Cerebral palsy is one of the most prevalent pediatric disorders, with an estimated incidence ranging from 1.6 to 3.4 cases per 1000 live births, varying based on the development of the reference country. Characterized by motor impairments such as spasticity and weakness, cerebral palsy may be associated with secondary symptoms and complications such as epilepsy, learning disorders, and visual problems. Early diagnosis allows for a multidisciplinary intervention involving a team of speech therapists, neuropsychiatrists, physiotherapists, occupational therapists, and psychologists from early childhood. In the rehabilitative context, the introduction of specific aids and the adoption of adapted physical activities, with a play-rehabilitative approach, represent fundamental strategies. This work is situated in the field of sports for individuals with disabilities and has two objectives: 1) to assess and develop orthoses aimed at enabling the execution of sports movements in individuals with functional limitations; 2) to define rehabilitative protocols using sports practice as a complementary approach to therapeutic exercise. In particular, my thesis has expanded understanding of the quantitative assessment of movement in children with cerebral palsy, focusing on the kinematic and kinetic analysis of walking and running with and without the use of ankle-foot orthoses (AFOs), as well as kinematic analysis during rowing and tests for upper limb evaluation. Through a multidisciplinary approach based on biomechanical assessment, my work has highlighted the importance of specific aids, such as AFOs, and explored the application of a rehabilitative protocol based on biomechanical assessment of indoor rowing as a play-motor strategy. The first project emphasized the need to design new orthoses suitable for sports, highlighting limitations in current market proposals. The newly tested brace demonstrated allowing greater dorsiflexion ranges during walking under various conditions and during running. The impact of commonly used AFOs was compared with a new generation of AFO designed for sports activities during walking in children with hemiplegia on different slopes (uphill, downhill, and flat). The new AFO showed significant improvements in ankle dorsiflexion and plantarflexion, foot progression angles, trunk rotation, and hip rotation during downhill walking. Both traditional and new AFOs did not eliminate differences between slopes, highlighting the importance of considering environmental factors, such as ground inclination, in the assessment of gait in individuals with motor impairments. These results highlight the potential benefits of innovative AFO designs in improving specific walking patterns, especially in challenging walking conditions. In the second project, I developed a sports-specific rehabilitative protocol based on biomechanical assessment of indoor rowing, using an engaging play-motor approach involving both lower and upper limbs. The goal was to make therapy fun and recreational for children, integrating motor activities with rehabilitative value. The child with hemiplegia showed significant asymmetries in shoulder, elbow, and wrist flexion-extension between the affected and less affected sides during activities such as rowing and reaching tasks. The affected side took more time to complete certain tasks than the less affected side, highlighting temporal differences in movement phases. In the rowing exercise, complete stroke, a possible compensation with the lower limbs was observed, suggesting that coordinated use of the lower limbs could help reduce temporal differences between upper limb movements. Participants, including the child with hemiplegia, showed a high level of satisfaction and engagement in rowing activity, indicating that it could be an acceptable and enjoyable therapeutic approach. The results suggest that it could be positively integrated into traditional rehabilitation programs for children with hemiplegia, contributing to improving motor function and quality of life. The need for further studies with a larger number of participants is acknowledged to confirm and expand these results, but it still suggests that rowing could offer significant benefits in pediatric rehabilitation. Overall, the results of my research have contributed to defining the differences between the use and non-use of ankle-foot orthoses in locomotion, walking on flat, uphill, and downhill, and running. Additionally, they have opened perspectives on the design of play-rehabilitative strategies based on adapted physical activity to enhance the inclusion and quality of life of children with cerebral palsy.
