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Flores MB, Ardolino EM, J Manella K. Current Trends for Children With Spina Bifida: A Survey of Pediatric Physical Therapists. Pediatr Phys Ther 2024:00001577-990000000-00088. [PMID: 38830058 DOI: 10.1097/pep.0000000000001107] [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: 06/05/2024]
Abstract
PURPOSE To describe contemporary physical therapy practice and management of children with spina bifida (SB) in the context of the International Classification of Functioning, Disability, and Health (ICF) framework. METHODS A descriptive, cross-sectional electronic survey was sent to US pediatric physical therapy clinics and posted in the American Physical Therapy Association Pediatrics newsletter. Data were analyzed using content analysis. Codes were compared, refined, and condensed into categories. RESULTS A total of 163 participants were included. Most assessments evaluated the ICF Activity component. Most frequently reported ICF components: impairments = decreased strength (17.9%), activity limitations = limited walking (22.5%), and participation restrictions = restricted socializing/playing with peers or siblings (22.6%). The most prevalent intervention was strength training. CONCLUSIONS Physical therapists (PTs) in the United States are performing assessments and interventions supported by available evidence; however, knowledge translation and more research are needed to support best practices in PT management of children with SB.
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Affiliation(s)
- Megan B Flores
- Department of Physical Therapy (Drs Flores and Ardolino), Baylor University, Waco, Texas; Doctor of Physical Therapy Program (Manella), Nova Southeastern University - Tampa Bay Regional Campus, Clearwater, Florida
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Singh G, Keller A, Lucas K, Borders C, Stout D, King M, Parikh P, Stepp N, Ugiliweneza B, D'Amico JM, Gerasimenko Y, Behrman AL. Safety and Feasibility of Cervical and Thoracic Transcutaneous Spinal Cord Stimulation to Improve Hand Motor Function in Children With Chronic Spinal Cord Injury. Neuromodulation 2024; 27:661-671. [PMID: 37269282 DOI: 10.1016/j.neurom.2023.04.475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/25/2023] [Accepted: 04/25/2023] [Indexed: 06/05/2023]
Abstract
OBJECTIVE In adults with cervical spinal cord injury (SCI), transcutaneous spinal stimulation (scTS) has improved upper extremity strength and control. This novel noninvasive neurotherapeutic approach combined with training may modulate the inherent developmental plasticity of children with SCI, providing even greater improvements than training or stimulation alone. Because children with SCI represent a vulnerable population, we first must establish the safety and feasibility of any potential novel therapeutic approach. The objectives of this pilot study were to determine the safety, feasibility, and proof of principle of cervical and thoracic scTS for short-term effect on upper extremity strength in children with SCI. MATERIALS AND METHODS In this nonrandomized, within-subject repeated measure design, seven participants with chronic cervical SCI performed upper extremity motor tasks without and with cervical (C3-C4 and C6-C7) and thoracic (T10-T11) site scTS. Safety and feasibility of using cervical and thoracic sites scTS were determined by the frequency count of anticipated and unanticipated risks (eg, pain, numbness). Proof-of-principle concept was tested via change in force production during hand motor tasks. RESULTS All seven participants tolerated cervical and thoracic scTS across the three days, with a wide range of stimulation intensities (cervical sites = 20-70 mA and thoracic site = 25-190 mA). Skin redness at the stimulation sites was observed in four of 21 assessments (19%) and dissipated in a few hours. No episode of autonomic dysreflexia was observed or reported. Hemodynamic parameters (systolic blood pressure and heart rate) remained within stable limits (p > 0.05) throughout the assessment time points at baseline, with scTS, and after the experiment. Hand-grip and wrist-extension strength increased (p < 0.05) with scTS. CONCLUSIONS We indicated that short-term application of scTS via two cervical and one thoracic site is safe and feasible in children with SCI and resulted in immediate improvements in hand-grip and wrist-extension strength in the presence of scTS. CLINICAL TRIAL REGISTRATION The Clinicaltrials.gov registration number for the study is NCT04032990.
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Affiliation(s)
- Goutam Singh
- Kosair Charities School of Physical Therapy, Spalding University, Louisville, KY, USA; Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA.
