Cook Children’s Neuroscience Research Center, led by Christos Papadelis, PhD, is the recipient of a $50,000 research grant funded by the National Institutes of Health (NIH) through the National Pediatric Rehabilitation Resource Center, also known as CPROGRESS, for a study mapping the brain’s response to robotic-assisted rehabilitation in children with unilateral cerebral palsy.

“We are one of very few centers in the United States mapping changes in the brain as a result of robotic rehabilitation,” Dr. Papadelis said. “It’s not the rehabilitation by itself or the robotic system by itself, but it's the fact that we try to map the brain’s plasticity or what type of plasticity takes place in the brains of these kids in response to the rehabilitation.”    

Cerebral palsy is one of the most common childhood disorders in the United States. About one in every 345 children in the country have some form of the neurological disorder, which affects movement and muscle coordination. The condition can impact the lower or upper extremities, all four limbs or one side of the body. In any case, physical rehabilitation is crucial to maximizing movement and muscle control.

For children with unilateral cerebral palsy, meaning one side of the body is affected, conventional rehabilitation utilizes constraint-induced movement therapy in which the dominant, unaffected limb is immobilized in order to force the paralytic limb to do all of the work. While effective, children aren’t always cooperative with wearing constraint devices and performing this type of repetitive, or what they might call boring, therapy. 

But kids do like video games. As digital natives, they have never known a smart device they couldn’t navigate. For this reason, robotic therapy is emerging as an important rehabilitation tool for children. The digital nature of the bot captures their attention and speaks a language they understand. 

While researchers know robot-assisted rehabilitation has its benefits, there is a lot they still do not know about the application of this type of therapy in the pediatric population.

“There's not much research on how robotics help children with cerebral palsy,” Dr. Papadelis said. “We don’t yet have a gold standard on how much treatment, how many days and how intense it should be in order to have successful outcomes. We want the brain to reorganize based on the rehabilitation, but can this kind of mapping be maladaptive and go in a direction we don’t want it to go?”

Thanks to the NIH grant, Cook Children’s Neuroscience Research Center is studying the use of robot-assisted rehabilitation for children with unilateral cerebral palsy in order to address these uncertainties and establish best practices. 

The robot used is akin to a video gaming system. Using the fingers and hand of the impacted limb, patients manipulate a type of sensor-based robotic joystick while playing a video game generated by the robot’s computer system. The system measures functions such as range of motion, spasticity and strength in order to tailor the interactive video games to the patient and increase engagement. It also uses vibrations to stimulate the patient’s motor sensories.  

“There's a hypothesis that the more information we provide to the somatosensory system in the brain, the better the motor responses,” Dr. Papadelis explained.

While interacting with the robot, patients also undergo an electroencephalography (EEG) study where dozens of electrodes are placed on the scalp to measure the electrical activity of the brain. 

“Using this tool, we are able to map changes in the brain as a result of this rehabilitation. It tells us if the parameters of the treatment are sufficient, or if we need more intense treatment, less intense treatment and whether this type of treatment is beneficial for one child or for all kids,” Dr. Papadelis said. “Kids with cerebral palsy all have different underlying etiologies. For example, some kids have cerebral palsy as a result of stroke. Some as a result of infection or hemorrhage. Because cerebral palsy is an umbrella term, we're trying to understand if this treatment is beneficial and for which group of patients. And, if it's beneficial for this group of patients, how much we should provide them in terms of treatment length.”

Sadra Shahdadian, PhD, a postdoctoral research fellow under Dr. Papadelis’ supervision, serves as co-principal investigator for the study. Drs. Papadelis and Shahdadian hope that at the completion of this one-year grant cycle the research team will have collected enough preliminary data to support their hypothesis and better define the use of robot-assisted rehabilitation in children with cerebral palsy. They also hope their work leads to a larger NIH grant or philanthropic support for a more in-depth and long-term study of pediatric robotic therapy.