Many children with physical disabilities experience difficulty using traditional exercise equipment for gait rehabilitation and fitness training, and the clinician resources required to deliver intensive overground or treadmill-based therapies are infrequently available in most clinics, hospitals, and school settings. This work describes design and testing of a comprehensive set of modifications that enabled children to use a commercially available robotic exercise device (i.e., Intelligently Controlled Assistive Rehabilitation Elliptical (ICARE)) initially developed to address walking and fitness goals of adults with physical disabilities and chronic conditions. Fifteen children (3–11 years old) concurrently enrolled in physical therapy due to varied neurologic conditions were recruited with their parent(s) to evaluate the safety, comfort, and usability of the adult ICARE and pediatric-modified ICARE. After children tried each device, feedback was recorded. To assess feasibility, each child then participated in up to ten sessions (two to five sessions per week; average session length: 38 min, range 21–66 min) using the pediatric-modified ICARE. Parents, on average, perceived that the pediatric-modified ICARE was significantly safer, more comfortable and usable than the adult ICARE. Children's perceptions of the pediatric-modified ICARE were similar, although not statistically significant. Children used the prototype device during 133 sessions for over 3800 min and more than 162,000 cycles. In conclusion, this study demonstrated the feasibility of using the pediatric-modified ICARE with children as young as 3 years old as an adjunct to ongoing therapy.

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