Effectiveness of a foot drop stimulator in children and adolescents with cerebral palsy

Aim

Ankle foot orthoses are the standard of care for foot drop in cerebral palsy (CP), but may overly constrain ankle movement and limit function in those with mild CP. Functional electrical stimulation (FES) may be a less restrictive and more effective alternative, but has rarely been used in CP.

The primary objective of this study was to conduct the first trial in CP examining the acceptability and clinical effectiveness of a novel, commercially available device that delivers FES to stimulate ankle dorsiflexion.

Method

Twenty-one individuals were enrolled (Gross Motor Function Classification System [GMFCS] levels I and II, mean age 13y 2mo). Gait analyses in FES and non-FES conditions were performed at two walking speeds over a 4 month period of device use.

Measures included ankle kinematics and spatiotemporal variables. Differences between conditions were revealed using repeated measures multivariate analyses of variance.

Results

Nineteen individuals (nine females, 10 males; mean age 12y 11mo, range 7y 5mo to 19y 11mo; 11 at GMFCS level I, eight at level II) completed the FES intervention, with all but one choosing to continue using FES beyond that phase. Average daily use was 5.6 hours (SD 2.3).

Improved dorsiflexion was observed during swing (mean and peak) and at foot–floor contact, with partial preservation of ankle plantarflexion at toe-off when using the FES at self-selected and fast walking speeds. Gait speed was unchanged.

Interpretation

This FES device was well accepted and effective for foot drop in those with mild gait impairments from CP.

  References
PROSSER_et_al-2012-Developmental_Medicine__Child_Neurology

Acceptability and potential effectiveness of a foot drop stimulator in children and adolescents with cerebral palsy, Prosser LA, Curatalo LA, Alter KE, Damiano DL. Dev Med Child Neurol. 2012 Nov;54(11):1044-9. doi: 10.1111/j.1469-8749.2012.04401.x. Epub 2012 Aug 27. Full text

  Further reading

Muscle plasticity and ankle control after repetitive use of a functional electrical stimulation device for foot drop in cerebral palsy, Damiano DL, Prosser LA, Curatalo LA, Alter KE. Neurorehabil Neural Repair. 2013 Mar-Apr;27(3):200-7. doi: 10.1177/1545968312461716. Epub 2012 Oct 4. Full text

Efficacy of prefabricated carbon-composite ankle foot orthoses for children with unilateral spastic cerebral palsy exhibiting a drop foot pattern, Altschuck N, Bauer C, Nehring I, Böhm H, Jakobeit M, Schröder AS, Mall V, Jung NH. J Pediatr Rehabil Med. 2019;12(2):171-180. doi: 10.3233/PRM-170524.

Functional electrical stimulation of the ankle dorsiflexors during walking in spastic cerebral palsy: a systematic review, Moll I, Vles JSH, Soudant DLHM, Witlox AMA, Staal HM, Speth LAWM, Janssen-Potten YJM, Coenen M, Koudijs SM, Vermeulen RJ. Dev Med Child Neurol. 2017 Dec;59(12):1230-1236. doi: 10.1111/dmcn.13501. Epub 2017 Aug 17. Full text

The orthotic and therapeutic effects following daily community applied functional electrical stimulation in children with unilateral spastic cerebral palsy: a randomised controlled trial, Pool D, Valentine J, Bear N, Donnelly CJ, Elliott C, Stannage K. BMC Pediatr. 2015 Oct 12;15:154. doi: 10.1186/s12887-015-0472-y. Full text

Also see
Functional electrical stimulation, FES, in children and adolescents with cerebral palsy

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