Establishing Reliability and Objective Evaluation of 12 Weeks of Robotic Walking: Spasticity, Contracture and Muscle Strength
Date
2024-09-19
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Abstract
Background: Neurological conditions like Cerebral Palsy (CP) often lead to spasticity, contracture, and muscle weakness, affecting mobility. Current clinical measures for these impairments lack reliability and/or responsiveness to change and cannot differentiate between spasticity and contracture. Using objective tools like stationary dynamometers can provide more objective assessments and resolution to detect change. Robotic training provides ways to reduce sedentary time and experience walking in a safe and stable frame at home or in the community, potentially changing spasticity, contracture, and muscle weakness. Objective Aim 1 was to establish reliability for measuring knee flexor spasticity, contracture and knee extensor muscle strength in children who cannot walk due to neurological disorders using a stationary dynamometer. Aim 2 was to evaluate the impact of 12 weeks of robotic training on knee flexor spasticity, contracture and knee extensor muscle strength in the same population. Methods Project 1: Assessment of knee flexor spasticity, contracture and knee extensor muscle strength was conducted one month apart using a stationary dynamometer. Test-retest reliability was assessed using Intraclass Correlation Coefficients, Standard Error Measurement and Bland-Altman plots. Project 2: The impact of 12 weeks of robotic training on knee flexor spasticity, contracture and knee extensor muscle strength was evaluated using a stationary dynamometer. Wilcoxon signed-rank test was used to assess the significance of the change in spasticity, contracture and muscle strength following 12 weeks of robotic training. Results Project 1: Good relative reliability was observed for spasticity and contracture outcomes except at a higher speed. Absolute reliability was less than 15% of the mean baseline value for spasticity outcomes and more than 25% for outcomes influenced by contracture. Good relative reliability was observed for torque outcome of muscle strength and moderate relative reliability was observed for muscle activity outcome. Project 2: Twelve weeks of robotic training significantly reduced spasticity. 2 of 3 outcomes influenced by contracture were also reduced significantly with the remaining outcome unchanged. All five participants showed increased strength after 12 weeks of robotic training.
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Keywords
Cerebral palsy, Spasticity, Contracture, Muscle weakness, Robotic gait training, Test-retest reliability
Citation
Isapure, K. M. (2024). Establishing reliability and objective evaluation of 12 weeks of robotic walking: Spasticity, contracture and muscle strength (Master's thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca.