Perturbation-Based Training on Compliant Surfaces to Improve Balance in Children With Cerebral Palsy: A Feasibility Study

Children with cerebral palsy suffer from balance deficits that may greatly reduce their quality of life. However, recent advancements in robotics allow for balance rehabilitation paradigms that provide greater control of the training environment and more robust measurement techniques. Previous works have shown functional balance improvement using standing surface perturbations and compliant surface balancing. Visual feedback during balance training has also been shown to improve postural balance control. However, the combined effect of these interventions has not been evaluated. This paper presents a robot-aided rehabilitation study for children with cerebral palsy on a side-specific performance-adaptive compliant surface with perturbations. Visual feedback of the participant's center of pressure and weight distribution were used to evaluate successful balance and trigger perturbations after a period of successful balancing. The platform compliance increased relative to the amount of successful balance during each training interval. Two participants trained for 6 weeks including 10, less than 2 hours long, training sessions. Improvements in functional balance as assessed by the Pediatric Balance Scale, Timed 10 Meter Walk Test, and 5 Times Sit-to-Stand Test were observed for both participants. There was a reduction in fall risk as evidenced by increased Virtual Time to Contact and an increase in dynamic postural balance supported by a faster Time to Perturb, Time to Stabilize, and Percent Stabilized. A mixed improvement in static postural balance was also observed. This paper highlights the feasibility of robot-aided rehabilitation interventions as a method of balance therapy for children with cerebral palsy.