Functional neuromuscular electrical stimulation while exergaming for toe-walking: a retrospective case report

Area of Science:

• Pediatric Physical Therapy
• Rehabilitation Technology
• Neuromuscular Electrical Stimulation

Background:

• Toe-walking and lower extremity muscle weakness can significantly impact a child's functional mobility.
• Traditional physical therapy (PT) techniques may have limitations in maintaining patient engagement and motivation.
• Novel therapeutic approaches are needed to enhance treatment efficacy and patient adherence.

Purpose of the Study:

• To evaluate the effectiveness of combining immersive exergaming with neuromuscular electrical stimulation (NMES) in an 8-year-old boy with toe-walking and lower extremity muscle weakness.
• To assess improvements in standing and gait function, plantarflexion strength, and overall therapeutic goal achievement.

Main Methods:

• The intervention involved 10 physical therapy sessions incorporating traditional PT, NMES targeting gastrocnemius muscles, and an immersive exergaming platform (ARWell PRO).
• The exergaming platform provided interactive tasks with immediate feedback to encourage full plantar contact and controlled movements.
• Neuromuscular electrical stimulation was administered concurrently with all exergame participation.

Main Results:

• Significant improvements in plantarflexion strength were observed, with heel raises increasing from 3 (right) and 0 (left) to 15 (right) and 14 (left).
• The child demonstrated improved gait function and balance.
• Full plantar surface contact was achieved during standing activities, indicating a reduction in toe-walking.

Conclusions:

• The integration of exergaming with NMES shows promise in enhancing engagement and tolerability of physical therapy.
• This combined approach can effectively support therapeutic goals, including the reduction of toe-walking and overall improvement in functional outcomes.
• Novel technology-assisted interventions may offer a valuable adjunct to conventional pediatric physical therapy.