Search

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 ([[??].sup.0.sub.2]), and oxygen ([O.sub.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 [[??].sup.0.sub.2] and walking endurance but not [O.sub.2] cost of walking at her original self-selected walking speed. The other participant (GMFCS II) improved [O.sub.2] cost of walking but not peak [[??].sup.0.sub.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., Cerebral palsy (CP) is a movement disorder caused by brain injury during development. Movement pathologies typically worsen over time, resulting in progressive loss of function, decreased quality of life, and [...]

Background. Poor control of postural muscles is a primary impairment in people with cerebral palsy (CP). Objective. The purpose of this study was to investigate differences in the timing characteristics of trunk and hip muscle activity during walking in young children with CP compared with children with typical development (TD). Methods. Thirty-one children (16 with TD, 15 with CP) with an average of 28.5 months of walking experience participated in this observational study. Electromyographic data were collected from 16 trunk and hip muscles as participants walked at a self-selected pace. A custom-written computer program determined onset and offset of activity. Activation and coactivation data were analyzed for group differences. Results. The children with CP had greater total activation and coactivation for all muscles except the external oblique muscle and differences in the timing of activation for all muscles compared with the TD group. The implications of the observed muscle activation patterns are discussed in reference to existing postural control literature. Limitations. The potential influence of recording activity from adjacent deep trunk muscles is discussed, as well as the influence of the use of an assistive device by some children with CP. Conclusions. Young children with CP demonstrate excessive, nonreciprocal trunk and hip muscle activation during walking compared with children with TD. Future studies should investigate the efficacy of treatments to reduce excessive muscle activity and improve coordination of postural muscles in CP., Poor control of trunk postural muscles is a primary impairment in people with cerebral palsy (CP). (l-3) To date, the majority of work investigating postural control in CP has done [...]

Background and Purpose The purpose of this study was to compare the biomechanics of recumbent cycling between adolescents with cerebral palsy (CP) classified at Gross Motor Function Classification System (GMFCS) levels III and IV and adolescents with typical development (TD). Subjects Twenty subjects, ages ([bar.x] ± SD) 15.2 ± 1.6 years (10 with TD, 10 with CP), participated. Methods Lower-extremity kinematics and muscle activity were measured at 30 and 60 rpm while subjects pedaled on a recumbent cycle. Energy expenditure and perceived exertion were measured during a 5-minute test, and efficiency was calculated. Noncircular data were analyzed with analyses of variance. Circular data were analyzed using circular t tests. Results Differences were found between groups for joint kinematics for all motions. Subjects with CP displayed earlier onsets and later offsets of muscle activity, increased co-contraction of agonist and antagonist muscles, and decreased efficiency compared with subjects with TD. There were no differences in perceived exertion. Discussion and Conclusion Differences in cycling biomechanics between children with CP and children with TD may be due to decreased strength and motor control in the children with CP., Children with cerebral palsy (CP) typically have progressive impairments that affect their function as children and later as adults, and they have decreased fitness levels versus children with typical development [...]

Background and Purpose. Following spinal cord injury (SCI), paralyzed muscles undergo physiological changes that alter their force responses to electrical stimulation. The purpose of this study was to investigate the effects of SCI on the contractile properties and force-frequency relationship (FFR) of the paralyzed human quadriceps femoris muscle of adolescents and young adults. Subjects. Thirteen subjects (11 male, 2 female; age range=11-24 years) with motor complete SCIs and 13 matched control subjects (11 male, 2 female; age range=9-23 years) without SCI participated in the study. Methods. Both groups of subjects underwent the same testing protocol using similar equipment. Results. The paralyzed muscles of the subjects with SCI produced 62% of the peak twitch force and had a fatigue ratio that was 65% of that of the control subjects. The paralyzed muscles contracted 14% and 25% faster and relaxed 38% and 46% faster than the nonparalyzed muscles in nonfatigued and fatigued conditions, respectively. Compared with the control subjects, the subjects with SCI had twitch-to-tetanus ratios that were 84% and 127% greater in nonfatigued and fatigued conditions, respectively. Relative to the control subjects, the FFR of the subjects with SCI was shifted to the left in the fatigued condition. Relative to their respective nonfatigued conditions, the FFR of both groups of subjects shifted to the right with fatigue. Discussion and Conclusion. These findings may have important implications for designing stimulation strategies to reduce the rapid fatigue that limits the clinical efficacy of functional electrical stimulation. [Scott WB, Lee SCK, Johnston TE, et al. Contractile properties and the force-frequency relationship of the paralyzed human quadriceps femoris muscle. Phys Ther. 2006;86:788-799.] Key Words: Electrical stimulation, Muscle fatigue, Muscle performance, Muscle weakness, Muscular atrophy, Paralysis, Spinal cord injuries., Electrical stimulation of paralyzed skeletal muscle can be used to assist people with spinal cord injury (SCI) in performance of functional movements. (1) This therapeutic intervention is called functional electrical [...]