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Sakzewski L, Pool D, Armstrong E, Reedman SE, Boyd RN, Elliott C, Novak I, Trost S, Ware RS, Comans T, Toovey R, Peterson MD, Kentish M, Horan S, Valentine J, Williams S. ACTIVE STRIDES-CP: protocol for a randomised trial of intensive rehabilitation (combined intensive gait and cycling training) for children with moderate-to-severe bilateral cerebral palsy. BMJ Open 2023; 13:e068774. [PMID: 36990490 PMCID: PMC10069600 DOI: 10.1136/bmjopen-2022-068774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
INTRODUCTION For children with cerebral palsy (CP), who are marginally ambulant, gross motor capacity peaks between 6 and 7 years of age with a subsequent clinical decline, impacting their ability to engage in physical activity. Active Strides-CP is a novel package of physiotherapy targeting body functions, activity and participation outcomes for children with bilateral CP. This study will compare Active Strides-CP to usual care in a multisite randomised waitlist-controlled trial. METHODS AND ANALYSIS 150 children with bilateral CP (5-15 years), classified in Gross Motor Function Classification System (GMFCS) levels III and IV will be stratified (GMFCS III vs IV, age 5-10 years; 11-15 years and trial site) and randomised to receive either (1) 8 weeks of Active Strides-CP two times/week for 1.5 hours in clinic and one time/week for 1 hour alternating home visits and telehealth (total dose=32 hours) or (2) usual care. Active Strides-CP comprises functional electrical stimulation cycling, partial body weight support treadmill training, overground walking, adapted community cycling and goal-directed training. Outcomes will be measured at baseline, immediately post-intervention at 9 weeks primary endpoint and at 26 weeks post-baseline for retention. The primary outcome is the Gross Motor Function Measure-66. Secondary outcomes include habitual physical activity, cardiorespiratory fitness, walking speed and distance, frequency/involvement of community participation, mobility, goal attainment and quality of life. Analyses will follow standard principles for randomised controlled trials using two-group comparisons on all participants on an intention-to-treat basis. Comparisons between groups for primary and secondary outcomes will be conducted using regression models. A within-trial cost utility analysis will be performed. ETHICS AND DISSEMINATION The Children's Health Queensland Hospital and Health Service, The University of Queensland, The University of Melbourne and Curtin University Human Research Ethics Committees have approved this study. Results will be disseminated as conference abstracts and presentations, peer-reviewed articles in scientific journals, and institution newsletters and media releases. TRIAL REGISTRATION NUMBER ACTRN12621001133820.
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Affiliation(s)
- Leanne Sakzewski
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland Child Health Research Centre, South Brisbane, Queensland, Australia
| | - Dayna Pool
- School of Allied Health, Curtin University, Carlisle, Western Australia, Australia
| | - Ellen Armstrong
- School of Health Sciences and Social Work, Griffith University, Nathan, Queensland, Australia
| | - Sarah Elizabeth Reedman
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland Child Health Research Centre, South Brisbane, Queensland, Australia
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland Child Health Research Centre, South Brisbane, Queensland, Australia
| | - Catherine Elliott
- School of Allied Health, Curtin University, Perth, Western Australia, Australia
- Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Iona Novak
- Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Stewart Trost
- School of Human Movement and Nutrition Sciences, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Tracy Comans
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Rachel Toovey
- The University of Melbourne Melbourne School of Health Sciences, Melbourne, Victoria, Australia
| | - Mark D Peterson
- Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Megan Kentish
- Queensland Paediatric Rehabilitation Service, Children's Health Queensland Hospital and Health Service, Herston, Queensland, Australia
| | - Sean Horan
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia
| | - Jane Valentine
- Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Sian Williams
- School of Allied Health, Curtin University, Perth, Western Australia, Australia
- The University of Auckland Liggins Institute, Auckland, New Zealand
