Pediatric Gait Research Articles

Telemedicine in pediatric rheumatology: the video pediatric gait, arms, legs, and spine (v-pGALS) examination.

Video pediatric gait, arms, leg, and spine (v-pGALS) is a virtual application of the pediatric gait, arms, leg, and spine (pGALS) examination performed by video. We aimed to verify the applicability, validity, and accuracy of the Turkish translation of v-pGALS in a large pediatric patient cohort. Children aged 4-18 years seen between May and June 2022 were included. A hands-on physical examination and v-pGALS were performed. Demographics, active symptoms, physical examination findings, diagnosis, and v-pGALS findings were recorded. The acceptability of v-pGALS, in terms of additional distress and duration, was measured by the parent/patient using a visual analog scale (VAS). 102 patients (median age 12.41 years) were included. Juvenile idiopathic arthritis (JIA) was the most common diagnosis. The median duration of v-pGALS was 7 min. An abnormal v-pGALS was identified in 25 patients while the hands-on physical examination was abnormal in 27 patients. Scoliosis and pes planus were missed in v-pGALS. Both children and parents gave a median VAS score of 0 for additional discomfort and duration. That is, the duration of v-pGALS was acceptable for ≥98% of the patients/parents, and ≥98% mentioned that it caused little/no discomfort. The sensitivity and specificity of v-pGALS were 92.6% and 100%, respectively, for the detection of musculoskeletal (MSK) abnormalities. The v-pGALS is an applicable, accurate, and practical tool for evaluating MSK problems in children. The Turkish translation was also conveniently acceptable.

Integrating Heart Rate Monitoring Into a Camp for Children With Neuromotor Disorders: A Case Series.

This case series investigated the implementation fidelity, feasibility, and effectiveness of integrating continuous heart rate monitoring with visual feedback into an established, intensive physical therapy camp for children with neuromotor disorders. The provision of continuous visual feedback through color-coded, individually calculated heart rate zones was a feasible and effective intervention, encouraging pediatric gait camp participants to exercise at intensities that produced aerobic and functional gains. The use of technology facilitated participation with peers, an outcome equally as important as their endurance and functional improvements. Pediatric physical therapists play a crucial role in enhancing the well-being and physical fitness of children with disabilities. Encouraging regular exercise in a social environment fosters enjoyable, inclusive experiences while promoting overall health. It is important for clinicians in various pediatric rehabilitation settings to establish programs that offer such opportunities for children with neuromotor disorders.

The prevalence of musculoskeletal pain among school students and its association with physical fitness in Guwahati urban society: a cross sectional study

Introduction and backgroundThe musculoskeletal pain (MSK) develops at an early age and pains in adolescence dispose to subsequent pain episodes in adulthood. High physical fitness levels in childhood and adolescence are linked to favorable health outcomes.This study has evaluated the prevalence of musculoskeletal pain among school students. Additionally, it examines the existing physical fitness of those children and explores potential associations between musculoskeletal pain and physical fitness.MethodsA cross sectional study was conducted in the Guwahati urban area, a capital city of North East India, in different schools. The mean and standard deviation of age was 9.49 ± 2.53. Prevalence of MSK pain was determined by the Faces Pain Scale–Revised and pediatric Gait Arm Leg Spine (pGALS) assessment, whereas physical fitness was assessed by Fitnessgram test battery.Statistical analysisPaired “t” test and logistic regression analysis were used. The level of significance was set at 0.05 for all tests performed, and 95% confidence intervals (CIs) were used in all cases.ResultsThe percentage of musculoskeletal pain is 38.28% where female school students have 40.33% and the male students have 36.52%. The odd ratio of 0.934 (CI = 0.916–0.972) was found between pain occurrence and aerobic capacity. The odd ratio of 0.72 (CI = 0.704–0.761) was found between the chances of pain onset and abdominal strength and endurance. The odd ratio of 0.859 (CI = 0.831–0.899) was found between pain occurrence and trunk extensor muscle strength and endurance.ConclusionThe prevalence of the musculoskeletal pain in school students is found to be 38.28%. The incidence of musculoskeletal pain and the physical fitness of a child has a significant relationship, with children who have poor physical fitness being more likely to develop musculoskeletal pain.

