Precision Gait Retraining for Children with Cerebral Palsy

Altec, Inc., Boston MA

Investigators

Linked publications & trials

Abstract

Gait impairments hinder mobility for more than 760,000 children and adults living with cerebral palsy (CP) in the US. Motor relearning is possible for these individual but typically requires numerous training sessions with a team of physical therapists and assistants to restore coupling between upper- and lower-body segments while assisting spastic uncoordinated limb movement to improve gait kinematics. While advancements in rehabilitation robotics have the potential to relieve therapists of the need to stabilize the patient and augment limb movement, existing devices excessively restrict the lower-limb to single-plane motion, impede natural rotation/translation of the pelvis, and impose rather than accommodate volitional adaptation of movement. Additional constraints of high cost and immobile configuration only further preclude translation of these devices for in-home therapy, where more frequent training sessions necessary to enhance neural plasticity can be attained. The proposed Phase I SBIR will target this health disparity by developing the first sensor-based mobile Pelvic Assist Device (mPAD) that is uniquely capable of delivering precise, adaptable, multi-degree-of-freedom pelvic control to promote natural intersegmental coupling, restore coordination of upper- and lower-limb movement, and improve normal gait kinematics in children with CP. Because of its proximity to the center of mass and critical role in coordinating upper- and lower-limb control, the pelvis provides an ideal access point for physiotherapists to manually improve gait. We propose to greatly simplify this task by designing a portable mPAD device that automates pelvic assistance, allows for full-body volitional control, and promotes relearning through biofeedback sensory-motor integration and in-home use. Our team of specialists in sensor-based systems for monitoring human movement is now partnering with clinical and engineering experts in rehabilitation robotics to translate the existing laboratory-based Tethered Pelvic Assist Device (TPAD) from a stationary system into a mobile device that utilizes body-worn sensors for mobility and programmable biofeedback for training in or out of the clinic. In Phase I we will integrate electromyographic (EMG) and inertial (IMU) biofeedback metrics with TPAD to demonstrate feasibility for gait training in children with spastic diplegia. Our Phase I deliverable will include validated sensor-based gait metrics and a new biofeedback system for motor learning that are integratable with TPAD and compliant with the target population. A fully portable mPAD, similar in appearance to a pediatric rollator, will be developed in Phase II, which will provide opportunities for enhanced motor relearning and improved mobility through therapist-guided gait retraining protocols tailored for adaptable pelvic intervention and biofeedback to patients representing a wide variety of gait disorders among CP populations. The impact of this innovation marks a first of its kind robotic rehabilitation technology that meets the immediate and long-term health needs of underserved children with CP who stand to benefit from translation of improved healthcare advancements beyond the clinic and into the community.