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Türker D, Yakut Y, Yaşar E, Kerem Günel M, Yılmaz B, Tan AK. The effects of functional electrical stimulation cycling on gait parameters in diplegic cerebral palsy: a single-blind randomized controlled trial. Somatosens Mot Res 2023; 40:62-71. [PMID: 36645809 DOI: 10.1080/08990220.2022.2157393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE To investigate the effects of functional electrical stimulation cycling (FES-C) training in addition to conventional physical therapy on gait, muscle strength, gross motor function, and energy expenditure in ambulatory children with spastic diplegic cerebral palsy. MATERIALS AND METHODS Twenty children with diplegic cerebral palsy were randomly assigned to FES-C group (n = 10) or control group (n = 10). Subjects trained 3 days/week for 8 weeks. Control group received conventional physical therapy. The FES-C group additionally received FES-C training. The functional muscle test was used for muscle strength assessment. Vicon-3D system was used for gait analysis. Gross Motor Function Measure (GMFM-88) was used for motor function assessment and calorimeter was used for energy expenditure. Measurements were performed at the baseline, at the eight week and at the sixteenth week. RESULTS Functional muscle strength, gross motor function, and energy expenditure improved more in the FES-C group after training and follow up (p < 0.05). There was no significant difference found between the changes in gait parameters of the two groups after treatment and follow up (p > 0.05). Pelvic tilt while walking decreased after training in the FES-C group (p < 0.05). CONCLUSIONS FES-C applied in addition to conventional physical therapy in children with diplegic cerebral palsy is more effective than conventional physical therapy for increasing functional muscle strength, improving gross motor function functions, and reducing energy expenditure.HighlightsFES-C improves lower extremity functional muscle strength, gross motor function, and energy expenditure in ambulatory children with spastic dCP.The use of FES-C in combination with conventional physiotherapy methods may be beneficial in outpatients with spastic dCP.
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Affiliation(s)
- Duygu Türker
- Faculty of Gülhane Physiotherapy and Rehabilitation, Department of Pediatric Rehabilitation, University of Health Sciences, Ankara, Turkey
| | - Yavuz Yakut
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Hasan Kalyoncu University, Gaziantep, Turkey
| | - Evren Yaşar
- Department of Physical Medicine and Rehabilitation, Gulhane School of Medicine, University of Health Sciences, Ankara City Hospital, Physical Therapy and Rehabilitation Hospital, Ankara, Turkey
| | - Mintaze Kerem Günel
- Faculty of Physical Therapy Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Bilge Yılmaz
- Department of Physical Medicine and Rehabilitation, Gulhane School of Medicine, University of Health Sciences, Ankara City Hospital, Physical Therapy and Rehabilitation Hospital, Ankara, Turkey.,Department of Physical Medicine and Rehabilitation, Gulhane School of Medicine, University of Health Sciences, Gaziler Training and Research Hospital, Ankara, Turkey.,Department of Physical Medicine and Rehabilitation, Gulhane School of Medicine, University of Health Sciences, Gaziler Training and Research Hospital
| | - Arif Kenan Tan
- Department of Physical Medicine and Rehabilitation, Gulhane School of Medicine, University of Health Sciences, Ankara City Hospital, Physical Therapy and Rehabilitation Hospital, Ankara, Turkey.,Department of Physical Medicine and Rehabilitation, Gulhane School of Medicine, University of Health Sciences, Gaziler Training and Research Hospital, Ankara, Turkey.,Department of Physical Medicine and Rehabilitation, Gulhane School of Medicine, University of Health Sciences, Gaziler Training and Research Hospital
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Maintenance of Functional Gains Following a Goal-Directed and FES-Assisted Cycling Program for Children With Cerebral Palsy. Pediatr Phys Ther 2022; 34:480-487. [PMID: 36067381 DOI: 10.1097/pep.0000000000000942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE This study investigated whether the functional improvements associated with functional electrical stimulation-assisted cycling, goal-directed training, and adapted cycling in children with cerebral palsy were maintained 8 weeks after the intervention ceased. METHODS The intervention (2 × 1-hour supervised sessions and 1-hour home program/week) ran for 8 weeks. Primary outcomes were the Gross Motor Function Measure (GMFM-88) and the Canadian Occupational Performance Measure (COPM). Secondary outcomes included the GMFM-66 and goal scores, 5 times sit-to-stand test (FTSTS), Participation and Environment Measure-Children and Youth (PEM-CY), Pediatric Evaluation of Disability Inventory Computer Adaptive Test (PEDI-CAT), and cycling power output (PO). Outcomes were assessed at baseline, 8 and 16 weeks. RESULTS Twenty children participated (mean age = 10 years 3 months; SD = 2 years 11 months; Gross Motor Function Classification System II = 5, III = 6, and IV = 9). Improvements were retained above baseline at 16 weeks on the GMFM and COPM. Improvements in cycling PO, PEDI-CAT scores, PEM-CY environmental barriers and FTSTS were also retained. CONCLUSION Functional improvements in children with cerebral palsy were retained 8 weeks post-intervention.