Preliminary Virtual Constraint-Based Control Evaluation on a Pediatric Lower-Limb Exoskeleton.

Pediatric gait rehabilitation and guidance strategies using robotic exoskeletons require a controller that encourages user volitional control and participation while guiding the wearer towards a stable gait cycle. Virtual constraint-based controllers have created stable gait cycles in bipedal robotic systems and have seen recent use in assistive exoskeletons. This paper evaluates a virtual constraint-based controller for pediatric gait guidance through comparison with a traditional time-dependent position tracking controller on a newly developed exoskeleton system. Walking experiments were performed with a healthy child subject wearing the exoskeleton under proportional-derivative control, virtual constraint-based control, and while unpowered. The participant questionnaires assessed the perceived exertion and controller usability measures, while sensors provided kinematic, control torque, and muscle activation data. The virtual constraint-based controller resulted in a gait similar to the proportional-derivative controlled gait but reduced the variability in the gait kinematics by 36.72% and 16.28% relative to unassisted gait in the hips and knees, respectively. The virtual constraint-based controller also used 35.89% and 4.44% less rms torque per gait cycle in the hips and knees, respectively. The user feedback indicated that the virtual constraint-based controller was intuitive and easy to utilize relative to the proportional-derivative controller. These results indicate that virtual constraint-based control has favorable characteristics for robot-assisted gait guidance.

Reference measures of lower-limb joint range of motion, muscle strength, and selective voluntary motor control of typically developing children aged 5-17 years.

Joint range of motion based on the neutral null method, muscle strength based on manual muscle testing, and selective voluntary motor control based on selective control assessment of the lower extremity are standard parameters of a pediatric three-dimensional clinical gait analysis. Lower-limb reference data of children are necessary to identify and quantify abnormalities, but these are limited and when present restricted to specific joints or muscles. This is the first study that encompasses the aforementioned parameters from a single group of 34 typically developing children aged 5-17 years. Left and right values were averaged for each participant, and then the mean and standard deviation calculated for the entire sample. The data set was tested for statistical significance (p < 0.05). Joint angle reference values are mostly consistent with previously published standards, although there is a large variability in the existing literature. All muscle strength distributions, except for M. quadriceps femoris, differ significantly from the maximum value of 5. The mean number of repetitions of heel-rise test is 12 ± 5. Selective voluntary motor control shows that all distributions, except for M. quadriceps femoris, differ significantly from the maximum value of 2. Since typically developing children do not match expectations and reference values from the available literature and clinical use, this study emphasizes the importance of normative data. Excessively high expectations lead to typically developing children being falsely underestimated and affected children being rated too low. This is of great relevance for therapists and clinicians. 3.

Fast terminal sliding mode control with rapid reaching law for a pediatric gait exoskeleton system

Fast terminal sliding mode control with rapid reaching law for a pediatric gait exoskeleton system

Implementation and assessment of a structured curriculum for a 4-week pediatric rheumatology rotation for pediatric residents

