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

CL Ho, BS, is a doctoral student in the Department of Physical Therapy and Athletic Training, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, Mass
KG Holt, PT, PhD, is Associate Professor, Department of Physical Therapy and Athletic Training, Sargent College of Health and Rehabilitation Sciences, Boston University, 635 Commonwealth Ave, Boston, MA 02215 (USA) Dr Holt is a fellow at the Center for the Ecological Study of Perception and Action, University of Connecticut, Storrs, Conn.
E Saltzman, PhD, is Associate Professor, Department of Physical Therapy and Athletic Training, Sargent College of Health and Rehabilitation Sciences, Boston University. Dr Saltzman is a fellow at the Center for the Ecological Study of Perception and Action, University of Connecticut, and a research scientist at the Haskins Laboratories, New Haven, Conn
RC Wagenaar, PhD, is Professor and Chair, Department of Physical Therapy and Athletic Training, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, Mass

(kgholt{at}bu.edu). Address all correspondence to Dr Holt

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.]

Key Words: Cerebral palsy • Dynamic systems • Electrical stimulation • Locomotion

This article has been cited by other articles:

				K. G Holt, E. Saltzman, C.-L. Ho, and B. D Ulrich Scaling of Dynamics in the Earliest Stages of Walking Physical Therapy, November 1, 2007; 87(11): 1458 - 1467. [Abstract] [Full Text] [PDF]