Robotic-assisted Therapy to Improve Manual Dexterity in Children With Cerebral Palsy

Participants will be assessed 2 times - before and after training with the robot. All the
testing and training will be done at Spaulding Rehabilitation Hospital and will include:

Clinical tests:

- A physical examination where the investigators will measure of range of motion and
muscular strength for the shoulder, elbow, forearm, wrist, and fingers of the
participant.

- A test to assess spasticity at the shoulder; elbow; forearm, and wrist.

- A test to evaluate movement range, accuracy, dexterity and fluency during specific
tasks.

- A test to assess unilateral gross manual dexterity.

- A test to assess quality of life (social wellbeing and acceptance, feelings about
functioning, participation and physical health, emotional wellbeing and self-esteem,
access to service, pain and impact of disability, and family health).

Muscle activity tests:

• A test to get detailed measures of how well participant can perform movements. The measures
collected will include the movements of fingers, hands, and arms while picking up different
objects. This is done by attaching small reflective markers to fingers, hands, and arms of
the participant and special cameras in the room will film the movement of the markers.
Special sensors (called EMG) will be attached to hands and arms to tell the investigators
when muscles turn on and off while moving.

Training with the Robot:

18 times - up to 4 times per week within 7 weeks. The training will be done with a trained
study staff. The robot will provide help do the movements while the participant moves their
fingers to control computer games. The assistance provided by the robot will be adjusted to
the ability of the participant to use their hand. Each training session will last about 1
hour. This will include about 20 minutes for stretching, setup, and warm-up. Rest breaks
should be requested whenever needed. The investigators will closely monitor subject while
testing.

Inclusion Criteria:

- Diagnosis of CP with upper-limb impairment

- 9 to 14 years of age.

- Manual Ability Classification Scale Level II or III.

- Ability to communicate pain or discomfort.

Exclusion Criteria:

- Recent use of upper-limb robotic-assisted training within the last 3 months.

- Contraindication to robotic-assisted manual training such acute and pronounced pain
symptoms despite conventional pain therapy of the upper-limb, lack of compliance,
high-grade ataxia, advanced osteoporosis, and fractures of the upper-limb.

- Modified Ashworth Scale (MAS) of 4 in the upper-limb.