BackgroundGeneral pediatricians often initially address children’s musculoskeletal (MSK) issues and play a crucial role in triaging and managing patients’ rheumatologic conditions. This study assessed the effectiveness of a structured curriculum in enhancing pediatric residents’ knowledge, MSK examination skills, and confidence during a 4-week pediatric rheumatology rotation.MethodsPediatric residents in their either second or third year who participated in the 4-week rheumatology rotation once across three academic years (July 2020–June 2023) were enrolled. Residents’ knowledge, MSK examination skills, and confidence were assessed at pre- and post-rotation by using 25 multiple-choice questions, the Thai pediatric Gait Arms Legs Spine examination, and a questionnaire, respectively. The curriculum comprised instruction on MSK examinations, interactive lectures, case-based discussion, topic reviews, MSK radiology conference, clinical experience in rheumatology clinic and consultations, with self-guided learning with educational resources.ResultsFifty-eight pediatric residents (48 females, 10 males) with a mean age of 28.9 ± 0.8 years participated. Significant improvements were noted postrotation. Knowledge scores rose from 63.0 ± 12.2 to 79.7 ± 9.1 (mean difference 16.7 ± 10.3, p < 0.001). Similarly, MSK examination scores increased from 67.5 ± 14.4 to 93.6 ± 8.7 (mean difference 26.1 ± 14.6, p < 0.001). Residents also reported a marked increase in confidence across all evaluated areas, including history taking, MSK examination, arthrocentesis, and diagnosing and treating rheumatologic conditions (p < 0.001).ConclusionsThe 4-week structured curriculum in the pediatric rheumatology rotation significantly enhanced pediatric residents’ knowledge, MSK examination skills, and confidence. These findings support the integration of pediatric rheumatology rotations into pediatric residency training programs.

Assessing Pediatric Gait Symmetry Through Accelerometry and Computational Intelligence

Assessing Pediatric Gait Symmetry Through Accelerometry and Computational Intelligence

Design and validation of a pediatric gait assistance exoskeleton system with fast non-singular terminal sliding mode controller

Existing exoskeletons for pediatric gait assistance have limitations in anthropometric design, structure weight, cost, user safety features, and adaptability to diverse users. Additionally, creating precise models for pediatric rehabilitation is difficult because the rapid anthropometric changes in children result in unknown model parameters. Furthermore, external disruptions, like unpredictable movements and involuntary muscle contractions, add complexity to the control schemes that need to be managed. To overcome these limitations, this study aims to develop an affordable stand-aided lower-limb exoskeleton specifically for pediatric subjects (8-12 years, 25-40 kg, 128-132 cm) in passive-assist mode. The authors modified a previously developed model (LLESv1) for improved rigidity, reduced mass, simplified motor arrangement, variable waist size, and enhanced mobility. A computer-aided design of the new exoskeleton system (LLESv2) is presented. The developed prototype of the exoskeleton appended with a pediatric subject (age: 12 years old, body mass: 40 kg, body height: 132 cm) is presented with real-time hardware architecture. Thereafter, an improved fast non-singular terminal sliding mode (IFNSTSM) control scheme is proposed, incorporating a double exponential reaching law for expedited error convergence and enhanced stability. The Lyapunov stability warrants the control system's performance despite uncertainties and disturbances. In contrast to fast non-singular terminal sliding mode (FNSTSM) control and time-scaling sliding mode (TSSM) control, experimental validation demonstrates the effectiveness of IFNSTSM control by a respective average of 5.39% and 42.1% in tracking desired joint trajectories with minimal and rapid finite time converging errors. Moreover, the exoskeleton with the proposed IFNSTSM control requires significantly lesser control efforts than the exoskeleton using contrast FNSTSM control. The Bland-Altman analysis indicates that although there is a minimal mean difference in variables when employing FNSTSM and IFNSTSM controllers, the latter exhibits significant performance variations as the mean of variables changes. This research contributes to affordable and effective pediatric gait assistance, improving rehabilitation outcomes and enhancing mobility support.

