Resumen de Design, development and evaluation of a robotic platform for gait rehabilitation and training in patients with cerebral palsy
Cerebral Palsy (CP) is a set of neurological disorders derived from a brain lesion occurred in infancy or early childhood, which permanently affect body movement and muscle coordination. In some cases, these limitations go together with sensory or intellectual problems, which depend on the severity of the disease. CP is the most common physical disability in childhood, presenting a prevalence of 2.11 cases per 1000 births. Conventional treatments for CP could be divided in three main pillars (physiotherapy, occupational therapy and speech therapy), which must be continuously improved looking for better results for the patients.
As part of the enrichment of these conventional treatments, robot-assisted gait therapy is a promising tool that has appeared in the last years to complement conventional physical therapy of people with gait disorders as those derived from CP. However, the use of robotic trainers in pediatric clinical practice is still limited: clinicians and families demand further research that confirms the effectiveness of robotic therapy, and clarifies if robotic rehabilitation is worthwhile for their children.
The main objective of this doctoral thesis is to provide a novel robotic solution for gait rehabilitation of pediatric population with CP and related disorders. The approach that the proposed robotic device expects to offer is different from those existing so far, providing new ideas not only about the design and control of the device, but also about clinical intervention protocols. The methodology used to reach this objective was based on a detailed study about the application of robotic trainers developed in the last years for CP rehabilitation. This research identified the main limitations and challenges of current robotic therapies, which served as the base to design and develop a novel robotic platform in the framework of this thesis: CPWalker.
CPWalker is composed by two main parts: a smart walker and an exoskeleton with 6 degrees of freedom. Through them, it is possible to provide user's partial body weight support in parallel with guided joint motion and over-ground displacement.
CPWalker trainer promotes the progression of patients with CP into the rehabilitation treatment, increasing the level of intensity and frequency of the exercises as well as enhancing the motivation and tailoring the therapy to each user. To do so, innovative control strategies were used, which may be individually selected per joint giving a high versatility for the treatment's design.
The developed robotic platform was evaluated both technically and in clinical environments with pediatric patients. The results show the potential of the novel robotic platform to serve as a rehabilitation tool, also providing preliminary support for future clinical implementations not only in CPWalker, but also in other existing robotic gait trainers.
The work developed in this dissertation has been carried out with the financial support from the Ministerio de Economía y Competitividad of Spain and the Secretaría de Estado de Investigación, Desarrollo e Innovación, under Contract BES-2013-064225/DPI2012-39133-C03-01.
