Studying and Restoring Neurological Function in Children and Adults with Developmental Disabilities using Robotics, Virtual Reality, Neuro-imaging and other Technologies to Establish Best Care Practices

Cerebral Palsy (CP) is by definition damage to the brain before the age of two years resulting in some degree of impaired movement. The degree of impairment can be as minor as a limp or so severe it causes the person to be unable to move or communicate. Some with CP have completely normal intellect and psychosocial development, and some have severe intellectual impairment, features of autism and numerous other “brain related signs and symptoms”. Recent discoveries suggest that intensive intervention and access to appropriate technologies can change the outcomes for those with CP and other developmental disorders. Translational research is needed to ascertain whether such interventions can indeed make a substantial difference in physical and cognitive abnormalities commonly seen not only in CP but in other developmental disorders, such as autism.

CPIRF recently sponsored a workshop with the Rehabilitation Institute of Chicago to explore new ways in which 21st Century Technologies can be combined with new developments in neuro-imaging and new concepts in brain plasticity. By sharing knowledge across disciplines and studying ways to use these technologies to provide appropriate and focused therapy, we can change the future for hundreds of thousands of people disabled by motor impairments caused by brain injury sustained early in childhood.

Typical therapy for children with CP uses purposeful activity and task-specific training to improve motor function and independence. (1, 2). Motor learning approaches combining repetition and practice in functional context are commonly used in physical therapy. No one form of intervention, to date, has proven more effective than others in improving motor abilities in the paretic arm. (3). Diane Damiano has emphasized that massed practice, cognitive engagement, and functional relevance are common features of successful therapy for movement disorders related to CP (4). Many believe that it is necessary for therapists to provide a far more intense and meaningful therapy experience, than is generally possible in conventional therapy programs. Highly intensive approaches, such as constraint induced movement therapy (CIMT), have produced positive results in children with CP and upper limb impairments. (5)

There is now preliminary, but statistically meaningful data that robotic therapy can provide new opportunities for improving upper limb coordination and function in children with moderate to severe impairments due to cerebral palsy or stroke, and Dr. Krebs who has authored a number of these papers spoke on this topic. Combining elements of mass practice, robotics, virtual reality, patterned neuro-muscular stimulation, priming with transcranial magnetic stimulation and other advanced technologies, may well be the way to a future which revolutionizes the neurologic rehabilitation of children and adults with developmental disabilities.

1. Valvano J. (2004) Activity-focused motor interventions for children with
neurological disorders. Phys Occup Ther Pediatr 24:79-107.

2. Volman MJ, Wijnroks A, Vermeer A. (2002) Effect of task context on reaching performance in children with spastic hemiparesis. Clin Rehabil 16:684-692.

3. Law M, Russell D, Pollock N, Rosenbaum P, Walter S, King G. (1997). A
comparison of intensive neurodevelopmental therapy plus casting and a regular occupational therapy program for children with cerebral palsy. Dev Med Child
Neurol 39:664-670.

4. Damiano, D. (2006). Activity, activity, activity: Rethinking our physical therapy
approach to cerebral palsy. Physical Therapy, 86: 1534-1540.

5. Charles, J.R., Wolf, S.L., Schneider, J.A., & Gordon, A.M. (2006). Efficacy of a child-friendly form of constraint-induced movement therapy in hemiplegic cerebral palsy: a randomized control trial. Dev Med Child Neurol, 48: 635-642.