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The Effectiveness of Robot-Assisted, Task-Specific Ankle

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The Effectiveness of Robot-Assisted, Task-Specific Ankle THE EFFECTIVENESS OF ROBOT-ASSISTED, TASK-SPECIFIC ANKLE TRAINING IN IMPROVING DEFICITS ACROSS THE THREE DOMAINS OF THE ICF IN CHILDREN WITH CEREBRAL PALSY (CP) Madawi H. Alotaibi Submitted to the faculty of the University Graduate School in partial fulfillment of the requirements for the degree Doctor of Philosophy in the School of Health and Human Sciences, Indiana University November 2018 Accepted by the Graduate Faculty of Indiana University, in partial fulfillment of the requirements for the degree of Doctor of Philosophy. Doctoral Committee ______________________________________ Brent Arnold, PhD, ATC, Co-Chair ______________________________________ Peter Altenburger, PhD, PT, Co-Chair May 4, 2018 ______________________________________ Niki Munk, PhD, LMT ______________________________________ Tracy Dierks, PhD ii © 2018 Madawi H. Alotaibi iii DEDICATION This dissertation is dedicated to my parents, husband, brothers, sisters, and children, all of whom made multiple sacrifices over the years to help me pursue my dream. Without their support and encouragement, I would not have had the time or the effort needed to complete this degree. I love you all. iv ACKNOWLEDGEMENT I would like to extend my deep appreciation to my advisor, Peter Altenburger, Ph.D, PT, for his guidance, support, and the wealth of knowledge he provided me for the past several years. I would also like to thank my committee members Brent Arnold Ph.D, Tracy Dierks Ph.D, and Niki Munk Ph.D for the knowledge each brought to this research. A special thank you for everyone who helped with data collection and analysis: Amy Bayliss DPT, PT, Emily Fuller, Katherine Bridgeman, George Eckert, and many DPT students. I would also like to express my gratitude to the robotics lab staff at the IU Neuroscience Center for their valuable help, especially Ryan Cardinal DPT, PT, and Jeff Frame. I would like to extend my appreciation to all children and their families who participated in my research. I also want to express my deepest gratitude to my loving and generous parents. Without their support, I would not have had the opportunities that have gotten me to this point. Thank you so much, Mom and Dad. I also would like to thank my brothers and sisters—Ohoud, Faisal, Kholoud, Mohammed, Rashed, Saad, and Nawaf—for supporting, loving, and encouraging me throughout this journey. Finally, I would like to thank my husband, Fahad who stood by me through the good and bad times, and my children—Mohammed, Abdullah, and Milla—who were always there to cheer me up. v Madawi H. Alotaibi THE EFFECTIVENESS OF ROBOT-ASSISTED, TASK-SPECIFIC ANKLE TRAINING IN IMPROVING DEFICITS ACROSS THE THREE DOMAINS OF THE ICF IN CHILDREN WITH CEREBRAL PALSY (CP) Background: Cerebral Palsy (CP) is considered to be the leading cause of motor disability among children. Children with CP present with multiple physical impairments including decreased strength and range of motion (ROM), increased spasticity, and poor balance and coordination. These impairments often lead to limitations in ankle motor control that impacts balance and gait function, which puts children at a higher risk for developing other problems. In recent studies, robotic devices have been developed to address poor motor control of the upper and lower extremities. Aim: The aim of this study is to investigate the extent to which the robot-assisted, task- specific ankle trainer improve deficits across the three domains of the International Classification of Functioning, Disability and Health (ICF) in children with CP. Method: This is a quasi-experimental, single group, repeated measure design with four time-testing points through a set training session/protocol. A convenience sample of 5 children with CP were enrolled in the study. All children received 6-weeks of ankle robot training that included two 45-60 minute sessions per week, for a total of 12 sessions. Data from Tardieu Scale of spasticity, Boyd and Graham selective motor control, Pediatric Balance Scale, goniometer, hand held dynamometer, gait mat analysis, accelerometer, LIFE-H for children questionnaires, ultrasound, and robotic evaluation were collected at the different time points (1 week and 1 month pre training and 1 week and 1 month post vi training). Descriptive statistics and repeated measure (ANOVA) were used with SPSS software for data analysis. Results: All participants showed improvement in 1. Body Function and Structures (ROM, tone, strength, balance, ankle control and performance, and muscle architecture), 2. Activity (gait and activity counts) and 3. Participations over the course of the study. Conclusion: The results revealed the potential of robot-assisted, task-specific ankle training to improve motor performance and capacity at the body function, activity and participation level. Training appeared to have a lasting impact as most gains were maintained one month following training. Brent Arnold, PhD, ATC, Co-Chair Peter Altenburger, PhD, PT, Co-Chair vii TABLE OF CONTENTS LIST OF TABLES ............................................................................................................ xii LIST OF FIGURES ......................................................................................................... xvi LIST OF ABBREVIATIONS .......................................................................................... xix DEFINITIONS ................................................................................................................ xxii CHAPTER I. INTRODUCTION ........................................................................................ 1 Background of the Problem ............................................................................................. 1 Motor Abnormalities ................................................................................................... 1 Associated Impairments .............................................................................................. 3 Anatomic and Radiological Findings .......................................................................... 3 Causation and Timing.................................................................................................. 4 Statement of Problem ...................................................................................................... 4 Purpose of the Study ....................................................................................................... 5 Research Questions/Aims/Hypotheses ........................................................................ 5 Significance ..................................................................................................................... 8 Theoretical Framework ................................................................................................. 11 Neuroplasticity .......................................................................................................... 12 Motor Learning .......................................................................................................... 17 Dynamic System Theory (DST) ................................................................................ 18 CHAPTER II. LITERATURE REVIEW ......................................................................... 20 Cerebral Palsy ............................................................................................................... 20 Current Approaches ....................................................................................................... 22 Drawbacks of Current Approaches ............................................................................... 24 viii Development of Robotics-Based Approaches ............................................................... 24 Advantages of Assisted Robotics Therapy .................................................................... 25 High-repetition .......................................................................................................... 25 Task Specificity ......................................................................................................... 26 Measurement Tool ..................................................................................................... 26 Engaging and Motivating .......................................................................................... 26 Increase Patients’ Compliance .................................................................................. 27 Active Assisted (As Needed)..................................................................................... 27 Work Efficiency ........................................................................................................ 27 Cost- and Time-efficient............................................................................................ 27 Previous Work in Upper-Limb Robotics ...................................................................... 28 Adult Studies ............................................................................................................. 28 Children Studies ........................................................................................................ 29 Previous Work in Lower-Limb Robotics ...................................................................... 31 Children Studies ........................................................................................................ 32 Introducing Ankle Robotics and Its Challenges ............................................................ 33
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