Pilot study on the role of passive and assisted ankle joint motion by a portable device for bedridden paediatric patients affected by upper motoreuron lesions: clinical and EEG results

Background. Upper motoreuron lesions (UML) affect people of all ages and are a major cause of disability in the young. Lower limb rehabilitation is a fundamental part of post-acute care in neurological disease. In this contest passive mobilisation could be of help for acute patients in a very early stage of their recovery to safeguard tissue properties and prevent the worsening of neural damages that cause cognitive and motor impairment, when paresis prevent the beginning of active workout and so physical treatment may be delayed. This research investigates the potential role of early passive motion in stimulating cortical areas of the brain dedicated to the control of the lower limb in UML. Methods. Seven pediatric patient (aged 15.35±4.36) took part in the study. They were treated for two weeks (2 daily sessions) with a robotic passive ankle mobiliser (Toe-Up!).The device was implemented using specially-designed shape-memory-alloy-based actuators. Range of motion, muscle length and Ashworth score were measured before and after this treatment. At the same time-points brain activity was recorded by 64-channels electroencephalography (EEG) under four different conditions: rest, active dorsiflexion of the ankle, assisted and passive mobilisation of the same joint. The acquired data were processed to obtain cortical ERD/ERS (Event Related Desynchronisation/ Synchronisation) maps, which were then compared. Results. Preliminary results show that this therapy is very well tolerated and that its application specifically improves ankle PROM (+4.71°, p=0.063) and plantarflexor muscle length (+7.57°, p=0.007). EEG data for the passive/assistive condition showed hints of improved desynchronisation in at least one frequency band. Conclusions. The results of this pilot study suggest that passive mobilisation by the Toe-Up! device produces valuable clinical effects and set a basis for the study of cortical re-organisation in UML patients treated with ankle passive/assistive mobilisation.