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Isaly A, Allen BC, Sanfelice RG, Dixon WE. Encouraging Volitional Pedaling in Functional Electrical Stimulation-Assisted Cycling Using Barrier Functions. Front Robot AI 2021; 8:742986. [PMID: 34901170 PMCID: PMC8652117 DOI: 10.3389/frobt.2021.742986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 09/27/2021] [Indexed: 11/13/2022] Open
Abstract
Stationary motorized cycling assisted by functional electrical stimulation (FES) is a popular therapy for people with movement impairments. Maximizing volitional contributions from the rider of the cycle can lead to long-term benefits like increased muscular strength and cardiovascular endurance. This paper develops a combined motor and FES control system that tasks the rider with maintaining their cadence near a target point using their own volition, while assistance or resistance is applied gradually as their cadence approaches the lower or upper boundary, respectively, of a user-defined safe range. Safety-ensuring barrier functions are used to guarantee that the rider's cadence is constrained to the safe range, while minimal assistance is provided within the range to maximize effort by the rider. FES stimulation is applied before electric motor assistance to further increase power output from the rider. To account for uncertain dynamics, barrier function methods are combined with robust control tools from Lyapunov theory to develop controllers that guarantee safety in the worst-case. Because of the intermittent nature of FES stimulation, the closed-loop system is modeled as a hybrid system to certify that the set of states for which the cadence is in the safe range is asymptotically stable. The performance of the developed control method is demonstrated experimentally on five participants. The barrier function controller constrained the riders' cadence in a range of 50 ± 5 RPM with an average cadence standard deviation of 1.4 RPM for a protocol where cadence with minimal variance was prioritized and used minimal assistance from the motor (4.1% of trial duration) in a separate protocol where power output from the rider was prioritized.
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Affiliation(s)
- Axton Isaly
- Department of Mechanical and Aerospace Engineering, University of Florida, Gainesville, FL, United States
| | - Brendon C Allen
- Department of Mechanical and Aerospace Engineering, University of Florida, Gainesville, FL, United States
| | - Ricardo G Sanfelice
- Department of Electrical and Computer Engineering, University of California, Santa Cruz, Santa Cruz, CA, United States
| | - Warren E Dixon
- Department of Mechanical and Aerospace Engineering, University of Florida, Gainesville, FL, United States
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Sansare A, Harrington AT, Wright H, Alesi J, Behboodi A, Verma K, Lee SCK. Aerobic Responses to FES-Assisted and Volitional Cycling in Children with Cerebral Palsy. SENSORS 2021; 21:s21227590. [PMID: 34833666 PMCID: PMC8622737 DOI: 10.3390/s21227590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/08/2021] [Accepted: 11/11/2021] [Indexed: 11/16/2022]
Abstract
Recumbent stationary cycling is a potential exercise modality for individuals with cerebral palsy (CP) that lack the postural control needed for upright exercises. Functional electrical stimulation (FES) of lower extremity muscles can help such individuals reach the cycling intensities that are required for aerobic benefits. The aim of this study was to examine the effect of cycling with and without FES assistance to that of a no-intervention control group on the cardiorespiratory fitness of children with CP. Thirty-nine participants were randomized to a FES group that underwent an 8-week FES-assisted cycling program, the volitional group (VOL), who cycled without FES, or a no-intervention control group (CON) (15 FES, 11 VOL, 13 CON). Cadence, peak VO2, and net rise in heart rate were assessed at baseline, end of training, and washout (8-weeks after cessation of training). Latent growth curve modeling was used for analysis. The FES group showed significantly higher cycling cadences than the VOL and CON groups at POST and WO. There were no differences in improvements in the peak VO2 and peak net HR between groups. FES-assisted cycling may help children with CP attain higher cycling cadences and to retain these gains after training cessation. Higher training intensities may be necessary to obtain improvements in peak VO2 and heart rate.
