Abstract
Acquired brain injuries (ABIs) can lead to a wide range of impairments, including weakness or paralysis on one side of the body known as hemiplegia. In hemiplegic patients, the rehabilitation of the upper limb skills is crucial, because the recovery has an immediate impact on patient quality of life. For this reason, several treatments were developed to flank physical therapy (PT) and improve functional recovery of the upper limbs. Among them, Constraint-Induced Movement Therapy (CIMT) and robot-aided therapy have shown interesting potentialities in the rehabilitation of the hemiplegic upper limb. Nevertheless, there is a lack of quantitative evaluations of effectiveness in a standard clinical setting, especially in children, as well as a lack of direct comparative studies between these therapeutic techniques. In this study, a group of 18 children and adolescents with hemiplegia was enrolled and underwent intensive rehabilitation treatment including PT and CIMT or Armeo®Spring therapy. The effects of the treatments were assessed using clinical functional scales and upper limb kinematic analysis during horizontal and vertical motor tasks. Results showed CIMT to be the most effective in terms of improved functional scales, while PT seemed to be the most significant in terms of kinematic variations. Specifically, PT resulted to have positive influence on distal movements while CIMT conveyed more changes in the proximal kinematics. Armeo treatment delivered improvements mainly in the vertical motor task, showing trends of progresses of the movement efficiency and reduction of compensatory movements of the shoulder with respect to other treatments. Therefore, every treatment gave advantages in a specific and different upper limb district. Therefore, results of this preliminary study may be of help to define the best rehabilitation treatment for each patient, depending on the goal, and may thus support clinical decision.
Highlights
Acquired brain injuries are nonprogressive, nonhereditary brain injuries acquired sometime after birth and are the leading cause of long-term disability and death in children and young adults
In children affected by acquired hemiplegia, several treatments were developed to improve functional recovery of the upper limbs
The rehabilitation of the upper limb skills is crucial, because the recovery has an immediate impact on patient quality of life
Summary
Acquired brain injuries are nonprogressive, nonhereditary brain injuries acquired sometime after birth and are the leading cause of long-term disability and death in children and young adults. Resulting from trauma, hypoxia, stroke, infection, or a variety of other sources, ABIs can lead to a wide variety of impairments, including deficiencies in cognitive, behavioral, metabolic, motor, perceptual motor, and/or sensory brain functions. A number of ABIs lead to significant hemiplegia [1], a weakness or paralysis on one side of the body, with relevant effects on the upper limb functionality [2]. The aim of rehabilitation of the upper limbs is to prevent the disuse of the impaired side of the body. Realistic contexts of functional activities, such as reaching or pointing towards an everyday object, help patients acquire control strategies to compensate for muscle weakness and inaccuracies [5]
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