Evaluation and Rehabilitation of Cerebral Palsy

Description

Cerebral Palsy (CP) is a group of permanent but not unchangeable disorders of movement and posture that cause a limitation of activities, attributed to events occurring before the brain has completed its development in fetus, newborn or infant.
Motor disturbances are prevalent but not exclusive and can accompany problems of sensory-perceptions, cognition, communication, behavior, critical phenomena and secondary skeletal muscle problems. CP is therefore a condition due to central nervous system changes due to pre-, post- or post-natal causes before it completes growth and development, extremely heterogeneous in terms of etiology, type and severity of the disorder itself. Classification systems allow the functional framing of the patient and a common language recognized at international level, in particular:
GMFCS for the evaluation of gross-motor skills
MACS for Bimanual Skills Assessment
CFCS for assessing the effectiveness of communication
EDACS for assessing the ability in eating and drinking
VFCS for evaluating the use of visual function
Instrumental examinations can be performed for complex motor evaluations: isokinetics, surface EMG, stabilometry, Gait analysis, oxygen consumption.
The rehabilitation approach should respect the child's centrality and provide for customized functional activities while safeguarding the emotional dimension of the child
The treatment, aimed at building adaptive functions, is the result of an integrated process, not only motor but also perceptual, visual, cognitive, praxic-manipulative. It is therefore necessary to provide a multidisciplinary approach that should be premature and of high intensity with the involvement of the family.
These include early integrated treatment and constraint induced movement therapy (CIMT) consisting in the therapeutic penalization of the limb maintained and directed to patients with hemiplegia.
Robotic rehabilitation is considered a therapeutic option in treating patients with motor impairment with neurological aetiology.
Robotic systems are particularly well suited to training motor functions because they allow to produce and control with high precision different forces, allowing for personalization of rehabilitation and stimulation of tactile, perceptual and visual sensory systems.
The main devices used in this field are the DGO (Driven Gait Orthosis) (Lokomat) for the robotic gait rehabilitation and the Armeo for upper limb treatment. It is currently considered that the use of robotic systems is an integral part of the rehabilitation program. In experimental projects, a rehabilitation system was also introduced through immersive virtual reality.

