Feasibility study of the assessment of upper limb function in children with Unilateral Cerebral Palsy using an end-effector robotic device

Abstract Background Children with Unilateral Cerebral Palsy (UCP) are characterized by significant upper limbs (ULs) impairment that hinders daily activities and participation, requiring accurate assessment. Although motor impairment mainly affects one side, significant evidence suggests that the less affected side (LAS) may also present impairments. Considering the growing interest in pediatrics technologies, a complementary approach combining standardized clinical scales and robotic devices may support a more objective and quantitative evaluation of ULs performance with high precision and objectivity. This study aimed to investigate the feasibility of a planar end-effector robotic device in children and adolescents with UCP and to explore whether robotic ULs indices show associations with clinical measures. Methods Twenty-eight children and adolescents with UCP (mean ages: 10.90 ± 3.32 years; 8 males, 20 females) underwent a single-session protocol comprising: (i) clinical assessment based on ULs classifications - Manual Ability Classification System (MACS), House Functional Classification System (HFCS) - and clinical standardized scales - Melbourne Assessment 2 (MA2), Box and Block Test (BBT) -; (ii) robotic assessment protocol with MOTORE with more and less affected side (MAS and LAS respectively), and (iii) feasibility questionnaires completed by both children and clinicians to evaluate usability and acceptability. Feasibility data were analysed as raw scores (mean value, SD, range) and percentages. Two different MANOVA analyses were applied to robotic parameters, including limb condition (LAS vs. MAS), hand dominance, and age as predictors, with HFCS or MACS levels analysed in separate models to avoid conceptual overlap and collinearity. Finally, Spearman’s r correlation coefficient assessed correlations between clinical and robotic measures. Results Feasibility questionnaires showed positive results, supporting the system’s user-feasible design. Across the MOTORE tasks, MANOVA analyses showed that HFCS or MACS levels and limb severity condition (MAS vs. LAS) were the main factors affecting robotic performance, with age influencing selected parameters, while hand dominance had no significant effect. Finally, correlation analyses further revealed moderate to strong associations between MOTORE’s robotic parameters and clinical scores (r range: 0.375–0.643). Conclusions This paper highlights the feasibility of MOTORE robotic system in pediatric assessment setting both for users and clinicians. The observed associations suggest that the system may provide complementary quantitative information related to ULs functions. As these findings are exploratory, further studies are required to establish validity, reliability, and responsiveness before clinical integration of the system to support objective and quantitative data to guide individualized rehabilitation strategies for children with UCP. Trial registration: ClinicalTrial.gov: NCT06012617 and NCT06666829.