title: Combined passive stretching and active movement rehabilitation of lower-limb impairments in children with cerebral palsy using a portable robot.
abstract: BACKGROUND
  Ankle impairments are closely associated with functional limitations in children with cerebral palsy (CP). Passive stretching is often used to increase the range of motion (ROM) of the impaired ankle. Improving motor control is also a focus of physical therapy. However, convenient and effective ways to control passive stretching and motivate active movement training with quantitative outcomes are lacking.
  
  
  OBJECTIVE
  To investigate the efficacy of combined passive stretching and active movement training with motivating games using a portable rehabilitation robot.
  
  
  METHODS
  Twelve children with mild to moderate spastic CP participated in robotic rehabilitation 3 times per week for 6 weeks. Each session consisted of 20 minutes of passive stretching followed by 30 minutes of active movement training and ended with 10 minutes of passive stretching. Passive ROM (PROM), active ROM (AROM), dorsiflexor and plantarflexor muscle strength, Selective Control Assessment of the Lower Extremity, and functional outcome measures (Pediatric Balance Scale, 6-minute walk, and Timed Up-and-Go) were evaluated before and after the 6-week intervention.
  
  
  RESULTS
  Significant increases were observed in dorsiflexion PROM (P = .002), AROM (P = .02), and dorsiflexor muscle strength (P = .001). Spasticity of the ankle musculature was significantly reduced (P = .01). Selective motor control improved significantly (P = .005). Functionally, participants showed significantly improved balance (P = .0025) and increased walking distance within 6 minutes (P = .025).
  
  
  CONCLUSIONS
  Passive stretching combined with engaging in active movement training was of benefit in this pilot study for children with CP. They demonstrated improvements in joint biomechanical properties, motor control performance, and functional capability in balance and mobility.
authors.affiliation: Rehabilitation Institute of Chicago, Chicago, IL, USA.
authors.forename: Yi-Ning
authors.initials: YN
authors.lastname: Wu
authors.forename: Miriam
authors.initials: M
authors.lastname: Hwang
authors.forename: Yupeng
authors.initials: Y
authors.lastname: Ren
authors.forename: Deborah
authors.initials: D
authors.lastname: Gaebler-Spira
authors.forename: Li-Qun
authors.initials: LQ
authors.lastname: Zhang
mesh_terms: D000293:Adolescent; D002547:Cerebral Palsy / Q000150:complications / Q000534:rehabilitation*; D002648:Child; D002675:Child, Preschool; D005260:Female; D020233:Gait Disorders, Neurologic / Q000209:etiology / Q000534:rehabilitation*; D006801:Humans; D007866:Leg / Q000294:innervation / Q000503:physiopathology*; D008297:Male; D009128:Muscle Spasticity / Q000209:etiology / Q000534:rehabilitation*; D026741:Physical Therapy Modalities / Q000295:instrumentation*; D012371:Robotics / Q000295:instrumentation* / Q000379:methods