Use of a Novel Functional Electrical Stimulation Gait Training System in 2 Adolescents With Cerebral Palsy: A Case Series Exploring Neurotherapeutic Changes

Behboodi, Ahad; Zahradka, Nicole; Alesi, James; Wright, Henry; Lee, Samuel C. K.

doi:10.1093/ptj/pzz040

Cited by 14 publications

(24 citation statements)

References 20 publications

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“…Quantifying gait event delays [ 5 ] and subsequently providing compensation algorithms for gait event timing errors [ 40 ] are crucial for applications in which gait events serve to trigger assistive applications. This approach allows for appropriate correction and compensation of gait event detection errors to minimize timing errors for the assistive applications [ 40 , 41 ].…”

Section: Introductionmentioning

confidence: 99%

An Evaluation of Three Kinematic Methods for Gait Event Detection Compared to the Kinetic-Based ‘Gold Standard’

Zahradka

Verma

Behboodi

et al. 2020

Sensors

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Video- and sensor-based gait analysis systems are rapidly emerging for use in ‘real world’ scenarios outside of typical instrumented motion analysis laboratories. Unlike laboratory systems, such systems do not use kinetic data from force plates, rather, gait events such as initial contact (IC) and terminal contact (TC) are estimated from video and sensor signals. There are, however, detection errors inherent in kinematic gait event detection methods (GEDM) and comparative study between classic laboratory and video/sensor-based systems is warranted. For this study, three kinematic methods: coordinate based treadmill algorithm (CBTA), shank angular velocity (SK), and foot velocity algorithm (FVA) were compared to ‘gold standard’ force plate methods (GS) for determining IC and TC in adults (n = 6), typically developing children (n = 5) and children with cerebral palsy (n = 6). The root mean square error (RMSE) values for CBTA, SK, and FVA were 27.22, 47.33, and 78.41 ms, respectively. On average, GED was detected earlier in CBTA and SK (CBTA: −9.54 ± 0.66 ms, SK: −33.41 ± 0.86 ms) and delayed in FVA (21.00 ± 1.96 ms). The statistical model demonstrated insensitivity to variations in group, side, and individuals. Out of three kinematic GEDMs, SK GEDM can best be used for sensor-based gait event detection.

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Section: Introductionmentioning

confidence: 99%

An Evaluation of Three Kinematic Methods for Gait Event Detection Compared to the Kinetic-Based ‘Gold Standard’

Zahradka

Verma

Behboodi

et al. 2020

Sensors

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“…Specifically, the Walkaide and Bioness devices provide a user-controlled intensity setting, which presumably alters the current, since no study that implemented these devices in a community setting reported current settings. All studies, except one (20), applied stimulation according to normal physiological timing. All studies utilized surface electrodes.…”

Section: Discussionmentioning

confidence: 99%

“…All studies utilized surface electrodes. An outlier in stimulation protocols was the most recent study which utilized a multi-channel device in two individuals (20). They used a substantially higher pulse width, up to 440 μs, and current up to 60 mA.…”

Section: Discussionmentioning

confidence: 99%

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A Scoping Review of Neuromuscular Electrical Stimulation to Improve Gait in Cerebral Palsy: The Arc of Progress and Future Strategies

Mooney

Rose

2019

Front. Neurol.