Reliability of the tunisian pediatric gait, arms, legs, and spine: toward a valid screening tool for tunisian children with musculoskeletal conditions

BackgroundPediatric musculoskeletal disorders account for 10% of first-line consultations in Tunisia. Referral delay and deficiencies in musculoskeletal screening raise a challenge to the early diagnosis and management of rheumatic conditions in children. The pGALS (Pediatric Gait Arms Legs Spine) was developed and translated into many languages to overcome these deficiencies. Our study aimed to adapt and validate pGALS to the Tunisian dialect for school-age children.MethodsUsing the Delphi method, we carried out a cross-cultural adaptation of the pGALS to the Tunisian dialect. This consensual version was validated in a cross-sectional study, in two pediatric centers.ResultsNinety-two patients were enrolled, 43 females (46.7%) and 49 males (53.3%), mean age was 9.4 ± 2.6 years. The mean test duration was 3.4 ± 2.3 min, and the acceptability and comprehension of the test were good. Six patients had a musculoskeletal complaint, 19 had positive pGALS, and 14 were diagnosed with musculoskeletal disease. The internal consistency score (Cronbach’s α) was 0.852. The sensitivity of the test was 92.8%, the specificity was 92.3%, the positive likelihood ratio was 2.16, and the negative likelihood ratio was 0.01.ConclusionThe pGALS test adapted to the Tunisian dialect is a relevant, quick, and valid tool for screening musculoskeletal abnormalities in school-age children.

Screening utility and acceptability of the Kiswahili-pGALS (paediatric Gait, Arms, Legs, Spine) at a tertiary referral hospital in Kenya-A diagnostic accuracy study

BackgroundPaediatric rheumatic diseases cause considerable disease burden to children and their families (Moorthy LN, Peterson MGE, Hassett AL, et al, Pediatric Rheumatology 8:20, 2010). Delayed diagnosis is a significant determinant of severity and mortality attributed to these conditions (Foster HE, Eltringham MS, Kay LJ, et al, Arthritis Care Res 57(6):921-7, 2007). pGALS is a simple clinical tool used to assess joints and identify musculoskeletal (MSK) conditions in school-going children to enable early referral to paediatric rheumatologists.ObjectivesThis study aimed to translate and determine the diagnostic accuracy and acceptability of a Kiswahili version of the pGALS screening tool among Kiswahili-speaking children.MethodsThe pGALS screening questions were translated into Kiswahili according to the World Health Organisation (WHO) standard for translation of a tool. The validity of the Kiswahili PGALS was ascertained and acceptability rated (time taken, discomfort). Using systematic random sampling, we enrolled children aged 5–16 years presenting at the Aga Khan University Hospital’s (AKUH) emergency department in Kenya, who spoke Kiswahili and had symptoms suggestive of an MSK condition. Those already under follow-up at the paediatric rheumatology service at AKUH were excluded. MSK assessment was undertaken by two resident doctors using the newly translated Kiswahili-pGALS and findings were compared with a paediatric rheumatologist examination (‘gold-standard’) on the same day, and who was blinded to the pGALS findings. We analysed demographic details of the participants and determined the diagnostic accuracy by cross tabulation of the index test results by the results of the reference standard.ResultsOne hundred children with a median age of nine years (IQR 7–11) were enrolled. The sensitivity and specificity of the Kiswahili-pGALS screening tool were 76.8% (95%CI 63.6–87.0%) and 40.0% (95%CI 23.9–57.9%), respectively. The diagnostic accuracy was 62.7% (95%CI 52.1–72.1%), area under the ROC was 0.58 (95%CI 0.48–0.68). The median time to perform the Kiswahili-pGALS was 5.0 min (IQR 3.5–6.0 min). Ninety percent of the guardians found the practice of Kiswahili-pGALS to have none, or only some discomfort.ConclusionsThe Kiswahili-pGALS’s was found to be a useful screening tool to aid early identification of MSK conditions in Kiswahili-speaking settings. However, the low specificity implies that relatively large number of false positives would still need to be reviewed by a rheumatologist if the tool is adapted for use.

