scholarly journals Use of a Novel Functional Electrical Stimulation Gait Training System in 2 Adolescents With Cerebral Palsy: A Case Series Exploring Neurotherapeutic Changes

2019 ◽  
Vol 99 (6) ◽  
pp. 739-747 ◽  
Author(s):  
Ahad Behboodi ◽  
Nicole Zahradka ◽  
James Alesi ◽  
Henry Wright ◽  
Samuel C K Lee
Sensors ◽  
2021 ◽  
Vol 21 (13) ◽  
pp. 4452
Author(s):  
Nicole Zahradka ◽  
Ahad Behboodi ◽  
Ashwini Sansare ◽  
Samuel C. K. Lee

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.


2009 ◽  
Vol 89 (5) ◽  
pp. 499-506 ◽  
Author(s):  
Kari Dunning ◽  
Kristy Black ◽  
Andrea Harrison ◽  
Keith McBride ◽  
Susan Israel

Background and Purpose Studies have suggested that peroneal nerve functional electrical stimulation (peroneal FES) during walking improves gait in patients with chronic stroke. The effect of peroneal FES during the acute stages of stroke recovery is not known. The purposes of this case report are: (1) to describe differences between walking with and without a neuroprosthesis during the first few weeks after stroke, (2) to offer a clinical perspective on decision making for the use of peroneal FES during acute rehabilitation, and (3) to determine the feasibility of rehabilitation with peroneal FES neuroprostheses during the acute phases of stroke recovery. Case Description This case report describes 2 patients with different clinical presentations but both receiving inpatient rehabilitation less than 2 weeks after stroke. Each patient received peroneal FES via a neuroprothesis as tolerated while gait training in therapy. Outcomes One patient immediately increased gait speed (128%) and decreased time to perform the Timed “Up & Go” Test (40%) using the neuroprothesis. Both patients immediately increased the 6-Minute Walk Test distance using the neuroprothesis (121% and 101%). The patient who underwent testing with the instrumented walking system also demonstrated improved gait symmetry. After 1 to 3 weeks of using the neuroprothesis, the difference between outcomes with and without the neuroprothesis decreased. Discussion It is possible that peroneal FES delivered through a neuroprosthesis during acute stroke recovery may improve gait outcomes. Research is needed to determine proper duration and timing.


2021 ◽  
Vol 35 (2) ◽  
pp. 131-144
Author(s):  
Maijke van Bloemendaal ◽  
Sicco A. Bus ◽  
Frans Nollet ◽  
Alexander C. H. Geurts ◽  
Anita Beelen

Background. Many stroke survivors suffer from leg muscle paresis, resulting in asymmetrical gait patterns, negatively affecting balance control and energy cost. Interventions targeting asymmetry early after stroke may enhance recovery of walking. Objective. To determine the feasibility and preliminary efficacy of up to 10 weeks of gait training assisted by multichannel functional electrical stimulation (MFES gait training) applied to the peroneal nerve and knee flexor or extensor muscle on the recovery of gait symmetry and walking capacity in patients starting in the subacute phase after stroke. Methods. Forty inpatient participants (≤31 days after stroke) were randomized to MFES gait training (experimental group) or conventional gait training (control group). Gait training was delivered in 30-minute sessions each workday. Feasibility was determined by adherence (≥75% sessions) and satisfaction with gait training (score ≥7 out of 10). Primary outcome for efficacy was step length symmetry. Secondary outcomes included other spatiotemporal gait parameters and walking capacity (Functional Gait Assessment and 10-Meter Walk Test). Linear mixed models estimated treatment effect postintervention and at 3-month follow-up. Results. Thirty-seven participants completed the study protocol (19 experimental group participants). Feasibility was confirmed by good adherence (90% of the participants) and participant satisfaction (median score 8). Both groups improved on all outcomes over time. No significant group differences in recovery were found for any outcome. Conclusions. MFES gait training is feasible early after stroke, but MFES efficacy for improving step length symmetry, other spatiotemporal gait parameters, or walking capacity could not be demonstrated. Trial Registration. Netherlands Trial Register (NTR4762).


2006 ◽  
Vol 86 (7) ◽  
pp. 987-1000 ◽  
Author(s):  
Chia-Ling Ho ◽  
Kenneth G Holt ◽  
Elliot Saltzman ◽  
Robert C Wagenaar

Abstract Background and Purpose. Children with cerebral palsy (CP) often are faced with difficulty in walking. The purpose of this experiment was to determine the effects of functional electrical stimulation (FES) applied to the gastrocnemius-soleus muscle complex on the ability to produce appropriately timed force and reduce stiffness (elastic property of the body) and on stride length and stride frequency during walking. Subjects and Methods. Thirteen children with spastic CP (including 4 children who were dropped from the study due to their inability to cooperate) and 6 children who were developing typically participated in the study. A crossover study design was implemented. The children with spastic CP were randomly assigned to either a group that received FES for 15 trials followed by no FES for 15 trials or a group that received no FES for 15 trials followed by FES for 15 trials. The children who were having typical development walked without FES. Kinematic data were collected for the children with CP in each walking condition and for the children who were developing typically. Impulse (force-producing ability) and stiffness were estimated from an escapement-driven pendulum and spring system model of human walking. Stride length and stride frequency also were measured. To compare between walking conditions and between the children with CP and the children who were developing typically, dimensional analysis and speed normalization procedures were used. Results. Nonparametric statistics showed that there was no significant difference between the children with CP in the no-FES condition and the children who were developing typically on speed-normalized dimensionless impulse. In contrast, the children with CP in the FES condition had a significantly higher median value than the children who were developing typically. The FES significantly increased speed-normalized dimensionless impulse from 10.02 to 16.32 when comparing walking conditions for the children with CP. No significant differences were found between walking conditions for stiffness, stride length, and stride frequency. Discussion and Conclusion. The results suggest that FES is effective in increasing impulse during walking but not in decreasing stiffness. The effect on increasing impulse does not result in more typical spatiotemporal gait parameters. [Ho CL, Holt KG, Saltzman E, Wagenaar RC. Functional electrical stimulation changes dynamic resources in children with spastic cerebral palsy. Phys Ther. 2006;86:987–1000.]


2008 ◽  
Vol 32 (4) ◽  
pp. 192-202 ◽  
Author(s):  
Vijaya Krishnamoorthy ◽  
Wei-Li Hsu ◽  
Trisha M. Kesar ◽  
Daniel L. Benoit ◽  
Sai K. Banala ◽  
...  

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