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Metzler MJ, Blaufuss M, Dean S, Levy TJ, Duff SV. Neuromuscular Electrical Stimulation for Children With Stroke. Arch Phys Med Rehabil 2024; 105:191-195. [PMID: 37436350 DOI: 10.1016/j.apmr.2023.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 01/27/2023] [Indexed: 07/13/2023]
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Liu Y, Li H. Electrical Stimulation for Children with Cerebral Palsy: A Meta-analysis for Randomized Controlled Trials. Neuropediatrics 2023; 54:381-387. [PMID: 37100402 DOI: 10.1055/a-2081-1560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
BACKGROUND Different types of electrical stimulation (ES) showed diverse effects on children with cerebral palsy (CP). Previous studies reported inconsistent results for effects of ES on children with CP. The present study aimed to conduct a meta-analysis to summarize these diverse results. METHODS We searched for studies exploring effects of ES on children with CP in databases (PubMed and Web of Science) from their inception until December 2022. Standard mean differences (SMDs) and 95% confidence intervals (CIs) were computed using STATA 12.0 software. RESULTS The meta-analysis included 19 randomized controlled trials (including 265 CP patients in test group and 263 CP patients in corresponding control group). The study showed an increased improvement in gross motor function, walking speed, step length, and daily living activities in ES group compared with corresponding control group with random effects models (gross motor function: SMD = 2.04, 95% CI = 1.43-2.65; walking speed: SMD = 3.71, 95% CI = 1.49-5.92; step length: SMD = 1.89, 95% CI = 0.65-3.13; daily living activities: SMD = 5.18, 95% CI = 3.04-7.31), whereas the study showed no significant difference in change of muscle strength between ES group and the corresponding control group with a random effects model (SMD = 0.42, 95% CI = -0.12 to 0.97). CONCLUSION The study demonstrated that ES might be used as therapy to improve gross motor function, gait, and daily living activities in children with CP.
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Affiliation(s)
- Yu Liu
- Department of Pediatrics, Xuanwu Hospital Capital Medical University, Beijing, People's Republic of China
| | - Hongzhi Li
- Department of Pediatrics, Xuanwu Hospital Capital Medical University, Beijing, People's Republic of China
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d'Andrea F, Taylor P, Yang K, Heller B. Can inertial measurement unit sensors evaluate foot kinematics in drop foot patients using functional electrical stimulation? Front Hum Neurosci 2023; 17:1225086. [PMID: 38021225 PMCID: PMC10666752 DOI: 10.3389/fnhum.2023.1225086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 10/04/2023] [Indexed: 12/01/2023] Open
Abstract
The accuracy of inertial measurement units (IMUs) in measuring foot motion in the sagittal plane has been previously compared to motion capture systems for healthy and impaired participants. Studies analyzing the accuracy of IMUs in measuring foot motion in the frontal plane are lacking. Drop foot patients use functional electrical stimulation (FES) to improve walking and reduce the risk of tripping and falling by improving foot dorsiflexion and inversion-eversion. Therefore, this study aims to evaluate if IMUs can estimate foot angles in the frontal and sagittal planes to help understand the effects of FES on drop foot patients in clinical settings. Two Gait Up sensors were used to estimate foot dorsi-plantar flexion and inversion-eversion angles in 13 unimpaired participants and 9 participants affected by drop foot while walking 6 m in a straight line. Unimpaired participants were asked to walk normally at three self-selected speeds and to simulate drop foot. Impaired participants walked with and without FES assistance. Foot angles estimated by the IMUs were compared with those measured from a motion capture system using curve RMSE and Bland Altman limits of agreement. Between participant groups, overall errors of 7.95° ± 3.98°, -1.12° ± 4.20°, and 1.38° ± 5.05° were obtained for the dorsi-plantar flexion range of motion, dorsi-plantar flexion at heel strike, and inversion-eversion at heel strike, respectively. The between-system comparison of their ability to detect dorsi-plantar flexion and inversion-eversion differences associated with FES use on drop foot patients provided limits of agreement too large for IMUs to be able to accurately detect the changes in foot kinematics following FES intervention. To the best of the authors' knowledge, this is the first study to evaluate IMU accuracy in the estimation of foot inversion-eversion and analyze the potential of using IMUs in clinical settings to assess gait for drop foot patients and evaluate the effects of FES. From the results, it can be concluded that IMUs do not currently represent an alternative to motion capture to evaluate foot kinematics in drop foot patients using FES.
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Affiliation(s)
- Francesca d'Andrea
- Sports EngineeringResearch Group, Sport and Physical Activity Research Centre, Advanced Wellbeing Research Centre (AWRC), Sheffield Hallam University, Sheffield, United Kingdom
| | - Paul Taylor
- The National Clinical FES Centre, Department of Clinical Science and Engineering, Salisbury District Hospital, Salisbury, United Kingdom
- Faculty of Health and Social Science, Bournemouth University, Poole, United Kingdom
- Odstock Medical Limited, Salisbury District Hospital, Salisbury, United Kingdom
| | - Kai Yang
- Etexsense, Southampton, United Kingdom
- Winchester School of Art, University of Southampton, Southampton, United Kingdom
| | - Ben Heller
- Sports EngineeringResearch Group, Sport and Physical Activity Research Centre, Advanced Wellbeing Research Centre (AWRC), Sheffield Hallam University, Sheffield, United Kingdom
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Patel D, Nguyen A, Fleeting C, Patel AB, Mumtaz M, Lucke-Wold B. Precision medicine in neurosurgery: The evolving role of theranostics. INNOSC THERANOSTICS & PHARMACOLOGICAL SCIENCES 2023; 6:417. [PMID: 37601162 PMCID: PMC10439809 DOI: 10.36922/itps.417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
Theranostics in neurosurgery is a rapidly advancing field of precision medicine that combines diagnostic and therapeutic modalities to optimize patient outcomes. This approach has the potential to provide real-time feedback during therapy and diagnose a condition while simultaneously providing treatment. One such form of theranostics is focused ultrasound, which has been found to be effective in inducing neuroablation and neuromodulation and improving the efficacy of chemotherapy drugs by disrupting the blood-brain barrier. Targeted radionuclide therapy, which pairs positron emission tomography tracers with therapeutic effects and imaging modalities, is another promising form of theranostics for neurosurgery. Automated pathology analysis is yet another form of theranostics that can provide real-time feedback during the surgical resection of tumors. Electrical stimulation has also shown promise in optimizing therapies for patients with cerebral palsy. Overall, theranostics is a cost-effective way to optimize medical care for patients in neurosurgery. It is a relatively new field, but the advancements made so far show great promise for improving patient outcomes.
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Affiliation(s)
- Drashti Patel
- Department of Neurosurgery, University of Florida, College of Medicine, Gainesville, Florida, USA
| | - Andrew Nguyen
- Department of Neurosurgery, University of Florida, College of Medicine, Gainesville, Florida, USA
| | - Chance Fleeting
- Department of Neurosurgery, University of Florida, College of Medicine, Gainesville, Florida, USA
| | - Anjali B. Patel
- Department of Neurosurgery, University of Florida, College of Medicine, Gainesville, Florida, USA
| | - Mohammed Mumtaz
- Department of Neurosurgery, University of Florida, College of Medicine, Gainesville, Florida, USA
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, College of Medicine, Gainesville, Florida, USA
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Musselman KE, Provad E, Djuric A, Bercovitch D, Yuen I, Kane KJ. Exploring the Experiences and Perceptions of Pediatric Therapists who use Functional Electrical Stimulation in their Clinical Practice. Phys Occup Ther Pediatr 2023; 43:759-779. [PMID: 37125689 DOI: 10.1080/01942638.2023.2197053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 03/25/2023] [Accepted: 03/26/2023] [Indexed: 05/02/2023]
Abstract
Aim: This study aimed to 1) explore the experiences and perceptions of pediatric physical therapists (PTs) and occupational therapists (OTs) who use FES in their practice, and 2) provide recommendations for overcoming common barriers to FES implementation.Methods: Eight Canadian PTs (n = 6) and OTs (n = 2), who use FES in their pediatric practice, participated in semi-structured interviews. Open-ended questions queried the motivation, goals, perceived benefits and challenges, and facilitators and barriers of FES use. Interviews were audio recorded and transcribed verbatim. Interpretive description was used to analyze the transcripts.Results: One overarching theme emerged: FES is a useful adjunct to therapy for certain pediatric clients. Four sub-themes were identified: Participants described 1) motivation for incorporating FES into clinical practice, which led to 2) experiences with the implementation of FES in clinical practice, including strategies for overcoming implementation barriers. These experiences influenced 3) how FES is used in practice (e.g. for which populations and therapeutic goals), and informed 4) recommendations for pediatric FES practice (e.g. more educational opportunities, research, and access for families).Conclusions: Pediatric PTs and OTs who use FES in clinical practice view FES as a valuable adjunct, especially for motor training to improve functional skills.
