title: Clinical application of a robotic ankle training program for cerebral palsy compared to the research laboratory application: does it translate to practice?
abstract: OBJECTIVE
  To determine the clinical efficacy of an ankle robotic rehabilitation protocol for patients with cerebral palsy.
  
  
  METHODS
  The clinic cohort was identified from a retrospective chart review in a before-after intervention trial design and compared with a previously published prospective research cohort.
  
  
  METHODS
  Rehabilitation hospital.
  
  
  METHODS
  Children (N=28; mean age, 8.2±3.62 y) with Gross Motor Function Classification System levels I, II, or III who were referred for ankle stretching and strengthening used a robotic ankle device in a clinic setting. Clinic results were compared with a previously published cohort of participants (N=12; mean age, 7.8±2.91 y) seen in a research laboratory-based intervention protocol.
  
  
  METHODS
  Patients in the clinic cohort were seen 2 times per week for 75-minute sessions for a total of 6 weeks. The first 30 minutes of the session were spent using the robotic ankle device for ankle stretching and strengthening, and the remaining 45 minutes were spent on functional movement activities. There was no control group.
  
  
  METHODS
  We compared pre- and postintervention measures of plantarflexor and dorsiflexor range of motion, strength, spasticity, mobility (Timed Up and Go test, 6-minute walk test, 10-m walk test), balance (Pediatric Balance Scale), Selective Control Assessment of the Lower Extremity (SCALE), and gross motor function measure (GMFM).
  
  
  RESULTS
  Significant improvements were found for the clinic cohort in all main outcome measures except for the GMFM. These improvements were equivalent to those reported in the research cohort, except for larger SCALE test changes in the research cohort.
  
  
  CONCLUSIONS
  These findings suggest that translation of repetitive, goal-directed biofeedback training into the clinic setting is both feasible and beneficial for patients with cerebral palsy.
authors.affiliation: Rehabilitation Institute of Chicago, Chicago, IL; National Institutes of Health, Clinical Center, Rehabilitation Medicine, Functional and Applied Biomechanics Section, Bethesda, MD.
authors.forename: Theresa
authors.initials: T
authors.lastname: Sukal-Moulton
authors.affiliation: Rehabilitation Institute of Chicago, Chicago, IL.
authors.forename: Theresa
authors.initials: T
authors.lastname: Clancy
authors.affiliation: Rehabilitation Institute of Chicago, Chicago, IL; Biomedical Engineering, Northwestern University, Evanston, IL; Orthopaedic Surgery, Northwestern University, Chicago, IL; Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL.
authors.forename: Li-Qun
authors.initials: LQ
authors.lastname: Zhang
authors.affiliation: Rehabilitation Institute of Chicago, Chicago, IL; Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL. Electronic address: dgaebler@ric.org.
authors.forename: Deborah
authors.initials: D
authors.lastname: Gaebler-Spira
mesh_terms: D000293:Adolescent; D000842:Ankle / Q000503:physiopathology*; D000843:Ankle Joint / Q000503:physiopathology*; D001676:Biofeedback, Psychology; D002547:Cerebral Palsy / Q000150:complications / Q000503:physiopathology* / Q000534:rehabilitation*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007753:Laboratories; D008297:Male; D009128:Muscle Spasticity / Q000150:complications / Q000503:physiopathology; D053580:Muscle Strength; D052580:Muscle Stretching Exercises; D018482:Muscle, Skeletal / Q000503:physiopathology; D004856:Postural Balance; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D012371:Robotics; D057170:Translational Research, Biomedical; D016138:Walking
keywords: Ankle; Cerebral palsy; Exercise; Rehabilitation; Resistance training; Robotics