Correction of Toe-Walking Gait in Children with Spastic Cerebral Palsy by using Electrical Stimulation Therapy

Toe-walking is a very common gait abnormality seen in children with Cerebral Palsy (CP). The present study aims to improvise the toe-walking gait by applying Electrical Stimulation (ES) therapy of the Tricep Surae (TS) muscles. The study was carried out on sixteen children with spastic CP with unilateral toe-walking gait problem, divided into the intervention group that received both ES therapy along with conventional physiotherapy treatment and the control group that received only conventional physiotherapy treatment. Both groups were treated for 60 (30 + 30) minutes per day, for 5 days a week, up to 12 weeks. The gait data were analyzed for spatiotemporal and parameters influencing the walking capacity. The results showed that those children who received the intervention had a significant increase in gait speed by 17.67 % (p = 0.019) and decrease in stride length by 10.25 % (p = 0.037), resulting in improvement of body balance. There was a significant percentage increase in initial contact (heel strike) of 85.71 % (p = 0.000) and flat foot position (loading response) of 49.2 % (p = 0.005), confirming reduction in toe-walking. There was also an increase in the swing power by 39.8 % (p = 0.028) and ground impact by 19.5 % (p = 0.003) suggesting a change in foot contact pattern. The results indicate that ES therapy on TS muscle along with conventional physiotherapy may correct the toe-walking gait in children with spastic hemiplegic CP.

Custom-made silicone hand prosthesis: A case study

Up to now, a cosmetic glove was the most common method for managing transmetacarpal (TMC) and carpometacarpal (CMC) amputations, but it is devoid of markings and body color. At this amputation level, it is very difficult to fit a functional prosthesis because of the short available length, unsightly shape, grafted skin, contracture and lack of functional prosthetic options. A 30-year-old male came to our clinic with amputation at the 1st to 4th carpometacarpal level and a 5th metacarpal that was projected laterally and fused with the carpal bone. The stump had grafted skin, redness, and an unhealed suture line. He complained of pain projected over the metacarpal and suture area. The clinical team members decided to fabricate a custom-made silicone hand prosthesis to accommodate the stump, protect the grafted skin, improve the hand's appearance and provide some passive function. The custom silicone hand prosthesis was fabricated with modified flexible wires to provide passive interphalangeal movement. Basic training, care and maintenance instructions for the prosthesis were given to the patient. The silicone hand prosthesis was able to restore the appearance of the lost digits and provide some passive function. His pain (VAS score) was reduced. Improvement in activities of daily living was found in the DASH questionnaire and Jebsen-Taylor Hand Function test. A silicone glove is a good option for more distal amputations, as it can accommodate any deformity, protect the skin, enhance the appearance and provide functional assistance. This case study provides a simple method to get passively movable fingers after proximal hand amputation.

Therapeutic effects of functional electrical stimulation on motor cortex in children with spastic Cerebral Palsy

In the present study we have evaluated the electroencephalogram (EEG) signal recorded during ankle dorsal and plantar flexion in children with spastic Cerebral Palsy (CP) after Functional Electrical Stimulation (FES) of the Tibialis Anterior (TA) muscles. The intervention group had 10 children with spastic diaplegic/hemiplegic CP within the age group of 5 to 14 years of age who received both FES for 30 minutes and the conventional physiotherapy for 30 minutes a day, while the control group had 5 children who received only conventional physiotherapy for 60(30 + 30) minutes a day only. Both group were treated for 5 days a week, up to 12 weeks. The EEG data were analyzed for Peak Alpha Frequency (PAF), sensorimotor rhythm (SMR), mu wave suppression and power spectral density (PSD) of all the bands. The results showed a decrease in SMR and mu wave suppression in the intervention group as compared to the control group, indicating a positive/greater improvement in performance of motor activities. Therefore, from this study we could conclude that FES combined with conventional physiotherapy improves the motor activity in children with spastic CP.

Surface EMG analysis of tibialis anterior muscle in walking with FES in stroke subjects

In this work we have examined the effect of functional electrical stimulation (FES) in the management of drop foot in stroke subjects with surface electromyographic (sEMG) analysis from the tibialis anterior (TA) muscle. Ten subjects were assigned to FES therapy combined with conventional stroke rehabilitation program 5 days a week, 60 min a day, for 12-weeks in clinical settings. Baseline and post-treatment measurements were made for temporal and spectral parameters of EMG signals of TA muscle. The evaluation results reported an increase in mean-absolute-value (MAV), root-mean-square (RMS) and also improved the amplitude and median frequency (MF) of the sEMG power spectrum in monitoring the improvement of the tibialis anterior muscle during maximum voluntary contractions (MVC). We conclude that walking with FES system combined with a conventional rehabilitation program improves the muscle strength in stroke survivors.