Most people can reach for a cup of coffee that they are not looking at and successfully bring it to their mouths. But for people with cerebral palsy who have hemiplegia, that proprioceptive skill is missing. They may not reach the cup at all, or if they do grasp it with the involved arm, they may end up tipping the cup over. Moreover, the lack of control on the affected side often gets progressively worse as these patients learn to favor the dominant side. To improve that scenario in hemiplegic children with cerebral palsy, clinical investigators are teaming up with engineers to devise robotic assistance devices to “retrain their brains,” with the goal of enhancing function on the involved side of the body.
How Robotic Assistance Devices Work
Strapped to the forearm, robotic assistance devices — which is in its earliest stages of development and is supported by funding from Columbia University’s Irving Institute for Clinical and Translational Research — is designed to provide auditory and vibratory “cues” (buzzing noises and feelings) to the patient so he or she will know where the arm is in space and learn to move the arm correctly. Over time, the goal is to get the patient to use the less functional hand more frequently, to retrain neural circuits to restore impaired proprioception, and to facilitate activities of daily living.
“Patients with hemiplegia don’t have spatial control,” explains Joseph Dutkowsky, MD, Associate Medical Director for the Weinberg Family Cerebral Palsy Center at NewYorkPresbyterian/Morgan Stanley Children’s Hospital. “Can this device tell them that a nearby cup they want to grab is tilting and about to spill? That’s the skill that it’s designed to help. Our hope is that the device will take advantage of the brain’s plasticity over time — allowing the affected side of the patient’s body to become more functional — and eventually, they won’t need the device.”
The current treatment for hemiplegia includes physical and occupational therapy, which typically require patients to leave their homes to receive care at an office or clinic, and this can be challenging for their parents. Hiroko Matsumoto, MA, Director of Clinical Research at the Weinberg Family Cerebral Palsy Center, notes that the portability of the arm device means that patients can use it at home. The investigators are collaborating with Sunil Agrawal, PhD, Professor of Mechanical Engineering and Rehabilitation Medicine at Columbia University, to design and evaluate the device, along with a team of pediatric orthopedists, physical therapists, rehabilitation medicine specialists, and orthotists. Babes Behind the Wheel Like many parents of children with physical challenges, parents of cerebral palsy patients worry about their children’s ability to be independent.
Columbia’s Robotics and Rehabilitation Lab
Prof. Agrawal and his team in Columbia’s Robotics and Rehabilitation (ROAR) Lab are developing innovative technologies, including robotic assistance devices, to improve the quality of care and outcomes of children with cerebral palsy and other causes of impaired mobility, such as spina bifida. The researchers developed small vehicles — essentially a booster seat on a dolly, connected to a robot — which infants as young as four to six months of age can learn to move by manipulating a joystick.
But while the study subjects could master a joystick to move forward — with the guidance of a supervising adult, of course — Prof. Agrawal and his colleagues found they could not navigate among obstacles, such as furniture. So the team created an algorithm and rigged the robots with sensors that could detect objects nearby, transmitting slight resistance from force field joysticks to train the child to guide the robot in a different direction and avoid obstacles. The work began at the University of Delaware and now continues at Columbia. Training physically challenged children during the toddler years could have tremendous benefits, given that the earliest years of life offer the most potential for neurological development.
“We’re training the brain with the help of a machine. We’re hoping to apply these devices and algorithms to help mobility-impaired children,” says Prof. Agrawal. “This work gives us an opportunity to extend our engineering applications to the field of medicine.”