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Affiliation(s)
- Ashwini Sansare
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE 19713, USA; (A.S.); (K.V.)
- Department of Physical Therapy, University of Delaware, Newark, DE 19713, USA; (H.W.); (J.A.)
| | | | - Henry Wright
- Department of Physical Therapy, University of Delaware, Newark, DE 19713, USA; (H.W.); (J.A.)
| | - James Alesi
- Department of Physical Therapy, University of Delaware, Newark, DE 19713, USA; (H.W.); (J.A.)
| | - Ahad Behboodi
- Functional and Applied Biomechanics Section, Rehabilitation Medicine Department, National Institutes of Health, Bethesda, MD 20892, USA;
| | - Khushboo Verma
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE 19713, USA; (A.S.); (K.V.)
- Department of Physical Therapy, University of Delaware, Newark, DE 19713, USA; (H.W.); (J.A.)
| | - Samuel C. K. Lee
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE 19713, USA; (A.S.); (K.V.)
- Department of Physical Therapy, University of Delaware, Newark, DE 19713, USA; (H.W.); (J.A.)
- Correspondence: ; Tel.: +1-302-831-2450
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Sansare A, Behboodi A, Johnston TE, Bodt B, Lee SCK. Characterizing Cycling Smoothness and Rhythm in Children With and Without Cerebral Palsy. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:690046. [PMID: 36188813 PMCID: PMC9397803 DOI: 10.3389/fresc.2021.690046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/09/2021] [Indexed: 06/16/2023]
Abstract
Stationary cycling is a practical exercise modality in children with cerebral palsy (CP) that lack the strength for upright exercises. However, there is a lack of robust, sensitive metrics that can quantitatively assess the motor control during cycling. The purpose of this brief report was to characterize the differences in motor control of cycling in children with CP and with typical development by developing novel metrics to quantify cycling smoothness and rhythm. Thirty one children with spastic diplegic CP and 10 children with typical development cycled on a stationary cycle. Cycling smoothness was measured by cross-correlating the crank angle with an ideal cycling pattern generated from participant-specific cadence and cycling duration. Cycling rhythmicity was assessed by evaluating the revolution-to-revolution variability in the time required to complete a revolution. Statistically significant differences (p < 0.001) using the Wilcoxon Rank Sum test were found between the two groups for both the metrics. Additionally, decision tree analysis revealed thresholds of smoothness <0.01 and rhythm <0.089-0.115 s for discriminating a less smooth, irregular cycling pattern characteristic of CP from typical cycling. In summary, the objective measures developed in this study indicate significantly less smoothness and rhythm of cycling in children with CP compared to children with typical development, suggestive of altered coordination and poor motor control. Such quantitative assessments of cycling motion in children with CP provide insights into neuromotor deficits that prevent them from cycling at intensities required for aerobic benefits and for participating in cycling related physical activities with their peers.