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Affiliation(s)
- Kristin E Musselman
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- KITE, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Elina Provad
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- KITE, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Alexander Djuric
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- KITE, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
| | - Dayna Bercovitch
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ingrid Yuen
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kyra J Kane
- Children's Program, Wascana Rehabilitation Centre, Regina, SK, Canada
- School of Rehabilitation Science, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
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Segal I, Khamis S, Sagie L, Genizi J, Azriel D, Katzenelenbogen S, Fattal-Valevski A. Functional Benefit and Orthotic Effect of Dorsiflexion-FES in Children with Hemiplegic Cerebral Palsy. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10030531. [PMID: 36980089 PMCID: PMC10047387 DOI: 10.3390/children10030531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 02/24/2023] [Accepted: 03/06/2023] [Indexed: 03/30/2023]
Abstract
Functional electrical stimulation of the ankle dorsiflexor (DF-FES) may have advantages over ankle foot orthoses (AFOs) in managing pediatric cerebral palsy (CP). This study assessed the functional benefit and orthotic effect of DF-FES in children with hemiplegic CP. We conducted an open-label prospective study on children with hemiplegic CP ≥ 6 years who used DF-FES for five months. The functional benefit was assessed by repeated motor function tests and the measurement of ankle biomechanical parameters. Kinematic and spatiotemporal parameters were assessed by gait analysis after one and five months. The orthotic effect was defined by dorsiflexion ≥ 0° with DF-FES at either the mid or terminal swing. Among 26 eligible patients, 15 (median age 8.2 years, range 6-15.6) completed the study. After five months of DF-FES use, the results on the Community Balance and Mobility Scale improved, and the distance in the Six-Minute Walk Test decreased (six-point median difference, 95% CI (1.89, 8.1), -30 m, 95% CI (-83.67, -2.6), respectively, p < 0.05) compared to baseline. No significant changes were seen in biomechanical and kinematic parameters. Twelve patients (80%) who showed an orthotic effect at the final gait analysis experienced more supported walking over time, with a trend toward slower walking. We conclude that the continuous use of DF-FES increases postural control and may cause slower but more controlled gait.
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Affiliation(s)
- Idan Segal
- Pediatric Neurology Institute, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv 6093246, Israel
- Pediatric Neurology Unit, Emek Medical Center, Afula 1834111, Israel
| | - Sam Khamis
- The Gait and Motion Analysis Laboratory, Department of Pediatric Orthopaedics, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv 6093246, Israel
| | - Liora Sagie
- Pediatric Neurology Institute, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv 6093246, Israel
| | - Jacob Genizi
- Pediatric Neurology Unit, Bnei-Zion Medical Center, Haifa 3339419, Israel
- Rappaport Family Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel
| | - David Azriel
- Faculty of Industrial Engineering and Management, Technion-Israel Institute of Technology, Haifa 3200003, Israel
| | - Sharona Katzenelenbogen
- Pediatric Neurology Institute, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv 6093246, Israel
| | - Aviva Fattal-Valevski
- Pediatric Neurology Institute, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv 6093246, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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Behboodi A, Sansare A, Zahradka N, Lee SCK. Case report: The gait deviation index may predict neurotherapeutic effects of FES-assisted gait training in children with cerebral palsy. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1002222. [PMID: 36937105 PMCID: PMC10020343 DOI: 10.3389/fresc.2023.1002222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 02/09/2023] [Indexed: 03/06/2023]
Abstract
Background Children with cerebral palsy (CP) show progressive loss of ambulatory function characterized by kinematic deviations at the hip, knee, and ankle. Functional electrical stimulation (FES) can lead to more typical lower limb kinematics during walking by eliciting appropriately timed muscle contractions. FES-assisted walking interventions have shown mixed to positive results in improving lower limb kinematics through immediate correction of gait during the application of FES, or long-term, persisting effects of non-FES-assisted gait improvements following multi-week FES-assisted gait training, at the absence of stimulation, i.e., neurotherapeutic effects. It is unknown, however, if children with CP will demonstrate a neurotherapeutic response following FES-assisted gait training because of the CP population's heterogeneity in gait deviations and responses to FES. Identifying the neurotherapeutic responders is, therefore, important to optimize the training interventions to those that have higher probability of benefiting from the intervention. Objective The purpose of this case study was to investigate the relationship between immediate and neurotherapeutic effects of FES-assisted walking to identify responders to a FES-assisted gait training protocol. Methods The primary outcome was Gait Deviation Index (GDI) and secondary outcome was root mean squared error (RMSE) of the lower extremity joint angles in the sagittal plane between participants with CP and a typically developing (TD) dataset. Potential indicators were defined as immediate improvements from baseline during FES-assisted walking followed by neurotherapeutic improvements at the end of training. Case description Gait analysis of two adolescent female participants with spastic diplegia (Gross Motor Function Classification System level II and III) was conducted at the start and end of a 12-week FES-assisted treadmill training protocol. Participant 1 had scissoring crouch gait, while participant 2 had jump gait. Outcomes The GDI showed both immediate (presence of FES) and neurotherapeutic (absence of FES after training period) improvements from baseline in our two participants. Joint angle RMSE showed mixed trends between immediate and neurotherapeutic changes from baseline. The GDI warrants investigation in a larger sample to determine if it can be used to identify responders to FES-assisted gait training.
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Affiliation(s)
- Ahad Behboodi
- NAB Laboratory, Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, United States
| | - Aswhini Sansare
- Pediatric Mobility Laboratory, Department of Physical Therapy, University of Delaware, Newark, DE, United States
| | - Nicole Zahradka
- Pediatric Mobility Laboratory, Department of Physical Therapy, University of Delaware, Newark, DE, United States
| | - Samuel C. K. Lee
- Pediatric Mobility Laboratory, Department of Physical Therapy, University of Delaware, Newark, DE, United States
- Correspondence: Samuel C. K. Lee
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Abouzakhm N, Choy S, Feld R, Taylor C, Carter K, Degroot S, Musselman KE. Evaluating the validity of a functional electrical stimulation clinical decision making tool: A qualitative study. Front Neurol 2022; 13:1001123. [PMID: 36457863 PMCID: PMC9707702 DOI: 10.3389/fneur.2022.1001123] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 10/31/2022] [Indexed: 10/20/2023] Open
Abstract
INTRODUCTION Following central nervous system damage, the recovery of motor function is a priority. For some neurological populations, functional electrical stimulation (FES) is recommended in best practice guidelines for neurorehabilitation. However, limited resources exist to guide FES application, despite clinicians reporting that a lack of FES knowledge prevents use in clinical practice. The FES Clinical Decision Making Tool was developed to assist clinicians with FES application and translation into clinical practice. The purpose of this study was to evaluate the content validity of the Tool from the perspectives of Canadian physical and occupational therapists using FES in neurorehabilitation. METHODS Thirteen participants (twelve women, one man), aged 40.5 ± 10.3 years, participated in individual semi-structured interviews to explore their clinical decision making experiences when applying FES and to evaluate the content validity (i.e., appropriateness, comprehensibility, and comprehensiveness) of the Tool. Interviews were analyzed using a qualitative conventional content analysis following the DEPICT model. RESULTS Three themes were identified. 1) Clinician context influences FES usage. Participants' experiences with FES use varied and application was influenced by treatment goals. 2) Parameter selection in clinical practice. Participants identified decision-making strategies and the challenges of parameter selection. 3) With modifications, the Tool is a valid resource to inform FES applications. Participants discussed its strengths, limitations, and suggested changes. While the Tool is useful, a more extensive resource (e.g., appendix) for the Tool is warranted. DISCUSSION A revised Tool was created to improve its comprehensiveness and comprehensibility. Thus, the Tool is a valid resource for applying FES in neurorehabilitation.
