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

Abstract

Background and Purpose Cerebral palsy (CP) is characterized by decreased passive joint range-of-motion and impaired walking, resulting in progressive loss of function. Typical gait training interventions for children with CP appear insufficient to mitigate these effects. The purpose of this case report is to describe the use of a new treadmill-based gait training intervention using active correction with functional electrical stimulation (FES) in 2 adolescents with CP. Case Description Two participants with CP (13-year-old girls, Gross Motor Function Classification System [GMFCS] level II and III) trained by walking on a treadmill, with FES assistance, for 30 minutes, 3 times per week, for 12 weeks. The intervention used a feedback control system to detect all 7 phases of gait in real time and triggered FES to the appropriate muscle groups (up to 5 bilaterally) based on the detected gait phase. Joint kinematics, step width, stride length, walking endurance, peak oxygen uptake ($\dot{v}^{o}-{2}$), and oxygen (O 2) cost of walking were evaluated preintervention and postintervention. Outcomes Both participants showed improved knee and ankle angles and step width relative to children who are typically developing, and both exhibited increased stride length. One participant (GMFCS III) improved peak $\dot{v}^{o}-{2}$and walking endurance but not O 2 cost of walking at her original self-selected walking speed. The other participant (GMFCS II) improved O 2 cost of walking but not peak $\dot{v}^{o}-{2}$ or walking endurance. These differences are partly explained by differences in gait type, functional abilities, and initial fitness levels. Most improvements persisted at follow-up, indicating short-term neurotherapeutic effects. Discussion Most improvements persisted at follow-up, suggesting short-term neurotherapeutic effects. This case series demonstrates the promising utility of FES-assisted gait-training interventions, tailored to target individual gait deviations, in improving walking performance.