Innovative Technologies and Dynamic Solution for Gait Recovery in Children with Acquired Brain Injury

Chair

Maurizio Petrarca

Presenters:

Elena Beretta
Daniele Panzeri
Erika Molteni

 

Description:

The recovery of walking ability is one of the primary rehabilitation goals for children with acquired brain injury (ABI). In the last few years, traditional physiotherapy has been supported by innovative technologies for gait rehabilitation in the field of Robot-Mediated Therapy (RMT) and Virtual Reality (VR).

The RMT can provide controlled, intensive task-specific training that is goal directed and cognitively engaging; VR therapy involves real-time simulation of an environment/activity that allows for user interaction and targets multiple senses. Motivation during RMT and VR may be greater for children because they are often both familiar and interested in technology and computer games. In addition, the kinematic and kinetic measures derived from robot data contribute to the understanding of how different treatment variables influence motor learning and recovery in children.

In the pediatric field a very limited number of studies exist on these new technologies, mainly conducted on children with cerebral palsy.

The multidisciplinary group, with the presence of physiatrists, bioengineers and physiotherapists, allowed to conduct deep evaluations thorough clinical and functional scales and gait analysis (GA). Results about the efficacy of RMT with Lokomat (Beretta et al, Brain Injury 2015) and VR using Grail (Biffi et al, Methods Inf Med 2017) will be presented: significant gains on clinical measures of erect posture and walking abilities will be shown. These studies will demonstrate the feasibility of technology-assisted therapies for children with ABI and will give the opportunity to discuss about important treatment variables.

In order to better understand the impact of technological device on rehabilitation the concept of multi factorial gait analysis in clinics will be deepened. The body joint kinematics during functional activities will be depicted beside the analysis of dynamic aspects represented by joint moments and powers. These biomechanical aspect will be correlated with a synchronic gathering of surface electromyography. The techniques of the clinical interpretations of multi factorial data will be exemplified. In order to facilitate the comprehension longitudinal clinical case will be illustrated. The analysis of longitudinal cases will be useful to discuss the development of functional recovery after the injury. Will be also discussed how the objective assessment gathered from gait analysis will address personalized gait training solution. An innovative dynamic solution for gait training will be showed at the side of both the functional permanent improvement and functional support. The analysis of the training follow-up will lead to a systematic interpretation of the functional goals achieved allowing to built a bridge between hypothesis of treatment and gait pattern modification. This discussion will let the attendees able to better understand the recovery expectation and, on the other side, the recovery limitations.

 

Learning Objectives:

  1. Examine and compare the characteristics and peculiarities of new technologies for recovery of gait in children with acquired brain injury.
  2. Determine and define treatment protocols, clinical applications, risks and benefits of rehabilitation with 

    new technologies.
  3. Interpret the evolution of the gait function in relationship with the achieved goals on the basis of objective assessments and for training selection.