Innovative technological approaches for evaluation and rehabilitation of children with motor disorders

The purpose of this thesis was to explore innovative approaches to evaluate and rehabilitate children with neurodevelopmental disabilities, emphasizing the motor domain. Given their complexity, timely and accurate assessments are crucial, enabling clinicians to design personalized treatment plans that address to the unique needs of each child and monitor their progress effectively. Throughout this study, we evaluated the feasibility of implementing various technological systems in paediatric clinical settings. These devices were first investigated as assessment tools, providing quantitative data to be integrated with clinical evaluations, thus offering a more comprehensive view of each child's functional profile. Additionally, the systems were used as rehabilitation tools, where their engaging and motivating designs facilitated the completion of treatment sessions. This approach ensured the achievement of therapeutic goals through personalized exercises, while fostering a positive and enjoyable rehabilitation experience for both children and families. The first devices investigated were wearable sensors. We initially focused on their use for motor assessment in 17 infants (aged 6.35±2.95 months) by applying non-invasive tri-axial accelerometers to the wrists and trunk within an ecological environment. Subsequently, we extended a similar approach to 80 older children and adolescents (54 with Unilateral Cerebral Palsy (UCP) and 26 Typically Developing (TD) peers), evaluating spontaneous upper limbs (ULs) use and asymmetry in daily life activities through Actigraphs worn on both wrists. These studies provided valuable insights into the natural movement patterns and motor asymmetries of infants and children with neurodevelopmental disabilities, as well as their TD peers. Before exploring the application of ULs technologies in children with UCP, it was essential to first examine the relationship between neuroanatomical characteristics of brain injury, manual functional impairment, and mirror movements (MMs). In a study involving 35 children with UCP (mean age 9.2±3.5 years), MRI scores was used to classify the severity of brain lesions, while UL function was evaluated through clinical scales measuring gross dexterity and MMs. The results showed that more severe brain lesions were correlated with greater UL impairment, and earlier brain injuries were associated to more pronounced MMs. Subsequently, we investigated the role of robotic devices, particularly an end-effector UL system called MOTORE, as an assessment tool in a sample of 68 children (28 with UCP, 20 with Diplegic CP, and 20 TD). Our findings indicated that MOTORE was not only feasible for developmental age despite being originally designed for adults, but it also effectively differentiated varying levels of ULs ability across different patient groups, particularly in time and velocity. Focusing on UCP group, we observed differences in non-dominant UL performance depending on unimanual ability levels. Furthermore, comparisons between the two ULs tasks showed significant differences, with manual ability levels influencing accuracy error and work parameters. Correlation analyses between clinical and robotic scores revealed moderate to strong significant associations indicating that some robotic indices can be integrated with traditional clinical assessment. MOTORE has also proven to be a feasible tool for the rehabilitation of children with hemiplegia, leading to significant short-term improvements in UL motor function and treatments tailored to individual needs. We then focused on telerehabilitation, conducting a systematic review of technological devices used for home-based care in paediatric neurological and neurodevelopmental disorders. Key factors influencing the effectiveness of telerehabilitation include multi-domain protocols and active caregiver’s involvement. The introduction of telerehabilitation marks a significant advancement, enabling intensive, personalized care in familiar settings. Among the devices studied, CareToy-R emerged as a promising tool for early intervention, demonstrating with an efficacy study involving 39 infants at high risk of CP, significant improvements in motor outcomes through early, intensive training. Additionally, we assessed the Virtual Reality Rehabilitation System (VRRS) for both assessment and telerehabilitation among children. Initially developed for adults, our studies established its feasibility, across a heterogeneous sample, with some clinical and demographic variables affecting usability and acceptability. VRRS was effective as an assessment tool for postural control, revealing significant differences in Centre of Posture parameters between 30 TD children, 28 children with CP and 20 with developmental coordination disorder (DCD). Moreover, we assessed also ULs movements in 12 children with UCP, founding differences in velocity and jerk parameters of a reaching task among different ULs abilities, suggesting distinct movement strategies. In telerehabilitation, VRRS showed promising feasibility in 88 children across 30 sessions of various treatments, with positive feedback from stakeholders, though clinicians noted some challenges with system customization and appropriateness. Three children with dyskinetic CP improved their balance after a 3-month postural control program, and three children with UCP showed progress in language and learning skills after a 3-month speech therapy program, supporting VRRS as a valuable tool for personalized, home-based therapy. Beyond the technological advancements, we also examined critical factors influencing paediatric development, such as environmental differences and the impact of social and cognitive factors on clinical care for children with CP. These considerations are essential for ensuring that rehabilitation interventions are not only effective but also inclusive and contextually relevant.