Adaptive backstepping human-cooperative control of a pediatric gait exoskeleton system with high- and low-level admittance

Post-neurological disorder, passive-assist training disregards human involvement during robot-aided lower-limb rehabilitation. This work presents a novel human-cooperative framework based on the admittance and trajectory control scheme to administer the subject–exoskeleton interaction for pediatric gait rehabilitation. Initially, the mechanical design and dynamic analysis of an existing exoskeleton system are briefly attended. Thereafter, an admittance model is designed in the outer loop, which recasts the desired human trajectory into a reference trajectory. As an inner-loop control scheme, a robust adaptive backstepping controller is designed to trace the reference gait trajectory under parametric uncertainties and external disturbances. Lyapunov stability analysis is solved to guarantee the uniform boundedness of the control signals. Moreover, the well-known problem of “explosion of complexity” and “overparameterization” is avoided through the design of the robust adaptive backstepping control scheme. The performance of the proposed robust adaptive backstepping-based human-cooperative control is studied under the low- and high-level admittance model. Finally, the effectiveness of the proposed control is validated with a variable structure adaptive robust-based human-cooperative control. The co-simulation results show that the proposed control with low-level admittance allows the subject to participate in the training process more frankly. The proposed robust adaptive backstepping-based human-cooperative control tracks the reference gait more promisingly than the variable structure adaptive robust-based human-cooperative control for both admittance levels.

Adaptive RBF neural network-computed torque control for a pediatric gait exoskeleton system: an experimental study

Adaptive RBF neural network-computed torque control for a pediatric gait exoskeleton system: an experimental study

Effectiveness of Neurodevelopmental Treatment and Sensory Integration Therapy on Gross Motor Function, Balance and Gait Parameters in Children With Spastic Diplegia.

Background Spastic diplegic cerebral palsy is the type that is most frequently seen in clinical settings. Spastic diplegic children have trouble maintaining their balance, gait, and gross motor function.This study investigated the effects of the Neurodevelopmental Technique (NDT) and Sensory Integration Technique (SIT) on balance, gross motor function, and gait characteristics in children with spastic diplegia. Method The study's participants were 8 to 12 years old, with spastic diplegia, categorized into stages I to III of the Gross Motor Function Classification System. While individuals in group B underwent sensory integration therapy, group A's subjects received NDT for 45 minutes. Both groups received traditional physiotherapy for 15 minutes. The protocol was given for five days a week, continuously for four weeks. All 40 subjects underwent pre- and post-treatment assessments using the Gross Motor Function Measure-88 (GMFM-88), Paediatric Balance Scale, Gait Parameters, and Gross Motor Function Classification System. Results The trial involved 40 children, divided into two groups of 20 each. Statistical analysis demonstrated a substantial improvement in group B post-intervention (P>0.0001).The study's findings were drawn using the Chi-Square test, paired and unpaired t-tests, and SPSS Statistics for Windows, version 27.0 (IBM Corp., Armonk, USA).A p<0.05 and theGraphPad Prism version 7.0 (GraphPad Software, Boston, USA)were used. A total of 40 children completed the entire duration of treatment for a month. 20 subjects participated in group A (age range 8-12 years; mean age 10.3 years) and 20 subjects in group B (age range 8-12 years; mean age 10.25 years). The GMFM-88, which assesses motor function, reveals that the between-group comparison indicates a substantial difference of 7.95 (6.04-9.86) in favor of Group B, with a p-value of 0.0001, signifying statistical significance.Similarly, the Pediatric Balance Scale (PBS) outcomes significantly enhanced in both groups post-intervention.The comparison between groups yields a difference of 1.85 (1.11-2.59) in favor of Group B,with a p-value of 0.0001. Conclusion The study concluded that SIT has a positive impact on gait metrics, balance, and gross motor function in children with spastic diplegia.

