Pilot evaluation of changes in motor control after wearable robotic resistance training in children with cerebral palsy

Benjamin C. Conner, Michael H. Schwartz, Zachary F. Lerner

Research output: Contribution to journalArticlepeer-review

7 Scopus citations

Abstract

Cerebral palsy (CP) is characterized by deficits in motor function due to reduced neuromuscular control. We leveraged the guiding principles of motor learning theory to design a wearable robotic intervention intended to improve neuromuscular control of the ankle. The goal of this study was to determine the neuromuscular and biomechanical response to four weeks of exoskeleton ankle resistance therapy (exo-therapy) in children with CP. Five children with CP (12 – 17 years, GMFCS I – II, two diplegic and three hemiplegic, four males and one female) were recruited for ten 20-minute sessions of exo-therapy. Surface electromyography, three-dimensional kinematics, and metabolic data were collected at baseline and after training was complete. After completion of training and with no device on, participants walked with decreased co-contraction between the plantar flexors and dorsiflexors (-29 ± 11%, p = 0.02), a more typical plantar flexor activation profile (33 ± 13% stronger correlation to a typical soleus activation profile, p = 0.01), and increased neural control complexity (7 ± 3%, p < 0.01 measured via muscle synergy analysis). These improvements in neuromuscular control led to a more mechanically efficient gait pattern (58 ± 34%, p < 0.05) with a reduced metabolic cost of transport (-29 ± 15%, p = 0.02). The findings from this study suggest that ankle exoskeleton resistance therapy shows promise for rapidly improving neuromuscular control for children with CP, and may serve as a meaningful rehabilitative complement to common surgical procedures.

Original languageEnglish (US)
Article number110601
JournalJournal of Biomechanics
Volume126
DOIs
StatePublished - Sep 20 2021

Bibliographical note

Funding Information:
This research was supported in part by the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health under Award Number R03HD094583. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. This work was also supported in part by the University of Arizona College of Medicine – Phoenix MD/PhD Program. The authors would like to thank Nushka Remec, Emily Frank, and Elizabeth Orum for their assistance with data collections, and James Babers and Leah Liebelt for their assistance with device manufacturing. The authors would also like to thank the participants and their families for their involvement in the study.

Funding Information:
This research was supported in part by the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health under Award Number R03HD094583. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. This work was also supported in part by the University of Arizona College of Medicine ? Phoenix MD/PhD Program. The authors would like to thank Nushka Remec, Emily Frank, and Elizabeth Orum for their assistance with data collections, and James Babers and Leah Liebelt for their assistance with device manufacturing. The authors would also like to thank the participants and their families for their involvement in the study.

Publisher Copyright:
© 2021 Elsevier Ltd

Keywords

  • Cerebral palsy
  • Exoskeleton
  • Gait
  • Muscle synergy
  • Neurorehabilitation

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