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Research Papers

Adapted Motor-Assisted Elliptical for Rehabilitation of Children With Physical Disabilities

[+] Author and Article Information
Judith M. Burnfield

Institute for Rehabilitation
Science and Engineering,
Madonna Rehabilitation Hospitals,
5401 South Street,
Lincoln, NE 68506
e-mail: jburnfield@madonna.org

Thad W. Buster

Institute for Rehabilitation
Science and Engineering,
Madonna Rehabilitation Hospitals,
5401 South Street,
Lincoln, NE 68506
e-mail: tbuster@madonna.org

Chase M. Pfeifer

Institute for Rehabilitation
Science and Engineering,
Madonna Rehabilitation Hospitals,
5401 South Street,
Lincoln, NE 68506
e-mail: cpfeifer@madonna.org

Sonya L. Irons

Institute for Rehabilitation
Science and Engineering,
Madonna Rehabilitation Hospitals,
5401 South Street,
Lincoln, NE 68506
e-mail: sirons@madonna.org

Guilherme M. Cesar

Institute for Rehabilitation
Science and Engineering,
Madonna Rehabilitation Hospitals,
5401 South Street,
Lincoln, NE 68506
e-mail: gcesar@madonna.org

Carl A. Nelson

Department of Mechanical and
Materials Engineering,
University of Nebraska-Lincoln,
W316 Nebraska Hall, P.O. Box: 880526,
Lincoln, NE 68588
e-mail: cnelson5@unl.edu

1Corresponding author.

Manuscript received February 7, 2018; final manuscript received September 12, 2018; published online December 4, 2018. Assoc. Editor: Elizabeth Hsiao-Wecksler.

J. Med. Devices 13(1), 011006 (Dec 04, 2018) (9 pages) Paper No: MED-18-1027; doi: 10.1115/1.4041588 History: Received February 07, 2018; Revised September 12, 2018

Many children with physical disabilities experience difficulty using traditional exercise equipment for gait rehabilitation and fitness training, and the clinician resources required to deliver intensive overground or treadmill-based therapies are infrequently available in most clinics, hospitals, and school settings. This work describes design and testing of a comprehensive set of modifications that enabled children to use a commercially available robotic exercise device (i.e., Intelligently Controlled Assistive Rehabilitation Elliptical (ICARE)) initially developed to address walking and fitness goals of adults with physical disabilities and chronic conditions. Fifteen children (3–11 years old) concurrently enrolled in physical therapy due to varied neurologic conditions were recruited with their parent(s) to evaluate the safety, comfort, and usability of the adult ICARE and pediatric-modified ICARE. After children tried each device, feedback was recorded. To assess feasibility, each child then participated in up to ten sessions (two to five sessions per week; average session length: 38 min, range 21–66 min) using the pediatric-modified ICARE. Parents, on average, perceived that the pediatric-modified ICARE was significantly safer, more comfortable and usable than the adult ICARE. Children's perceptions of the pediatric-modified ICARE were similar, although not statistically significant. Children used the prototype device during 133 sessions for over 3800 min and more than 162,000 cycles. In conclusion, this study demonstrated the feasibility of using the pediatric-modified ICARE with children as young as 3 years old as an adjunct to ongoing therapy.

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References

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Figures

Grahic Jump Location
Fig. 1

ICARE technology used to address walking and fitness goals of adults and adolescents with physical disabilities and chronic conditions

Grahic Jump Location
Fig. 2

Bruno Valet® Plus installed on the pediatric-modified ICARE. The white arrows demonstrate the motion of the motorized chair as it elevates from the lowest position (a), retracts over the base of the ICARE (b), and pivots to align the child facing forward (c–e).

Grahic Jump Location
Fig. 3

Screw-driven pedal jack

Grahic Jump Location
Fig. 4

Movement profile of markers placed on posterior and anterior surface of right pedal demonstrated notable similarities when pedal was elevated 33 cm (17 in) on the screw-driven pedal mount (upper trajectories) compared to the traditional ICARE pedal mount (lower trajectories). These data suggest that the screw-driven pedal mount could provide a suitable means of elevating a young child to the console without disrupting pedal trajectory.

Grahic Jump Location
Fig. 5

Adjustable rear crank mechanism accommodated the shorter step length and height requirements of younger/smaller children

Grahic Jump Location
Fig. 6

Pediatric-modified ICARE pedal mounting interface with width adjustable slots

Grahic Jump Location
Fig. 7

Pedal-integrated ankle-foot orthosis in translational dovetail channel allowed customization of external support for each lower extremity during use

Grahic Jump Location
Fig. 8

Removable adjustable handles made it easier for young children with shorter arms to reach and use the reciprocally moving handles without leaning forward or stretching upward. Handles rotated inward and outward to accommodate variations in upper extremity range of motion.

Grahic Jump Location
Fig. 9

Tablet and mounting system on pediatric-modified ICARE

Grahic Jump Location
Fig. 10

Example of challenges a young child might experience when trying to use the ICARE (a) and pediatric-modified ICARE (b)

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