Morbidity pattern of musculoskeletal disorders among school children in a selected ward of urban Bengaluru using pediatric Gait, Arms, Legs, and Spine screening tool

Abstract Background: Musculoskeletal disorders (MSDs) among children are common globally and in India with the prevalence ranging from 4% to 15%. Musculoskeletal symptoms can be due to trauma or growing pains or symptoms of potentially life-threatening conditions such as malignancy, sepsis, and autoimmune disorders. With their indefinite onset and long latent period, early detection of these disorders and prompt treatment reduce the severity of outcomes; hence, screening is necessary. Objective: The objective of this study was to estimate the occurrence and describe the morbidity patterns of MSDs among school children in a selected school cluster of urban Bengaluru using the pediatric Gait, Arms, Legs, and Spine (pGALS) screening tool. Methods: A cross-sectional study was done, which included all the students of one randomly selected school cluster in one ward of urban Bengaluru. The total number of students was 260; 37 students did not get their parental consent, and 29 students were chronically absent. The pGALS tool has demonstrated an excellent sensitivity (around 97%) and specificity (around 98%) at all joints with high acceptability among children and parent/guardian and across cultures. Results: The overall occurrence of MSDs based on the pGALS tool among school children was 46.9% (91/194). Males were the most affected than females (males: 51.6% and females: 48.4%). Children in the age group of 10–15 years were most affected by MSDs (51.6%). Conclusion: The prevalence of MSDs is high among school-going children based on the pGALS screening tool, and this may be due to a recent sports event.

Comparison of kinematics between Theia markerless and conventional marker-based gait analysis in clinical patients

BackgroundMarkerless motion capture systems have the potential to make clinical gait analysis more efficient and convenient. Theia3D is a commercially available markerless system that may serve as an alternative to traditional gait analysis for clinical gait laboratories. Research QuestionWhat is the concurrent validity of markerless gait analysis using Theia3D compared to traditional marker-based gait analysis in pediatric clinical gait patients? MethodsThirty-six patients (20 male, age 2–25 years) with a range of diagnoses underwent clinical gait analysis with data being captured concurrently by a traditional marker-based motion capture system (Vicon Nexus) and a commercial markerless system (Theia3D). Multiple left strides were averaged for each subject, and the difference in kinematics (Theia - Vicon) was calculated over the gait cycle and evaluated using root mean square difference (RMSD), mean difference, and RMSD after subtracting the mean value across the gait cycle (RMSDoffset). Sub-analysis was performed for 25 patients with foot deformities, 9 wearing ankle-foot orthoses, and 6 walking with assistance (cane, crutches, walker, or handheld). ResultsKinematics showed similar patterns between the marker-based and markerless systems. RMSD was < 6° except for pelvic tilt, hip flexion, ankle inversion, foot progression, and transverse plane rotation of the hip, knee, and ankle. These measures mainly differed due to an offset between the curves. After adjusting for offsets, all RMSDoffset were < 6°. RMSD was larger for patients with foot deformities, wearing orthoses, or using assistive devices, but all RMSDoffset were still < 8°. In some cases, however, the markerless system had greater trial-to-trial variability, showed a larger knee varus “bump” in swing, or failed to track the subject. SignificanceThis study provides preliminary evidence of concurrent validity of Theia3D for pediatric patients with abnormal gait. However, some questions remain regarding identification of the knee axis and for patients with foot deformity or assistive devices.

Feature Selection using Random Forest Classifier for Foot Strike Event Detection in Toe Walkers

Automated Gait event identification of Foot Strike (FS) and Foot Off (FO) in pathological gait data, can be time saving in comparison to conventional manual annotations done currently. Identification of FS and FO allows breaking walking trials into gait cycles and hence aids in comparison of gait parameters like joint angles, forces and moments across gait cycles. Automated Gait Event Detection is also useful in development of wearable sensor devices and robotic systems that assist gait. Researchers have proposed several automatic gait event detection algorithms based on kinematic parameters and systematic study of the literature suggests specific parameters to have higher contribution in identification of FS event in all common pathological gait patterns. We used Random Forest Classifier Feature selection technique to identify high contributing features in FS event in toe walking pediatric pathological gait dataset and the results suggest high similarity in selected features by the machine learning technique with those suggested by popular event detection algorithms based on kinematic parameters for pathological gait. Hence we conclude that RFC feature selection is suitable for feature selection in toe walkers gait dataset for event detection purpose. Keyword : Feature selection, foot off, foot strike, pathological gait.