La paralisi cerebrale è una delle patologie pediatriche più diffuse, con un'incidenza stimata tra 1.6 e 3.4 casi ogni 1000 nati vivi, variabile in base allo sviluppo del paese di riferimento. Caratterizzata da disturbi motori come spasticità e debolezza, la paralisi cerebrale può associarsi a sintomi secondari e complicanze quali epilessia, disturbi dell'apprendimento e problemi visivi. Una diagnosi precoce consente un intervento multidisciplinare che coinvolge un team composto da logopedisti, neuropsichiatri, fisioterapisti, terapisti occupazionali e psicologi fin dalla prima infanzia. Nel contesto riabilitativo, l'introduzione di ausili specifici e l'adozione di attività fisiche adattate, con un approccio ludico-riabilitativo, rappresentano strategie fondamentali. Questo lavoro si colloca nell'ambito dello sport nella disabilità e ha due obiettivi: 1) valutare e sviluppare ortesi atte a consentire la realizzazione del movimento sportivo in persone con limitazioni funzionali; 2) definire dei protocolli riabilitativi utilizzando la pratica sportiva come approccio complementare all'esercizio terapeutico. In particolare, la mia tesi ha ampliato la comprensione sulla valutazione quantitativa del movimento in bambini affetti da paralisi cerebrale, concentrandosi sull'analisi cinematica e cinetica del cammino e della corsa con e senza l'uso di ortesi piede-caviglia (AFOs), nonché sull'analisi cinematica durante il canottaggio e test per la valutazione dell'arto superiore. Attraverso un approccio multidisciplinare basato sulla valutazione biomeccanica, il mio lavoro ha evidenziato l'importanza degli ausili specifici, come le ortesi AFO, e ha esplorato l'applicazione di un protocollo riabilitativo basato sulla valutazione biomeccanica del canottaggio indoor come strategia ludico-motoria. Il primo studio ha sottolineato la necessità di progettare nuove ortesi, adatte anche alla pratica sportiva, evidenziando limitazioni nelle attuali proposte di mercato. Il nuovo tutore testato ha dimostrato di consentire maggiori range di dorsiflessione durante il cammino in varie condizioni e durante la corsa. È stato confrontato l'impatto di ortesi AFO comunemente utilizzate con una nuova generazione di AFO progettata per attività sportive durante la camminata in bambini con emiplegia su diverse pendenze (in salita, in discesa e in paino). La nuova AFO ha mostrato miglioramenti significativi nella dorsiflessione e plantarflessione della caviglia, negli angoli di progressione del piede, nella rotazione del tronco e nella rotazione dell'anca durante la camminata in discesa. Sia le AFO tradizionali che quelle nuove non hanno eliminato le differenze tra le pendenze, evidenziando l'importanza di considerare fattori ambientali, come l'inclinazione del terreno, nella valutazione della deambulazione in individui con compromissioni motorie. Questi risultati evidenziano i potenziali benefici delle innovative progettazioni di AFO nel migliorare specifici schemi di deambulazione, soprattutto in condizioni di cammino impegnative. Nel secondo studio, ho sviluppato un protocollo riabilitativo sport-specifico basato sulla valutazione biomeccanica del canottaggio indoor, utilizzando un approccio ludico-motorio coinvolgente sia gli arti inferiori che superiori. L'obiettivo era rendere la terapia divertente e ricreativa per i bambini, integrando attività motorie con valenza riabilitativa. Il bambino con emiplegia ha mostrato asimmetrie significative nella flesso-estensione della spalla, del gomito e del polso tra il lato affetto e quello meno affetto durante attività come il canottaggio e i compiti di raggiungimento e portare la mano alla bocca. Il lato colpito ha impiegato più tempo per completare determinati compiti rispetto al lato meno affetto, evidenziando differenze temporali nelle fasi di movimento. Nell'esercizio di canottaggio, remata completa, si è osservata una possibile compensazione con gli arti inferiori, suggerendo che l'utilizzo coordinato degli arti inferiori potrebbe aiutare a ridurre le differenze temporali tra i movimenti degli arti superiori. I partecipanti, compreso il bambino con emiplegia, hanno mostrato un alto livello di soddisfazione e coinvolgimento nell'attività di canottaggio, indicando che potrebbe essere un approccio terapeutico accettabile e gradevole. I risultati suggeriscono che potrebbe essere integrato positivamente nei programmi di riabilitazione tradizionali per i bambini con emiplegia, contribuendo a migliorare la funzionalità motoria e la qualità della vita. Viene riconosciuta la necessità di ulteriori studi con un numero più ampio di partecipanti per confermare e ampliare questi risultati, ma suggerisce comunque che il canottaggio potrebbe offrire benefici significativi nell'ambito della riabilitazione pediatrica. Complessivamente, i risultati della mia ricerca hanno contribuito a definire le differenze tra l'uso e il non uso delle ortesi piede-caviglia nella locomozione, nel cammino in piano in salita e in discesa e nella corsa. Inoltre, hanno aperto prospettive sulla progettazione di strategie ludico-riabilitative basate sull'attività fisica adattata per migliorare l'inclusione e la qualità di vita dei bambini con paralisi cerebrale.
