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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Fowler, E. G. , Kolobe, T. H. , Damiano, D. L. , Thorpe, D. E. , Morgan, D. W. , Brunstrom, J. E. , Coster, W. J. , Henderson, R. C. , Pitetti, K. H. , Rimmer, J. H. , Rose, J. , Stevenson, R. D. , Section on Pediatrics Research Summit Participants, and Section on Pediatrics Research Committee Task Force, 2007, “ Promotion of Physical Fitness and Prevention of Secondary Conditions for Children With Cerebral Palsy: Section on Pediatrics Research Summit Proceedings,” Phys. Ther., 87(11), pp. 1495–1510. [CrossRef] [PubMed]
Bandini, L. , Danielson, M. , Esposito, L. E. , Foley, J. T. , Fox, M. H. , Frey, G. C. , Fleming, R. K. , Krahn, G. , Must, A. , Porretta, D. L. , Rodgers, A. B. , Stanish, H. , Urv, T. , Vogel, L. C. , and Humphries, K. , 2015, “ Obesity in Children With Developmental and/or Physical Disabilities,” Disability Health J., 8(3), pp. 309–316. [CrossRef]
Verschuren, O. , Peterson, M. D. , Balemans, A. C. , and Hurvitz, E. A. , 2016, “ Exercise and Physical Activity Recommendations for People With Cerebral Palsy,” Dev. Med. Child Neurol., 58(8), pp. 798–808. [CrossRef] [PubMed]
Fowler, E. G. , Knutson, L. M. , Demuth, S. K. , Siebert, K. L. , Simms, V. D. , Sugi, M. H. , Souza, R. B. , Karim, R. , and Azen, S. P. , and Physical Therapy Clinical Research Network (PTClinResNet), 2010, “ Pediatric Endurance and Limb Strengthening (PEDALS) for Children With Cerebral Palsy Using Stationary Cycling: A Randomized Controlled Trial,” Phys. Ther., 90(3), pp. 367–381. [CrossRef] [PubMed]
Fragala-Pinkham, M. A. , Haley, S. M. , Rabin, J. , and Kharasch, V. S. , 2005, “ A Fitness Program for Children With Disabilities,” Phys. Ther., 85(11), pp. 1182–1200. [PubMed]
Burnfield, J. M. , Shu, Y. , Buster, T. , and Taylor, A. , 2010, “ Similarity of Joint Kinematics and Muscle Demands Between Elliptical Training and Walking: Implications for Practice,” Phys. Ther., 90(2), pp. 289–305. [CrossRef] [PubMed]
Burnfield, J. M. , Irons, S. L. , Buster, T. W. , Taylor, A. P. , Hildner, G. A. , and Shu, Y. , 2014, “ Comparative Analysis of Speed's Impact on Muscle Demands During Partial Body Weight Support Motor-Assisted Elliptical Training,” Gait Posture, 39(1), pp. 314–320. [CrossRef] [PubMed]
Nelson, C. A. , Burnfield, J. M. , Shu, Y. , Buster, T. W. , Taylor, A. , and Graham, A. , 2011, “ Modified Elliptical Machine Motor-Drive Design for Assistive Gait Rehabilitation,” ASME J. Med. Devices, 5(2), p. 021001. [CrossRef]
Irons, S. L. , Brusola, G. A. , Buster, T. W. , and Burnfield, J. M. , 2015, “ Novel Motor-Assisted Elliptical Training Intervention Improves Six-Minute Walk Test and Oxygen Cost for an Individual With Progressive Supranuclear Palsy,” Cardiopulm. Phys. Ther. J., 26(2), pp. 36–41. [CrossRef]
Irons, S. L. , Buster, T. W. , Karkowski-Schelar, E. , Johns, E. , and Burnfield, J. M. , 2016, “ Individuals With Multiple Sclerosis Improved Walking Endurance and Decreased Fatigue Following Motor-Assisted Elliptical Training Intervention,” Arch. Phys. Med. Rehabil., 97(10), p. e34. [CrossRef]
