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Published on: August 9, 2024
Immediate effect of percutaneous intramuscular stimulation during gait in children with cerebral palsy: a feasibility
Margo N Orlin1, Samuel R Pierce, Carrie Laughton Stackhouse
1Programs in Rehabilitation Sciences, Drexel University, Philadelphia, PA 19102-1192, USA. margo.n.orlin@drexel.edu
Insights
Percutaneous functional electrical stimulation (P-FES) may improve ankle movement in children with cerebral palsy (CP). This study found immediate gait improvements with P-FES, suggesting its potential as a therapeutic tool.
Area of Science:
- Biomedical Engineering
- Pediatric Rehabilitation
- Neurology
Background:
- Cerebral palsy (CP) often impairs gait due to abnormal muscle function.
- Functional electrical stimulation (FES) is a potential intervention for improving motor control.
- Percutaneous intramuscular FES (P-FES) has not been studied for immediate gait improvements in children with CP.
Purpose of the Study:
- To investigate the feasibility and immediate effects of P-FES on ankle kinematics during gait in children with CP.
- To assess P-FES effects on gait parameters in children with different CP subtypes.
Main Methods:
- Eight children with CP underwent percutaneous intramuscular electrode implantation in gastrocnemius (GA) and tibialis anterior (TA) muscles.
- Participants practiced gait with three P-FES conditions: GA only, TA only, and combined GA/TA.
- Gait analysis was performed immediately after one week of practice, with and without stimulation.
Main Results:
- Significant improvements in peak dorsiflexion during swing (more affected limb) and at initial contact (less affected limb) were observed in the GA/TA condition.
- Clinically meaningful trends indicated improved dorsiflexion kinematics with TA only and GA/TA P-FES conditions.
- P-FES demonstrated potential for immediate enhancement of ankle function during gait.
Conclusions:
- P-FES is a feasible intervention for improving ankle kinematics in children with CP.
- Immediate improvements in gait parameters suggest P-FES as a promising therapeutic approach.
- Further research is warranted to explore the long-term effects and optimal parameters for P-FES in pediatric CP rehabilitation.
Abstract:
The feasibility of percutaneous intramuscular functional electrical stimulation (P-FES) in children with cerebral palsy (CP) for immediate improvement of ankle kinematics during gait has not previously been reported. Eight children with CP (six with diplegia, two with hemiplegia; mean age 9 years 1 month [SD 1 y 4 mo; range 7 y 11 mo to 11 y 10 mo]) had percutaneous intramuscular electrodes implanted into the gastrocnemius (GA) and tibialis anterior (TA) muscles of their involved limbs. Stimulation was provided during appropriate phases of the gait cycle in three conditions (GA only, TA only, and GA/TA). immediately after a week of practice for each stimulation condition, a gait analysis was performed with and without stimulation. A significant improvement in peak dorsiflexion in swing for the more affected extremity and dorsiflexion at initial contact for the less affected extremity were found in the GA/TA condition. Clinically meaningful trends were evident for improvements in dorsiflexion kinematics for the more and less affected extremities in the TA only and GA/TA conditions. The results suggest that P-FES might immediately improve ankle kinematics in children with CP.