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Affiliation(s)
- Nathalie Abouzakhm
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Samantha Choy
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Rebecca Feld
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Chris Taylor
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kathryn Carter
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Spencer Degroot
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kristin E. Musselman
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- KITE, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Effect of Functional Electrical Stimulation on Gait Parameters in Children with Cerebral Palsy: A Meta-Analysis. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:3972958. [PMID: 36238472 PMCID: PMC9553333 DOI: 10.1155/2022/3972958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 09/01/2022] [Indexed: 12/05/2022]
Abstract
Objective At present, there are controversies on the effectiveness of functional electrical stimulation devices in gait improvement in the clinic, and the results reported in limited literature are contradictory. This paper summarizes and analyzes the relationship between functional electrical stimulation treatment and gait parameter changes in children with cerebral palsy, thus exploring the above controversies' results. Methods Two researchers conducted a detailed search of the literature from the establishment of the database to June 2022. Literature retrieved from databases, including PubMed, Embase, Ovid, Cochrane Library, and Web of Science and the search process followed the principles of Cochrane. The search keywords were “cerebral palsy”, “functional electrical stimulation”, “gait”, or “walk”. Gait and balance parameters were extracted from the literature. Gait parameters, such as walking speed and step length, were included in the meta-analysis. The study used standard mean difference (STD) and 95% confidence interval (CI) to calculate the mean difference between the two groups. The statistic I2 was used to evaluate the heterogeneity between the evaluation studies. Begg's test detected publication bias and the funnel chart was used for visual analysis. Furthermore, Review Manager software was used to make a risk bias map for literature publication bias analysis. Results 9 literatures were included in the analysis, with a total of 282 children with cerebral palsy, including 142 patients in the functional electrical stimulation treatment group and 140 patients in the comfort treatment, general nursing, or other physical therapy. The randomization scheme and result report used in most studies were low risk, which was important for the credibility of this study. Most studies have limitations in the blinding method of participants and subjects, and most of them were single-blind studies, which might have a high risk. The results showed that functional electrical stimulation could increase the walking speed of children with cerebral palsy (SMD = 0.82, P < 0.0001) and increase the walking step length of children with cerebral palsy (SMD = 1.34, 95%CI = 1.07, 1.60, Z = 9.91, P < 0.0001). Funnel plot analysis showed that the literature distribution was uniform and symmetrical, and Begg's test showed no publication bias in included literature. Conclusion This study compared the effects of the functional nerve stimulation treatment group and control group on improving gait parameters of children with cerebral palsy. The results indicated that functional nerve stimulation treatment could increase the gait speed and step length of children with cerebral palsy, which could improve the walking of children with cerebral palsy. Furthermore, this study needs more research data to support our findings. The results of this study might better guide the clinical practice and better use of health as well as financial resources.
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Chiasson-Poirier L, Younesian H, Turcot K, Sylvestre J. Detecting Gait Events from Accelerations Using Reservoir Computing. SENSORS (BASEL, SWITZERLAND) 2022; 22:7180. [PMID: 36236278 PMCID: PMC9570885 DOI: 10.3390/s22197180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/07/2022] [Accepted: 09/14/2022] [Indexed: 06/16/2023]
Abstract
Segmenting the gait cycle into multiple phases using gait event detection (GED) is a well-researched subject with many accurate algorithms. However, the algorithms that are able to perform accurate and robust GED for real-life environments and physical diseases tend to be too complex for their implementation on simple hardware systems limited in computing power and memory, such as those used in wearable devices. This study focuses on a numerical implementation of a reservoir computing (RC) algorithm called the echo state network (ESN) that is based on simple computational steps that are easy to implement on portable hardware systems for real-time detection. RC is a neural network method that is widely used for signal processing applications and uses a fast-training method based on a ridge regression adapted to the large quantity and variety of IMU data needed to use RC in various real-life environment GED. In this study, an ESN was used to perform offline GED with gait data from IMU and ground force sensors retrieved from three databases for a total of 28 healthy adults and 15 walking conditions. Our main finding is that despite its low complexity, ESN is robust for GED, with performance comparable to other state-of-the-art algorithms. Our results show the ESN is robust enough to obtain good detection results in all conditions if the algorithm is trained with variable data that match those conditions. The distribution of the mean absolute errors (MAE) between the detection times from the ESN and the force sensors were between 40 and 120 ms for 6 defined gait events (95th percentile). We compared our ESN with four different state-of-the-art algorithms from the literature. The ESN obtained a MAE not more than 10 ms above three other reference algorithms for normal walking indoor and outdoor conditions and yielded the 2nd lowest MAE and the 2nd highest true positive rate and specificity when applied to outdoor walking and running conditions. Our work opens the door to using the ESN as a GED for applications in wearable sensors for long-term patient monitoring.
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Affiliation(s)
- Laurent Chiasson-Poirier
- Interdisciplinary Institute for Technological Innovation (3IT), Department of Mechanical Engineering, Université de Sherbrooke, Sherbrooke, QC J1K 2R1, Canada
| | - Hananeh Younesian
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (Cirris), Department of Kinesiology, Université Laval, Quebec, QC G1M 2S8, Canada
| | - Katia Turcot
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (Cirris), Department of Kinesiology, Université Laval, Quebec, QC G1M 2S8, Canada
| | - Julien Sylvestre
- Interdisciplinary Institute for Technological Innovation (3IT), Department of Mechanical Engineering, Université de Sherbrooke, Sherbrooke, QC J1K 2R1, Canada
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Greve KR, Joseph CF, Berry BE, Schadl K, Rose J. Neuromuscular electrical stimulation to augment lower limb exercise and mobility in individuals with spastic cerebral palsy: A scoping review. Front Physiol 2022; 13:951899. [PMID: 36111153 PMCID: PMC9468780 DOI: 10.3389/fphys.2022.951899] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Neuromuscular Electrical Stimulation (NMES) is an emerging assistive technology applied through surface or implanted electrodes to augment skeletal muscle contraction. NMES has the potential to improve function while reducing the neuromuscular impairments of spastic cerebral palsy (CP). This scoping review examines the application of NMES to augment lower extremity exercises for individuals with spastic CP and reports the effects of NMES on neuromuscular impairments and function in spastic CP, to provide a foundation of knowledge to guide research and development of more effective treatment. Methods: A literature review of Scopus, Medline, Embase, and CINAHL databases were searched from 2001 to 2 November 2021 with identified inclusion and exclusion criteria. Results: Out of 168 publications identified, 33 articles were included. Articles on three NMES applications were identified, including NMES-assisted strengthening, NMES-assisted gait, and NMES for spasticity reduction. NMES-assisted strengthening included the use of therapeutic exercises and cycling. NMES-assisted gait included the use of NMES to improve gait patterns. NMES-spasticity reduction included the use of transcutaneous electrical stimulation or NMES to decrease tone. Thirteen studies investigated NMES-assisted strengthening, eleven investigated therapeutic exercise and demonstrated significant improvements in muscle structure, strength, gross motor skills, walking speed, and functional mobility; three studies investigated NMES-assisted cycling and demonstrated improved gross motor skills and walking distance or speed. Eleven studies investigated NMES-assisted gait and demonstrated improved muscle structure, strength, selective motor control, gross motor skills, and gait mechanics. Seven studies investigated NMES for spasticity reduction, and five of the seven studies demonstrated reduced spasticity. Conclusion: A growing body of evidence supports the use of NMES-assisted strengthening, NMES-assisted gait, and NMES for spasticity reduction to improve functional mobility for individuals with spastic CP. Evidence for NMES to augment exercise in individuals with spastic CP remains limited. NMES protocols and parameters require further clarity to translate knowledge to clinicians. Future research should be completed to provide richer evidence to transition to more robust clinical practice.