Sports and physical activities for children with cerebral palsy : from validation of new generation ankle foot orthoses to rehabilitation protocols
Federica, Camuncoli
2024
Abstract
Cerebral palsy is one of the most prevalent pediatric disorders, with an estimated incidence ranging from 1.6 to 3.4 cases per 1000 live births, varying based on the development of the reference country. Characterized by motor impairments such as spasticity and weakness, cerebral palsy may be associated with secondary symptoms and complications such as epilepsy, learning disorders, and visual problems. Early diagnosis allows for a multidisciplinary intervention involving a team of speech therapists, neuropsychiatrists, physiotherapists, occupational therapists, and psychologists from early childhood. In the rehabilitative context, the introduction of specific aids and the adoption of adapted physical activities, with a play-rehabilitative approach, represent fundamental strategies. This work is situated in the field of sports for individuals with disabilities and has two objectives: 1) to assess and develop orthoses aimed at enabling the execution of sports movements in individuals with functional limitations; 2) to define rehabilitative protocols using sports practice as a complementary approach to therapeutic exercise. In particular, my thesis has expanded understanding of the quantitative assessment of movement in children with cerebral palsy, focusing on the kinematic and kinetic analysis of walking and running with and without the use of ankle-foot orthoses (AFOs), as well as kinematic analysis during rowing and tests for upper limb evaluation. Through a multidisciplinary approach based on biomechanical assessment, my work has highlighted the importance of specific aids, such as AFOs, and explored the application of a rehabilitative protocol based on biomechanical assessment of indoor rowing as a play-motor strategy. The first project emphasized the need to design new orthoses suitable for sports, highlighting limitations in current market proposals. The newly tested brace demonstrated allowing greater dorsiflexion ranges during walking under various conditions and during running. The impact of commonly used AFOs was compared with a new generation of AFO designed for sports activities during walking in children with hemiplegia on different slopes (uphill, downhill, and flat). The new AFO showed significant improvements in ankle dorsiflexion and plantarflexion, foot progression angles, trunk rotation, and hip rotation during downhill walking. Both traditional and new AFOs did not eliminate differences between slopes, highlighting the importance of considering environmental factors, such as ground inclination, in the assessment of gait in individuals with motor impairments. These results highlight the potential benefits of innovative AFO designs in improving specific walking patterns, especially in challenging walking conditions. In the second project, I developed a sports-specific rehabilitative protocol based on biomechanical assessment of indoor rowing, using an engaging play-motor approach involving both lower and upper limbs. The goal was to make therapy fun and recreational for children, integrating motor activities with rehabilitative value. The child with hemiplegia showed significant asymmetries in shoulder, elbow, and wrist flexion-extension between the affected and less affected sides during activities such as rowing and reaching tasks. The affected side took more time to complete certain tasks than the less affected side, highlighting temporal differences in movement phases. In the rowing exercise, complete stroke, a possible compensation with the lower limbs was observed, suggesting that coordinated use of the lower limbs could help reduce temporal differences between upper limb movements. Participants, including the child with hemiplegia, showed a high level of satisfaction and engagement in rowing activity, indicating that it could be an acceptable and enjoyable therapeutic approach. The results suggest that it could be positively integrated into traditional rehabilitation programs for children with hemiplegia, contributing to improving motor function and quality of life. The need for further studies with a larger number of participants is acknowledged to confirm and expand these results, but it still suggests that rowing could offer significant benefits in pediatric rehabilitation. Overall, the results of my research have contributed to defining the differences between the use and non-use of ankle-foot orthoses in locomotion, walking on flat, uphill, and downhill, and running. Additionally, they have opened perspectives on the design of play-rehabilitative strategies based on adapted physical activity to enhance the inclusion and quality of life of children with cerebral palsy.File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.14242/205783
URN:NBN:IT:POLIMI-205783