Robot-assisted rehabilitation for children with neurological disabilities: Results of the Italian consensus conference CICERONE

Issue title: Thematic Issue: Integrating Robot-assisted Therapy Into Neurorehabilitation Clinical Practice: Where Are We Now? Where Are We Heading?

Guest editors: Giovanni Morone, Robert Riener and Stefano Mazzoleni

Article type: Review Article

Authors: Castelli, Enrico^a | Beretta, Elena^b | De Tanti, Antonio^c | Arduini, Francesca^a | Biffi, Emilia^b | Colazza, Alessandra^a | Di Pede, Chiara^b | Guzzetta, Andrea^{d; e} | Lucarini, Ludovica^f | Maghini, Irene^g | Mandalà, Martina^h | Nespoli, Maurizioⁱ | Pavarelli, Claudia^j | Policastro, Francesca^k | Polverelli, Marco^l | Rossi, Andrea^m | Sgandurra, Giuseppina^{d; e} | Boldrini, Paoloⁿ | Bonaiuti, Donatellaⁿ | Mazzoleni, Stefano^o | Posteraro, Federico^p | Benanti, Paolo^q | Draicchio, Francesco^r | Falabella, Vincenzo^s | Galeri, Silvia^t | Gimigliano, Francesca^u | Grigioni, Mauro^v | Mazzon, Stefano^w | Molteni, Franco^x | Morone, Giovanni^y | Petrarca, Maurizio^z | Picelli, Alessandro^aa | Senatore, Michele^bb | Turchetti, Giuseppe^cc | Saviola, Donatella^{c; *}

Affiliations: [a] Bambino Gesù Children’s Hospital, Rome, Italy | [b] IRCCS Eugenio Medea, La Nostra Famiglia, Ponte Lambro, Italy | [c] KOS-CARE, Santo Stefano Rehabilitation, Cardinal Ferrari Center, Parma, Italy | [d] Dipartimento di Medicina Clinica e Sperimentale, Università di Pisa, Pisa, Italy | [e] Dipartimento di Neuroscienze dello Sviluppo, IRCCS Stella Maris, Pisa, Italy | [f] USL Umbria 2, Terni, Italy | [g] Department of Women’s and Children’s Health, Pediatric Pain and Palliative Care Service, University of Padua, Padua, Italy | [h] IRCCS Santa Maria Nascente - Fondazione Don C. Gnocchi, Milan, Italy | [i] AORN Santobono Pausilipon, Naples, Italy | [j] Servizio di Neuropsichiatria Infanzia e dell’Adolescenza (NPIA), Vignola, Italy | [k] Dipartimento Scienze Mediche e Chirurgiche, Università degli Studi di Trieste, Trieste, Italy | [l] Dipartimento Riabilitazione, Azienda Ospedaliera Nazionale SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy | [m] ASST Spedali Civili di Brescia, Ospedale dei Bambini, Brescia, Italy | [n] Italian Society of Physical Medicine and Rehabilitation, (SIMFER), Rome, Italy | [o] Department of Electrical and Information Engineering, Politecnico di Bari, Bari, Italy | [p] Department of Rehabilitation, Versilia Hospital – AUSL12, Viareggio, Italy | [q] Pontifical Gregorian University, Rome, Italy | [r] Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Rome, Italy | [s] Italian Federation of Persons with Spinal Cord Injuries (FAIP Onlus), Rome, Italy | [t] IRCCS Don Gnocchi Foundation Onlus, Milan, Italy | [u] Department of Mental, Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy | [v] National Center for Innovative Technologies in Public Health, Italian National Institute of Health, Rome, Italy | [w] Rehabilitation Unit, ULSS (Local Health Autority) Euganea, Camposampietro Hospital, Padua, Italy | [x] Department of Rehabilitation Medicine, Villa Beretta Rehabilitation Center, Valduce Hospital, Lecco, Italy | [y] IRCCS Santa Lucia Foundation, Rome, Italy | [z] Movement Analysis and Robotics Laboratory (MARlab), IRCCS Bambino Gesù Children’s Hospital, Rome, Italy | [aa] Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy | [bb] Associazione Italiana dei Terapisti Occupazionali (AITO), Rome, Italy | [cc] Insitute of Management, Scuola Superiore Sant’Anna, Pisa, Italy

Correspondence: [*] Address for correspondence: Donatella Saviola, KOS-CARE, Santo Stefano Rehabilitation, Cardinal Ferrari Center, Parma, Italy. E-mail: donatella.saviola@centrocardinalferrari.it.

Abstract: BACKGROUND:The use of robotic technologies in pediatric rehabilitation has seen a large increase, but with a lack of a comprehensive framework about their effectiveness. OBJECTIVE:An Italian Consensus Conference has been promoted to develop recommendations on these technologies: definitions and classification criteria of devices, indications and limits of their use in neurological diseases, theoretical models, ethical and legal implications. In this paper, we present the results for the pediatric age. METHODS:A systematic search on Cochrane Library, PEDro and PubMed was performed. Papers published up to March 1st, 2020, in English, were included and analyzed using the methodology of the Centre for Evidence-Based Medicine in Oxford, AMSTAR2 and PEDro scales for systematic reviews and RCT, respectively. RESULTS:Some positives aspects emerged in the area of gait: an increased number of children reaching the stance, an improvement in walking distance, speed and endurance. Critical aspects include the heterogeneity of the studied cases, measurements and training protocols. CONCLUSION:Many studies demonstrate the benefits of robotic training in developmental age. However, it is necessary to increase the number of trials to achieve greater homogeneity between protocols and to confirm the effectiveness of pediatric robotic rehabilitation.

Keywords: Robots, rehabilitation, gait, upper limb, lower limb, children

DOI: 10.3233/NRE-220036

Journal: NeuroRehabilitation, vol. 51, no. 4, pp. 665-679, 2022