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Effects of Functional Electrical Stimulation Neuroprosthesis in Children with Hemiplegic Cerebral Palsy

Year: 2014
Type: article
Study design: Clinical Trial
Abstract: Background: Studies examining the effects of FES neuroprosthesis in children with hemiplegia are limited and only examine its effects on body structure and function (BSF) outcomes.Unstudied, but of importance, are the effects of this novel intervention on activities and participation (AP) outcomes in children with hemiplegic cerebral palsy (CP).The purpose of this study was to evaluate the effects of FES neuroprosthesis use across the International Classification of Function (ICF) categories of BSF and AP.Specifically assessed were effects on ankle motion, overall gait pathology, walking endurance, oxygen cost, stair climbing ability and obstacle course negotiation.Methods: Using a two factor repeated measures design, eleven children with hemiplegic CP (mean age 9 years 11 months) were evaluated before and after participation in an intervention consisting of FES neuroprosthesis daily use.A comprehensive set of outcomes spanning the ICF categories of BSF and AP were collected with the FES turned off (Stim Off) and repeated with the FES turned on (Stim On) at baseline and post assessment.Further performance and satisfaction with individualized goals, and safety and satisfaction with the device were assessed.Pairwise comparisons of interest were: Baseline Stim On -Baseline Stim Off (immediate orthotic effect), Post Stim Off -Baseline Stim Off (therapeutic effect) and Post Stim On -Baseline Stim Off (total effect).Results: Statistically significant improvement on BSF measures were observed for a total effect of FES neuroprosthesis use on average dorsiflexion at initial contact df initial , (adjusted p =0.01) walking speed (adjusted p =0.006), and walking endurance (adjusted p=0.005), but not on peak dorsiflexion during swing (df swing ), overall gait pathology, oxygen cost, stride length or cadence.Although not statistically significant, large effect sizes were observed for a total effect on df swing (d=.89) and for a therapeutic effect on walking endurance (d=0.92).Statistically significant iii improvement on AP measures were observed for a therapeutic effect on the number of steps to complete an obstacle course (p=0.004)but not on stair climbing ability.Although not statistically significant a large effect size was observed for a total effect of device use on the number of steps off the obstacle course path (d=0.83).Further, participants reported a statistically significant improvement in performance (p=0.0006) and satisfaction (p=0.0007) with individualized goals, a reduced frequency of trips after the intervention (p=0.008) and high satisfaction with the device.Conclusions: Results from this study support previous studies of FES neuroprosthesis effects on BSF outcomes, and add to the literature in supporting positive effects on AP outcomes.Further, satisfaction is high when using the device with a high level of regular support and communication with therapists trained in using the device.These results should be interpreted with caution because of the limitations including a small sample size, lack of control group, selection bias, and lack of blinding of the assessor.Further studies of this intervention should be performed with larger samples of children over longer intervention periods, combined with other interventions, and compare FES neuroprosthesis to ankle foot orthosis (AFO) use in children with hemiplegic CP. iv v vi
Language: English
Field: Medicine
Open Access status: green
OpenAlex ID: W2222567433
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