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Affiliation(s)
- Kelly R. Greve
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Department of Rehabilitation, Exercise and Nutrition Sciences, University of Cincinnati, College of Allied Health Sciences, Cincinnati, OH, United States
- *Correspondence: Kelly R. Greve,
| | - Christopher F. Joseph
- Department of Physical Therapy, Kennedy Krieger Institute, Baltimore, MD, United States
| | - Blake E. Berry
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Department of Rehabilitation, Exercise and Nutrition Sciences, University of Cincinnati, College of Allied Health Sciences, Cincinnati, OH, United States
| | - Kornel Schadl
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA, United States
- Motion and Gait Analysis Lab, Lucile Packard Children’s Hospital, Stanford Children’s Health, Stanford, CA, United States
| | - Jessica Rose
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA, United States
- Motion and Gait Analysis Lab, Lucile Packard Children’s Hospital, Stanford Children’s Health, Stanford, CA, United States
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Moll I, Marcellis RGJ, Coenen MLP, Fleuren SM, Willems PJB, Speth LAWM, Witlox MA, Meijer K, Vermeulen RJ. A randomized crossover study of functional electrical stimulation during walking in spastic cerebral palsy: the FES on participation (FESPa) trial. BMC Pediatr 2022; 22:37. [PMID: 35027013 PMCID: PMC8756646 DOI: 10.1186/s12887-021-03037-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 11/30/2021] [Indexed: 11/24/2022] Open
Abstract
Background Spastic cerebral palsy is the most common cause of motor disability in children. It often leads to foot drop or equinus, interfering with walking. Ankle-foot orthoses (AFOs) are commonly used in these cases. However, AFOs can be too restrictive for mildly impaired patients. Functional electrical stimulation (FES) of the ankle-dorsiflexors is an alternative treatment as it could function as a dynamic functional orthosis. Despite previous research, high level evidence on the effects of FES on activities and participation in daily life is missing. The primary aim of this study is to evaluate whether FES improves the activity and participation level in daily life according to patients, and the secondary aim is to provide evidence of the effect of FES at the level of body functions and activities. Furthermore, we aim to collect relevant information for decisions on its clinical implementation. Methods A randomized crossover trial will be performed on 25 children with unilateral spastic cerebral palsy. Patients aged between 4 and 18 years, with Gross Motor Functioning Classification System level I or II and unilateral foot drop of central origin, currently treated with AFO or adapted shoes, will be included. All participants will undergo twelve weeks of conventional treatment (AFO/adapted shoes) and 12 weeks of FES treatment, separated by a six-week washout-phase. FES treatment consists of wearing the WalkAide® device, with surface electrodes stimulating the peroneal nerve during swing phase of gait. For the primary objective, the Goal Attainment Scale is used to test whether FES improves activities and participation in daily life. The secondary objective is to prove whether FES is effective at the level of body functions and structures, and activities, including ankle kinematics and kinetics measured during 3D-gait analysis and questionnaire-based frequency of falling. The tertiary objective is to collect relevant information for clinical implementation, including acceptability using the device log file and side effect registration, cost-effectiveness based on quality adjusted life years (QALYs) and clinical characteristics for patient selection. Discussion We anticipate that the results of this study will allow evidence-based use of FES during walking in children with unilateral spastic cerebral palsy. Trial registration ClinicalTrials.gov: NCT03440632. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-021-03037-9.
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El-Shamy SM, El Kafy EMA. Effect of functional electrical stimulation versus TheraTogs on gait and balance in children with hemiplegic cerebral palsy: a randomized controlled trial. BULLETIN OF FACULTY OF PHYSICAL THERAPY 2021. [DOI: 10.1186/s43161-021-00058-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Children with cerebral palsy exhibit postural restrictions and gait problems as a result of both primary and secondary brain damage impairments. One of the main goals of cerebral palsy rehabilitation is to improve gait and balance. As a result, the purpose of this study was to compare the effects of FES and TheraTogs on gait and balance in children with hemiplegic CP. A randomized controlled study was conducted on 30 children with hemiplegic CP (18 boys and 12 girls) between the ages of 8 and 12 years. The children were divided into two equal groups. In addition to the traditional physical treatment program, the FES group received functional electrical stimulation (pulse width 300 μs, frequency 33 Hz, 2 h/day, 3 days/week, 3 months). The TheraTogs group, on the other hand, received the TheraTogs strapping system as well as the same traditional program for the same time period. The 3-D motion analysis and the Biodex balance system were used to analyze gait parameters and postural stability at baseline and 3 months after the intervention.
Results
When comparing the mean values of the gait parameters and postural stability indices of children in both groups before and after treatment, a significant improvement was reported. Furthermore, the FES group showed a greater improvement in all of the measured outcomes (P < 0.001).
Conclusion
Functional electrical stimulation improves gait pattern and postural stability in children with hemiplegic cerebral palsy significantly more than TheraTogs strapping systems.
Clinical trial registration
This study was registered in the ClinicalTrial.gov PRS (NCT05020834).
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El-Shamy SM, El Kafy EMA. Effect of functional electrical stimulation on postural control in children with hemiplegic cerebral palsy: a randomized controlled trial. BULLETIN OF FACULTY OF PHYSICAL THERAPY 2021. [DOI: 10.1186/s43161-021-00040-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Children with cerebral palsy have impairments of postural control during static and dynamic activities. Improving postural control is one of the primary objectives of rehabilitation for children with cerebral palsy. Therefore, the objective of this study was to study the effect of functional electric stimulation on postural control in children with hemiplegic cerebral palsy. A randomized controlled study was conducted on 30 children with hemiplegic cerebral palsy (18 boys and 12 girls) between the ages of 8 and 12 years. The children were distributed in two equal groups. The experimental group received functional electrical stimulation (pulse width 300 μs, frequency 33 Hz, 2 h/day, 3 days/week, / 3 consecutive months) in addition to the traditional physical therapy program. While the control group received the traditional physiotherapy program only for the same duration. The outcomes included postural stability indices that were measured at baseline and following 3 months of intervention using the Biodex balance system.
Results
A significant improvement was found in the postural stability indices of children in both groups, comparing their mean values before and after treatment. Furthermore, the results revealed a greater improvement in the postural stability of the experimental group (P < 0.001).
Conclusion
Functional electrical stimulation may be a useful tool to enhance the postural stability of children with hemiplegic cerebral palsy.
Clinical trial registration
This study was registered in the ClinicalTrial.gov PRS (NCT04269798). https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S0009LHP&selectaction=Edit&uid=U0003GAI&ts=4&cx=74k74l
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15
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Cobo-Vicente F, San Juan AF, Larumbe-Zabala E, Estévez-González AJ, Donadio MVF, Pérez-Ruiz M. Neuromuscular Electrical Stimulation Improves Muscle Strength, Biomechanics of Movement, and Functional Mobility in Children With Chronic Neurological Disorders: A Systematic Review and Meta-Analysis. Phys Ther 2021; 101:6310565. [PMID: 34184031 DOI: 10.1093/ptj/pzab170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 02/10/2021] [Accepted: 05/02/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Chronic neurological disorders (CNDs) generally produce deleterious effects on the musculoskeletal system and can affect physical activity and increase sedentary behavior in children, hindering the execution of training programs and the attainment of a correct dose of exercise. The purpose of this systematic review was to analyze the effect of neuromuscular electrical stimulation (NMES) on skeletal muscle and then on biomechanics of movement, functional mobility, strength, spasticity, muscle architecture, and body composition of children and adolescents with CNDs and chronic diseases. METHODS The search was conducted in April 2020 in PubMed, MEDLINE, Scopus, the Cochrane Library, and Web of Science, without publication period restriction. Publications investigating the effect of NMES on children and adolescents with CNDs and other chronic diseases were independently selected by 2 researchers. One author independently extracted data from the studies selected, and a second author cross-checked. RESULTS Eighteen studies with 595 participants aged between 3 and 14 years were included. Quality assessment showed that 50% of the studies presented a low risk of bias. The pooled effect of NMES on gross motor functional measure, calculated as a standardized mean difference using a random effects model, was 0.41 (95% CI = 0.19-0.64). CONCLUSION The use of NMES programs for children diagnosed with cerebral palsy, spinal muscular atrophy, and obstetric injury of the brachial plexus was effective in improving muscle strength, biomechanics of movement, and functional mobility. IMPACT NMES can be a useful tool to prevent the reduction of mobility that results from CNDs.
