An ankle strengthening device with virtual reality interface for children with cerebral palsy

Cerebral Palsy  Nonprogressive lesion in CNS during development  Characterization Types of CP Spasticity and Weakness Gait  Impact on quality of life Introduction ○ Current Technologies ○ The Need ○ Project Scope ○ Our Approach

Current Treatment Approach  Currently no cure  Treatments goals  Typical treatments Surgical Pharmaceutical Orthotics Physical, occupational, and speech therapies  Historical perspective  Recent research findings Introduction ○ Current Technologies ○ The Need ○ Project Scope ○ Our Approach Engsberg 2007

Physical Therapy Devices for CP MIT Anklebot LokomatKinCom Introduction ○ Current Technologies ○ The Need ○ Project Scope ○ Our Approach Rutgers AnkleNeuroGym Ankle Trainer  Key Limitations Lab vs home use Cost Reliability Patient motivation

The Need  A strength training device that is safe for in-home use requires minimal setup or user training is affordable is portable motivates patient participation Introduction ○ Current Technologies ○ The Need ○ Project Scope ○ Our Approach

Virtual Reality in Rehabilitation Introduction ○ Current Technologies ○ The Need ○ Project Scope ○ Our Approach Rutgers Ankle  Virtual Reality  Rehabilitation Applications Virtual Environments Kinect Rutgers Ankle Wii Sun Yat-Sen Memorial Hospital Mirelman 2010 Engsberg 2011

Virtual Reality in Rehabilitation  Virtual Reality  Rehabilitation Applications Virtual Environments Kinect Rutgers Ankle Wii Introduction ○ Current Technologies ○ The Need ○ Project Scope ○ Our Approach

The Scope To design an at-home ankle strengthening device – Flex2Play – that motivates participation by interfacing the therapy with a WiiMote which controls online video games Introduction ○ Current Technologies ○ The Need ○ Project Scope ○ Our Approach

Specifications  Full range of motion 20° from neutral in dorsiflexion -50° from neutral in plantarflexion  Progressive Resistance 115 Nm dorsiflexion torque 173 Nm plantarflexion torque Available in at least 15% increments  Affordable – $200 target  Portable – 8 ft 3  Virtual Reality Interface 2010 BME401 Group “Wii Controlled Gaming for Therapy” Introduction ○ Current Technologies ○ The Need ○ Project Scope ○ Our Approach 20° Dorsiflexion 0° Neutral –50° Plantarflexion Plantarflexion τ=F*d*sin(θ) F=173Nm*0.28m*sin(90) F=605N Dorsiflexion τ=F*d*sin(θ) F=115Nm*0.28m*sin(90) F=402N

Additional Design Considerations  Training muscles during concentric vs eccentric contractions  Training muscles at peak power Introduction ○ Current Technologies ○ The Need ○ Project Scope ○ Our Approach

The Flex2Play Approach Division of Labor Liz – Expressive Final Presentation CAD Drawings Web Designer Amanda – Driver Progress Presentation Schedule Manager Design Safe Kelly – Analytical Preliminary Presentation Weekly Reports Software Interface Manager Meet weekly with mentor Write and revise reports Conduct background research Provide feedback to group Mentorship Dr. Jack Engsberg Dr. Frank Yin Lin Bai Introduction ○ Current Technologies ○ The Need ○ Project Scope ○ Our Approach

– Preliminary Report and Presentation The Flex2Play Approach Schedule of Events Introduction ○ Current Technologies ○ The Need ○ Project Scope ○ Our Approach Sept 1 Oct 1 Nov 1Dec 1 – Choose Project– Define Scope – Launch Website– Design Safe Analysis – Progress Report and Presentation – Final Report and Presentation – Concept Selection – Design Fabrication and Optimization

Works Cited  An, Tonya, Eric Boccio and Andrew Bolano. "Wii Controlled Gaming System for Therapy". BME401 Senior Design Report. St. Louis: Washington University in St. Louis,  Bax, MCO, O Flodmark and C Tydeman. "Definition and classifi cation of cerebral palsy. From syndrome toward disease." Dev Med Child Neurol Suppl 109 (2007): 39–41.  Borggraefe, Ingo. "Robotic-assisted treadmill therapy improves walking and standing performance in children and adolescents with cerebral palsy." European Journal of Paediatric Neurology (2010):  Cioi, D, et al. "Ankle Control and Strength Training for Children with Cerebral Palsy using the Rutgers Ankle CP." IEEE International Conference on Rehabilitation Robotics. Zurich,  Damiano, DL and MF Abel. "Functional Outcomes of Strength Training in Spastic Cerebral Palsy." Arch Phys Med REhabil (1998):  Dodd, KJ, NF Taylor and HK Graham. "A randomized clinical trial of strength training in young people with cerebral palsy." Developmental Medicine and Child Neurology (2003):  Engsberg, Jack, Daniel Cioi and Janes William. "Ankle Control and Strength Training for Children with Cerebral Palsy using the Rutgers Ankle CP." IEEE International Conference on Rehabilitation Robotics (2011):  Engsberg, JR, et al. "Gait and clinical movement analysis research priorities: 2007 Update from the research committee of the gait and clinical movement analysis society." Gait and Posture (2009):  Engsberg, JR, SA Ross and DR Collins. "Increasing Ankle Strength to Improve Gait and Function in Children with Cerebral Palsy: A Pilot Study." Pediatric Physical Therapy (2006):  Hocoma. Lokomat - Enhanced Functional Locomotion Therapy September  Levac, DE and J Galvin. "Facilitating clinical decision-making about the use of virtual reality within paediatric motor rehabilitation: Application of a classification framework." Developmental Neurorehabilitation (2011):  NeuroGym. NeuroGym Rehabilitation September  —. NeuroGym Technologies September  Roy, A., H. I. Krebs and D. J. Williams. "Robot-Aided Neurorehabilitation: A Novel Robot for Ankle Rehabilitation." Robotics (2009):