SEREBRAL PALSİDE GİYİLEBİLİR CİHAZLARIN KLİNİK ETKİLERİ

Öz

Serebral palsi (SP), çocukluk çağında en sık görülen nörogelişimsel bozukluklardan biridir ve motor fonksiyon, denge, yürüme ve üst ekstremite kullanımı üzerinde önemli kısıtlılıklara yol açmaktadır. Son yıllarda giyilebilir teknolojilerin SP rehabilitasyonuna entegrasyonu, klinik değerlendirme ve müdahalelerde yeni bir yaklaşım ortaya koymuştur. Literatürde robotik dış iskeletler, fonksiyonel elektriksel stimülasyon (FES), nöromüsküler elektriksel stimülasyon (NMES), sanal gerçeklik (VR) tabanlı sistemler ve ivmeölçer/jiyroskop gibi sensör destekli cihazların, SP’li bireylerde motor öğrenmeyi ve nöroplastisiteyi destekleyerek yürüyüş, denge, üst ekstremite fonksiyonları ve günlük yaşam aktivitelerinde anlamlı iyileşmeler sağladığı gösterilmiştir. Bununla birlikte, cihazların maliyet, ağırlık, kullanım kolaylığı ve uzun dönem sürdürülebilirliği gibi sınırlılıkları bulunmaktadır. Ayrıca, mevcut çalışmaların çoğu küçük örneklemli ve kısa süreli olup, uzun dönem etkinliği değerlendiren araştırmalar sınırlıdır. Sonuç olarak, giyilebilir teknolojiler SP rehabilitasyonunda umut verici araçlar olarak öne çıkmakta, ancak bireyselleştirilmiş uygulama, kullanıcı kabulü ve uzun dönem etkilere odaklanan daha güçlü klinik kanıtlara ihtiyaç duyulmaktadır.

Anahtar Kelimeler

• Fonksiyonel elektriksel stimülasyon
• Giyilebilir teknolojiler
• Robotik Dış İskelet
• Sanal Gerçeklik
• Serebral Palsi

CLINICAL EFFECTS OF WEARABLE DEVICES IN CEREBRAL PALSY

Öz

Cerebral palsy (CP) is one of the most common neurodevelopmental disorders of childhood, leading to significant limitations in motor function, balance, gait, and upper extremity use. In recent years, the integration of wearable technologies into CP rehabilitation has introduced a novel approach in both clinical assessment and intervention. The literature demonstrates that robotic exoskeletons, functional electrical stimulation (FES), neuromuscular electrical stimulation (NMES), virtual reality (VR)-based systems, and sensor-supported devices such as accelerometers and gyroscopes can enhance motor learning and neuroplasticity, thereby improving gait, balance, upper extremity functions, and participation in daily life activities in individuals with CP. However, limitations such as device cost, weight, usability, and long-term sustainability remain. Moreover, most existing studies have small sample sizes and short follow-up durations, with limited data on long-term effectiveness. In conclusion, wearable technologies represent promising tools in CP rehabilitation; nevertheless, stronger clinical evidence focusing on individualized application, user acceptance, and long-term outcomes is needed to support their effective integration into practice.

Anahtar Kelimeler

• Functional electrical stimulation
• Wearble technologies
• Robotic exoskeleton
• Virtual reality
• Cerebral palsy

Kaynakça

1. McIntyre S, Colver A, De La Cruz J, Paneth N, Williams K, Himmelmann K, et al. Global prevalence of cerebral palsy: a systematic analysis. Dev Med Child Neurol. 2022;64(12):1494-506.
2. Oskoui M, Coutinho F, Dykeman J, Jetté N, Pringsheim T. An update on the prevalence of cerebral palsy: a systematic review and meta-analysis. Dev Med Child Neurol. 2013;55(6):509-19.
3. Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M, Damiano D, et al. A report: the definition and classification of cerebral palsy April 2006. Dev Med Child Neurol Suppl. 2007;109:8-14.
4. Fauconnier J, Dickinson HO, Beckung E, Marcelli M, McManus V, Michelsen SI, et al. Participation in life situations of 8–12 year old children with cerebral palsy: cross sectional European study. BMJ. 2009;338:b1458.
5. Hunt M, Everaert L, Brown M, Hatzidimitriadou E, Desloovere K. Effectiveness of robotic exoskeletons for improving gait in children with cerebral palsy: a systematic review. Gait Posture. 2021;90:108–109. doi:10.1016/j.gaitpost.2021.09.055.
6. Novak I, Morgan C, Fahey M, Finch-Edmondson M, Galea C, Hines A, et al. State of the evidence traffic lights 2020: systematic review of interventions for preventing and treating children with cerebral palsy. Curr Neurol Neurosci Rep. 2020;20(3):3.
7. Pashmdarfard M, Richards LG, Amini M. Factors Affecting Participation of Children with Cerebral Palsy in Meaningful Activities: Systematic Review. Occupational Therapy in Health Care. 2021;35(4):442-479. doi:10.1080/07380577.2021.1938339 tandfonline.com
8. Salomon I. Neurobiological insights into cerebral palsy: a review of the mechanisms and therapeutic strategies. Brain Behav. 2024 Oct;14(10):e70065. doi:10.1002/brb3.70065. PMID:39378294; PMCID:PMC11460637.

9. Goldsmith S, Smithers-Sheedy H, Almasri N, Andersen GL, Diviney L, Gincota EB, et al. Cerebral palsy registers around the world: a survey. Dev Med Child Neurol. 2024;66(6):765-77.
10. Novak I, Morgan C, Adde L, Blackman J, Boyd RN, Brunstrom-Hernandez J, et al. Early, accurate diagnosis and early intervention in cerebral palsy: advances in diagnosis and treatment. JAMA Pediatr. 2017;171(9):897-907.
11. Choi JY, Shin YK, Lee H, Ko SH, Choi JH. Overground gait training with a wearable robot in children with cerebral palsy: a randomized clinical trial. JAMA Netw Open. 2024;7(5):e241234.
12. El-Shamy SM, Abd El Kafy EM. Efficacy of axial TheraTogs on gait pattern in children with dyskinetic cerebral palsy: a randomized controlled trial. Bull Fac Phys Ther. 2021;26(1):18.
13. Molteni F, Gasperini G, Cannaviello G, Guanziroli E. Exoskeleton and end-effector robots for upper and lower limbs rehabilitation: narrative review. PM R. 2018;10(9 Suppl 2):S174-88.
14. Emara HA, El-Sayed A, Mohamed RA. Effect of the dynamic orthotic garment (TheraTogs) on postural control and functional ability in children with spastic cerebral palsy. BMC Pediatr. 2024;24:178.
15. de Miguel-Fernández J, Muñoz-Gómez J, Martínez-García M, López-Larraz E, del-Ama AJ. Control strategies in lower-limb exoskeletons for gait rehabilitation: implications for clinical outcomes. J Neuroeng Rehabil. 2023;20:12.
16. Patel S, Park H, Bonato P, Chan L, Rodgers M. A review of wearable sensors and systems with application in rehabilitation. J Neuroeng Rehabil. 2022;19(1):28.
17. Al-Ayyad M, Ibrahim H, Al-Jumeily D. Application of surface electromyography in the assessment and rehabilitation of cerebral palsy: a review. Biomed Signal Process Control. 2023;82:104513.
18. Brégou Bourgeois A, Mariani B, Aminian K, Zambelli PY, Newman CJ. Spatio-temporal gait analysis in children with cerebral palsy using foot-worn inertial sensors. Gait Posture. 2014;39(1):436-42. doi:10.1016/j.gaitpost.2013.08.029. Epub 2013 Sep 1. PMID:24044970.
19. Rodgers MM, Alon G, Pai VM, Conroy RS. Wearable technologies for active living and rehabilitation: current research challenges and future opportunities. J Rehabil Assist Technol Eng. 2019 Apr 26;6:2055668319839607. doi:10.1177/2055668319839607. PMID:31245033; PMCID:PMC6582279.
20. Chiu HC, Ada L. Effect of functional electrical stimulation on activity in children with cerebral palsy: a systematic review. Pediatr Phys Ther. 2014 Fall;26(3):283-8. doi:10.1097/PEP.0000000000000045. PMID:24819681.
21. Storm FA, Nair KPS, Clarke AJ, Van der Meulen JM, Mazzà C. Wearable inertial sensors to assess gait during the 6-minute walk test: a systematic review. Sensors. 2020;20(9):2660.
22. Wallard L, Dietrich G, Kerlirzin Y, Bredin J. Robotic-assisted gait training improves walking abilities in diplegic children with cerebral palsy. Eur J Paediatr Neurol. 2017;21(3):557-64.
23. Olmos-Gómez R, Gómez-Conesa A, Calvo-Muñoz I, López-López JA. Effects of robotic-assisted gait training in children and adolescents with cerebral palsy: a network meta-analysis. J Clin Med. 2021;10(21):4908. doi: 10.3390/jcm10214908.
24. Khawaja AR, Jamwal PK, Karibzhanova D, Kapsalyamov A, Agrawal S. Advancing gait rehabilitation: a systematic review of robotic exoskeletons for cerebral palsy. Wearable Technol. 2025 Sep 17;6:e46. doi: 10.1017/wtc.2025.10027.
25. Shull PB, Jirattigalachote W, Hunt M, Cutkosky M. Quantified self and human movement: a review on the clinical impact of wearable sensing and feedback for gait analysis and intervention. Gait Posture. 2014 May;40(1):11-19. doi: 10.1016/j.gaitpost.2014.03.189.
26. Sarajchi M, Al-Hares MK, Sirlantzis K. Wearable lower-limb exoskeleton for children with cerebral palsy: a systematic review of mechanical design, actuation type, control strategy, and clinical evaluation. IEEE Trans Neural Syst Rehabil Eng. 2021;29:2695-720.
27. Cho C, Hwang W, Hwang S, Chung Y. Treadmill training with virtual reality improves gait, balance, and muscle strength in children with cerebral palsy. Tohoku J Exp Med. 2016;238(3):213-8.
28. Rozin Kleiner AF, Bellomo A, Pagnussat AS, de Athayde Costa E Silva A, Sforza C, Cicuto Ferreira Rocha NA. Wearable sensors, cerebral palsy and gait assessment in everyday environments: is it a reality? Funct Neurol. 2019;34(2):85-91.
29. Conner BC, Schwartz MH, Steele KM. Adaptive resistance training improves ankle strength, walking efficiency and mobility in cerebral palsy: a pilot clinical trial. Neuroeng Rehabil. 2020;17(1):107.
30. Greve KR, Joseph CF, Berry BE, Schadl K, Rose J. Neuromuscular electrical stimulation to augment lower limb exercise and mobility in individuals with spastic cerebral palsy: a scoping review. Front Physiol. 2022;13:951899.
31. Beani E, Franchi de’ Cavalieri M, Filogna S, et al. Wearable sensors for measuring spontaneous upper limb use in children with unilateral cerebral palsy and typical development. J Neuroeng Rehabil. 2025;22:71.
32. Garzon LC, Switzer L, Musselman KE, Fehlings D. The use of functional electrical stimulation to improve upper limb function in children with hemiplegic cerebral palsy: a feasibility study. J Rehabil Assist Technol Eng. 2018;5:2055668318768402.
33. Cardone D, Perpetuini D, Di Nicola M, Merla A, Morone G, Ciancarelli I, et al. Robot-assisted upper limb therapy for personalized rehabilitation in children with cerebral palsy: a systematic review. Front Neurol. 2025;15:1499249.
34. Patel S, Park H, Bonato P, et al. A review of wearable sensors and systems with application in rehabilitation. J Neuroeng Rehabil. 2012;9:21.
35. Ou CH, Shiue CC, Kuan YC, Liou TH, Chen HC, Kuo TJ. Neuromuscular electrical stimulation of upper limbs in patients with cerebral palsy: a systematic review and meta-analysis of randomized controlled trials. Am J Phys Med Rehabil. 2023;102(2):151-8.
36. Rodrigues J, Freeman J, Richards J. Does user perception affect adherence when wearing biomechanically optimised ankle foot orthosis-footwear combinations: a pilot study. Prosthet Orthot Int. 2020;44(2):72-80.
37. Moll F, Kessel A, Bonetto A, Stresow J, Herten M, Dudda M, Adermann J. Safety and feasibility of robot-assisted gait training in adults with cerebral palsy in an inpatient setting: an observational study. J Dev Phys Disabil. 2023 Feb 11:1-16. doi: 10.1007/s10882-023-09895-8. PMID: 36817800; PMCID: PMC9918396.
38. Brown R, Pearse JE, Nappey T, Jackson D, Edmonds G, Guan Y, Basu AP. Wrist-worn devices to encourage affected upper limb movement in unilateral cerebral palsy: participatory design workshops. Front Rehabil Sci. 2022 Dec 21;3:1021760. doi: 10.3389/fresc.2022.1021760. PMID: 36619529; PMCID: PMC9812553.
39. Weizman Y, Shakouri SK, Zeilig G, Plotnik M. Recent state of wearable IMU sensors use in people living with spasticity: a systematic review. Sensors. 2022;22(5):1791.
40. Liu W, Hu Y, Li J, Chang J. Effect of virtual reality on balance function in children with cerebral palsy: a systematic review and meta-analysis. Front Public Health. 2022 Apr 25;10:865474. doi: 10.3389/fpubh.2022.865474. PMID: 35548088; PMCID: PMC9081327.
41. Bunge LR, Davidson AJ, Helmore BR, Mavrandonis AD, Page TD, Schuster-Bayly TR, Kumar S. Effectiveness of powered exoskeleton use on gait in individuals with cerebral palsy: a systematic review. PLoS One. 2021 May 26;16(5):e0252193. doi: 10.1371/journal.pone.0252193. PMID: 34038471; PMCID: PMC8153467.
42. Rossi S, Morasso P, Giovacchini F, et al. Feasibility study of a wearable exoskeleton for children: is the gait altered by adding masses on lower limbs? PLoS One. 2013;8(9):e73139.
43. Tagoe EA, Fang Y, Williams JR, Lerner ZF. Walking on real-world terrain with an ankle exoskeleton in cerebral palsy. IEEE Trans Med Robot Bionics. 2024 Feb;6(1):202-212. doi: 10.1109/tmrb.2023.3328649. Epub 2023 Oct 31. PMID: 39130167; PMCID: PMC11309519.
44. Moll F, Kessel A, Bonetto A, Stresow J, Herten M, Dudda M, Adermann J. Use of robot-assisted gait training in pediatric patients with cerebral palsy in an inpatient setting—a randomized controlled trial. Sensors (Basel). 2022 Dec 16;22(24):9946. doi: 10.3390/s22249946. PMID: 36560316; PMCID: PMC9783925.
45. Garzon LC, Switzer L, Musselman KE, Fehlings D. The use of functional electrical stimulation to improve upper limb function in children with hemiplegic cerebral palsy: a feasibility study. J Rehabil Assist Technol Eng. 2018 May 14;5:2055668318768402. doi: 10.1177/2055668318768402. PMID: 31191936; PMCID: PMC6453088.
46. Choi JY, Yi SH, Shim D, Yoo B, Park ES, Rha DW. Home-based virtual reality-enhanced upper limb training system in children with brain injury: a randomized controlled trial. Front Pediatr. 2023 May 18;11:1131573. doi: 10.3389/fped.2023.1131573. PMID: 37274815; PMCID: PMC10233002.
47. Rast FM, Herren S, Labruyère R. Acceptability of wearable inertial sensors, completeness of data, and day-to-day variability of everyday life motor activities in children and adolescents with neuromotor impairments. Front Rehabil Sci. 2022;3:923328. doi:10.3389/fresc.2022.923328.