Feasibility of gestural feedback treatment for upper extremity movement in children with cerebral palsy.

External feedback of performance is an important component of therapy, especially for children with impairments due to cerebral palsy because they lack intrinsic experience of "good movements" to compare effort and determine performance outcomes. A robotic therapy system was developed to provide feedback for specific upper extremity movements (gestures) which are therapeutically desirable. The purpose of this study was to compare changes in forearm supination/pronation or wrist extension/flexion motion following conventional therapy and gestural robotic feedback therapy intervention. Six subjects with cerebral palsy (ages 5-18, GMFCS level IV--three subjects, level III--one subject, and level I--two subjects) participated in a blinded crossover design study of conventional and robotic feedback therapy targeting either forearm supination or wrist extension. Functional upper extremity motion at baseline and following conventional and robotic feedback therapy interventions were obtained using a motion capture system by personnel blinded to the intervention order. All activities were approved by IRB. Use of the robotic feedback system did result in slightly increased movement in the targeted gesture without change in untargeted motions. Data also suggest a decrease in both agonist and antagonist motion following conventional therapy intervention. Results suggest improved motion when robotic feedback therapy intervention precedes conventional therapy intervention. Robotic feedback therapy is no different than conventional therapy to improve supination or wrist extension function in upper extremity impairments of children with cerebral palsy when changes were considered as aggregate data. In this very small group of diverse patients, individual subject results suggested that intervention order could be responsible for obscuring differences due to intervention type. Outcomes from several individual subjects suggest that results could be different given a more homogeneous group of subjects which future studies should be considered to ultimately determine efficacy of the robotic feedback therapy. Future studies should also address efficacy in other neuromuscular patient populations.

No benefit of the two-incision THA over mini-posterior THA: a pilot study of strength and gait.

UNLABELLED: Proponents of the two-incision minimally invasive approach for THA have claimed recovery is dramatically better than after other methods of THA, but this has not been confirmed with any objective data. We designed a prospective randomized trial of the two-incision THA versus the mini-posterior technique to determine whether patients having two-incision THA, when compared with patients having mini-posterior THA, had evidence of less muscle damage as reflected by changes in hip muscle strength after surgery, a less antalgic gait as reflected by changes in the single-leg stance time and walking velocity, and better hip function as reflected by changes in the hip moments during level walking and stair climbing as assessed by comprehensive gait analysis testing. Twenty-one patients, including 13 men and eight women, were prospectively randomized to either the two-incision or the mini-posterior approach and completed preoperative and 6-week postoperative three-dimensional gait analyses and isometric strength testing. We found no evidence that patients who had two-incision THA had less muscle damage, less antalgic gait, or better gait kinematics than patients who had mini-posterior THA. Instead, when there was a difference in strength or gait parameters, it was the patients who had mini-posterior THA who tended to have quicker recovery. LEVEL OF EVIDENCE: Level II, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.