on data and inform the development of the living lab prototype. User engagement with the prototype will occur during an online or in-person event, and findings shared through non-technical research summaries, journal articles and academic presentations.

Single-centre parental survey of paediatric rehabilitation services for children with cerebral palsy

Cerebral palsy (CP) is the most common childhood motor disability. The dose of usual care for rehabilitation therapies is unknown. The purpose of this study was to describe current dosage of rehabilitation services for children with CP recruited from a paediatric hospital system in the USA. 96 children with CP were included in this cross-sectional survey. Parents reported frequency, intensity, time and type of therapy services. Weekly frequency was the most common. Children with CP received 0.9–1.2 hours/month of each discipline in the educational setting and 1.5–2.0 hours/month in the clinical setting, lower than the recommendations for improvements in motor skills.

Preliminary design and development of a low-cost lower-limb exoskeleton system for paediatric rehabilitation

In this work, the design, modeling, and development of a low-cost lower limb exoskeleton (LLES) system are presented for paediatric rehabilitation (age: 8–12 years, mass: 25–40 kg, height: 115–125 cm). The exoskeleton system, having three degrees-of-freedom (DOFs) for each limb, is designed in the SolidWorks software. A wheel support module is introduced in the design to ensure the user’s stability and safety. The finite element analysis of the hip joint connector along with the wheel support module is realized for maximum loading conditions. The holding torque capacity of exoskeleton joints is estimated using an affordable spring-based experimental setup. A working prototype of the LLES is developed with holding torque rated actuators. Thereafter, the dynamic analysis for the human-exoskeleton coupled system is carried out using the Euler-Lagrange principle and SimMechanics model. The simulation results of estimating joint actuator torques are obtained for two paraplegic subjects (Case I: 10 years age, 30 kg mass, 120 cm height and Case II: 12 years age, 40 kg mass, 125 cm height). The details of input parameters such as body mass, link lengths, joint angles, and contact forces are discussed. The simulation results of dynamic analysis have shown the potential of estimating the torques of joint actuators for the developed prototype during motion assistance and gait rehabilitation.