Combining nonlinear mechanical stimulation via a chaotic mathematical model and game-based exercise for upper extremity rehabilitation in children with spastic hemiparetic cerebral palsy: a pilot study

Designing an upper extremity neurorehabilitation protocol for children with unilateral cerebral palsy (UCP) is a significant challenge. In this study, a combined rehabilitation protocol is proposed for restoring upper extremity function in children with unilateral cerebral palsy. The proposed protocol combines mechanical stimulation of cutaneous mechanoreceptors on the back of the affected hand with computer game-based training. Drawing on insights into neural self-organization, a chaotic model was identified and utilized to generate the stimulation pattern. The efficacy of the proposed approach was evaluated in four patients. The results were analyzed across various clinical and signal-processing aspects. The clinical findings are promising, demonstrating intriguing improvement in wrist flexion and extension motion following the interventions. Additionally, nonlinear analyses of EMG dynamics and muscle activation timings suggest that the creation of a new motor program post-intervention is plausible. Clinical analyses and nonlinear analysis of EMG dynamics supported the emergence of neuroplasticity following the designed rehabilitation protocol.