A functional electrical stimulation system improves knee control in crouch gait

Background Crouch gait is a major sagittal plane deviation in children diagnosed with cerebral palsy (CP). It is defined as a combination of excessive ankle dorsiflexion and knee and hip flexion throughout the stance phase. To the best of our knowledge, functional electrical stimulation (FES) has no...

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Veröffentlicht in:Journal of children's orthopaedics 2015-04, Vol.9 (2), p.137-143
Hauptverfasser: Khamis, Sam, Martikaro, Raz, Wientroub, Shlomo, Hemo, Yoram, Hayek, Shlomo
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container_end_page 143
container_issue 2
container_start_page 137
container_title Journal of children's orthopaedics
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creator Khamis, Sam
Martikaro, Raz
Wientroub, Shlomo
Hemo, Yoram
Hayek, Shlomo
description Background Crouch gait is a major sagittal plane deviation in children diagnosed with cerebral palsy (CP). It is defined as a combination of excessive ankle dorsiflexion and knee and hip flexion throughout the stance phase. To the best of our knowledge, functional electrical stimulation (FES) has not been used to decrease the severity of crouch gait in CP subjects and assist in achieving lower limb extension. Purpose To evaluate the short- and long-term effects of FES to the quadriceps muscles in preventing crouch gait and achieving ankle plantar flexion, knee and hip extension at the stance phase. Methods An 18-year-old boy diagnosed with CP diplegia [Gross Motor Function Classification System (GMFCS) level II] was evaluated. The NESS L300® Plus neuroprosthesis system provided electrical stimulation of the quadriceps muscle. A three-dimensional gait analysis was performed using an eight-camera system measuring gait kinematics and spatiotemporal parameters while the subject walked shod only, with ground reaction ankle foot orthotics (GRAFOs) and using an FES device. Results Walking with the FES device showed an increase in the patient's knee extension at midstance and increased knee maximal extension at the stance phase. In addition, the patient was able to ascend and descend stairs with a “step-through” pattern immediately after adjusting the FES device. Conclusions This report suggests that FES to the quadriceps muscles may affect knee extension at stance and decrease crouch gait, depending on the adequate passive range of motion of the hip, knee extension, and plantar flexion. Further studies are needed in order to validate these results.
doi_str_mv 10.1007/s11832-015-0651-2
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It is defined as a combination of excessive ankle dorsiflexion and knee and hip flexion throughout the stance phase. To the best of our knowledge, functional electrical stimulation (FES) has not been used to decrease the severity of crouch gait in CP subjects and assist in achieving lower limb extension. Purpose To evaluate the short- and long-term effects of FES to the quadriceps muscles in preventing crouch gait and achieving ankle plantar flexion, knee and hip extension at the stance phase. Methods An 18-year-old boy diagnosed with CP diplegia [Gross Motor Function Classification System (GMFCS) level II] was evaluated. The NESS L300® Plus neuroprosthesis system provided electrical stimulation of the quadriceps muscle. A three-dimensional gait analysis was performed using an eight-camera system measuring gait kinematics and spatiotemporal parameters while the subject walked shod only, with ground reaction ankle foot orthotics (GRAFOs) and using an FES device. Results Walking with the FES device showed an increase in the patient's knee extension at midstance and increased knee maximal extension at the stance phase. In addition, the patient was able to ascend and descend stairs with a “step-through” pattern immediately after adjusting the FES device. Conclusions This report suggests that FES to the quadriceps muscles may affect knee extension at stance and decrease crouch gait, depending on the adequate passive range of motion of the hip, knee extension, and plantar flexion. Further studies are needed in order to validate these results.</description><identifier>ISSN: 1863-2521</identifier><identifier>EISSN: 1863-2548</identifier><identifier>DOI: 10.1007/s11832-015-0651-2</identifier><identifier>PMID: 25786388</identifier><language>eng</language><publisher>London, England: SAGE Publications</publisher><subject>Ankle ; Bone surgery ; Cerebral palsy ; Electrodes ; Gait ; Kinematics ; Knee ; Laboratories ; Medicine ; Medicine &amp; Public Health ; Orthopedics ; Pediatrics ; Standard deviation ; Technical Note ; Traumatic Surgery ; Walking</subject><ispartof>Journal of children's orthopaedics, 2015-04, Vol.9 (2), p.137-143</ispartof><rights>2015 European Pediatric Orthopaedic Society (EPOS), unless otherwise noted. Manuscript content on this site is licensed under Creative Commons Licenses.