Distal Femoral Extension Osteotomy with a Retrograde Nail for Treatment of pediatric Crouch Gait

Distal Femoral Extension Osteotomy with a Retrograde Nail for Treatment of pediatric Crouch Gait

09 Validation of the francophone version of pGALS with the Delphi approach

BackgroundThe pediatric Gait, Arms, Legs, and Spine (pGALS) is a practical quick musculoskeletal assessment to increase awareness of the joint disease, facilitate early recognition of joint problems, and prompt referral to specialist teams to optimize clinical outcomes. pGALS has been shown to be practical and useful, with excellent acceptability by children and their parents. Its use was limited in French-speaking countries because of the lack of the francophone version.ObjectivesTo describe the steps of the translation of the pGALS francophone version using the Delphi approach.MethodsDelphi method is the consensus-building method, providing the consensual opinion of the experts. For each translated item of the pGALS, the experts assessed the relevance using a scale ranging from 1 to 9 (not relevant-completely relevant). Then median was calculated giving for each item the position of the group: disagree (if the median < 3), equivocal (median between 4–6) and agreement (median >7). The degree of the convergence with the group was assessed to clarify this result: the group’s opinion is consensual if 70% of the responses were within the range of the median; otherwise, it’s “not consensual”. For the no consensual and no relevant item, the experts propose a comment to reformulate the sentence.ResultsThree native speakers were invited to translate the English form of the pGALS into the francophone language. The different propositions were mixed in a consensual way by a children’s musculoskeletal specialist. The version was validated according to the Delphi method. Six experts (pediatricians and rheumatologists) from different French-speaking countries were interviewed during 3 rounds by electronic survey individually and anonymously. After each round: the median, consensus, and comments of every item are collected and a meeting with experts was held to analyze the results. During the first meeting, we were consensual and we had an agreement on 82% of the items (28 items were validated, and 6 items were reformulated). Then the form was reformulated using the results of the preliminary rounds: opinions of the experts and their proposals during the last meeting). We were in agreement and we validated the remaining six-item during the second meeting. In the last round, we obtain a consensual version of pGALS.ConclusionOur approach contributed to the consensual translation of the francophone version of pGALS. This tool is now ready to be used as a basic clinical skill. More research is mandatory to assess its sensibility and specificity in screening musculoskeletal disorders.

Using a robotic exoskeleton at home: An activity tolerance case study of a child with spinal muscular atrophy

PurposeSpinal Muscular Atrophy (SMA) Type II is a neurodegenerative disease that leads to progressive muscle weakness. It prevents children from walking and affects their respiratory function and their activity tolerance, among other health problems. We aimed to assess the activity tolerance showed by a child with SMA using a pediatric gait exoskeleton at home when walking and performing activities. Design and methodsThis study presents the case of a 6-year-old boy with SMA Type II and respiratory failure who used a pediatric gait exoskeleton at home for a period of two months. A nursing assessment was done before and during the use of the device to evaluate the child's activity tolerance during the sessions. Nursing interviews, performance, vital signs, fatigue, field notes, and functional scales were analyzed. ResultsThe nursing assessment showed a good activity tolerance of the child. Performance using the device improved over time; vital signs did not vary significantly during the sessions; fatigue perception decreased over time; and the child reached a higher score on some functional outcomes. ConclusionsA first step has been taken to evaluate the impact of exoskeleton technology in children with SMA Type II from the nursing point of view, exposing the potential of this technology for the care of children with neuromuscular diseases, and the need for more research on the topic. Practice implicationsThe information in this study will be useful to nurses to know the effects of gait exoskeletons in pediatric care of children with neuromuscular diseases like SMA.