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Affiliation(s)
| | - Alejandro F San Juan
- Sport Biomechanics Laboratory, Department of Health and Human Performance, Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica de Madrid, Madrid, Spain
| | | | | | - Márcio Vinícius Fagundes Donadio
- Laboratory of Pediatric Physical Activity, Centro Infant, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
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16
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Evaluation of Individualized Functional Electrical Stimulation-Induced Acute Changes during Walking: A Case Series in Children with Cerebral Palsy. SENSORS 2021; 21:s21134452. [PMID: 34209917 PMCID: PMC8271667 DOI: 10.3390/s21134452] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/25/2021] [Accepted: 06/25/2021] [Indexed: 01/25/2023]
Abstract
Functional electrical stimulation (FES) walking interventions have demonstrated improvements to gait parameters; however, studies were often confined to stimulation of one or two muscle groups. Increased options such as number of muscle groups targeted, timing of stimulation delivery, and level of stimulation are needed to address subject-specific gait deviations. We aimed to demonstrate the feasibility of using a FES system with increased stimulation options during walking in children with cerebral palsy (CP). Three physical therapists designed individualized stimulation programs for six children with CP to target participant-specific gait deviations. Stimulation settings (pulse duration and current) were tuned to each participant. Participants donned our custom FES system that utilized gait phase detection to control stimulation to lower extremity muscle groups and walked on a treadmill at a self-selected speed. Motion capture data were collected during walking with and without the individualized stimulation program. Eight gait metrics and associated timing were compared between walking conditions. The prescribed participant-specific stimulation programs induced significant change towards typical gait in at least one metric for each participant with one iteration of FES-walking. FES systems with increased stimulation options have the potential to allow the physical therapist to better target the individual's gait deviations than a one size fits all device.
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Pool D, Valentine J, Taylor NF, Bear N, Elliott C. Locomotor and robotic assistive gait training for children with cerebral palsy. Dev Med Child Neurol 2021; 63:328-335. [PMID: 33225442 DOI: 10.1111/dmcn.14746] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/26/2020] [Indexed: 12/20/2022]
Abstract
AIM To determine if robotic assisted gait training (RAGT) using surface muscle electrical stimulation and locomotor training enhances mobility outcomes when compared to locomotor training alone in children with cerebral palsy (CP). METHOD Forty children (18 females, 22 males; mean age 8y 1mo, SD 2y 1mo; range 5y 1mo-12y 11mo) with CP in Gross Motor Function Classification System levels (GMFCS) III, IV, and V were randomly assigned to the RAGT and locomotor training (RAGT+LT) group or locomotor training only group (dosage for both: three 1-hour sessions a week for 6 weeks). Outcomes were assessed at baseline T1 (week 0), post-treatment T2 (week 6), and retention T3 (week 26). The primary outcome measure was the Goal Attainment Scale. Secondary outcome measures included the 10-metre walk test, children's functional independence measure mobility and self-care domain, the Canadian Occupational Performance Measure, and the Gross Motor Function Measure. RESULTS There were no significant differences between the groups for both the primary and secondary outcome measures. All participants completed the intervention in their original group allocation. There were no reported adverse events. INTERPRETATION The addition of RAGT to locomotor training does not significantly improve motor outcomes in children with CP in GMFCS levels III, IV, and V. Future studies could investigate health and well-being outcomes after locomotor training. WHAT THIS PAPER ADDS Marginally ambulant and non-ambulant children with cerebral palsy can participate in locomotor training. Robotic assisted gait training when added to locomotor training does not appear to be any more effective than locomotor training alone.
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Affiliation(s)
- Dayna Pool
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Western Australia, Australia.,Kids Rehab, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Jane Valentine
- Kids Rehab, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Nicholas F Taylor
- School of Allied Health, La Trobe University, Melbourne, Victoria, Australia
| | - Natasha Bear
- Kids Rehab, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Catherine Elliott
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Western Australia, Australia.,Kids Rehab, Perth Children's Hospital, Perth, Western Australia, Australia.,Telethon Kids Institute, Perth, Western Australia, Australia
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18
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Svane C, Nielsen JB, Lorentzen J. Nonsurgical Treatment Options for Muscle Contractures in Individuals With Neurologic Disorders: A Systematic Review With Meta-Analysis. Arch Rehabil Res Clin Transl 2021; 3:100104. [PMID: 33778477 PMCID: PMC7984980 DOI: 10.1016/j.arrct.2021.100104] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objective To investigate whether nonsurgical treatment can reduce muscle contractures in individuals with neurologic disorders. The primary outcome measure was muscle contractures measured as joint mobility or passive stiffness. Data Sources Embase, MEDLINE, Cumulative Index to Nursing and Allied Health, and Physiotherapy Evidence Database in June-July 2019 and again in July 2020. Study Selection The search resulted in 8020 records, which were screened by 2 authors based on our patient, intervention, comparison, outcome criteria. We included controlled trials of nonsurgical interventions administered to treat muscle contractures in individuals with neurologic disorders. Data Extraction Authors, participant characteristics, intervention details, and joint mobility/passive stiffness before and after intervention were extracted. We assessed trials for risk of bias using the Downs and Black checklist. We conducted meta-analyses investigating the short-term effect on joint mobility using a random-effects model with the pooled effect from randomized controlled trials (RCTs) as the primary outcome. The minimal clinically important effect was set at 5°. Data Synthesis A total of 70 trials (57 RCTs) were eligible for inclusion. Stretch had a pooled effect of 3° (95% CI, 1-4°; prediction interval (PI)=−2 to 7°; I2=66%; P<.001), and robot-assisted rehabilitation had an effect of 1 (95% CI, 0-2; PI=−8 to 9; I2=73%; P=.03). We found no effect of shockwave therapy (P=.56), physical activity (P=.27), electrical stimulation (P=.11), or botulinum toxin (P=.13). Although trials were generally of moderate to high quality according to the Downs and Black checklist, only 18 of the 70 trials used objective measures of muscle contractures. In 23 trials, nonobjective measures were used without use of assessor-blinding. Conclusions We did not find convincing evidence supporting the use of any nonsurgical treatment option. We recommend that controlled trials using objective measures of muscle contractures and a sufficiently large number of participants be performed.
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Key Words
- BTX, botulinum toxin
- CCT, controlled clinical trial
- Contracture
- Nervous System Diseases
- PI, prediction interval
- PICO, patient, intervention, comparison, outcome
- PROM, passive range of motion
- RCT, randomized controlled trial
- Range of motion, articular
- Rehabilitation
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Affiliation(s)
- Christian Svane
- Department of Neuroscience, University of Copenhagen, Copenhagen.,Elsass Foundation, Charlottenlund, Denmark
| | - Jens Bo Nielsen
- Department of Neuroscience, University of Copenhagen, Copenhagen.,Elsass Foundation, Charlottenlund, Denmark
| | - Jakob Lorentzen
- Department of Neuroscience, University of Copenhagen, Copenhagen.,Elsass Foundation, Charlottenlund, Denmark
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19
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Wages NP, Simon JE, Clark LA, Amano S, Russ DW, Manini TM, Clark BC. Relative contribution of muscle strength, lean mass, and lower extremity motor function in explaining between-person variance in mobility in older adults. BMC Geriatr 2020; 20:255. [PMID: 32723298 PMCID: PMC7385889 DOI: 10.1186/s12877-020-01656-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 07/15/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Approximately 35% of individuals > 70 years have mobility limitations. Historically, it was posited lean mass and muscle strength were major contributors to mobility limitations, but recent findings indicate lean mass and muscle strength only moderately explain mobility limitations. One likely reason is that lean mass and muscle strength do not necessarily incorporate measures globally reflective of motor function (defined as the ability to learn, or to demonstrate, the skillful and efficient assumption, maintenance, modification, and control of voluntary postures and movement patterns). In this study we determined the relative contribution of lean mass, muscle strength, and the four square step test, as an index of lower extremity motor function, in explaining between-participant variance in mobility tasks. METHODS In community-dwelling older adults (N = 89; 67% women; mean 74.9 ± 6.7 years), we quantified grip and leg extension strength, total and regional lean mass, and time to complete the four square step test. Mobility was assessed via 6-min walk gait speed, stair climb power, 5x-chair rise time, and time to complete a complex functional task. Multifactorial linear regression modeling was used to determine the relative contribution (via semi-partial r2) for indices of lean mass, indices of muscle strength, and the four square step test. RESULTS When aggregated by sex, the four square step test explained 17-34% of the variance for all mobility tasks (p < 0.01). Muscle strength explained ~ 12% and ~ 7% of the variance in 6-min walk gait speed and 5x-chair rise time, respectively (p < 0.02). Lean mass explained 32% and ~ 4% of the variance in stair climb power and complex functional task time, respectively (p < 0.02). When disaggregated by sex, lean mass was a stronger predictor of mobility in men. CONCLUSION The four square step test is uniquely associated with multiple measures of mobility in older adults, suggesting lower extremity motor function is an important factor for mobility performance. TRIAL REGISTRATION NCT02505529 -2015/07/22.
