Upper limb robotic neurorehabilitation after pediatric stroke

Introduction Pediatric brain stroke is a rare condition, with the incidence of 1.2-13/100,000. The most common consequence is hemiparesis with unilateral hand impairment. There is level 4 evidence that robotics may improve the function of upper limbs. In this paper, we present the effect of combined robotic rehabilitation and kinesitherapy on the distal portion of the arm in the chronic phase of hemiparesis in childhood. Case outline In a 7.5-year-old girl the treatment with robotic neurorehabilitation was administered in the chronic phase of post-stroke rehabilitation, 18 months after the stroke, involving individualized kinesitherapy for 30 minutes, and virtual reality-based rehabilitation using the robotic Smart Glove for 30 minutes. The rehabilitation protocol was administered for 12 weeks (five times a week). The results of therapeutic evaluation showed that the level 2 of Manual Ability Classification System remained unchanged until the end of treatment, while the grade assigned for the spasticity of flexors in the forearm and fingers was 2 at the treatment onset, 1+ after four weeks of therapy, and 1 after eight and 12 weeks of therapy. Qualitative improvement of arm function through the increase of the overall value of the Quality of Upper Extremity Skills Test was evidenced at each evaluation testing, being the greatest after the first four weeks of rehabilitation (4.83%). Conclusion The result of our study suggests that combined robotic rehabilitation and kinesitherapy can improve the functional motor performance of the arm involved in the chronic recovery phase after a pediatric stroke.