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Commentary on “Feasibility and Effectiveness of a Novel Exoskeleton for an Infant With Arm Movement Impairments”

Donohoe, Maureen PT, DPT, PCS; Fink, Michael L. PT, DSc, SCS, OCS

Pediatric Physical Therapy: October 2016 - Volume 28 - Issue 3 - p 346
doi: 10.1097/PEP.0000000000000290

Nemours/Alfred I. duPont Hospital for Children Wilmington, Delaware

Father of a boy with arthrogryposis, Lebanon Valley College Annville, Pennsylvania

The authors declare no conflicts of interest.

“How can I apply this information?”

Infants typically learn by exploring and manipulating toys. Those who lack strength and/or range of motion may use compensatory strategies to interact with objects, such as mouth to toy, foot to toy, or hand to toy. These compensations often lead to inefficient visual opportunities with toys during manipulation. Although the Pediatric-Wilmington Robotic Exoskeleton (P-WREX) may not be readily feasible to include in a young child's therapy plan, its biomechanical advantage for promoting upper body use is important to consider. Bringing objects to a level the child can reach and clearly view toys, as well as facilitating upper extremity use, can enhance early learning and exploration. Clinicians may consider inexpensive, external devices such as overhead slings to support arm lifting. The variety of play positions may be limited to the chair where the slings are attached, but the child will have opportunities for expanded arm movement with visual contact of toys during play.

Parent response: I observed a change in my infant son Matthew's motivation and ability to use his arms during play when wearing the P-WREX and this change continued after the device was removed, albeit to a lesser degree. The P-WREX seemed to “unlock” previously unseen physical performance in Matthew. The device showed him what was possible to do with his arms, which really excited him. Removing the device gave him renewed determination to use his arms in the way he could when wearing the device. The P-WREX could only be used in sitting; this was a challenge because Matthew preferred to play in the supine position and the device's rigid materials made it impossible for him to lay or roll when wearing it.

“What should I be mindful about when applying this information?”

The ability to reach heavily impacts a child's ability to explore. The use of external supportive devices to assist reaching may hinder the ability to work simultaneously on transitional movements and mobility. To maximize the benefit of using a device to support expanding arm movements, targeted play is more beneficial than global exploration alone.

Parent response: The P-WREX was not a long-term solution for my son, but it was pivotal in advancing his physical abilities at a critical time in his development. This device exposed Matthew to new movements, allowing him to use his arms to play in a variety of ways that had not been previously possible—a way that more closely mimicked the movements of my other children. I really liked how the P-WREX accommodated strength and ability changes in his arms by adding/removing elastic bands. But notably, this device did not “grow” with him. Matthew outgrew it shortly after the study ended, but I did not perceive this as a drawback because by then, the carryover from using the P-WREX was evident by the amount of independent arm movement he had attained.

Maureen Donohoe, PT, DPT, PCS

Nemours/Alfred I. duPont Hospital for Children

Wilmington, Delaware

Michael L. Fink, PT, DSc, SCS, OCS

Father of a boy with arthrogryposis, Lebanon Valley College

Annville, Pennsylvania

Copyright © 2016 Academy of Pediatric Physical Therapy of the American Physical Therapy Association