Lecture Scientific/Practical : Abstract Topic: Orthotics
: (Author : Alexander Michael (zvia IL) | CO (Certified Orthotist) Ped (Pedorthist
Stride Orthopedics Ltd. - Orthotics
Effects of Functional Electrical Stimulation on Gait in Children with Hemiplegia – A preliminary
Segal I, Katzenellenbogen# S, Sagi L, Fattal-Valvsky A,
A new study undergoing in Tel Aviv - Dana-Dwek Childrens Hospital Neurology Unit, will try to
provide evidence based data for physicians and patients, who consider using an FES device,
with regards to a better selection of patient who could profit from this device and the expected
Cerebral palsy (CP) is the most common neuromuscular disorder among children, resulting
from a non-progressive injury during early brain development which leads to impairment of
movement and posture. Functional Electrical Stimulation – FES for the treatment of drop foot
externally induces dosiflextion by electrical stimulation to the peroneal nerve. It helps during
the swing phase with patients who suffer from central nervous system injury such as CP , CVA,
incomplete spinal cord injury, MS, etc. FES was first introduced in the beginning of the 60s.
Computerized FES has been used since 2007 (Innovative Neurotronics WalkAide, Bioness
L300, Otto Bock MyGait). Application of FES with the pediatric CP population is limited, yet
studies have shown good acceptability, improved ankle kinematic parameter, (dorsiflextion),
use dependent muscle plasticity. There is still no solid evidence whether the improvements
seen in laboratory setting are reflected in functional ambulation in daily life.
Study population: 20 patients with CP will participate. Inclusion criteria: children above age of
6 years, with CP hemiplegia (GMFCS I/II), with drop foot and dynamic contracture of the ankle
on examination, who are being treated at the CP clinic in the Tel Aviv Dana-Dwek Childrens
Hospital. Exclusion criteria: Children with fixed contracture of ankle joint (passive range of
motion< 0 degree); children who had orthopedic surgery to the lower extremity or had botulinum
toxin injection to the plantar or dorsiflexor muscles within 6 months prior to the study; children
who cannot tolerate the electrical stimulation delivered by the device.
STUDY DESIGN: open label study. FES device used (WalkAide; Innovative Neurotronics, USA)
delivers electrical stimulation to the common peroneal nerve, triggered by an accelerometer and
a tilt sensor, to improve dorsiflexion and foot clearance during swing phase. The duration of the
study - 5 months: First month is an adaptation period and 4 months of daily using of the device
- intervention period. The aim is a "minimal threshold" use of at least 5 days per week, 4 hours
per day and 1500 steps per day. Each child will go through: Medical interview and neurological
and physical therapist examination (Definition of passive range of ankle dorsiflexion, modified
Ashworth scale test), Motor function tests: "6 min walk test", Gross motor function measure
(GMFM),"Timed up and down stairs test", walking on a ramp, with and without the FES device.
Gait analysis test with and without FES device (ankle kinematics and analysis of foot clearance
parameters). Parents will complete questionnaires on the quality of life, and frequency of
falling + the compliance to the FES. Gait analysis will be performed by: Hasomed RehaGait
at adaptation period and A 3D gait analysis Vicon MX Giganet motion analysis system at
intervention period. Kinetic data will be collected using four force plates. For each child, the
results of the gait analysis and the functional tests will be compared between the baseline
(beginning of intervention period) and final parameters using the paired t-test analysis.
Study is still undergoing. At the OT-World congress we have described the experience
accumulated at that point in time, including preliminary results.
1.Pakula AT, Van Naarden Braun K, Yeargin-AllsoppM. Cerebral palsy: classification and
epidemiology. Phys Med Rehabil Clin N Am. 2009
2.Liberson WT, Holmquest ME, Scot D, Dow M. Functional electrotherapy: stimulation of the
peroneal nerve synchronized with the swing phase of the gait of hemiplegic patients. Arch Phys
Med Rehabil.1961 Feb;42:101-5.
.Postans NJ, Granat MH. Effect of functional electrical stimulation, applied during walking, on
gait in spastic cerebral palsy. Dev Med Child Neurol. 2005 Jan;47(1):46-52.
4.Prosser LA, Curatalo LA, Alter KE, Damiano DL. Acceptability and potential effectiveness of
a foot drop stimulator in children and adolescents with cerebral palsy. Dev Med Child Neurol.
2012 Nov; 54(11):1044-9.
5.Damiano DL, Prosser LA, Curatalo LA, Alter KE. Muscle plasticity and ankle control after
repetitive use of a functional electrical stimulation device for foot drop in cerebral palsy.
Neurorehabil Neural Repair. 2013 Mar-Apr;27(3):200-7.
6. Galen S, Wiggins L, McWilliam R, Granat M. A combination of Botulinum Toxin A therapy
and Functional Electrical Stimulation in children with cerebral palsy--a pilot study.Technol
Health Care. 2012;20(1):1-9.
7.Maher C, Williams MT, OLDs TS. The six minute walk test for children with cerebral palsy. Int
J Rehabil Res. 2008 Jun;31