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Affiliation(s)
- Nathan P Wages
- Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University, 250 Irvine Hall, 1, Athens, OH, 43147, USA
- Department of Biomedical Sciences, Ohio University, 250 Irvine Hall, Athens, OH, 43147, USA
| | - Janet E Simon
- Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University, 250 Irvine Hall, 1, Athens, OH, 43147, USA
- School of Applied Health Sciences and Wellness, Ohio University, Athens, OH, USA
| | - Leatha A Clark
- Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University, 250 Irvine Hall, 1, Athens, OH, 43147, USA
- Department of Biomedical Sciences, Ohio University, 250 Irvine Hall, Athens, OH, 43147, USA
- Department of Family Medicine, Ohio University, Athens, OH, USA
| | - Shinichi Amano
- Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University, 250 Irvine Hall, 1, Athens, OH, 43147, USA
- Xenoma Inc., Ota-Ku, Tokyo, Japan
| | - David W Russ
- University of South Florida Morsani College of Medicine, School of Physical Therapy & Rehabilitation Sciences, Tampa, FL, USA
| | - Todd M Manini
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, USA
| | - Brian C Clark
- Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University, 250 Irvine Hall, 1, Athens, OH, 43147, USA.
- Department of Biomedical Sciences, Ohio University, 250 Irvine Hall, Athens, OH, 43147, USA.
- Division of Geriatric Medicine, Ohio University, 250 Irvine Hall, Athens, OH, 43147, USA.
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20
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Böhm H, Döderlein L, Dussa CU. Functional electrical stimulation for foot drop in the upper motor neuron syndrome: does it affect 3D foot kinematics during the stance phase of walking? ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.fuspru.2020.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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21
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Corsi C, Santos MM, Moreira RFC, Dos Santos AN, de Campos AC, Galli M, Rocha NACF. Effect of physical therapy interventions on spatiotemporal gait parameters in children with cerebral palsy: a systematic review. Disabil Rehabil 2019; 43:1507-1516. [PMID: 31588810 DOI: 10.1080/09638288.2019.1671500] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
AIM To investigate the effect of physical therapy interventions on spatiotemporal gait parameters in children with cerebral palsy. METHODS Six databases were searched: PubMed, Embase, Web of Science, Science Direct, Lilacs, and Scopus. Two independent reviewers worked on primary study selection based on titles, abstracts, and full text reading. We included randomized controlled trials investigating the role of therapeutic interventions on gait kinematics in children with cerebral palsy. The independent reviewers extracted information about study population, intervention type, main outcomes, and methodological quality according to PEDro Scale. The body of evidence was synthesized through GRADE. RESULTS Twenty-six studies were found addressing the following treatment categories: functional electrical stimulation, transcranial stimulation, gait training, muscular strengthening, vibratory platform training, and serial casting. A moderate level of evidence was identified for vibratory platform training, gait training, transcranial stimulation (positive effect), and isolated muscle strengthening (negative effect) in relation to gait velocity. Electrical stimulation showed a moderate level of evidence regarding stride length. The evidence for other outcomes was of low or very low quality. CONCLUSION Vibratory platform, gait training, electrical stimulation, and transcranial stimulation were effective to improve spatiotemporal gait parameters, especially velocity in children with cerebral palsy.Implication for rehabilitationImprovement and maintenance of gait of children with cerebral palsy is a great challenge to rehabilitation professionalsVibratory platform, gait training, electrical stimulation, and transcranial stimulation improve gait parameters.Isolated strength training was not effective to improve gait parameters in Cerebral Palsy.Long-term effect of most techniques on gait parameters until unclear.
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Affiliation(s)
- Carolina Corsi
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil.,Bioengineering Department, Politecnico di Milano, Milan, Italy
| | - Mariana M Santos
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil
| | - Roberta F C Moreira
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil
| | - Adriana N Dos Santos
- Department of Physical Therapy, Federal University of Santa Catarina, Araranguá, Brazil
| | - Ana C de Campos
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil
| | - Manuela Galli
- Bioengineering Department, Politecnico di Milano, Milan, Italy.,Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele di Pisana, Rome, Italy
| | - Nelci A C F Rocha
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil
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22
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Mooney JA, Rose J. A Scoping Review of Neuromuscular Electrical Stimulation to Improve Gait in Cerebral Palsy: The Arc of Progress and Future Strategies. Front Neurol 2019; 10:887. [PMID: 31496986 PMCID: PMC6712587 DOI: 10.3389/fneur.2019.00887] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 07/31/2019] [Indexed: 11/17/2022] Open
Abstract
Background: Neuromuscular deficits of children with spastic cerebral palsy (CP) limits mobility, due to muscle weakness, short muscle-tendon unit, spasticity, and impaired selective motor control. Surgical and pharmaceutical strategies have been partially effective but often cause further weakness. Neuromuscular electrical stimulation (NMES) is an evolving technology that can improve neuromuscular physiology, strength, and mobility. This review aims to identify gaps in knowledge to motivate future NMES research. Methods: Research publications from 1990- July 20th 2019 that investigated gait-specific NMES in CP were reviewed using the PubMed and Google Scholar databases. Results were filtered by the National Institute of Neurological Disorder and Stroke common data elements guidelines for CP. The Oxford Centre for Evidence Based Medicine guidelines were used to determine levels of evidence for each outcome. Gait-specific NMES research protocols and trends are described, with implications for future research. Results: Eighteen studies met inclusion criteria, reporting on 212 participants, 162 of whom received NMES while walking, average age of 9.8 years, GMFCS levels I–III. Studies included 4 randomized control trials, 9 cohort studies and 5 case studies. A historical trend emerged that began with experimental multi-channel NMES device development, followed by the commercial development of single-channel devices with inertial sensor-based gait event detection to facilitate ankle dorsiflexion in swing phase. This research reported strong evidence demonstrating improved ankle dorsiflexion kinematics in swing and at initial contact. Improved walking speed, step length, and muscle volume were also reported. However, improvements in global walking scores were not consistently found, motivating a recent return to investigating multi-channel gait-specific NMES applications. Conclusions: Research on single-channel gait-specific NMES found that it improved ankle motion in swing but was insufficient to address more complex gait abnormalities common in CP, such as flexed-knee and stiff-knee gait. Early evidence indicates that multi-channel gait-specific NMES may improve gait patterns in CP, however significantly more research is needed. The conclusions of this review are highly limited by the low level of evidence of the studies available. This review provides a historical record of past work and a technical context, with implications for future research on gait-specific NMES to improve walking patterns and mobility in CP.
