Rehabilitation Engineering Research Centers (RERC) Program: RERC on Rehabilitation Technologies for Children with Orthopedic Disabilities

Background:Pediatric orthopedic disabilities affect children's musculoskeletal systems, including their bones, joints, and muscles. Orthopedic disabilities affect mobility, manipulation, education, recreation, and the performance of daily activities. The most common pediatric orthopedic disabilities include neuromotor impairments such as cerebral palsy and spina bifida; musculoskeletal conditions such as limb loss and limb difference, scoliosis, club foot, and developmental dysplasia of the hip; and degenerative diseases such as muscular dystrophy (Ghandour, 2023; Kumar, 2023). These conditions can be present at birth or acquired later due to disease, injury, or developmental issues (Dev, 2022), and, therefore, orthopedic disabilities affect infants, children, and adolescents.Pediatric orthopedic rehabilitation has several unique aspects that distinguish it from adult rehabilitation. Rehabilitation must account for children's ongoing physical growth and developmental stage, requiring frequent adjustments to treatment plans. Rehabilitation should maximize a child's independence in age-appropriate daily activities, considering factors like school participation and social interaction. In addition, parents and caregivers play a crucial role in pediatric rehabilitation, requiring clinicians to educate and involve families in treatment plans (Shamus, et al., 2025).Like all children, those with orthopedic disabilities want to perform tasks independently and participate in activities like their peers. They also want to be included in social activities and develop friendships (Murchland & Parkyn, 2010). They need school and community spaces that allow them to move and participate freely and opportunities to pursue their interests (Adolfsson, 2011). Through innovative rehabilitation engineering, children with orthopedic disabilities can improve their health and function, independence, and quality of life, allowing them to engage more fully in daily activities and social interactions.Several rehabilitation technologies have yet to be fully developed, adapted, and analyzed for children with orthopedic disabilities. Virtual reality (VR) is emerging as a promising tool in the rehabilitation of children with orthopedic disabilities. It offers engaging and interactive environments that can enhance traditional therapeutic approaches. VR can provide task-specific training, immediate feedback, and customizable difficulty levels depending on the child’s abilities (Jeyaraman, et al., 2024). Robotic-assisted therapy is an innovative approach to the rehabilitation of children with orthopedic disabilities. This therapy utilizes robotic devices to assist in movement and enhance physical therapy outcomes. Robotic-assisted devices can offer engagement and motivation, repetitive task training, and customizable therapy allowing for personalized rehabilitation plans (Gonzalez et al., 2021). Exoskeletons are increasingly being used in the rehabilitation of children with orthopedic disabilities. They can improve walking mechanics, provide high-intensity training outside the clinic, and can be designed to be adjustable to accommodate a range of physical abilities (Bradley, et al., 2024). Functional electrical stimulation (FES) for children is a growing area of interest with increasing evidence and experience but there is a lack of awareness in the many applications of FES as a form of treatment for children (Singleton, et al., 2019). Artificial intelligence (AI) can be integrated into rehabilitation therapy sessions allowing for the customization of rehabilitation programs based on individual progress and needs. This data-driven approach may enhance therapy effectiveness (Sumner, et al., 2023). Advances in technology and device development are leading to new strategies in rehabilitation for infants. These include 24-hour sensor-based monitoring of infant movement (Lobo, et al., 2019), exoskeletal garments (Babik, et al., 2019), robotic and sensor technologies to study prone mobility in infants with and without cerebral palsy (CP) (Kolobe & Fagg, 2019), and transcranial magnetic stimulation (TMS) (Nemanich, et al., 2019). Continued research and development into these rehabilitation technologies is needed to expound their effectiveness and optimize their integration into pediatric rehabilitation programs.Assistive technologies (AT) are instrumental for the development and participation of children with disabilities (Botelho, 2021). They span a wide range of tools and solutions and have been shown to increase autonomy, enhance engagement, improve social interaction, and build confidence (Fernández-Batanero, et al., 2022). Advancements in software, batteries, and sensors will allow for new and improved assistive technologies. In addition, the development of new materials and additive manufacturing techniques should advance the field of AT significantly. Many different assistive technologies can benefit children with orthopedic disabilities. Environmental control systems allow children with limited mobility to control their surroundings, such as lights, TVs, and other appliances through voice commands or adaptive switches (Hollenbeck & Wagenfeld, 2024; Tavares, et al., 2024). Custom prosthetic limbs and orthotic devices that provide support or enhance movement for children with orthopedic impairments can be tailored to fit the child's growing body and specific functional needs (Hedman, 2020). Standers allow children to stand upright, promoting weight-bearing activities that are crucial for bone health and muscle development (McLean, et al., 2023). Crutches and walkers provide support and stability, helping children improve balance and mobility while bearing weight on their legs (Rasouli & Reed, 2020; Tao, et al., 2020). Wheelchairs, both manual and powered, enhance children’s mobility and participation in daily life. The pediatric wheelchair must not only support growing, changing bodies but also facilitate improvement of motor control, allow for cognitive growth by ensuring age-appropriate interaction with the environment, and allow peer interaction and participation to promote social and emotional growth and development (Lange & Minkel, 2024). Continued research and development into assistive technologies for children with orthopedic disabilities is needed to improve their functionality, effectiveness, and usability. In addition, assistive technologies should be appropriate, safe, acceptable, and accessible to those who need them. References:Adolfsson, M. (2011). Applying the ICF-CY to identify everyday life situations of children and youth with disabilities (PhD dissertation, School of Education and Communication). https://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-16195.Babik, I., Cunha, A. B., Moeyaert, M., Hall, M. L., Paul, D. A., Mackley, A., & Lobo, M. A. (2019). Feasibility and effectiveness of intervention with the Playskin Lift exoskeletal garment for infants at risk. Physical Therapy, 99(6), 666–676. https://doi.org/10.1093/ptj/pzz035.Botelho, F. H. F. (2021). Childhood and Assistive Technology: Growing with opportunity, developing with technology. Assistive Technology: The Official Journal of RESNA, 33(sup1), 87–93. https://doi.org/10.1080/10400435.2021.1971330.Bradley, S. S., de Holanda, L. J., Chau, T., & Wright, F. V. (2024). Physiotherapy-assisted overground exoskeleton use: mixed methods feasibility study protocol quantifying the user experience, as well as functional, neural, and muscular outcomes in children with mobility impairments. Frontiers in Neuroscience, 18, 1398459. https://doi.org/10.3389/fnins.2024.1398459.Dev, D. (2022, December 24). Orthopedic Impairment: Definition, Characteristics, Causes & Types. OPA Ortho. https://www.opaortho.com/what-is-orthopedic-impairment/.Fernández-Batan…, J. M., Montenegro-Rueda, M., Fernández-Cerero, J., & García-Martínez, I. (2022). Assistive technology for the inclusion of students with disabilities: a systematic review. Educational Technology Research and Development: ETR & D, 70(5), 1911–1930. https://doi.org/10.1007/s11423-022-10127-7.Ghandour, M., Klotz, M., & Horsch, A. (2023). Orthopedics and trauma in children: Key problems and future insights. Children (Basel, Switzerland), 10(1), 119. https://doi.org/10.3390/children10010119.Gonzalez, A., Garcia, L., Kilby, J., & McNair, P. (2021). Robotic devices for paediatric rehabilitation: a review of design features. Biomedical Engineering Online, 20(1), 89. https://doi.org/10.1186/s12938-021-00920-5.Hedman, G. E. (2020). Rehabilitation Technology (G. Hedman, Ed.). Routledge.Hollenbeck, J., & Wagenfeld, A. (Eds.). (2024). Foundations of pediatric practice for the occupational therapy assistant (3rd ed.). Routledge.Jeyaraman, M., Jeyaraman, N., Ramasubramanian, S., & Shyam, A. (2024). Enhancing orthopedic rehabilitation: The emergence and impact of virtual reality technology. Journal of Orthopaedic Case Reports, 14(4), 1–6. https://doi.org/10.13107/jocr.2024.v14.i04.4338.Kolobe, T. H. A., & Fagg, A. H. (2019). Robot reinforcement and error-based movement learning in infants with and without cerebral palsy. Physical Therapy, 99(6), 677–688. https://doi.org/10.1093/ptj/pzz043.Kumar, J. (2023, April 18). Common pediatric orthopedic impairments explained. Total Orthopaedic Care. https://www.toc.md/2023/04/18/common-pediatric-orthopedic-impairments-e…, M. L., & Minkel, J. L. (2024). Seating and wheeled mobility: A clinical resource guide (M. L. Lange & J. L. Minkel, Eds.). Taylor & Francis.Lobo, M. A., Hall, M. L., Greenspan, B., Rohloff, P., Prosser, L. A., & Smith, B. A. (2019). Wearables for pediatric rehabilitation: How to optimally design and utilize products to meet the needs of users. Phys Ther, 99, 647–657.McLean, L. J., Paleg, G. S., & Livingstone, R. W. (2023). Supported-standing interventions for children and young adults with non-ambulant cerebral palsy: A scoping review. Developmental Medicine and Child Neurology, 65(6), 754–772. https://doi.org/10.1111/dmcn.15435.Murchland, S., & Parkyn, H. (2010). Using assistive technology for schoolwork: the experience of children with physical disabilities. Disability and Rehabilitation. Assistive Technology, 5(6), 438–447. https://doi.org/10.3109/17483107.2010.481773.Nemanich, S. T., Chen, C.-Y., Chen, M., Zorn, E., Mueller, B., Peyton, C., Elison, J. T., Stinear, J., Rao, R., Georgieff, M., Menk, J., Rudser, K., & Gillick, B. (2019). Safety and feasibility of transcranial magnetic stimulation as an exploratory assessment of corticospinal connectivity in infants after perinatal brain injury: An observational study. Physical Therapy, 99(6), 689–700. https://doi.org/10.1093/ptj/pzz028.Rasouli, F., & Reed, K. B. (2020). Walking assistance using crutches: A state of the art review. Journal of Biomechanics, 98(109489), 109489. https://doi.org/10.1016/j.jbiomech.2019.109489.Shamus E, & Ubben C, & Walczak S (2025). Pediatric orthopedic and sports injuries. Bloyer M, & Shamus E, & Catalino T, & Miles C(Eds.), Guide to Pediatric Physical Therapy: A Clinical Approach. McGraw Hill. https://accessphysiotherapy.mhmedical.com/content.aspx?bookid=3506&sect…, C., Jones, H., & Maycock, L. (2019). Functional electrical stimulation (FES) for children and young people with cerebral palsy. Paediatrics and Child Health, 29(11), 498–502. https://doi.org/10.1016/j.paed.2019.07.015.Sumner, J., Lim, H. W., Chong, L. S., Bundele, A., Mukhopadhyay, A., & Kayambu, G. (2023). Artificial intelligence in physical rehabilitation: A systematic review. Artificial Intelligence in Medicine, 146(102693), 102693. https://doi.org/10.1016/j.artmed.2023.102693.Tao, R., Feng, L., Xiao, Z., & Zhang, B.-H. (2020). Posterior versus anterior walkers for children with cerebral palsy-biomechanical analysis and energy consumption: A systematic review. Journal of Developmental and Physical Disabilities, 32(6), 877–892. https://doi.org/10.1007/s10882-020-09731-3.Tavares, R., Inácio, A., Sousa, H., & Ribeiro, J. (2024). Smart speakers as an environmental control unit for severe motor dependence: The case of a young adult with duchenne muscular dystrophy. International Journal of Environmental Research and Public Health, 21(6), 778. https://doi.org/10.3390/ijerph21060778.Priority:The Administrator of the Administration for Community Living (ACL) establishes a priority for a Rehabilitation Engineering Research Center (RERC) on Technologies for Children with Orthopedic Disabilities. Under this priority, the RERC must conduct research, development, and evaluation activities toward innovative rehabilitation and assistive technologies that contribute to improved outcomes for children with orthopedic disabilities. Under this priority, the RERC must increase the understanding of the scientific and engineering principles of human locomotion, reaching, grasping, and manipulation, and incorporate those principles into the design of rehabilitation and assistive technologies that are accessible and usable for children with orthopedic disabilities. Research and development under this priority must be designed to lead to state-of-the-science knowledge and evidence-based rehabilitation and assistive technologies. The RERC must consider and optimize the accessibility, usability, utility, and acceptability of the technological devices that it focuses upon. The RERC must involve children with orthopedic disabilities, their families, caretakers, and other key stakeholders in the design and implementation of RERC research and development activities.Applicants should consult the NIDILRR Long-Range Plan for Fiscal Years 2024-2028 when preparing their applications. According to the plan, rehabilitation technologies restore, maintain, or slow the decline of function, and assistive technologies address activity and participation difficulties encountered by people with disability by augmenting, compensating for the loss of, or restoring function to improve performance. The plan is organized around the following outcome domains: (1) community living and participation, (2) health and function, and (3) employment. The RERC must be designed to benefit children with orthopedic disabilities in one or more of these outcome domains.The RERC must conduct advanced engineering research and development activities that contribute to improved outcomes for children with orthopedic disabilities. Applicants under the priority in this notice are required to specify in their proposal the following:The NIDILRR outcome domain or domains to be addressed.The target population or populations of children with orthopedic disabilities.The technological and informational products to be produced.The benefits of those products to children with orthopedic disabilities.The means of testing and evaluating the products to be produced.The way input of children with orthopedic disabilities and other stakeholders will be sought and incorporated into research and development activities. Applicants must demonstrate, in their original application, that children with orthopedic disabilities from racial and ethnic minority backgrounds will be included in study samples in sufficient numbers to generate knowledge and products that are relevant to the racial and ethnic diversity of the RERC’s target population. The RERC must describe and justify, in its original application, the planned racial and ethnic distribution of children with orthopedic disabilities who will participate in the proposed research and development activities.Requirements applicable to RERC priorities:As a national center, the RERC must conduct high-quality research, development, technical assistance, capacity building, knowledge translation, and dissemination activities that address significant needs, promote independence, and improve the quality of life and community living outcomes of people with disabilities. In order to optimize benefits to people with disabilities, the RERC must ascertain the efficacy and safety of proposed strategies, technologies, or interventions, and collaborate with