Validation of Assessment Protocol in Rehabilitation Technologies for Hand and Arm (R3THA) in Children with Cerebral Palsy

Research Objectives: To assess the reliability and validity of R3THA™, which uses exergame technology and AI-driven analytics for adaptive rehabilitation, by comparing its kinematic assessments to standard clinical evaluations in children with Cerebral Palsy.

Design: Enrolled study participants were evaluated with clinical assessments and kinematic assessments during the first week of the camp, and in the last week of the summer camp.

Setting: The study took place at Intensive Therapeutics in West Caldwell, NJ, during the 2023 Helping Hands Summer Camp, where participants received initial clinical and R3THA-AP kinematic assessments, including the Box and Block Test (BBT) and Melbourne Assessment 2 (MA2), conducted by licensed Occupational Therapists.

Participants: Participants were selected for the study based on the following inclusion criteria: 1) Children with Cerebral Palsy or hemiplegia due to brain injury, 2) Aged 3 – 18, 3) Gross Motor Function Classification System level of I – IV, 4) No severe arm weakness and tone, 5) Able to follow verbal instructions, 6) No visual problems that make it difficult for them to interact with the entire computer screen. A total of 36 participants were recruited for this study, 21 participants completed with pre and post assessments.

Interventions: All participants participated in Intensive Therapeutic’s Helping Hand summer camp in 2023.

Main Outcome Measures: Clinical assessments include the Box and Block Test (BBT) and Melbourne Assessment 2 (MA2). Kinematics assessment is R3THA-AP kinematic assessments.

Results: Correlations between the Box and Blocks Test (BBT) and R3THA-AP revealed positive correlations for Hand Open/Close and Wrist Pitch ranges with the BBT score of the impaired hand (BBTI). Negative correlations were found between Hand Open/Close and Wrist Pitch tracing errors with BBTI, indicating higher accuracy with higher BBTI scores.
For the Melbourne Assessment 2 (MA2) Range of Motion (ROM) and R3THA-AP, significant correlations were observed with Hand Open Range, Wrist Pitch Range, and Wrist Extension/Flexion Accuracy. MA2-Accuracy and MA2-Dexterity also showed correlations with R3THA’s Hand Open Range and Wrist Extension/Flexion Range, respectively.

Conclusions: The R3THA-AP marks a significant advancement in neurorehabilitation assessment for children with Cerebral Palsy, providing a robust framework for detailed evaluation and progress tracking. It enables precise assessments of specific impairments, allowing clinicians to create personalized rehabilitation plans tailored to each patient's needs. Overall, R3THA's clinical relevance lies in its comprehensive, engaging, and personalized approach, leading to improved outcomes for children with hand and arm impairments.

Author(s) Disclosures: Qinyin Qiu, Amanda Gross, Ashley Mont, and Mee Eriksson are co-founders of NeurtoTechR3, a company designed and developed R3THA.