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Affiliation(s)
- Jake A Mooney
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA, United States.,Motion & Gait Analysis Lab, Lucile Packard Children's Hospital, Stanford Children's Health, Stanford, CA, United States
| | - Jessica Rose
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA, United States.,Motion & Gait Analysis Lab, Lucile Packard Children's Hospital, Stanford Children's Health, Stanford, CA, United States
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23
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Magalhães P, Figueirêdo BB, Vasconcelos A, de Andrade ÉM, Dornelas de Andrade A, Reinaux C. Is transcutaneous electrical muscle stimulation an alternative for preventing acquired muscle weakness in the pediatric intensive care unit? A scoping review. Pediatr Pulmonol 2019; 54:1108-1116. [PMID: 31134767 DOI: 10.1002/ppul.24293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 01/25/2019] [Accepted: 02/04/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND Transcutaneous electrical muscle stimulation (TEMS) has been progressively used as add-on therapy to reduce muscle atrophy in adults unable to carry out active mobilization in the intensive care unit (ICU). There are no studies addressing TEMS in the pediatric ICU. Therefore, we decided to develop a scoping review, a type of knowledge synthesis, which unlike systematic review, identify gaps in the literature to aid the planning and commissioning of future research. OBJECTIVE To provide current perspectives on the application of TEMS for combating pediatric intensive care unit acquired weakness (PICUAW). METHODS Online databases were used to identify papers published 2006-2016, from which we selected those used musculoskeletal and cardiorespiratory performance as a primary or secondary outcome variable in participants under 18 years. RESULTS The publications reported six clinical trials from 218 outpatients with 9.5 ± 8 years old. There were differences in current modulation and duration of TEMS sessions, with a predominance of high intensity and short duration in which a muscle contraction is triggered. The main use of TEMS was in pediatric neurological disorders. TEMS was more effective when compared with SHAM on spasticity, bone mineral density, disability, and gait. One study regarding spine injury showed improvement in VO2 (P = 0.035) when combined cycling with TEMS. CONCLUSION TEMS was an effective and safe treatment for musculoskeletal impairments and cardiorespiratory performance in children with neurological disorders. Although the physiopathology is different in outpatients, an individualized protocol with TEMS might be promising for preventing PICUAW. Its effectiveness, however, deserves further investigation.
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Affiliation(s)
- Paulo Magalhães
- Department of Physical Therapy, Pernambuco University, Petrolina, Pernambuco, Brazil.,Department of Physical Therapy, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | | | - Alanna Vasconcelos
- Department of Physical Therapy, Pernambuco University, Petrolina, Pernambuco, Brazil
| | | | | | - Cyda Reinaux
- Department of Physical Therapy, Pernambuco University, Petrolina, Pernambuco, Brazil
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24
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Behboodi A, Zahradka N, Alesi J, Wright H, Lee SCK. Use of a Novel Functional Electrical Stimulation Gait Training System in 2 Adolescents With Cerebral Palsy: A Case Series Exploring Neurotherapeutic Changes. Phys Ther 2019; 99:739-747. [PMID: 31155665 PMCID: PMC6545278 DOI: 10.1093/ptj/pzz040] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 03/03/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND PURPOSE Cerebral palsy (CP) is characterized by decreased passive joint range-of-motion and impaired walking, resulting in progressive loss of function. Typical gait training interventions for children with CP appear insufficient to mitigate these effects. The purpose of this case report is to describe the use of a new treadmill-based gait training intervention using active correction with functional electrical stimulation (FES) in 2 adolescents with CP. CASE DESCRIPTION Two participants with CP (13-year-old girls, Gross Motor Function Classification System [GMFCS] level II and III) trained by walking on a treadmill, with FES assistance, for 30 minutes, 3 times per week, for 12 weeks. The intervention used a feedback control system to detect all 7 phases of gait in real time and triggered FES to the appropriate muscle groups (up to 5 bilaterally) based on the detected gait phase. Joint kinematics, step width, stride length, walking endurance, peak oxygen uptake ($\dot{v}^{o}_{2}$), and oxygen (O2) cost of walking were evaluated preintervention and postintervention. OUTCOMES Both participants showed improved knee and ankle angles and step width relative to children who are typically developing, and both exhibited increased stride length. One participant (GMFCS III) improved peak $\dot{v}^{o}_{2}$and walking endurance but not O2 cost of walking at her original self-selected walking speed. The other participant (GMFCS II) improved O2 cost of walking but not peak $\dot{v}^{o}_{2}$ or walking endurance. These differences are partly explained by differences in gait type, functional abilities, and initial fitness levels. Most improvements persisted at follow-up, indicating short-term neurotherapeutic effects. DISCUSSION Most improvements persisted at follow-up, suggesting short-term neurotherapeutic effects. This case series demonstrates the promising utility of FES-assisted gait-training interventions, tailored to target individual gait deviations, in improving walking performance.
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Affiliation(s)
| | - Nicole Zahradka
- InHealth Measurement Corps, Johns Hopkins University, Baltimore, Maryland
| | - James Alesi
- Department of Physical Therapy, University of Delaware
| | - Henry Wright
- Department of Physical Therapy, University of Delaware; and Shriners Hospitals for Children, Philadelphia, Pennsylvania
| | - Samuel C K Lee
- Department of Physical Therapy, University of Delaware; and Shriners Hospitals for Children, Philadelphia, Pennsylvania
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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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Matsunaga N, Ito T, Noritake K, Sugiura H, Kamiya Y, Ito Y, Mizusawa J, Sugiura H. Correlation between the Gait Deviation Index and skeletal muscle mass in children with spastic cerebral palsy. J Phys Ther Sci 2018; 30:1176-1179. [PMID: 30214121 PMCID: PMC6127487 DOI: 10.1589/jpts.30.1176] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 06/22/2018] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study aimed to identify a simple and useful muscle parameter for use with
the Gait Deviation Index in assessment of ambulatory children with unilateral and
bilateral spastic cerebral palsy. [Participants and Methods] Twenty-eight patients (aged 6
to 18 years; 16 females and 12 males) participated in this cross-sectional study. Outcome
measurements included the Gait Deviation Index, grip strength, 5-repetition chair stand
test, upper limb skeletal muscle mass index, and lower limb skeletal muscle mass index.
[Results] By multiple regression analysis, significant independent correlations were
observed between the Gait Deviation Index and 5-repetition chair stand test and the Gait
Deviation Index and lower limb skeletal muscle mass index, but not between the Gait
Deviation Index and grip strength or upper limb skeletal muscle mass index. [Conclusion]
The Gait Deviation Index was correlated with lower limb muscle mass in children with
spastic cerebral palsy. Determination of lower limb muscle mass may be useful gait
evaluation.
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Affiliation(s)
- Naomichi Matsunaga
- Department of Physical Therapy, Graduate School of Medicine, Nagoya University: 1-1-20 Daiko-minami, Higashi-ku, Nagoya 461-8673, Japan.,Three-dimensional Motion Analysis Room, Aichi Prefecture Mikawa Aoitori Medical and Rehabilitation Center for Developmental Disabilities, Japan
| | - Tadashi Ito
- Three-dimensional Motion Analysis Room, Aichi Prefecture Mikawa Aoitori Medical and Rehabilitation Center for Developmental Disabilities, Japan
| | - Koji Noritake
- Department of Orthopedic Surgery, Aichi Prefecture Mikawa Aoitori Medical and Rehabilitation Center for Developmental Disabilities, Japan
| | - Hiroshi Sugiura
- Department of Orthopedic Surgery, Aichi Prefecture Mikawa Aoitori Medical and Rehabilitation Center for Developmental Disabilities, Japan
| | - Yasunari Kamiya
- Department of Orthopedic Surgery, Nagoya University Hospital, Japan
| | - Yuji Ito
- Department of Pediatrics, Aichi Prefecture Mikawa Aoitori Medical and Rehabilitation Center for Developmental Disabilities, Japan
| | - Jun Mizusawa
- Department of Physical Therapy, Graduate School of Medicine, Nagoya University: 1-1-20 Daiko-minami, Higashi-ku, Nagoya 461-8673, Japan.,Three-dimensional Motion Analysis Room, Aichi Prefecture Mikawa Aoitori Medical and Rehabilitation Center for Developmental Disabilities, Japan
| | - Hideshi Sugiura
- Department of Physical Therapy, Graduate School of Medicine, Nagoya University: 1-1-20 Daiko-minami, Higashi-ku, Nagoya 461-8673, Japan
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Khamis S, Herman T, Krimus S, Danino B. Is functional electrical stimulation an alternative for orthotics in patients with cerebral palsy? A literature review. Eur J Paediatr Neurol 2018; 22:7-16. [PMID: 29102346 DOI: 10.1016/j.ejpn.2017.10.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 08/09/2017] [Accepted: 10/08/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Functional electrical stimulation (FES) is a well-known intervention used during walking to improve walking abilities and correct gait deviations by facilitating the proper muscle group at the appropriate timing in the gait cycle. Our aim was to study the types of surface FES currently used in a cerebral palsy (CP) population and examine the evidence of its ability to improve gait deviations, functional ability and therapeutic effects. METHODS A computerized database search was conducted from inception until 6/2016. Included were all clinical trials performing gait analysis of children with CP applying surface FES to any lower leg muscles evaluating the efficiency of the stimulation and any carry-over effect. RESULTS Fifteen studies met the inclusion criteria. The most common FES stimulated the dorsi flexors muscles with a positive orthotic effect, improved dorsi flexion during the swing phase and enhanced the foot contact pattern. A smaller positive effect was found for knee extensors stimulation facilitating knee extension during the stance phase and for hip abductors stimulation improving frontal plane knee alignment. No evidence was found to support the use of plantar flexors stimulation in correcting gait deviations. There is scarce evidence of any retention effect. CONCLUSION We encourage the clinician to evaluate the use of FES on a case to case basis. Controlled investigations with larger numbers of participants are warranted to determine the orthotic and therapeutic efficacy of FES.
