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Serious Game with Electromyography Feedback and Physical Therapy in Young Children with Unilateral Spastic Cerebral
Christophe Boulay1,2, Jean-Michel Gracies3,4, Lauren Garcia1,2
1Gait Laboratory, Pediatric Orthopaedic Surgery Department, Timone Children Hospital, 13385 Marseille, France.
Insights
This study shows that a serious game with electromyography feedback (EMGs_SG) combined with physical therapy (PT) improved gait velocity and reduced muscle shortening in children with unilateral spastic cerebral palsy (USCP). Further research is recommended.
Area of Science:
- Pediatrics
- Neurology
- Rehabilitation Medicine
Background:
- Unilateral spastic cerebral palsy (USCP) often affects gait due to muscle spasticity and shortening.
- Current physical therapy (PT) aims to improve function but may benefit from innovative therapeutic approaches.
Purpose of the Study:
- To investigate the clinical effects of a serious game with electromyography feedback (EMGs_SG) combined with PT in children with USCP.
- To explore the influence of muscle shortening on functional outcomes in this population.
Main Methods:
- A prospective study involving 30 children with USCP (mean age 7.6 years).
- Participants received 4 weeks of EMGs_SG sessions twice weekly, alongside usual PT.
- Outcome measures included gait velocity, plantar flexor extensibility, and muscle shortening/spasticity/weakness coefficients, assessed pre and post-intervention.
Main Results:
- Significant improvement in normalized gait velocity (0.72 to 0.77 m/s, p=0.025).
- Significant reduction in coefficients of shortening (soleus and gastrosoleus complex), spasticity (soleus), and weakness (soleus).
- Baseline gait velocity correlated negatively with gastrosoleus complex shortening (R=-0.43, p=0.02).
Conclusions:
- Four weeks of EMGs_SG combined with PT is associated with enhanced gait velocity and reduced plantar flexor muscle shortening in children with USCP.
- The findings suggest EMGs_SG is a promising adjunct to PT for improving function in USCP.
- A randomized controlled trial is warranted to compare EMGs_SG directly with conventional PT.
Abstract:
The clinical effects of a serious game with electromyography feedback (EMGs_SG) and physical therapy (PT) was investigated prospectively in children with unilateral spastic cerebral palsy (USCP). An additional aim was to better understand the influence of muscle shortening on function. Thirty children with USCP (age 7.6 ± 2.1 years) received four weeks of EMGs_SG sessions 2×/week including repetitive, active alternating training of dorsi- and plantar flexors in a seated position. In addition, each child received usual PT treatment ≤ 2×/week, involving plantar flexor stretching and command strengthening on dorsi- and plantar flexors. Five-Step Assessment parameters, including preferred gait velocity (normalized by height); plantar flexor extensibility (XV1); angle of catch (XV3); maximal active ankle dorsiflexion (XA); and derived coefficients of shortening, spasticity, and weakness for both soleus and gastrosoleus complex (GSC) were compared pre and post treatment (t-tests). Correlations were explored between the various coefficients and gait velocities at baseline. After four weeks of EMGs_SG + PT, there was an increase in normalized gait velocity from 0.72 ± 0.13 to 0.77 ± 0.13 m/s (p = 0.025, d = 0.43), a decrease in coefficients of shortening (soleus, 0.10 ± 0.07 pre vs. 0.07 ± 0.08 post, p = 0.004, d = 0.57; GSC 0.16 ± 0.08 vs. 0.13 ± 0.08, p = 0.003, d = 0.58), spasticity (soleus 0.14 ± 0.06 vs. 0.12 ± 0.07, p = 0.02, d = 0.46), and weakness (soleus 0.14 ± 0.07 vs. 0.11 ± 0.07, p = 0.005, d = 0.55). At baseline, normalized gait velocity correlated with the coefficient of GSC shortening (R = -0.43, p = 0.02). Four weeks of EMGs_SG and PT were associated with improved gait velocity and decreased plantar flexor shortening. A randomized controlled trial comparing EMGs_SG and conventional PT is needed.
