[Effects of locomotor training and functional electrical stimulation on postural function in children with severe...

Area of Science:

• Neurology
• Rehabilitation Medicine
• Pediatrics

Background:

• Cerebral palsy (CP) significantly impacts upright stance and postural control in children.
• Children with severe CP (GMFCS Level III) exhibit distinct postural deficits, including altered center of pressure (COP) dynamics and lack of response to visual input changes.
• Current rehabilitation strategies aim to improve motor function and balance in this population.

Purpose of the Study:

• To evaluate the efficacy of robot-assisted locomotor training combined with functional electrical stimulation (FES) on postural control in children with severe CP.
• To compare the effects of locomotor training with and without FES on stabilometry and plantography measures.
• To assess changes in postural control parameters relative to age-matched healthy children.

Main Methods:

• A cohort of 27 children (aged 6–12 years) with severe CP (GMFCS Level III) underwent 15 sessions of robot-assisted passive stepping.
• Functional electrical stimulation (FES) was applied to 12 participants during the locomotor training.
• Stabilometry, plantography, and posturography tests were conducted before and after the intervention period, with comparisons to 23 healthy controls.

Main Results:

• Children with CP demonstrated impaired postural control, characterized by forward COP shift, increased COP trajectory area/length, and reduced sway response to eye closure.
• Locomotor training alone showed a tendency towards normalization of postural control in 43% of participants.
• The addition of FES to locomotor training resulted in significant improvements, observed in 75% of participants, with normalization of footprints also noted.

Conclusions:

• Robot-assisted locomotor training shows potential for improving postural control in children with severe CP.
• Functional electrical stimulation (FES) significantly enhances the benefits of locomotor training, leading to greater improvements in vertical posture control and normalized gait patterns.
• FES combined with locomotor training represents a promising therapeutic approach for addressing severe postural deficits in pediatric cerebral palsy.