Robot-Assisted Therapy Improves Motor Function in Individuals after Cerebral Hemispherectomy (P5.180)

OBJECTIVE: To evaluate the feasibility and efficacy of intensive robot-assisted therapy for improving long-term motor deficits after cerebral hemispherectomy. BACKGROUND: Few studies exist on rehabilitation methods for hemiparesis in chronic-phase cerebral hemispherectomy patients. Effective regimens are needed as they face significant disabilities. Robot-assisted rehabilitative devices are designed to deliver high-intensity, high-repetition therapy with continuous interactive responses. DESIGN/METHODS: Seven post-hemispherectomy patients (11.2±0.9 years; age at time of first surgery 0.25-9 years; all subjects >1 year from last surgery) received 8 days of robot-assisted rehabilitation, three hours/day (1 hour each of Hocoma Lokomat® driven gait orthosis on treadmill, InMotion ANKLE™ for foot dorsiflexion/plantarflexion and InMotion ARM™ for upper extremity horizontal movements) over 2 weeks. Outcome measures were assessed pre- and post-intervention on the hemiparetic side using Fugl-Meyer Assessment, Wolf Motor Function Test functional ability (WFMT-FAS) and time (WFMT-TIME), Chedoke Arm and Hand Activity Inventory (CAHAI), Six-Minute Walk Test (6MWT), and 10 Meter Walk Test (10MWT). RESULTS: Significant improvements were seen in Fugl-Meyer (P=0.02), WFMT-FAS (P=0.005), WFMT-TIME (P<0.001), 6MWT distance (P=0.04) and 6MWT speed (P<0.05). No significant improvement was seen in CAHAI or 10MWT. CONCLUSIONS: Intensive robot-assisted therapy improved upper extremity motor functional ability and gait endurance in post-hemispherectomy children. A short-duration, high-intensity regimen of robot-assisted therapy is a feasible and efficacious rehabilitation method in these children. Improvements were seen despite participants being well out of the acute recovery period, supporting the idea of continuing neuroplasticity in the remaining cerebral cortex. The CAHAI may not be sensitive enough to capture the participants’ changes, and the number of therapy sessions may not be enough to effect a change in top walking speed. Whether greater improvements would be seen with more prolonged therapy, or with a less-intense regimen over a greater period of time, remains to be tested. Disclosure: Dr. Shaw has nothing to disclose. Dr. Chu Jr has nothing to disclose. Dr. Blydt-Hansen has nothing to disclose. Dr. Aisen has nothing to disclose.