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A functional electrical stimulation system improves knee control in crouch gait
Sam Khamis1, Raz Martikaro, Shlomo Wientroub
1The Gait and Motion Analysis Laboratory, Department of Pediatric Orthopaedics, Dana Children's Hospital, Tel Aviv Sourasky Medical Center, 6 Weizman St., 64239, Tel Aviv, Israel, khamisam@gmail.com.
Insights
Functional electrical stimulation (FES) may help reduce crouch gait in cerebral palsy (CP) by improving knee extension during walking. This approach shows potential for enhancing mobility and function in individuals with CP.
Area of Science:
- Biomedical Engineering
- Neurorehabilitation
- Gait Analysis
Background:
- Crouch gait, characterized by excessive flexion in the ankle, knee, and hip during stance, is a common gait deviation in children with cerebral palsy (CP).
- Current treatments aim to improve lower limb extension, but functional electrical stimulation (FES) has not been extensively studied for its efficacy in reducing crouch gait severity in CP.
- This study explores the novel application of FES to the quadriceps muscles to address crouch gait in CP.
Purpose of the Study:
- To assess the immediate and sustained effects of quadriceps FES on preventing crouch gait.
- To evaluate FES's ability to promote ankle plantar flexion, knee extension, and hip extension during the stance phase of walking.
- To investigate the potential of FES as an intervention for improving gait mechanics in individuals with CP.
Main Methods:
- A case study involving an 18-year-old male with CP diplegia (GMFCS level II) was conducted.
- The NESS L300 Plus neuroprosthesis system was used to deliver FES to the quadriceps.
- Three-dimensional gait analysis, including kinematic and spatiotemporal parameters, was performed with and without FES and ground reaction ankle foot orthotics (GRAFOs).
Main Results:
- FES application resulted in improved knee extension at midstance and maximal knee extension during the stance phase.
- The patient demonstrated an enhanced ability to ascend and descend stairs using a "step-through" pattern post-FES adjustment.
- Gait analysis indicated a positive short-term effect of FES on knee extension during walking.
Conclusions:
- Quadriceps FES may be a viable strategy for decreasing crouch gait by improving knee extension during stance.
- The effectiveness of FES appears contingent upon adequate passive range of motion in the hip, knee, and ankle.
- Further research is warranted to validate these preliminary findings and explore long-term outcomes of FES in CP management.
Background:
Crouch gait is a major sagittal plane deviation in children diagnosed with cerebral palsy (CP). It is defined as a combination of excessive ankle dorsiflexion and knee and hip flexion throughout the stance phase. To the best of our knowledge, functional electrical stimulation (FES) has not been used to decrease the severity of crouch gait in CP subjects and assist in achieving lower limb extension.
Purpose:
To evaluate the short- and long-term effects of FES to the quadriceps muscles in preventing crouch gait and achieving ankle plantar flexion, knee and hip extension at the stance phase.
Methods:
An 18-year-old boy diagnosed with CP diplegia [Gross Motor Function Classification System (GMFCS) level II] was evaluated. The NESS L300(®) Plus neuroprosthesis system provided electrical stimulation of the quadriceps muscle. A three-dimensional gait analysis was performed using an eight-camera system measuring gait kinematics and spatiotemporal parameters while the subject walked shod only, with ground reaction ankle foot orthotics (GRAFOs) and using an FES device.
Results:
Walking with the FES device showed an increase in the patient's knee extension at midstance and increased knee maximal extension at the stance phase. In addition, the patient was able to ascend and descend stairs with a "step-through" pattern immediately after adjusting the FES device.
Conclusions:
This report suggests that FES to the quadriceps muscles may affect knee extension at stance and decrease crouch gait, depending on the adequate passive range of motion of the hip, knee extension, and plantar flexion. Further studies are needed in order to validate these results.
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