| | | | - Kathryn Lucas
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA; Department of Neurological surgery, University of Louisville, KY, USA
| | | | | | - Molly King
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA; Department of Neurological surgery, University of Louisville, KY, USA
| | - Parth Parikh
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA; Department of Neurological surgery, University of Louisville, KY, USA
| | - Nicole Stepp
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA; Department of Neurological surgery, University of Louisville, KY, USA
| | - Beatrice Ugiliweneza
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA; Department of Neurological surgery, University of Louisville, KY, USA
| | - Jessica M D'Amico
- Glenrose Rehabilitation Hospital, Alberta Health Services, Edmonton, Alberta, Canada; Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Yury Gerasimenko
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA; Department of Neurological surgery, University of Louisville, KY, USA; Pavlov Institute of Physiology, St Petersburg, Russia
| | - Andrea L Behrman
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA; Department of Neurological surgery, University of Louisville, KY, USA
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Chaikho L, Clark E, Raison M. Transcutaneous Functional Electrical Stimulation Controlled by a System of Sensors for the Lower Limbs: A Systematic Review. SENSORS (BASEL, SWITZERLAND) 2022; 22:9812. [PMID: 36560179 PMCID: PMC9780889 DOI: 10.3390/s22249812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 11/30/2022] [Accepted: 12/11/2022] [Indexed: 06/17/2023]
Abstract
In the field of transcutaneous functional electrical stimulation (FES), open-loop and closed-loop control strategies have been developed to restore functions of the lower limbs: walking, standing up, maintaining posture, and cycling. These strategies require sensors that provide feedback information on muscle activity or biomechanics of movement. Since muscle response induced by transcutaneous FES is nonlinear, time-varying, and dependent on muscle fatigue evolution, the choice of sensor type and control strategy becomes critical. The main objective of this review is to provide state-of-the-art, emerging, current, and previous solutions in terms of control strategies. Focus is given on transcutaneous FES systems for the lower limbs. Using Compendex and Inspec databases, a total of 135 review and conference articles were included in this review. Recent studies mainly use inertial sensors, although the use of electromyograms for lower limbs has become more frequent. Currently, several researchers are opting for nonlinear controllers to overcome the nonlinear and time-varying effects of FES. More development is needed in the field of systems using inertial sensors for nonlinear control. Further studies are needed to validate nonlinear control systems in patients with neuromuscular disorders.
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Affiliation(s)
- Layal Chaikho
- Lab of Intelligent Biomechanics, Robotics, and Rehab Technology (LIBRTy), Department of Mechanical Engineering, Polytechnique Montréal, P.O. Box 6079 Station Centre-Ville, Montréal, QC H3C 3A7, Canada
- Institute of Biomedical Engineering, Polytechnique Montreal, P.O. Box 6079 Station Centre-Ville, Montréal, QC H3C 3A7, Canada
| | | | - Maxime Raison
- Lab of Intelligent Biomechanics, Robotics, and Rehab Technology (LIBRTy), Department of Mechanical Engineering, Polytechnique Montréal, P.O. Box 6079 Station Centre-Ville, Montréal, QC H3C 3A7, Canada
- Institute of Biomedical Engineering, Polytechnique Montreal, P.O. Box 6079 Station Centre-Ville, Montréal, QC H3C 3A7, Canada
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Singh G, Lucas K, Keller A, Martin R, Behrman A, Vissarionov S, Gerasimenko YP. Transcutaneous Spinal Stimulation From Adults to Children: A Review. Top Spinal Cord Inj Rehabil 2022; 29:16-32. [PMID: 36819932 PMCID: PMC9936896 DOI: 10.46292/sci21-00084] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Neuromodulation via spinal stimulation is a promising therapy that can augment the neuromuscular capacity for voluntary movements, standing, stepping, and posture in individuals with spinal cord injury (SCI). The spinal locomotor-related neuronal network known as a central pattern generator (CPG) can generate a stepping-like motor output in the absence of movement-related afferent signals from the limbs. Using epidural stimulation (EP) in conjunction with activity-based locomotor training (ABLT), the neural circuits can be neuromodulated to facilitate the recovery of locomotor functions in persons with SCI. Recently, transcutaneous spinal stimulation (scTS) has been developed as a noninvasive alternative to EP. Early studies of scTS at thoracolumbar, coccygeal, and cervical regions have demonstrated its effectiveness in producing voluntary leg movements, posture control, and independent standing and improving upper extremity function in adults with chronic SCI. In pediatric studies, the technology of spinal neuromodulation is not yet widespread. There are a limited number of publications reporting on the use of scTS in children and adolescents with either cerebral palsy, spina bifida, or SCI.