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Affiliation(s)
- Ashwini Sansare
- Department of Physical Therapy, University of Delaware, Newark, DE, United States
| | - Ahad Behboodi
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, United States
| | - Therese E. Johnston
- Department of Physical Therapy, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, United States
| | - Barry Bodt
- Biostatistics Core Facility, University of Delaware, Newark, DE, United States
| | - Samuel C. K. Lee
- Department of Physical Therapy, University of Delaware, Newark, DE, United States
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Abstract
For individuals with movement impairments due to neurological injuries, rehabilitative therapies such as functional electrical stimulation (FES) and rehabilitation robots hold vast potential to improve their mobility and activities of daily living. Combining FES with rehabilitation robots results in intimately coordinated human–robot interaction. An example of such interaction is FES cycling, where motorized assistance can provide high-intensity and repetitive practice of coordinated limb motion, resulting in physiological and functional benefits. In this paper, the development of multiple FES cycling testbeds and safeguards is described, along with the switched nonlinear dynamics of the cycle–rider system. Closed-loop FES cycling control designs are described for cadence and torque tracking. For each tracking objective, the authors’ past work on robust and adaptive controllers used to compute muscle stimulation and motor current inputs is presented and discussed. Experimental results involving both able-bodied individuals and participants with neurological injuries are provided for each combination of controller and tracking objective. Trade-offs for the control algorithms are discussed based on the requirements for implementation, desired rehabilitation outcomes and resulting rider performance. Lastly, future works and the applicability of the developed methods to additional technologies including teleoperated robotics are outlined.
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Armstrong EL, Boyd RN, Horan SA, Kentish MJ, Ware RS, Carty CP. Functional electrical stimulation cycling, goal-directed training, and adapted cycling for children with cerebral palsy: a randomized controlled trial. Dev Med Child Neurol 2020; 62:1406-1413. [PMID: 33146438 DOI: 10.1111/dmcn.14648] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/07/2020] [Indexed: 11/26/2022]
Abstract
AIM To test the efficacy of functional electrical stimulation (FES) cycling, goal-directed training, and adapted cycling, compared with usual care, to improve function in children with cerebral palsy (CP). METHOD The intervention was delivered between 2017 and 2019 and included three sessions per week for 8 weeks (2×1h sessions at a children's hospital, and 1h home programme/week). Hospital sessions included 30 minutes of FES cycling and 30 minutes of goal-directed training. Home programmes included goal-directed training and adapted cycling. The comparison group continued usual care. Primary outcomes were gross motor function assessed by the Gross Motor Function Measure (GMFM) and goal performance/satisfaction assessed using the Canadian Occupational Performance Measure (COPM). Secondary outcomes were sit-to-stand and activity capacity, participation in home, school, and community activities, and power output. Linear regression was used to determine the between-group mean difference immediately post-training completion after adjusting for baseline scores. RESULTS This randomized controlled trial included 21 participants (mean age=10y 3mo, standard deviation [SD]=3y; Gross Motor Function Classification System level: II=7, III=6, IV=8) who were randomized to the intervention (n=11) or usual care group (n=10). Between-group differences at T2 favoured the intervention group for GMFM-88 (mean difference=7.4; 95% confidence interval [CI]: 2.3-12.6; p=0.007), GMFM-66 (mean difference=5.9; 95% CI: 3.1-8.8; p<0.001), COPM performance (mean difference=4.4; 95% CI: 3.9-5.3; p<0.001) and satisfaction (mean difference=5.2; 95% CI: 4.0-6.4; p<0.001). INTERPRETATION Children with CP achieved meaningful functional improvements after FES cycling, goal-directed training, and adapted cycling training. Cycling programmes for children with CP should be individualized and goal directed.