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Affiliation(s)
- Sam Khamis
- The Gait and Motion Analysis Laboratory, Department of Pediatric Orthopaedics, Dana Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
| | - Talia Herman
- Center for the Study of Movement, Cognition, and Mobility (CMCM), Department of Neurology, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Sima Krimus
- The Gait and Motion Analysis Laboratory, Department of Pediatric Orthopaedics, Dana Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Barry Danino
- The Gait and Motion Analysis Laboratory, Department of Pediatric Orthopaedics, Dana Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Department of Pediatric Orthopaedics, Dana Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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Moll I, Vles JSH, Soudant DLHM, Witlox AMA, Staal HM, Speth LAWM, Janssen-Potten YJM, Coenen M, Koudijs SM, Vermeulen RJ. Functional electrical stimulation of the ankle dorsiflexors during walking in spastic cerebral palsy: a systematic review. Dev Med Child Neurol 2017; 59:1230-1236. [PMID: 28815571 DOI: 10.1111/dmcn.13501] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/26/2017] [Indexed: 11/30/2022]
Abstract
AIM To assess the effect of functional electrical stimulation (FES) of ankle dorsiflexors in children and adolescents with spastic cerebral palsy (CP) during walking. METHOD A systematic review was performed using the American Academy of Cerebral Palsy and Developmental Medicine methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Six databases were searched for studies applying interventions to patients aged younger than 20 years. Outcomes were classified according to the International Classification of Functioning, Disability and Health (ICF). RESULTS Seven hundred and eighty abstracts were found, 35 articles were fully screened, and 14 articles were used for analysis. Only five articles (three studies) were of level I to III evidence. At ICF participation and activity level, there is limited evidence for a decrease in self-reported frequency of toe-drag and falls. At ICF body structure and function level, there is clear evidence (I-III) that FES increased (active) ankle dorsiflexion angle, strength, and improved selective motor control, balance, and gait kinematics, but decreased walking speed. Adverse events include skin irritation, toleration, and acceptation issues. INTERPRETATION There are insufficient data supporting functional gain by FES on activity and participation level. However, evidence points towards a role for FES as an alternative to orthoses in children with spastic CP. WHAT THIS PAPER ADDS Effects of functional electrical stimulation (FES) point towards a potential role as an alternative to orthoses for patients with spastic cerebral palsy (CP). Some evidence for a decrease in self-reported frequency of toe-drag and falls with the use of FES in spastic CP. Limited evidence for improvements in activity and participation in patients with spastic CP using FES.
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Affiliation(s)
- Irene Moll
- Department of Neurology, Section Child Neurology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Johannes S H Vles
- Department of Neurology, Section Child Neurology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Dan L H M Soudant
- Department of Neurology, Section Child Neurology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Adhiambo M A Witlox
- Orthopedic Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Heleen M Staal
- Orthopedic Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Lucianne A W M Speth
- Department of Neurology, Section Child Neurology, Maastricht University Medical Center, Maastricht, the Netherlands.,Adelante, Pediatric Rehabilitation, Valkenburg, the Netherlands
| | - Yvonne J M Janssen-Potten
- Department of Neurology, Section Child Neurology, Maastricht University Medical Center, Maastricht, the Netherlands.,Adelante, Pediatric Rehabilitation, Valkenburg, the Netherlands
| | - Marcel Coenen
- Department of Neurology, Section Child Neurology, Maastricht University Medical Center, Maastricht, the Netherlands.,Adelante, Pediatric Rehabilitation, Valkenburg, the Netherlands
| | - Suzanne M Koudijs
- Department of Neurology, Section Child Neurology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - R Jeroen Vermeulen
- Department of Neurology, Section Child Neurology, Maastricht University Medical Center, Maastricht, the Netherlands
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Bailes AF, Caldwell C, Clay M, Tremper M, Dunning K, Long J. An exploratory study of gait and functional outcomes after neuroprosthesis use in children with hemiplegic cerebral palsy. Disabil Rehabil 2016; 39:2277-2285. [PMID: 27636551 DOI: 10.1080/09638288.2016.1225827] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate the immediate orthotic, total and therapeutic effects of functional electrical stimulation (FES) neuroprosthesis use on clinic based measures of gait and function in children with hemiplegic cerebral palsy. METHODS Eleven children (mean 9 years 11 months) participated in an FES neuroprosthesis (Ness L300) intervention (4 week accommodation period followed by 12 weeks of daily use) and were assessed at baseline and post in stimulation off and stimulation on conditions. Measures included clinic based outcomes of gait and function. RESULTS No significant immediate orthotic effects were observed. Significant (p < 0.01) total effects were noted for dorsiflexion at initial contact, Six-Minute Walk Test (6MWT), and walking speed. A significant therapeutic effect was found for steps off path on the Standardized Walking Obstacle Course (SWOC). CONCLUSIONS Results support previous findings of neuroprosthesis total effects on gait and provide some evidence for effects on function. Therapeutic effects remain unclear. Implications for Rehabilitation In this study, children with hemiplegic CP did not demonstrate immediate improvements in gait or function at their first clinic visit using the FES neuroprosthesis device suggesting one visit using the device is not sufficient to determine potential benefits. Over time with daily use of the FES neuroprosthesis, ankle dorsiflexion in swing and at initial contact, walking speed and endurance increased with the device worn. Overtime, no carryover effects in ankle dorsiflexion in swing and at initial contact were noted at the end of the intervention period with the device off. Clinicians should consider purchasing units to loan or rent to individuals to trial a device at home before determining long-term potential for benefit.
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Affiliation(s)
- Amy F Bailes
- a Division of Occupational Therapy and Physical Therapy , Cincinnati Children's Hospital Medical Center , Cincinnati , OH , USA.,b College of Allied Health Sciences , University of Cincinnati , Cincinnati , OH , USA
| | - Cailee Caldwell
- a Division of Occupational Therapy and Physical Therapy , Cincinnati Children's Hospital Medical Center , Cincinnati , OH , USA
| | - Mike Clay
- a Division of Occupational Therapy and Physical Therapy , Cincinnati Children's Hospital Medical Center , Cincinnati , OH , USA
| | - Melissa Tremper
- a Division of Occupational Therapy and Physical Therapy , Cincinnati Children's Hospital Medical Center , Cincinnati , OH , USA
| | - Kari Dunning
- b College of Allied Health Sciences , University of Cincinnati , Cincinnati , OH , USA
| | - Jason Long
- a Division of Occupational Therapy and Physical Therapy , Cincinnati Children's Hospital Medical Center , Cincinnati , OH , USA.,c Division of Orthopaedic Surgery Motion Analysis Laboratory , Cincinnati Children's Hospital Medical Center , Cincinnati , OH , USA
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