Organisers: The Foundation for Biomedical Research at the Niño Jesús University Children’s Hospital in Madrid and the Movement Analysis Laboratory (LAM) at the University Children’s Hospital.

Collaborating organisations: Ramon Molinas Foundation and Convives con Espasticidad (Living with Spasticity).

Dates of implementation: 01/02/2016 – 31/01/2017.

 

Research programme aims to maximise control of the head and torso of children with cerebral palsy.

The Ramon Molinas Foundation is sponsoring a research programme carried out by the Movement Analysis Laboratory (LAM) of the Niño Jesús University Children’s Hospital in Madrid with the objective of improving the functionality of the head and torso of children with cerebral palsy using a new human-machine interface. The sponsored project, with the support of Convives con Espasticidad (Living with Spasticity), originates from technology developed by the National Spanish Council Research into the Sciences Bioengineering Group (GBIO-CSIC) and utilises an inertial measurement device integrating a tri-dimensional accelerometer, a gyroscope and a 3D magnetometer located on the arm of a pair of glasses. The mechanism is capable of measuring the acceleration caused by movement and gravity, the angular velocity and the earth’s magnetic field. The interface automatically collects kinematic parameters like orientation, angular velocity and acceleration, data which is used to identify the involuntary movements and posture of people with cerebral palsy[1].

People with cerebral palsy often have an anomalous body posture. They usually have deficient cephalic control with a tendency to let the cranium drop forwards, backwards, or to one side of their body. This part of the human body is responsible for directional orientation of the senses, and its movements are influenced by the information which the senses provide. Subsequently, disorders of the senses can cause the head to make unusual movements, and movement disorders of the head can cause uncommon conditions in the senses[2].

Maximising the control of the cranium to improve the posture of the head, or reducing these anomalies is important for functional reasons and to correct some secondary conditions linked with health and social interaction. For example, in a child with cerebral palsy, the alignment and stability of the oral structures for swallowing can be compromised by the irregular muscle tone and movement patterns. The oral function required for correct alimentation begins with obtaining better head stability in order to optimise control of the jaw[3].

Currently, the majority of research on children with cerebral palsy is centered around the evaluation and treatment of the lower extremities, considered the most important element for the mobility and independence of minors.  The Research programme to improve head and torso functionality in children with cerebral palsy hopes to amplify the approach towards children who suffer from this disorder, because in addition, they often suffer from a deterioration of the upper extremities such as the neck, the torso and the head.

 

The aim of the research is to explore the changes in the quality of life related to the health of people with cerebral palsy

The objective of the programme is to investigate the impact of utilising the interface to analyse the anomalous position of the head and cranial movement of children with cerebral palsy, and explore the changes in quality of life related to the health of the participants.

The study will be developed through two weekly sessions which will run over ten weeks. The participants will be children and young people from 4 to 17 years old diagnosed with cerebral palsy and have difficulties controlling the head. In addition, they should have the necessary cognitive capacity to understand the tasks and instructions given to them by the researchers, and should show active participation in the study.

Firstly, the participants will have to control the pointer of a mouse, which they have to locate on top of a virtual target through the movements of their head using the interface discussed above. Each position of the mouse corresponds to a unique angular orientation of the head. Once they reach the correct position, the device will change its position following a sequential order. This exercise will create a statistical analysis of the involuntary movements made throughout the activity. Secondly, the research will also involve an exercise based on completing 16 objectives maintaining a constant width and distance between them.

Finally, the participants will play a dozen video games following the same methodology of the two previous exercises. Six of these video games have been specifically designed to be played with the interface. The other six are commercial video games that have been adapted for the research project. However, all of them provide systematic training, audio and visual feedback and present a clear objective for the participants, who have access to different levels of difficulty.

The sessions, which last 30 minutes, will measure the command of time, frequency, posture and functional analysis of the participants with the objective of carrying out a bio-statistical analysis to evaluate the possible therapeutic benefits.

 

The Niño Jesús University Children’s Hospital in Madrid, a health centre dedicated to paediatrics

The Niño Jesús University Children’s Hospital in Madrid was formed over 130 years ago with the intention of offering the best possible service to patients, and at the same time, undergo research and teaching with the aim of guaranteeing a continual improvement in care quality. The centre, which began attending to 120 children and young people daily, now cares for 1,900 minors per day and also has an integrated medical school where 1,300 students are trained annually. In the year 2008 the centre launched the Foundation for Biomedical Research of the Niño Jesús University Children’s Hospital in Madrid with the objective of directing, improving and increasing the tasks linked to paediatric research.

Living with Spasticity (Convives con Espasticidad), on the other hand, is a non-profit organisation created in 2008 whose mission is to promote the personal autonomy and inclusion of people that live with spasticity, using the benefits of information and communication technology. Spasticity is a motor disorder associated with many illnesses and disabilities. Among them is a type of cerebral palsy named “spastic”. Of all of the cases of cerebral palsy this is the most common – it is present in over 90% of children who suffer from cerebral palsy.

 

Cerebral palsy, the most common cause of permanent, severe physical disability in infancy

Cerebral palsy is a permanent psychomotor disorder which causes limitations in the activity of the person affected. It is an irreversible disorder, but not degenerative. Those affected will have it their whole lives, even though it will not deteriorate. For this reason, people with cerebral palsy often suffer from other problems that also require treatment. Although no cure exists for the disorder, it is possible to achieve a certain degree of development in the motor, cognitive, linguistic and social areas thanks to stimulation and learning techniques.

Cerebral palsy is the most common cause of permanent, severe physical disability in infancy. The damage which causes cerebral palsy can occur from the foetal stage up until four years of life. The disorder affects between two and three out of every 1,000 newborns, according to the data provided by the Surveillance of Cerebral Palsy in Europe (SCPE)[4]. In Catalonia there are more than 14,000 people with the disorder. The same number of cases, between two and three in every 1,000 newborns, are registered with this disease, which is the same as the European average determined by the SCPE. This means that there are between 120 and 150 new cases detected every year. In Spain, there are 84,000 people who suffer from cerebral palsy.

 

Links of interest:

Niño Jesús University Children’s Hospital in Madrid website.

Living with Spasticity (Convives con Espasticidad) website.

 

[1] Raya, E. Rocon, R. Ceres, J. Harlaar and J. Geytenbeek. Characterizing Head Motor Disorders to Create Novel Interfaces for People with Cerebral Palsy. IEEE International Conference on Rehabilitation Robotics 2011.

[2] Gresty, M. and Halmagyi, G.M. Abnormal head movements. Journal of Neurology, Neurosurgery, and Psychiatry, 1979, 42, 705-714.

[3] F. Redstone; J. F. West. The Importance of Postural Control for Feeding. Pediatric Nursing. 2004;30.

[4] Johnson, A. Prevalence and characteristics of children with cerebral palsy in Europe. Develop-mental Medicine and Child Neurology 2002, 44,9, 633.