Evaluation of a Game-Based Mechatronic Device for Rehabilitation of Hand-Arm Function in Children With Cerebral
Mrudula Kanakapura Peramalaiah1, Sanjay Tejraj Parmar1, Nariman Sepehri2
1SDM College of Physiotherapy, Shri Dharmasthala Manjunatheshwara University, Dharwad, India.
Insights
This study shows a new robotic manipulandum device (RMD) game-based program significantly improves hand function in children with cerebral palsy (CP). The RMD therapy enhanced manual dexterity and daily task independence more than traditional methods.
Area of Science:
- Pediatric Rehabilitation
- Robotics in Medicine
- Neurodevelopmental Disorders
Background:
- Children with cerebral palsy (CP) often have motor impairments affecting manual dexterity and daily activities.
- Traditional therapies can lack engagement, limiting sustained practice.
- Game-based systems with object manipulation are needed for effective motor learning.
Purpose of the Study:
- To evaluate the feasibility and therapeutic benefits of a novel robotic manipulandum device (RMD) game-based program for children with CP.
- To compare the RMD program's effectiveness against traditional task-specific training.
Main Methods:
- 34 children with CP (ages 4-10) were randomized into an experimental group (RMD game) or control group (task-specific training).
- Both groups underwent 8 weeks of therapy, 3 times per week.
- Outcomes included the Peabody Developmental Motor Scale-2 (PDMS-2) and a computer game-based upper extremity (CUE) assessment.
Main Results:
- Both groups improved significantly, but the RMD group showed superior gains in PDMS-2 grasping and visual-motor integration.
- The RMD group also achieved higher success rates and fewer movement errors on specific CUE tasks.
- Parents reported increased independence in children's daily tasks.
Conclusions:
- The RMD game-based program is feasible, acceptable, and effective for enhancing hand function in children with CP.
- This technology shows promise for computer game-assisted rehabilitation.
- Further research into game-assisted rehabilitation technologies is warranted.
Background:
Children with neurodevelopmental disorders, such as cerebral palsy (CP), often experience motor impairments in manual dexterity, which hinder daily tasks and social interactions. Traditional rehabilitation methods require repetitive task practice, which can be difficult for children to sustain due to low engagement. Game-based rehabilitation devices and robots offer a promising alternative by combining therapy with digital play, improving motivation and compliance. However, many systems fail to incorporate actual object manipulation, which is essential for motor learning through sensory feedback. To address this limitation, a low-cost, easy-to-use robotic manipulandum device (RMD) was developed. The RMD enables real-time object manipulation during gameplay while providing assistive force, allowing the practice of a wide range of manual dexterity skills beyond gross reaching. This system offers an engaging and effective rehabilitation approach to enhance hand function in children with CP.
Objective:
This study aimed to provide evidence for the feasibility and therapeutic value of the RMD game-based exercise program for children with CP.
Methods:
In total, 34 children with CP, aged 4 to 10 years, were randomly assigned to the experimental group (XG) or the control group (CG). The XG received a computer game-based exercise program using the RMD, focusing on object manipulation tasks, while the CG received task-specific training similar to constraint-induced movement therapy. Both groups received their respective therapy programs 3 times per week for 8 weeks. Semistructured interviews with parents and children, along with qualitative analysis, were conducted to evaluate their experiences with the exercise program. The following outcome measures were used: (1) the Peabody Developmental Motor Scale-2 (PDMS-2) grasping and visual-motor integration subtests and (2) the computer game-based upper extremity (CUE) assessment of manual dexterity.
Results:
No dropouts occurred during the 8-week program. Both groups showed significant improvements in the PDMS-2 subtests (P<.001) and the CUE assessment of manual dexterity, including success rates (tennis ball: P=.001; cone: P<.001; medicine ball: P=.001; and peanut ball: P<.001) and movement errors (tennis ball: P=.01; cone: P<.001; medicine ball: P=.04; and peanut ball: P<.001). The XG outperformed the CG, showing greater improvements in PDMS-2 grasping (P=.002) and visual-motor integration (P=.01). In the CUE assessment, the XG demonstrated higher success rates (medicine ball: P=.001 and peanut ball: P=.02) and fewer movement errors (cone: P<.001). Parents reported an increase in the children's independence in daily tasks.
Conclusions:
This study demonstrates the feasibility, acceptability, and positive outcomes of the RMD game-based exercise program for improving hand function in children with CP. The findings support further research and development of computer game-assisted rehabilitation technologies.
Trial Registration:
Clinical Trials Registry - India CTRI/2021/07/034903; https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=NTc4ODU.
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