Selected publications

• Effects of dose and duration of Robot-Assisted Gait Training on walking ability of children affected by cerebral palsy. Peri E, Turconi AC, Biffi E, Maghini C, Panzeri D, Morganti R, Pedrocchi A, Gagliardi C. Technol Health Care. 2017 Aug 9;25(4):671-681. doi: 10.3233/THC-160668.2.
• Family-centred care for children and young people with cerebral palsy: results from an Italian multicenter observational study. Molinaro A, Fedrizzi E, Calza S, Pagliano E, Jessica G, Fazzi E; GIPCI Study Group. Child Care Health Dev. 2017 Jul;43(4):588-597. doi: 10.1111/cch.12449. Epub 2017 Mar 9. No abstract available
• An Immersive Virtual Reality Platform to Enhance Walking Ability of Children with Acquired Brain Injuries. Biffi E, Beretta E, Cesareo A, Maghini C, Turconi AC, Reni G, Strazzer S.Methods Inf Med. 2017 Mar 23;56(2):119-126. doi: 10.3414/ME16-02-0020. Epub 2017 Jan 24
• Whole-Brain DTI Assessment of White Matter Damage in Children with Bilateral Cerebral Palsy: Evidence of Involvement beyond the Primary Target of the Anoxic Insult. Arrigoni F, Peruzzo D, Gagliardi C, Maghini C, Colombo P, Iammarrone FS, Pierpaoli C, Triulzi F, Turconi AC. AJNR Am J Neuroradiol. 2016 Jul;37(7):1347-53. doi: 10.3174/ajnr.A4717. Epub 2016 Mar 17
• Gait rehabilitation with a high tech platform based on virtual reality conveys improvements in walking ability of children suffering from acquired brain injury. Biffi E, Beretta E, Diella E, Panzeri D, Maghini C, Turconi AC, Strazzer S, Reni G. Conf Proc IEEE Eng Med Biol Soc. 2015;2015:7406-9. doi: 10.1109/EMBC.2015.7320103.
• An ecological evaluation of the metabolic benefits due to robot-assisted gait training. Peri E, Biffi E, Maghini C, Marzorati M, Diella E, Pedrocchi A, Turconi AC, Reni G. Conf Proc IEEE Eng Med Biol Soc. 2015 Aug;2015:3590-3. doi: 10.1109/EMBC.2015.7319169.
• Quantitative Evaluation of Performance during Robot-assisted Treatment. Peri E, Biffi E, Maghini C, Servodio Iammarrone F, Gagliardi C, Germiniasi C, Pedrocchi A, Turconi AC, Reni G. Methods Inf Med. 2016;55(1):84-8. doi: 10.3414/ME14-01-0126. Epub 2015 Dec 7
• Can new technologies improve upper limb performance in grown-up diplegic children? Turconi AC, Biffi E, Maghini C, Peri E, Servodio Iammarone F, Gagliardi C. Eur J Phys Rehabil Med. 2016 Oct;52(5):672-681. Epub 2015 Nov 10
• SIAMOC position paper on gait analysis in clinical practice: General requirements, methods and appropriateness. Results of an Italian consensus conference.Benedetti MG, Beghi E, De Tanti A, Cappozzo A, Basaglia N, Cutti AG, Cereatti A, Stagni R, Verdini F, Manca M, Fantozzi S, Mazzà C, Camomilla V, Campanini I, Castagna A, Cavazzuti L, Del Maestro M, Croce UD, Gasperi M, Leo T, Marchi P, Petrarca M, Piccinini L, Rabuffetti M, Ravaschio A, Sawacha Z, Spolaor F, Tesio L, Vannozzi G, Visintin I, Ferrarin M. Gait Posture. 2017 Aug 5;58:252-260
• Kinematic analysis of upper limb during walking in diplegic children with Cerebral Palsy.  Galli M, Cimolin V, Albertini G, Piccinini L, Turconi AC, Romkes J, Brunner R. Eur J Paediatr Neurol. 2014 Mar;18(2):134-9. doi: 10.1016/j.ejpn.2013.09.007. Epub 2013 Oct 11.
• Comparison of two pelvic positioning belt configurations in a pediatric wheelchair. Cimolin V, Avellis M, Piccinini L, Corbetta C, Cazzaniga A, Turconi AC, Galli M. Assist Technol. 2013 Winter;25(4):240-6
• The effects of femoral derotation osteotomy in cerebral palsy: a kinematic and kinetic study. Cimolin V, Piccinini L, Portinaro N, Turconi AC, Albonico S, Crivellini M, Galli M. Hip Int. 2011 Nov-Dec;21(6):657-64. doi: 10.5301/HIP.2011.8758
• Constraint-induced movement therapy for children with hemiplegia after traumatic brain injury: a quantitative study. Cimolin V, Beretta E, Piccinini L, Turconi AC, Locatelli F, Galli M, Strazzer S. J Head Trauma Rehabil. 2012 May-Jun;27(3):177-87. doi: 10.1097/HTR.0b013e3182172276
• Are knee kinematic anomalies in swing due to rectus femoris spasticity different from those due to femoral anteversion in children with cerebral palsy? A quantitative evaluation using 3D gait analysis.Cimolin V, Piccinini L, Turconi AC, Crivellini M, Galli M.J Pediatr Orthop B. 2010 May;19(3):221-5. doi: 10.1097/BPB.0b013e32833390ca
• 3D-Quantitative evaluation of a rigid seating system and dynamic seating system using 3D movement analysis in individuals with dystonic tetraparesis.Cimolin V, Piccinini L, Avellis M, Cazzaniga A, Turconi AC, Crivellini M, Galli M. Disabil Rehabil Assist Technol. 2009 Nov;4(6):422-8. doi: 10.3109/17483100903254553
• Relationship between kinematic knee deviations and femoral anteversion in children with cerebral palsy. Piccinini L, Cimolin V, Turconi AC, Galli M.

Partnership

• Neurological Institute “C. Besta”- Milan
• Italian Group for Cerebral Palsy (GIPCI)
• Gillette Children’s Specialty Healthcare – Saint Paul – MN – USA
• Karolinska Institutet - Ann-Christin Eliasson – Stockolm
• Kinderspital – Zurich – Andreas Meyer
• Hokoma – Motek Force – Floris Morang