</rights><rights>The Author(s) 2015</rights><rights>2015. This work is published under https://creativecommons.org/licenses/by-nc/4.0/ (the “License”). 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It is defined as a combination of excessive ankle dorsiflexion and knee and hip flexion throughout the stance phase. To the best of our knowledge, functional electrical stimulation (FES) has not been used to decrease the severity of crouch gait in CP subjects and assist in achieving lower limb extension. Purpose To evaluate the short- and long-term effects of FES to the quadriceps muscles in preventing crouch gait and achieving ankle plantar flexion, knee and hip extension at the stance phase. Methods An 18-year-old boy diagnosed with CP diplegia [Gross Motor Function Classification System (GMFCS) level II] was evaluated. The NESS L300® Plus neuroprosthesis system provided electrical stimulation of the quadriceps muscle. A three-dimensional gait analysis was performed using an eight-camera system measuring gait kinematics and spatiotemporal parameters while the subject walked shod only, with ground reaction ankle foot orthotics (GRAFOs) and using an FES device. Results Walking with the FES device showed an increase in the patient's knee extension at midstance and increased knee maximal extension at the stance phase. In addition, the patient was able to ascend and descend stairs with a “step-through” pattern immediately after adjusting the FES device. Conclusions This report suggests that FES to the quadriceps muscles may affect knee extension at stance and decrease crouch gait, depending on the adequate passive range of motion of the hip, knee extension, and plantar flexion. 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Medical Collection (Alumni Edition)</collection><collection>Nursing &amp; Allied Health Premium</collection><collection>Access via ProQuest (Open Access)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of children's orthopaedics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Khamis, Sam</au><au>Martikaro, Raz</au><au>Wientroub, Shlomo</au><au>Hemo, Yoram</au><au>Hayek, Shlomo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A functional electrical stimulation system improves knee control in crouch gait</atitle><jtitle>Journal of children's orthopaedics</jtitle><stitle>J Child Orthop</stitle><addtitle>J Child Orthop</addtitle><date>2015-04-01</date><risdate>2015</risdate><volume>9</volume><issue>2</issue><spage>137</spage><epage>143</epage><pages>137-143</pages><issn>1863-2521</issn><eissn>1863-2548</eissn><abstract>Background Crouch gait is a major sagittal plane deviation in children diagnosed with cerebral palsy (CP). It is defined as a combination of excessive ankle dorsiflexion and knee and hip flexion throughout the stance phase. To the best of our knowledge, functional electrical stimulation (FES) has not been used to decrease the severity of crouch gait in CP subjects and assist in achieving lower limb extension. Purpose To evaluate the short- and long-term effects of FES to the quadriceps muscles in preventing crouch gait and achieving ankle plantar flexion, knee and hip extension at the stance phase. Methods An 18-year-old boy diagnosed with CP diplegia [Gross Motor Function Classification System (GMFCS) level II] was evaluated. The NESS L300® Plus neuroprosthesis system provided electrical stimulation of the quadriceps muscle. A three-dimensional gait analysis was performed using an eight-camera system measuring gait kinematics and spatiotemporal parameters while the subject walked shod only, with ground reaction ankle foot orthotics (GRAFOs) and using an FES device. Results Walking with the FES device showed an increase in the patient's knee extension at midstance and increased knee maximal extension at the stance phase. In addition, the patient was able to ascend and descend stairs with a “step-through” pattern immediately after adjusting the FES device. Conclusions This report suggests that FES to the quadriceps muscles may affect knee extension at stance and decrease crouch gait, depending on the adequate passive range of motion of the hip, knee extension, and plantar flexion. Further studies are needed in order to validate these results.</abstract><cop>London, England</cop><pub>SAGE Publications</pub><pmid>25786388</pmid><doi>10.1007/s11832-015-0651-2</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record>
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subjects Ankle
Bone surgery
Cerebral palsy
Electrodes
Gait
Kinematics
Knee
Laboratories
Medicine
Medicine & Public Health
Orthopedics
Pediatrics
Standard deviation
Technical Note
Traumatic Surgery
Walking
title A functional electrical stimulation system improves knee control in crouch gait
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