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Background: Neuromuscular deficits of children with spastic cerebral palsy (CP) limits mobility, due to muscle weakness, short muscle-tendon unit, spasticity, and impaired selective motor control. Surgical and pharmaceutical strategies have been partially effective but often cause further weakness. Neuromuscular electrical stimulation (NMES) is an evolving technology that can improve neuromuscular physiology, strength, and mobility. This review aims to identify gaps in knowledge to motivate future NMES research. Methods: Research publications from 1990- July 20th 2019 that investigated gait-specific NMES in CP were reviewed using the PubMed and Google Scholar databases. Results were filtered by the National Institute of Neurological Disorder and Stroke common data elements guidelines for CP. The Oxford Centre for Evidence Based Medicine guidelines were used to determine levels of evidence for each outcome. Gait-specific NMES research protocols and trends are described, with implications for future research. Results: Eighteen studies met inclusion criteria, reporting on 212 participants, 162 of whom received NMES while walking, average age of 9.8 years, GMFCS levels I–III. Studies included 4 randomized control trials, 9 cohort studies and 5 case studies. A historical trend emerged that began with experimental multi-channel NMES device development, followed by the commercial development of single-channel devices with inertial sensor-based gait event detection to facilitate ankle dorsiflexion in swing phase. This research reported strong evidence demonstrating improved ankle dorsiflexion kinematics in swing and at initial contact. Improved walking speed, step length, and muscle volume were also reported. However, improvements in global walking scores were not consistently found, motivating a recent return to investigating multi-channel gait-specific NMES applications. Conclusions: Research on single-channel gait-specific NMES found that it improved ankle motion in swing but was insufficient to address more complex gait abnormalities common in CP, such as flexed-knee and stiff-knee gait. Early evidence indicates that multi-channel gait-specific NMES may improve gait patterns in CP, however significantly more research is needed. The conclusions of this review are highly limited by the low level of evidence of the studies available. This review provides a historical record of past work and a technical context, with implications for future research on gait-specific NMES to improve walking patterns and mobility in CP.

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“…1 Also, FES is a technique that widely used to restore lost motor function. 2,3 Unsupported standing using FES can enable the paraplegic patients to perform manual functions at self-selected leaning positions. 4 Also, standing brings other benefits to spinal cord injury patients such as decreasing bone osteoporosis, prevention of pressure sores, prevention of orthostatic hypotension, and improvement of the digestive system.…”

Section: Introductionmentioning

confidence: 99%

A Robust Nonlinear Control Strategy for Unsupported Paraplegic Standing Using Functional Electrical Stimulation: Controller Synthesis and Simulation

Ruhbakhsh

Kobravi

2020

Int Clin Neurosci J

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Background: Functional electrical stimulation (FES) applies electrical pulses to paralyzed muscles to restore their function. Closed-loop control of an FES system, incorporating the control strategies, promises to improve the performance of FES systems. Therefore, the purpose of this paper is to design a new control strategy applicable to restoring the upright standing in paraplegic patients through FES. The control strategies proposed in the previous works based on controlling the angular joint position and none of them focused on controlling the center of pressure (CoP) dynamics directly. Since the CoP is representative of posture balance dynamics, in this study, the adopted FES based control strategy designed to control the CoP dynamics directly. Methods: In the proposed control strategy, two controllers determine the stimulation intensity of ankle muscles in a manner to restrict the CoP to a specific zone. According to the proposed strategy, until the CoP confined to the stable zone, an adaptive controller is active. When the CoP goes out of the stable zone, the adaptive controller is deactivated. Then, a sliding mode controller is activated instead of the adaptive controller. In this manner, not only the posture balance can be guaranteed, but also the emerged balance dynamics can be similar to the elicited balance dynamics in the healthy subjects. Results: In this study, extended evaluations carried out through the simulation studies. According to the achieved results, the proposed control strategy is not only robust against the external disturbances, but also insensitive to the initial postural conditions. Conclusion: The achieved results prove the acceptable performance of the proposed control strategy

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Use of a Novel Functional Electrical Stimulation Gait Training System in 2 Adolescents With Cerebral Palsy: A Case Series Exploring Neurotherapeutic Changes

Cited by 14 publications

References 20 publications

An Evaluation of Three Kinematic Methods for Gait Event Detection Compared to the Kinetic-Based ‘Gold Standard’

An Evaluation of Three Kinematic Methods for Gait Event Detection Compared to the Kinetic-Based ‘Gold Standard’

A Scoping Review of Neuromuscular Electrical Stimulation to Improve Gait in Cerebral Palsy: The Arc of Progress and Future Strategies

A Robust Nonlinear Control Strategy for Unsupported Paraplegic Standing Using Functional Electrical Stimulation: Controller Synthesis and Simulation

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