A randomized crossover study of functional electrical stimulation during walking in spastic cerebral palsy: the FES on participation (FESPa) trial

Abstract Background Spastic cerebral palsy is the most common cause of motor disability in children. It often leads to foot drop or equinus, interfering with walking. Ankle-foot orthoses (AFOs) are commonly used in these cases. However, AFOs can be too restrictive for mildly impaired patients. Functional electrical stimulation (FES) of the ankle-dorsiflexors is an alternative treatment as it could function as a dynamic functional orthosis. Despite previous research, high level evidence on the effects of FES on activities and participation in daily life is missing. The primary aim of this study is to evaluate whether FES improves the activity and participation level in daily life according to patients, and the secondary aim is to provide evidence of the effect of FES at the level of body functions and activities. Furthermore, we aim to collect relevant information for decisions on its clinical implementation. Methods A randomized crossover trial will be performed on 25 children with unilateral spastic cerebral palsy. Patients aged between 4 and 18 years, with Gross Motor Functioning Classification System level I or II and unilateral foot drop of central origin, currently treated with AFO or adapted shoes, will be included. All participants will undergo twelve weeks of conventional treatment (AFO/adapted shoes) and 12 weeks of FES treatment, separated by a six-week washout-phase. FES treatment consists of wearing the WalkAide® device, with surface electrodes stimulating the peroneal nerve during swing phase of gait. For the primary objective, the Goal Attainment Scale is used to test whether FES improves activities and participation in daily life. The secondary objective is to prove whether FES is effective at the level of body functions and structures, and activities, including ankle kinematics and kinetics measured during 3D-gait analysis and questionnaire-based frequency of falling. The tertiary objective is to collect relevant information for clinical implementation, including acceptability using the device log file and side effect registration, cost-effectiveness based on quality adjusted life years (QALYs) and clinical characteristics for patient selection. Discussion We anticipate that the results of this study will allow evidence-based use of FES during walking in children with unilateral spastic cerebral palsy. Trial registration ClinicalTrials.gov: NCT03440632.

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Functional Electrical Stimulation Changes Dynamic Resources in Children With Spastic Cerebral Palsy

Physical Therapy ◽

10.1093/ptj/86.7.987 ◽

2006 ◽

Vol 86 (7) ◽

pp. 987-1000 ◽

Cited By ~ 27

Author(s):

Chia-Ling Ho ◽

Kenneth G Holt ◽

Elliot Saltzman ◽

Robert C Wagenaar

Keyword(s):

Cerebral Palsy ◽

Electrical Stimulation ◽

Functional Electrical Stimulation ◽

Stride Length ◽

The Body ◽

Stride Frequency ◽

Spastic Cerebral Palsy ◽

Significant Difference ◽

Muscle Complex ◽

Spring System

Abstract Background and Purpose. Children with cerebral palsy (CP) often are faced with difficulty in walking. The purpose of this experiment was to determine the effects of functional electrical stimulation (FES) applied to the gastrocnemius-soleus muscle complex on the ability to produce appropriately timed force and reduce stiffness (elastic property of the body) and on stride length and stride frequency during walking. Subjects and Methods. Thirteen children with spastic CP (including 4 children who were dropped from the study due to their inability to cooperate) and 6 children who were developing typically participated in the study. A crossover study design was implemented. The children with spastic CP were randomly assigned to either a group that received FES for 15 trials followed by no FES for 15 trials or a group that received no FES for 15 trials followed by FES for 15 trials. The children who were having typical development walked without FES. Kinematic data were collected for the children with CP in each walking condition and for the children who were developing typically. Impulse (force-producing ability) and stiffness were estimated from an escapement-driven pendulum and spring system model of human walking. Stride length and stride frequency also were measured. To compare between walking conditions and between the children with CP and the children who were developing typically, dimensional analysis and speed normalization procedures were used. Results. Nonparametric statistics showed that there was no significant difference between the children with CP in the no-FES condition and the children who were developing typically on speed-normalized dimensionless impulse. In contrast, the children with CP in the FES condition had a significantly higher median value than the children who were developing typically. The FES significantly increased speed-normalized dimensionless impulse from 10.02 to 16.32 when comparing walking conditions for the children with CP. No significant differences were found between walking conditions for stiffness, stride length, and stride frequency. Discussion and Conclusion. The results suggest that FES is effective in increasing impulse during walking but not in decreasing stiffness. The effect on increasing impulse does not result in more typical spatiotemporal gait parameters. [Ho CL, Holt KG, Saltzman E, Wagenaar RC. Functional electrical stimulation changes dynamic resources in children with spastic cerebral palsy. Phys Ther. 2006;86:987–1000.]