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Affiliation(s)
- Goutam Singh
- Kosair Charities School of Physical Therapy, Spalding University, Louisville, Kentucky
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky
| | - Kathryn Lucas
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky
| | - Anastasia Keller
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Rebecca Martin
- International Center for Spinal Cord Injury, Hugo W. Moser Research Institute at Kennedy Krieger Institute, Baltimore, Maryland
- Department of Physical Medicine and Rehabilitation, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Andrea Behrman
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky
| | - Sergey Vissarionov
- Turner Scientific Research Institute for Children's Orthopedics, St. Petersburg, Russia
| | - Yury P Gerasimenko
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky
- Department of Physiology, University of Louisville, Louisville, Kentucky
- Pavlov Institute of Physiology Russian Academy of Sciences, St. Petersburg, Russia
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Pattanshetti S, Mahajan JK, Saxena S, Saxena A. Transcutaneous Electrical Nerve Stimulation in Management of Neurogenic bladder Secondary to Spina Bifida. J Indian Assoc Pediatr Surg 2022; 27:570-576. [PMID: 36530811 PMCID: PMC9757791 DOI: 10.4103/jiaps.jiaps_220_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/02/2022] [Accepted: 03/26/2022] [Indexed: 06/17/2023] Open
Abstract
AIMS To assess the role of transcutaneous electrical nerve stimulation (TENS), alone or in combination with anticholinergic drugs in the management of neurogenic bladder (NB) in spina bifida (SB). MATERIALS AND METHODS All the consecutive patients, visiting outpatient clinic between July 2017 and December 2018, who were toilet trained and at least 1 year post-SB surgery with clinical and/or urodynamic evidence of NB, were included in the study. Out of 65 patients, 40 fulfilled the inclusion criteria and were randomised into: group A (ten patients, placebo TENS with anticholinergic agents), Group B (14 patients, TENS therapy with placebo medications) and Group C (16 patients, TENS therapy with anticholinergic medications). All the patients maintained a voiding diary and underwent assessment before and after the intervention. The study was approved by the Institutional Ethics Committee. RESULTS The presenting symptoms were urinary incontinence (100%), increased frequency (45%), straining during micturition (22.5%), urgency (22.5%), and hesitancy (30%). The demographic parameters were comparable in all the groups. After group specific intervention, the wet episodes/day significantly improved in Group C (P = 0.001). Similarly, the mean wet days/week also improved significantly in Group C (6.5-4.37 days/week, P = 0.01). Out of 40 patients, 29 had abnormal findings on ultrasonography before the start of the therapy. Following intervention, only two patients in Group C showed normalization of findings. On Urodynamic studies, detrusor pressure (Pdet max) decreased in all the groups; however, the patients in Group C, showed the maximum reduction (56.6 ± 11-30 ± 6.7 cm H2O). Similarly compliance (9.4 to 14.5 cm H2O, P = 0.02) and bladder capacity (68%-88% of EBC, P = 0.001) also improved significantly in Group C as compared to other 2 groups Overall, nine patients (Group A, B, and C = 1, 3, and five patients, respectively) showed detrusor instability, while post therapy, only one patient (Group B) had unstable bladder. Maximum decrease in postvoid residue (mean) was also observed in Group C (77-41 ml, P = 0.01). CONCLUSIONS The application of TENS in NB secondary to SB is effective and its application led to improvement in symptoms, decrease in the wet episodes/day, maximum detrusor pressure, instability, bladder compliance, and capacity. TENS therapy in combination with anticholinergic agents had a better outcome as compared to monotherapy with either of the two modalities.
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Affiliation(s)
- Swapnil Pattanshetti
- Department of Pediatric Surgery, Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jai Kumar Mahajan
- Department of Pediatric Surgery, Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Somya Saxena
- Department of Physical and Rehabilitation Medicine, Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Akshay Saxena
- Department of Radio-Diagnosis, Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Yan D, Vassar R. Neuromuscular electrical stimulation for motor recovery in pediatric neurological conditions: a scoping review. Dev Med Child Neurol 2021; 63:1394-1401. [PMID: 34247385 DOI: 10.1111/dmcn.14974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/28/2021] [Indexed: 12/31/2022]
Abstract
AIM To explore the breadth of pediatric neurological conditions for which neuromuscular electrical stimulation (NMES) has been studied. METHOD Databases (PubMed, Google Scholar, Scopus, and Embase) were searched from 2000 to 2020, using the search terms 'neuromuscular electrical stimulation' OR 'functional electrical stimulation' with at least one of the words 'pediatric OR child OR children OR adolescent', and without the words 'dysphagia OR implanted OR enuresis OR constipation'. Articles focused on adults or individuals with cerebral palsy (CP) were excluded. RESULTS Thirty-five studies met the inclusion criteria, with a total of 353 pediatric participants (293 unique participants; mean age 7y 4mo, range 1wk-38y). NMES was applied in a range of pediatric conditions other than CP, including stroke, spinal cord injury, myelomeningocele, scoliosis, congenital clubfoot, obstetric brachial plexus injury, genetic neuromuscular diseases, and other neuromuscular conditions causing weakness. INTERPRETATION All 35 studies concluded that NMES was well-tolerated and most studies suggested that NMES could augment traditional therapy methods to improve strength. Outcome measurements were heterogeneous. Further research on NMES with larger, randomized studies will help clarify its potential to improve physiology and mobility in pediatric patients with neuromuscular conditions. What this paper adds Neuromuscular electrical stimulation (NMES) appears to be tolerated by pediatric patients. NMES shows potential for augmenting recovery in pediatric patients with a range of rehabilitation needs.
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Affiliation(s)
- Derek Yan
- Winston Churchill High School, Potomac, MD, USA
| | - Rachel Vassar
- Department of Neurology, Division of Pediatric Neurology, University of California San Francisco, San Francisco, CA, USA
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