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Electromyographic biofeedback-driven gaming to alter calf muscle activation during gait in children with spastic
Eline Flux1, Lynn Bar-On2, Annemieke I Buizer3
1Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands.
Insights
Children with cerebral palsy can improve calf muscle activation during gait using enjoyable biofeedback gaming. This single session showed improvements in muscle activity patterns, benefiting gait training potential.
Area of Science:
- Biomedical Engineering
- Neuroscience
- Rehabilitation Science
Background:
- Children with cerebral palsy (CP) exhibit atypical calf muscle activation during gait, characterized by excessive early stance and insufficient push-off.
- These gait deviations can impact mobility and increase the risk of secondary complications.
Purpose of the Study:
- To investigate if a single session of implicit biofeedback-driven gaming can improve calf muscle activation patterns in children with spastic cerebral palsy during gait.
- To assess the feasibility and engagement of using game-based biofeedback for gait training in this population.
Main Methods:
- Eighteen children with spastic CP (ages 6-17) participated in a single session of treadmill walking with electromyographic (EMG) biofeedback.
- Biofeedback targeted reducing early stance, increasing push-off, or both, delivered through an implicit game-based approach.
- EMG activity, double-bump index, perceived competence, and interest-enjoyment were measured.
Main Results:
- Children demonstrated statistically significant reductions in early stance calf muscle EMG activity (6.8%) and increases in push-off activity (8.1%).
- A trend towards improvement was observed during combined feedback trials (6.5%).
- Twelve out of eighteen participants showed individual improvements, and children reported high interest-enjoyment (8.4/10) and perceived competence (8.1/10).
Conclusions:
- Implicit biofeedback-driven gaming can elicit immediate, albeit small, improvements in calf muscle activation patterns in children with CP within a single session.
- The enjoyable nature of the gaming intervention suggests potential for engaging children in future gait training.
- This approach warrants further investigation in follow-up studies to assess long-term retention and functional benefits.
Background:
Children with cerebral palsy often show deviating calf muscle activation patterns during gait, with excess activation during early stance and insufficient activation during push-off.
Research Question:
Can children with cerebral palsy improve their calf muscle activation patterns during gait using one session of biofeedback-driven gaming?
Methods:
Eighteen children (6-17 y) with spastic cerebral palsy received implicit game-based biofeedback on electromyographic activity of the calf muscle (soleus or gastrocnemius medialis) while walking on a treadmill during one session. Biofeedback alternately aimed to reduce early stance activity, increase push-off activity, and both combined. Early stance and push-off activity and the double-bump-index (early stance divided by push-off activity) were determined during baseline and walking with feedback. Changes were assessed at group level using repeated measures ANOVA with simple contrast or Friedman test with post-hoc Wilcoxon signed rank test, as well as individually using independent t-tests or Wilcoxon rank sum tests. Perceived competence and interest-enjoyment were assessed through a questionnaire.
Results:
Children successfully decreased their electromyographic activity during early stance feedback trials (relative decrease of 6.8 ± 12.2 %, P = 0.025), with a trend during the combined feedback trials (6.5 ± 13.9 %, P = 0.055), and increased their electromyographic activity during push-off feedback trials (8.1 ± 15.8 %, P = 0.038). Individual improvements were seen in twelve of eighteen participants. All children experienced high levels of interest-enjoyment (8.4/10) and perceived competence (8.1/10).
Significance:
This exploratory study suggests that children with cerebral palsy can achieve small within-session improvements of their calf muscle activation pattern when provided with implicit biofeedback-driven gaming in an enjoyable manner. Follow-up gait training studies can incorporate this method to assess retention and long-term functional benefits of electromyographic biofeedback-driven gaming.
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