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Functional electrical stimulation during walking in spastic cerebral palsy - study protocol

Gait & Posture ◽

10.1016/j.gaitpost.2019.07.175 ◽

2019 ◽

Vol 73 ◽

pp. 397-398

Keyword(s):

Cerebral Palsy ◽

Electrical Stimulation ◽

Study Protocol ◽

Functional Electrical Stimulation ◽

Spastic Cerebral Palsy

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Benefits of Upper Limb Functional Electrical Stimulation in Children with Spastic Cerebral Palsy

Medicina Moderna - Modern Medicine ◽

10.31689/rmm.2021.28.2.201 ◽

2021 ◽

Vol 28 (2) ◽

pp. 201-207

Author(s):

Corina SPOREA ◽

◽

Dumitru FERECHIDE ◽

Keyword(s):

Cerebral Palsy ◽

Electrical Stimulation ◽

Upper Limb ◽

Functional Electrical Stimulation ◽

Motor Performance ◽

Functional Limitation ◽

Spastic Cerebral Palsy ◽

Control Group ◽

Wrist Flexion ◽

Effective Manner

Aim: The aim of this study was to assess the effectiveness of Functional Electrical Stimulation in upper limb rehabilitation in children with cerebral palsy. Methods: 90 children with spastic cerebral palsy, age between 6 and 9 years, were randomized into two groups. 45 children, represented the control group, performed conventional physical and occupational therapy and robot-assisted therapy. In addition to the control group, the experimental group received functional electrical stimulation interventions with postural control on the affected upper limb. Results: The experimental group's motor performance after treatment (improved coordination by 8.2%, wrist flexion by 9.75°, three-fingered grasp strength by 1.04°, and functional limitation lowered by 5.93) was considerably better than the control group's which coordination increased by 5.5%, wrist flexion by 8.72°, three-fingered grasp strength by 0.7 and functional limitation decreased by 2.33. Conclusions: Functional electrical stimulation intervention was found to be an effective manner to improve motor performance, in terms of coordination, range of motion, and three-fingered grasp strength, visibly reducing functional limitation and improving performance in activities of daily living.

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Evaluation of Functional Electrical Stimulation to Assist Cycling in Four Adolescents with Spastic Cerebral Palsy

International Journal of Pediatrics ◽

10.1155/2012/504387 ◽

2012 ◽

Vol 2012 ◽

pp. 1-11 ◽

Cited By ~ 11

Author(s):

Ann Tokay Harrington ◽

Calum G. A. McRae ◽

Samuel C. K. Lee

Keyword(s):

Cerebral Palsy ◽

Electrical Stimulation ◽

Functional Electrical Stimulation ◽

Power Output ◽

Cycling Performance ◽

Cardiovascular Fitness ◽

Spastic Cerebral Palsy ◽

Surface Electrodes ◽

Future Work

Introduction. Adolescents with cerebral palsy (CP) often have difficulty participating in exercise at intensities necessary to improve cardiovascular fitness. Functional electrical stimulation- (FES-) assisted cycling is proposed as a form of exercise for adolescents with CP. The aims of this paper were to adapt methods and assess the feasibility of applying FES cycling technology in adolescents with CP, determine methods of performing cycling tests in adolescents with CP, and evaluate the immediate effects of FES assistance on cycling performance.Materials/Methods. Four participants (12–14 years old; GMFCS levels III-IV) participated in a case-based pilot study of FES-assisted cycling in which bilateral quadriceps muscles were activated using surface electrodes. Cycling cadence, power output, and heart rate were collected.Results. FES-assisted cycling was well tolerated (n=4) and cases are presented demonstrating increased cadence (2–43 rpm), power output (19–70%), and heart rates (4-5%) and decreased variability (8–13%) in cycling performance when FES was applied, compared to volitional cycling without FES assistance. Some participants (n=2) required the use of an auxiliary hub motor for assistance.Conclusions. FES-assisted cycling is feasible for individuals with CP and may lead toimmediateimprovements in cycling performance. Future work will examine the potential for long-term fitness gains using this intervention.

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