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Affiliation(s)
- Ellen L Armstrong
- School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia.,The Queensland Cerebral Palsy Rehabilitation Research Centre, Centre for Children's Health Research, Faculty of Medicine, The University of Queensland, South Brisbane, QLD, Australia
| | - Roslyn N Boyd
- The Queensland Cerebral Palsy Rehabilitation Research Centre, Centre for Children's Health Research, Faculty of Medicine, The University of Queensland, South Brisbane, QLD, Australia
| | - Sean A Horan
- School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Megan J Kentish
- The Queensland Cerebral Palsy Rehabilitation Research Centre, Centre for Children's Health Research, Faculty of Medicine, The University of Queensland, South Brisbane, QLD, Australia.,Queensland Paediatric Rehabilitation Service, Children's Health Queensland Hospital and Health Service, Brisbane, QLD, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Christopher P Carty
- School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia.,Gold Coast Orthopaedic Research Engineering and Education Alliance, Griffith University, Gold Coast, QLD, Australia
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Armstrong EL, Boyd RN, Kentish MJ, Carty CP, Horan SA. Effects of a training programme of functional electrical stimulation (FES) powered cycling, recreational cycling and goal-directed exercise training on children with cerebral palsy: a randomised controlled trial protocol. BMJ Open 2019; 9:e024881. [PMID: 31213443 PMCID: PMC6589006 DOI: 10.1136/bmjopen-2018-024881] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Children with cerebral palsy (CP) experience declines in gross motor ability as they transition from childhood to adolescence, which can result in the loss of ability to perform sit-to-stand transfers, ambulate or participate in leisure activities such as cycling. Functional electrical stimulation (FES) cycling is a novel technology that may provide opportunities for children with CP to strengthen their lower limbs, improve functional independence and increase physical activity participation. The proposed randomised controlled trial will test the efficacy of a training package of FES cycling, adapted cycling and goal-directed functional training to usual care in children with CP who are susceptible to functional declines. METHODS AND ANALYSIS Forty children with CP (20 per group), aged 6-8 years and classified as Gross Motor Function Classification System (GMFCS) levels II-IV will be recruited across South East Queensland. Participants will be randomised to either an immediate intervention group, who will undertake 8 weeks of training, or a waitlist control group. The training group will attend two 1 hour sessions per week with a physiotherapist, consisting of FES cycling and goal-directed, functional exercises and a 1 hour home exercise programme per week, consisting of recreational cycling. Primary outcomes will be the gross motor function measure and Canadian occupational performance measure, and secondary outcomes will include the five times sit-to-stand test, habitual physical activity (accelerometry), power output during cycling and Participation and Environment Measure-Children and Youth. Outcomes will be assessed at baseline, postintervention (8 weeks) and 8 weeks following the intervention (retention). ETHICS AND DISSEMINATION Ethical approval has been obtained from Griffith University (2018/037) and the Children's Health Queensland Hospital and Health Service (CHQHHS) Human Research Ethics Committee (HREC/17/QRCH/88). Site-specific approval was obtained from CHQHHS research governance (SSA/17/QRCH/145). Results from this trial will be disseminated via publication in relevant peer-reviewed journals. TRIAL REGISTRATION NUMBER ACTRN12617000644369p.
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Affiliation(s)
- Ellen L Armstrong
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
- Queensland Paediatric Rehabilitation Service, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Megan J Kentish
- Queensland Paediatric Rehabilitation Service, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Christopher P Carty
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
- Queensland Paediatric Rehabilitation Service, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- Gold Coast Orthopaedic Research Engineering and Education Alliance, Griffith University, Gold Coast, Queensland, Australia
| | - Sean A Horan
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
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Rouse CA, Downey RJ, Gregory CM, Cousin CA, Duenas VH, Dixon WE. FES Cycling in Stroke: Novel Closed-Loop Algorithm Accommodates Differences in Functional Impairments. IEEE Trans Biomed Eng 2019; 67:738-749. [PMID: 31170062 DOI: 10.1109/tbme.2019.2920346] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The objective of this paper was to develop and test a novel control algorithm that enables stroke survivors to pedal a cycle in a desired cadence range despite varying levels of functional abilities after stroke. METHODS A novel algorithm was developed which automatically adjusts 1) the intensity of functional electrical stimulation (FES) delivered to the leg muscles, and 2) the current delivered to an electric motor. The algorithm automatically switches between assistive, uncontrolled, and resistive modes to accommodate for differences in functional impairment, based on the mismatch between the desired and actual cadence. Lyapunov-based methods were used to theoretically prove that the rider's cadence converges to the desired cadence range. To demonstrate the controller's real-world performance, nine chronic stroke survivors performed two cycling trials: 1) volitional effort only and 2) volitional effort accompanied by the control algorithm assisting and resisting pedaling as needed. RESULTS With a desired cadence range of 50-55 r/min, the developed controller resulted in an average rms cadence error of 1.90 r/min, compared to 6.16 r/min during volitional-only trials. CONCLUSION Using FES and an electric motor with a two-sided cadence control objective to assist and resist volitional efforts enabled stroke patients with varying strength and abilities to pedal within a desired cadence range. SIGNIFICANCE A protocol design that constrains volitional movements with assistance and resistance from FES and a motor shows potential for FES cycles and other rehabilitation robots during stroke rehabilitation.