Burnfield, J. M. , Taylor, A. P. , Buster, T. W. , Shu, Y. , Goldman, A. J. , and Nelson, C. A. , 2011, “ Use of Intelligently Controlled Assistive Rehabilitation Elliptical Trainer to Improve Walking and Fitness During Acute Stroke Rehabilitation,” Stroke, 42(3), p. e326. https://www.ahajournals.org/doi/pdf/10.1161/STR.0b013e3182074d9b
Burnfield, J. M. , Yeseta, M. , Buster, T. W. , Taylor, A. P. , and Shu, Y. , 2012, “ Individuals With Physical Limitations Can Benefit From Training on a Motorized Elliptical for Community-Based Exercise,” Med. Sci. Sports Exercise, 45(5S), p. S360. https://journals.lww.com/acsm-msse/Fulltext/2012/05002/Abst_D_FreeCommPosters.5.aspx
Burnfield, J. M. , Shu, Y. , Buster, T. W. , Taylor, A. P. , and Nelson, C. A. , 2011, “ Impact of Elliptical Trainer Ergonomic Modifications on Perceptions of Safety, Comfort, Workout, and Usability for People With Physical Disabilities and Chronic Conditions,” Phys. Ther., 91(11), pp. 1604–1617. [CrossRef] [PubMed]
Beck, R. J. , Andriacchi, T. P. , Kuo, K. N. , Fermier, R. W. , and Galante, J. O. , 1981, “ Changes in the Gait Patterns of Growing Children,” J. Bone Jt. Surg. Am., 63(9), pp. 1452–1457. [CrossRef]
Perry, J. , and Burnfield, J. M. , 2010, Gait Analysis: Normal and Pathological Function, Slack Incorporated, Thorofare, NJ.
Nelson, C. A. , Stolle, C. J. , Burnfield, J. M. , and Buster, T. W. , 2015, “ Modification of the ICARE System for Pediatric Therapy,” ASME J. Med. Devices, 9(4), p. 041010. [CrossRef]
Fryar, C. D. , Gu, Q. , and Ogden, C. L. , 2012, “ Anthropometric Reference Data for Children and Adults: United States, 2007-2010,” Vital Health Stat., Ser., 11(252), pp. 1–48. https://www.cdc.gov/nchs/data/series/sr_11/sr11_252.pdf
Snyder, R. G. , Schneider, L. W. , Owings, C. L. , Reynolds, H. M. , Golomb, D. H. , and Schork, M. A. , 1977, “ Anthropometry of Infants, Children, and Youths to Age 18 for Product Safety Design, Final Report,” Highway Safety Research Institute, The University of Michigan, Ann Arbor, MI, Report Nos. UM-HSRI-77-17 and SAE SP-450.
Winter, D. A. , 2009, Biomechanics and Motor Control of Human Movement, 4th ed., Wiley, Hoboken, NJ.
Contini, R. , 1972, “ Body Segment Parameters—Part II,” Artif. Limbs, 16(1), pp. 1–19. http://www.oandplibrary.org/al/pdf/1972_01_001.pdf [PubMed]
Kadaba, M. P. , Ramakrishnan, H. K. , Wootten, M. E. , Gainey, J. , Gorton, G. , and Cochran, G. V. B. , 1989, “ Repeatability of Kinematic, Kinetic and Electromyographic Data in Normal Adult Gait,” J. Orthop. Res., 7(6), pp. 849–860. [CrossRef] [PubMed]
Kraus, L. , 2017, 2016 Disability Statistics Annual Report, University of New Hampshire, Durham, NH.
Centers for Disease Control and Prevention, 2018, “ Physical Activity Basics: How Much Physical Activity Do You Need?,” Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, accessed Sept. 11, 2018, http://www.cdc.gov/physicalactivity/basics/index.htm


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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