PedBotLab: A Novel Video Game–Based Robotic Ankle Platform Created for Therapeutic Exercise for Children With Neurological Impairments

Abstract

Aims

Assess the potential benefits of using PedBotLab, a clinic based robotic ankle platform with integrated video game software, to improve ankle active and passive range of motion, strength, selective motor control, gait efficiency, and balance.

Methods

Ten participants with static neurological injuries and independent ambulation participated in a 10-week pilot study (Pro00013680) to assess feasibility and efficacy of PedBotLab as a therapeutic device twice weekly. Isometric ankle strength, passive and active ankle range of motion, plantarflexor spasticity, selective motor control of the lower extremity, balance, and gait speed were measured pre- and post-trial.  

Results

Statistically significant improvements were seen in flexibility, active range of motion, and strength in multiple planes of ankle motion. Ankle dorsiflexion with knee flexion and knee extension demonstrated statistically significant results in all outcome measures. No significant changes were observed in gait speed outcomes.  

Conclusions

The use of PedbotLab can lead to improvements in ankle strength, flexibility, and active range of motion for children with static neurological injuries. Future studies aim to evaluate the effect on gait quality and work toward developing a home-based device. 

Keywords:

• Adaptive gaming
• cerebral palsy
• constraint-induced movement therapy
• pediatrics
• rehabilitative robotics

IRB registration number:

• Pro00007337

Acknowledgements

We would like to thank William Coley, PhD, for his assistance with editing and formatting this paper. We would also like to thank our wonderful participants that enrolled in this study.

Disclosure statement

The authors report that they were part of the design and development team for the PedBotLab device and the PedBotLab study. The following authors are also on the patent US11389686B2: Cleary, Evans, Monfaredi, Talari, and Coley.

Additional information

Funding

This research was funded by U.S. Department of Health and Human Services (AWD00002531); NIH National Center for Advancing Translational Sciences (Clinical and Translational Science Institute Award UL1TR001876); and the American Academy for Cerebral Palsy and Developmental Medicine.

Notes on contributors

Justine Belschner

Justine Belschner, PT, DPT, PCS, is a physical therapist and board certified pediatric clinical specialist who has been practicing at Children’s National Hospital for the last 10 years. She practices in both the acute and outpatient settings at Children’s in addition to her research with rehabilitation robotics.

Catherine Coley

Catherine Coley, PT, DPT, PCS, is a physical therapist and pediatric clinical specialist at Childrens National Hospital since 2005. She treats children with cerebral palsy, arthrogryposis, and complex medical conditions using neurodevelopmental treatment, therapeutic handling, task specific training, and serial casting, in addition to performing gait analysis in the motion capture lab.

Staci Kovelman

Staci Kovelman, PT, DPT, PCS, is physical therapist, board certified pediatric clinical specialist, with 10 years of experience in the outpatient, acute care, and research settings. During her time at Children’s National she joined the PedBot research team with an interest in rehabilitation robotics. She currently works for INOVA LJ Murphy Childrens Hospital.

Tyler Salvador

Tyler Salvador, BS, is a mechanical engineering graduate from the University of Maryland. He has worked in the Sheikh Zayed Institute for Pediatric Surgical Innovation at Children’s National Hospital for 7 years as a research engineer. His skills include rapid prototyping and mechanical design.

Reza Monfaredi

Reza Monfaredi, PhD, is an assistant professor at Pediatric Department of George Washington University, and Children’s National Medical Center, Washington DC, where he completed his postdoctoral fellowship in 2013. He is also an adjunct faculty at Maryland University–College Park. His main focus is medical devices, MRI-compatible, and rehabilitation robotics.

Manon Schladen

Manon Schladen, PhD, is a biomedical engineer researching interactive technologies for health management. As a principal investigator at Catholic University's NIDILRR-sponsored Rehabilitation Engineering Research Center, Dr. Schladen studies reach and grasp development, game-based exercise systems, and exoskeleton technology for therapeutic hand exercise.

Hadi Fooladi Talari

Hadi Fooladi Talari, M.Sc., is a software engineer at Children’s National Health System. He has served as a research and development engineer in the Sheikh Zayed Institute for Pediatric Surgical Engineering since 2016. In that time, he has developed variety of windows/web/mobile applications and games for different projects.

Eduardo A. Trujillo Rivera

Eduardo A. Trujillo Rivera, PhD, is Assistant Professor in Data Science at Children’s National Hospital. He assists a wide range of medical researchers across numerous Departments at different stages of their research projects by proposing experimental/observational designs, suggesting, performing, and explaining statistical and machine learning models specifics to the task at hand.

Kevin Cleary

Kevin Cleary, PhD, is medical researcher with over 25 years of experience. He is an Associate Director at the Sheikh Zayed Institute for Pediatric Surgical Innovation at Children’s National Hospital. He directs the Bioengineering Team. He has worked with many clinical departments, including surgery, radiology, the ICUs, rehabilitation, and the ER.

Sarah Helen Evans

Sarah Helen Evans, MD, is a Professor of Clinical Pediatrics and Physical Medicine and Rehabilitation at the Perelman School of Medicine, University of Pennsylvania, where she practices as a pediatric physiatrist. She helped to develop PedBot at Children’s National Hospital. Dr. Evans co-authored “Rehabilitation Robotics” in Pediatric Rehabilitation.