February 4, 2020
Clinical Experience with the Armeo®Senso in Children
Swiss Children’s Rehab, University Children’s Hospital Zurich, Switzerland
Our robotic upper extremity team is experienced in applying robotic technologies to children and adolescents with upper extremity impairments, mainly caused by neurological disorders like cerebral palsy, stroke or traumatic brain injury. We recently added the Armeo®Senso to our robotic therapy, as it fills a gap in the therapeutic goals that can be addressed. Here we would like to share our first experience with using the ArmeoSenso in a pediatric patient population.
In our center, we provide upper extremity therapy with rehabilitation technologies to children and adolescents starting from age 4-5 years old with neurological diagnoses. We rarely apply technologies to younger children because of the cognitive status of the child and sometimes anthropometrics. In general, we find that the ArmeoSenso is well accepted by our young patients.
The Upper Extremity Training Program
We offer both an inpatient and an outpatient therapy program, whereby we combine rehabilitation technologies and conventional therapy. With the technologies, including robotics and exergames, we focus on improving upper extremity body functions (according to the International Classification of Functioning, Disability and Health), while the conventional upper extremity therapies target the transfer to daily life. In our opinion, by using these highly complementary approaches, we can offer the best upper extremity program tailored to the needs of our patients.
Prior to the upper extremity training program, every patient and his/her parents together with the rehabilitation team formulate personalized therapeutic goals related to improving their arm and hand function.
The inpatient robotic therapy program typically consists of 2 to 3 training sessions per week, each lasting 45 minutes (30 to 35 minutes of effective training time). The total number of sessions will ultimately depend on the duration of the inpatient stay.
The outpatient program includes 12 conventional and 12 technology based therapeutic sessions (45 minutes each), as well as 3 assessment sessions, and a closure meeting with the parents.
In general, the therapist supervises the patient in a one to one session.
Some children start their training program with technology that provides more physical support, like the Armeo®Spring, and they graduate onto the ArmeoSenso when strength and coordination allow. Another approach for children who require physical assistance to move their arm against gravity could be to use an arm suspension system while the children are training with the ArmeoSenso. It is a good solution, as it allows higher shoulder elevation or abduction movements compared to other technologies, such as table-mounted arm weight support systems.
Reasons to Include the ArmeoSenso as Part of the Therapy Program
The ArmeoSenso is part of the technology range we have in our center. It is currently used with a vast majority of our patients to collect experiences with its application in a broad group of patients. The ArmeoSenso fills a niche in our range of technologies, as it allows us to focus specifically on training selective movements as well as strength-endurance in those children who can lift their arm against gravity.
The short setup time allows to spend most of the session in effective therapy time. The device is intuitive to use and the therapists could master it fast. The fixation material (belt and arm bands) fits children starting from 4-5 years old. While the hand module fits in the hand of smaller children, its weight sometimes does not allow to use it for a full training session. In this case, we continue training without hand module, unchecking the option in the software.
Due to the combination with game-like exercises, the children like to train with the device and perform many repetitions of arm and hand movements. This supports the recovery of arm and hand motor function (for example, reaching workspace and movement coordination). The conventional occupation therapy aims to improve daily life independence and participation. The improved motor functions could contribute to a better outcome on the activity level (for example, reach and grab a cup on a shelf, pour a glass of water).
When children improve, we change the settings (like the workspace) to adapt the exercises to the actual performance of the child and to keep training challenging and engaging.
Organization: Responsible Therapy Team
Our team of experienced and trained occupational therapists work with both the various rehabilitation technologies as well as the conventional occupational methods and techniques. They are responsible for planning the treatment, performing the assessments, are in contact with the companies and are closely involved in research in combination with the Pediatric Rehab Research Department of our center.
The research team currently uses the ArmeoSenso for a project sponsored by the Swiss National Science Foundation. The goal of this project is to specifically train selective voluntary motor control. The research group has developed a special exercise that they are now being tested in healthy participants and patients using the ArmeoSenso, as well as an EMG based system.
About Us: Swiss Children’s Rehab, University Children’s Hospital Zurich
The Children’s Hospital Zurich is the largest pediatric university hospital in Switzerland and one of the leading pediatric medical centers in Europe. Patients from newborns to 18-year-olds receive care at the hospital. The aim of the Swiss Children’s Rehab is to help the affected children and adolescents to become as independent as possible, thereby improving the quality of life of the whole family. The rehabilitation programs are continually being advanced through the projects of the Pediatric Rehab Research Group, which focus on robotic and computer-assisted movement therapy in a virtual environment.
This clinical experience report is meant to serve as an example of how the ArmeoSenso is integrated into one particular rehabilitation centre. It is not necessarily a standard recommendation from Hocoma.