title: Motor learning characterizes habilitation of children with hemiplegic cerebral palsy.
abstract: BACKGROUND
  This study tested in children with cerebral palsy (CP) whether motor habilitation resembles motor learning.
  
  
  METHODS
  Twelve children with hemiplegic CP ages 5 to 12 years with moderate to severe motor impairments underwent a 16-session robot-mediated planar therapy program to improve upper limb reach, with a focus on shoulder and elbow movements. Participants were trained to execute point-to-point movements (with robot assistance) with the affected arm and were evaluated (without robot assistance) in trained (point-to-point) and untrained (circle-drawing) conditions. Outcomes were measured at baseline, midpoint, immediately after the program, and 1 month postcompletion. Outcome measures were the Fugl-Meyer (FM), Quality of Upper Extremity Skills Test (QUEST), and Modified Ashworth Scale (MAS) scores; parent questionnaire; and robot-based kinematic metrics. To assess whether learning best characterizes motor habilitation in CP, the authors quantified (a) improvement on trained tasks at completion of training (acquisition) and 1 month following completion (retention) and (b) quantified generalization of improvement to untrained tasks.
  
  
  RESULTS
  After robotic intervention, the authors found significant gains in the FM, QUEST, and parent questionnaire. Robot-based evaluations demonstrated significant improvement in trained movements and that improvement was sustained at follow-up. Furthermore, children improved their performance in untrained movements indicating generalization.
  
  
  CONCLUSIONS
  Motor habilitation in CP exhibits some traits of motor learning. Optimal treatment may not require an extensive repertoire of tasks but rather a select set to promote generalization.
authors.affiliation: Massachusetts Institute of Technology, Cambridge, MA, USA. hikrebs@mit.edu
authors.forename: Hermano I
authors.initials: HI
authors.lastname: Krebs
authors.forename: Susan E
authors.initials: SE
authors.lastname: Fasoli
authors.forename: Laura
authors.initials: L
authors.lastname: Dipietro
authors.forename: Maria
authors.initials: M
authors.lastname: Fragala-Pinkham
authors.forename: Richard
authors.initials: R
authors.lastname: Hughes
authors.forename: Joel
authors.initials: J
authors.lastname: Stein
authors.forename: Neville
authors.initials: N
authors.lastname: Hogan
mesh_terms: D001132:Arm / Q000503:physiopathology*; D001696:Biomechanical Phenomena / Q000502:physiology; D002547:Cerebral Palsy / Q000150:complications / Q000534:rehabilitation*; D002648:Child; D002675:Child, Preschool; D005081:Exercise Therapy / Q000295:instrumentation / Q000379:methods*; D006185:Habituation, Psychophysiologic / Q000502:physiology*; D006429:Hemiplegia / Q000175:diagnosis / Q000209:etiology / Q000534:rehabilitation*; D006801:Humans; D012371:Robotics / Q000295:instrumentation; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome