Physiological responses to discomfort induced by the use of technological rehabilitation devices in children

During the last years, many new technologies have been developed for children*s
rehabilitation, such as treadmills in combination with a virtual environment,
robotics, and exoskeletons. Interventions using these technological devices can
improve walking function, endurance, and gross motor function in children with
Cerebral Palsy (CP) and induce a more intensive and task-specific exercise,
which can improve the engagement of children. However, the technological
devices may also cause discomfort in children, because they are not used to
these forms of therapy and it may cause pain, fear, unpleasant feelings or
friction of parts of the technological devices to the body. Until now, mostly
subjective measurement instruments are used to measure discomfort during
children*s rehabilitation. However, many children with CP also have cognitive
problems. Therefore, it can be difficult to complete the questions and to
express discomfort. Physiological parameters, such as heart rate, blood
pressure, and respiratory rate are altered during discomfort or stressful
situations. Some tests exist to generate discomfort in adults population during
for example free speech in front of an audience or while keeping a hand in cold
water (Trier Social Stress Test, Mental Arithmetic Stress Test, Socially
Evaluated Cold Pressor Test). However, these tests are not adapted to children
and are performed while subjects are seated and standing still while these
parameters are affected by physical activity. Measuring physiological
parameters during training situations can be integrated into the new
rehabilitation technologies by use of smart garments. In this way, it is easy
to use during training with a minimal impact on children.

The primary goal of this research project is to study physiological responses
of typically developing (TD) children and children with CP (only if the results
of TD children are promising) to discomfort induced by the use of technological
devices during walking. The obtained data will be also used to develop a
discomfort recognition algorithm.

Experimental study

Children have to visit the Sint Maartenskliniek only once for 1.5 or 2 hours,
dependent on whether they have CP or are typically developing. We expect the
experiments to cause some discomfort as this is the goal of the experiments.
However, all situations will be controlled and are safe. In the experiment with
Charlie*s Plank, a therapist/researcher with experience in assisting patients
in virtual reality will assist the child and take care he/she won*t hurt
him/herself. In the experiment on the GRAIL, all children will wear a harness
and cannot fall on the treadmill. All experiments can be terminated at any time
when the child feels too uncomfortable or the child/parent is not willing to
continue for any other reason.
The current study is group related, as it is expected that children behave
differently from adults when placed in a situation that might cause discomfort.
Therefore, we cannot use the results of experiments in adults to make
assumptions about physiological reactions caused by discomfort in children.
Consequently, this study can only be done using this patient group of children.
Children will have no benefits from participating in this study.