Cerebral Palsy Clinical Trial
Official title:
Study of the Effectiveness of an Interactive Robot for the Rehabilitation of the Upper Limb in Children With Cerebral Palsy by Evaluating the 3 Fields of the ICF: A Prospective, Randomized, Controlled, Simple Blind Study.
Cerebral Palsy (CP) is a major cause of impairments in child population. This disease
justifies an intensive and prolonged multidisciplinary rehabilitation which can be optimised
by robotics.
Our team has developed a robot designed to rehabilitate the child's upper limb. This robot
allows the patient to perform active, passive, or assisted exercises.
This therapy is designed to promote motor development in children with CP. Its finality is
to improve patients' quality of life and participation.
Several pilot studies evaluated the efficacy of robotic assisted therapy in children with CP
but none RCT has been done.
Then, the aim of the study is to evaluate the efficacy of robotic-assisted therapy in
children with cerebral palsy by evaluating the 3 fields of the ICF (International
Classification of Functioning, Disability and Health) and performing a prospective
randomized controlled single blind trial. Therefore, all patients will benefit from a
classical rehabilitation as a basis. Furthermore, patients of the control and experimental
groups will receive a supplement of classical rehabilitation and robotic-assisted therapy,
respectively.
INTRODUCTION
Cerebral Palsy (CP) is a major cause of impairments in child population. Indeed, CP affects
two births per thousand (1). The brain damage is expressed by different neurological
impairments and functional disabilities. These disabilities justify intensive and sustained
multidisciplinary rehabilitation to reduce neurological impairments, to improve the
activities and participation of patients, and, ultimately, their quality of life (2, 3, 4).
Robotics interest has already been shown for lower limb rehabilitation (5). The development
of the upper limb rehabilitation robotic devices started later. To better stimulate brain
plasticity, these tools meet the actual recommendations existing in CP's rehabilitation (4).
Indeed, the robots allow the execution of a large number of movements whose quality is
controlled (6). A visual interface gives the patient a feedback of its movements (7), and
offers exercises oriented functional tasks that have meaning for him (8) and the possibly
dive into a virtual reality. All these elements justify the clinical development of robots
to assist the therapists.
In children with CP, several pilot studies have verified the clinical applicability of these
tools (9-11). However, no randomized controlled study has been performed to evaluate the
effectiveness of robotic-assisted therapy in children with CP (12). Moreover, no study
evaluated the effect of these therapies on the three areas of the ICF : Many studies focus
on impairments (e.g. muscle) without assessing the functional capacity of the patient: what
about their ability in every day life?
OBJECTIVES
To perform a prospective, randomized, controlled, single blind trial to assess the efficacy
of robotic-assisted therapy in children with cerebral palsy by evaluating the three fields
of the ICF.
METHODS
Twenty patients enrolled at the "Institut Royal de l'Accueil du Handicap Moteur" (IRAHM)
(1200 Brussels) will be included according to the following criteria: CP, whose location is
unilateral (hemiplegia) or bilateral (diplegia, quadriplegia), with a MACS (Manual Ability
Classification System) score > 1 (moderate to severe motor impairments) (13). The exclusion
criteria are the following: injection in the upper member of botulinum toxin within 6 months
or intrathecal baclofen used for the upper limb, an unstable clinical condition
contraindicating the upper limb rehabilitation treatments, cognitive disorders preventing
the understanding of the instructions or other neurological or orthopedic pathology
affecting the upper limb.
A randomisation of patients in two groups (control and experimental) will be performed,
using a stratified randomization method to ensure the equivalence of the two groups for age,
the location of the symptoms (diplegia, quadriplegia, left or right hemiplegia) and motor
neurological impairments (MACS score).
At IRAHM, each child benefits of 3 physiotherapy sessions and 2 occupational therapy
sessions per week. Each session lasts 45 minutes. The children in the control group will see
no change in their treatment. In the experimental group, 1 physiotherapy session and 1
occupational therapy session will be replaced by two sessions of intensive rehabilitation of
the arm with the robot. In total for each group, each child will benefit from 40 sessions of
45 minutes over 8 weeks therapy
Patients will be evaluated three times in the study: before the start of treatments, at the
end of treatments, and 3 months after the end of treatments.
Functional assessments will be carried out according to a protocol exploring the three
fields of the ICF. Impairments will be evaluated by the score of Quality of Upper Extremity
Skills Test (14), MACS (13), and the Box and Block test (15). Then, spasticity (with two
scales), kinematics and strength of the paretic arm will be evaluated using the modified
Ashworth and Tardieu scales, the ReaPLAN robot and a dynamometer, respectively (9, 16, 17).
Disability will be evaluated via Abilhand-kids (18) and Pediatric Evaluation of Disability
Inventory (19). Participation restrictions will be evaluated via the MHAVIE questionnaire
(20). All assessments will be carried out by a occupational therapist, which will be not
informed the group that the child is assigned (single-blind). All rehabilitation and
assessment sessions will be conducted at the IRAHM.
PERSPECTIVES
From this study, we hope to demonstrate the efficacy of robotic-assisted therapy in children
with cerebral palsy by evaluating the three fields of the ICF. These results could prove
that this tool can be a significant complement for the CP rehabilitation.
;
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Single Blind (Outcomes Assessor), Primary Purpose: Treatment
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