Physical recovery from hemispherectomy is often a difficult process. For example, once balance and the ability to walk are acquired, massive amounts of repetition are needed to improve on those functions – which most physical therapists are unable to perform. Additionally, probably the most important piece to recovery is intent – the child must be interested in the intervention in order to do it. To help improve therapy, various robotic devices have been designed to train patients to move their arms and legs hundreds of times during a therapy session by using an video game interface which makes the therapy fun for the child.
Improving Hand, Wrist, and Ankle Use
Hand, wrist, and ankle use opposite the removed hemisphere are profoundly affected after hemispherectomy because the upper motor neurons primarily responsible for their movement are removed or disconnected during the procedure. Interactive, highly-responsive robotics developed at the Massachusetts Institute of Technology by Dr. Hermano Igo Krebs and his team of researchers have been shown to help children with cerebral palsy reach and grasp for objects. Patients handshake with the robot via a handle, which is connected to a computer monitor that displays tasks similar to those of simple video games. This technology, currently manufactured by Interactive Motion Technologies, has shown improvements in coordination and function in children with hemiplegia. (Fasoli, et al, Upper Limb Robotic Therapy for Children with Hemiplegia.)
The shoulder/elbow robot works on bending and straightening the elbow (flexing and bending) and bringing the shoulder forward (flexion), backward (extension), in (horizontal adduction) and out (horizontal abduction). The wrist robot works on bending and straightening (flexing and extending) the elbow as well as side to side (ulnar and radial deviation). The wrist robot also addresses the forearm to flip it up and down (supination/pronation). An ankle robot works on similar issues for the hemiparetic leg.
The Brain Recovery Project, through its collaboration with Rancho Research Institute and the Rancho Los Amigos National Rehabilitation Center (“Rancho”), has initiated several studies at Rancho to determine whether robotics-assisted therapy is an effective intervention that can be delivered in a camp-like environment. Learn more about “Robocamp at Rancho” here.
Improving gait and ambulation
Gaining or regaining the ability to walk is a major goal of all post-hemispherectomy rehabilitation programs. Gait training of severely affected patients is technically difficult because of their motor weakness and balance disturbances. An innovative locomotor training that incorporates high repetitions of task-oriented practice by the use of body weight-supported treadmill training (BWSTT) was developed to overcome these obstacles. To facilitate the delivery of BWSTT, a motorized robotic driven gait orthosis (robotic–assisted gait training-RAGT) was developed.
Hokoma’s Lokomat is one device that delivers RAGT. Here is it in use at a recent Robocamp: