EFFECTIVENESS OF FUNCTIONAL TRAINING USING SOFT EXOSUITS IN CHILDREN WITH SMA TYPE II

Abstract

Neuromuscular diseases in children, particularly spinal muscular atrophy (SMA), remain a significant medical and social issue requiring a multidisciplinary approach to treatment and rehabilitation. SMA type II (Dubowitz disease) is the most common form among children who survive early childhood, but they require constant rehabilitation support due to progressive loss of motor function and the development of secondary complications. For these patients, the search for new physical therapy methods that can improve motor skills, reduce spasticity, and minimize respiratory risks is particularly relevant. In this context, the use of soft exoskeletons, such as the Mollii Suit, opens new opportunities for supporting physical activity and enhancing the quality of life in children with SMA type II.The aim of the study was to determine the effectiveness of functional training using soft exoskeletons in children with SMA type II to improve their physical activity, motor skills, and overall quality of life.Materials and Methods. The study was conducted at the Sumy Regional Center for Comprehensive Rehabilitation for Children and Persons with Disabilities during 2024–2025. It was based on a case study structure, allowing for a detailed analysis of changes in the child’s condition during physical therapy. The participant was a 5-year-old child with a confirmed diagnosis of SMA type II (SMN1 gene mutation) who was able to sit independently, used a wheelchair for mobility, and had preserved cognitive function. To assess the dynamics of motor and respiratory function, the Hammersmith Functional Motor Scale Expanded (HFMSE), Revised Upper Limb Module (RULM), and forced vital capacity (FVC) measured by spirometry were used. The 12-week physical therapy program included 2–3 sessions per week lasting 45–60 minutes with the use of the Mollii Suit and an individualized selection of functional tasks.Results. The rehabilitation program led to clinically significant improvements in the child’s motor function. The HFMSE total score increased from 22 to 26 points (+4 points, an 18.2% increase), reflecting improved control of the sitting position, functional arm movements, and the ability to change positions with assistance. The RULM score increased by 3 points (from 23 to 26), indicating better control of both proximal and distal upper limb movements and manipulation precision. Additionally, FVC showed a slight but clinically important increase (from 0.85 L, 57% of the predicted value to 0.89 L, 59%), suggesting stabilization of respiratory function.Conclusions. The implementation of a physical therapy program using the soft exoskeleton Mollii Suit for a 5-year-old child with SMA type II demonstrated a highly individualized approach, taking into account the specific characteristics of motor impairments and the patient’s needs. The program is aimed at activating motor functions, improving trunk and upper limb movement control, as well as supporting respiratory function. Thanks to the use of the exoskeleton, better body stabilization, reduced fatigue, and increased motivation of the child to perform exercises in the form of play activities were achieved.