appropriate entities to facilitate the transfer and adoption of development products. The RERC must follow and understand emerging technologies and communicate to NIDILRR, ACL, and other appropriate stakeholders about the potential opportunities and drawbacks associated with these technologies.An RERC established under the proposed priority in this notice must be designed to contribute to the following outcomes:Increased technical and scientific knowledge relevant to its designated priority research area. The RERC must contribute to this outcome by conducting high-quality, rigorous research projects. The RERC must use appropriate engineering knowledge and techniques to collect, analyze, and/or synthesize research data.Increased innovation in technologies, products, environments, performance guidelines, or monitoring and assessment tools applicable to its designated priority research area. The RERC must contribute to this outcome through the development and testing of these innovations. The RERC must apply appropriate engineering knowledge and techniques to achieve development objectives.Improved research capacity in its designated priority research area. The RERC must contribute to this outcome by collaborating with the relevant industry, professional associations, and institutions of higher education, health care providers, or educators, as appropriate, to train research and development professionals in its designated priority research area.Improved awareness and understanding of cutting-edge developments in technologies within its designated priority research area. The RERC must contribute to this outcome by communicating with NIDILRR, people with disabilities and their representatives, disability organizations, service providers, professional journals, manufacturers, State Assistive Technology Act Programs, and other interested parties about trends and evolving product concepts related to its designated priority research area.Increased impact of research and development in the designated priority research area. The RERC must contribute to this outcome by providing technical assistance to relevant public and private organizations, people with disabilities, employers, and schools on policies, guidelines, and standards related to its designated priority research area.Increased transfer of RERC-developed technologies to the marketplace. The RERC must contribute to this outcome by developing and implementing a plan for ensuring that all technologies developed by the RERC are made available to the public. The technology transfer plan must be developed in the first year of the project period in consultation with the NIDILRR-funded Initiative to Mobilize Partnerships For Successful Assistive Technology Transfer (IMPACT) Center.Improved usability and accessibility of products and environments in the RERC’s designated priority research area. The RERC must contribute to this outcome by emphasizing the principles and goals of universal design in its product research and development. For purposes of this section, the term “universal design” refers to the design of products and environments to be usable by all people, to the greatest extent possible, without the need for adaptation or specialized design.In addition, under each priority, the RERC must--Have the capability to design, build, and test prototype devices and assist in the technology transfer and knowledge translation of successful solutions to relevant production and service delivery settings;Evaluate the efficacy and safety of its new products, instrumentation, or assistive devices;Provide as part of its proposal, and then implement, a plan that describes how it will include, as appropriate, people with disabilities or their representatives in all phases of its activities, including research, development, training, dissemination, and evaluation;Provide as part of its proposal, and then implement, in consultation with the NIDILRR-funded National Center on Knowledge Translation for Disability and Rehabilitation Research, a plan to disseminate its research results to people with disabilities and their representatives, disability organizations, service providers, professional journals, manufacturers, and other interested parties;Conduct a state-of-the-science conference on its designated priority research area in the fourth year of the project period, and publish a comprehensive report on the final outcomes of the conference in the fifth year of the project period; andCoordinate research projects of mutual interest with relevant NIDILRR-funded projects, as identified through consultation with the NIDILRR project officer.Specify the stage or stages of research projects that they are proposing. If the applicant proposes to conduct research that can be categorized under more than one stage, including research that progresses from one stage to another, those stages must be clearly specified. These stages (exploration and discovery, intervention development, intervention efficacy, and scale-up evaluation) are defined on ACL’s website.Specify the stage or stages of development of the development projects that they are proposing. If the applicant proposes to conduct development that can be categorized under more than one stage, those stages must be clearly specified. These stages (proof of concept, proof of product, and proof of adoption) are defined on ACL’s website.