Citation

Rose J, Cahill-Rowley K, Butler EE. Artif. Organs 2017; 41(11): E233-E239.

Affiliation

Neukom Institute for Computational Sciences, Dartmouth College, Hanover, NH, USA.

Copyright

(Copyright © 2017, International Center for Artificial Organs and Transplantation, Publisher John Wiley and Sons)

DOI

10.1111/aor.13058

PMID

29148138

Abstract

Cerebral palsy (CP) is the most common childhood motor disability and often results in debilitating walking abnormalities, such as flexed-knee and stiff-knee gait. Current medical and surgical treatments are only partially effective in improving gait abnormalities and may cause significant muscle weakness. However, emerging artificial walking technologies, such as step-initiated, multichannel neuromuscular electrical stimulation (NMES), can substantially improve gait patterns and promote muscle strength in children with spastic CP. NMES may also be applied to specific lumbar-sacral sensory roots to reduce spasticity. Development of tablet computer-based multichannel NMES can leverage lightweight, wearable wireless stimulators, advanced control design, and surface electrodes to activate lower-limb muscles. Musculoskeletal models have been used to characterize muscle contributions to unimpaired gait and identify high muscle demands, which can help guide multichannel NMES-assisted gait protocols. In addition, patient-specific NMES-assisted gait protocols based on 3D gait analysis can facilitate the appropriate activation of lower-limb muscles to achieve a more functional gait: stance-phase hip and knee extension and swing-phase sequence of hip and knee flexion followed by rapid knee extension. NMES-assisted gait treatment can be conducted as either clinic-based or home-based programs. Rigorous testing of multichannel NMES-assisted gait training protocols will determine optimal treatment dosage for future clinical trials. Evidence-based outcome evaluation using 3D kinematics or temporal-spatial gait parameters will help determine immediate neuroprosthetic effects and longer term neurotherapeutic effects of step-initiated, multichannel NMES-assisted gait in children with spastic CP. Multichannel NMES is a promising assistive technology to help children with spastic CP achieve a more upright, functional gait.

© 2017 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

Language: en

Keywords

-Artificial walking technologies; -Cerebral palsy; -Functional electrical stimulation; -NMES-assisted gait; -Neuroprosthetic effect; Neuromuscular electrical stimulation