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Vova JA, Eggebrecht EM. Utilizing Functional Electrical Stimulation and Exoskeletons in Pediatrics: a Closer Look at Their Roles in Gait and Functional Changes in Cerebral Palsy. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2019. [DOI: 10.1007/s40141-019-00215-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Giannasi LC, Matsui MY, Freitas SRB, Caldas BF, Grossmann E, Amorim JBO, dos Santos IDR, Oliveira LVF, Oliveira CS, Gomes MF. Effects of Neuromuscular Electrical Stimulation on the Masticatory Muscles and Physiologic Sleep Variables in Adults with Cerebral Palsy: A Novel Therapeutic Approach. PLoS One 2015; 10:e0128959. [PMID: 26247208 PMCID: PMC4527754 DOI: 10.1371/journal.pone.0128959] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 03/31/2015] [Indexed: 12/02/2022] Open
Abstract
Cerebral palsy (CP) is a term employed to define a group of non-progressive neuromotor disorders caused by damage to the immature or developing brain, with consequent limitations regarding movement and posture. CP may impair orapharygeal muscle tone, leading to a compromised chewing function and to sleep disorders (such as obstructive sleep apnea). Thirteen adults with CP underwent bilateral masseter and temporalis neuromuscular electrical stimulation (NMES) therapy. The effects on the masticatory muscles and sleep variables were evaluated using electromyography (EMG) and polysomnography (PSG), respectively, prior and after 2 months of NMES. EMG consisted of 3 tests in different positions: rest, mouth opening and maximum clenching effort (MCE). EMG values in the rest position were 100% higher than values recorded prior to therapy for all muscles analyzed (p < 0.05); mean mouth opening increased from 38.0 ± 8.0 to 44.0 ± 10.0 cm (p = 0.03). A significant difference in MCE was found only for the right masseter. PSG revealed an improved in the AHI from 7.2±7.0/h to 2.3±1.5/h (p < 0.05); total sleep time improved from 185 min to 250 min (p = 0.04) and minimun SaO2 improved from 83.6 ± 3.0 to 86.4 ± 4.0 (p = 0.04). NMES performed over a two-month period led to improvements in the electrical activity of the masticatory muscles at rest, mouth opening, isometric contraction and sleep variables, including the elimination of obstructive sleep apnea events in patients with CP.
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Affiliation(s)
- Lilian Chrystiane Giannasi
- Bioscience, State of São Paulo University “Julio de Mesquita Filho”, UNESP/SJC, São José dos Campos, Brazil
- Rehabilitation Sciences Master and PhD Program, Nove de Julho University-UNINOVE, São Paulo, Brazil
- * E-mail:
| | - Miriam Yumi Matsui
- Bioscience, State of São Paulo University “Julio de Mesquita Filho”, UNESP/SJC, São José dos Campos, Brazil
| | | | - Bruna F. Caldas
- Bioscience, State of São Paulo University “Julio de Mesquita Filho”, UNESP/SJC, São José dos Campos, Brazil
| | - Eduardo Grossmann
- Anatomy Laboratory, Federal University of Rio Grande do Sul- UFRGS, Porto Alegre, RS, Brazil
| | - José Benedito O. Amorim
- Bioscience, State of São Paulo University “Julio de Mesquita Filho”, UNESP/SJC, São José dos Campos, Brazil
| | | | | | - Claudia Santos Oliveira
- Rehabilitation Sciences Master and PhD Program, Nove de Julho University-UNINOVE, São Paulo, Brazil
| | - Monica Fernandes Gomes
- Bioscience, State of São Paulo University “Julio de Mesquita Filho”, UNESP/SJC, São José dos Campos, Brazil
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