Effects of spinal stimulation and short-burst treadmill training on gait biomechanics in children with cerebral palsy

IF 2.4 3区医学 Q3 NEUROSCIENCES Gait & posture Pub Date : 2025-05-01 Epub Date: 2025-01-29 DOI:10.1016/j.gaitpost.2025.01.016

Charlotte R. DeVol , Siddhi R. Shrivastav , Victoria M. Landrum , Kristie F. Bjornson , Desiree Roge , Chet T. Moritz , Katherine M. Steele

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Abstract

Background

Children with cerebral palsy (CP) have an injury to the central nervous system around the time of birth that affects the development of the brain and spinal cord. This injury leads to changes in gait neuromechanics, including muscle activity and joint kinematics. Transcutaneous spinal cord stimulation (tSCS) is a novel neuromodulation technique that may improve movement and coordination in children with CP when paired with targeted physical therapy.

Research Question

How does the combination of tSCS and short-burst interval locomotor treadmill training (SBLTT) affect individual gait neuromechanics in children with CP?

Methods

Four children with CP (4–13 years old), received 24 sessions each of SBLTT only and SBLTT with tSCS (tSCS+SBLTT). Clinical assessments of spasticity and passive range of motion (PROM), as well as biomechanical assessments of joint kinematics, musculotendon lengths, and muscle activity were recorded during overground, barefoot walking. Assessments were taken before and after each intervention, and 8-weeks later.

Results

The combination of tSCS+SBLTT led to greater increases in hip and knee extension than SBLTT only for three participants. Three children also became more plantarflexed at the ankle during stance after tSCS+SBLTT compared to SBLTT only. While tSCS+SBLTT reduced spasticity, these changes were only weakly correlated with changes in musculotendon lengths during gait or PROM, with the largest correlation between change in gastrocnemius operating musculotendon length during fast walking and gastrocnemius spasticity (R² = 0.26) and change in plantarflexor PROM and gastrocnemius spasticity (R² = 0.23).

Significance

Children with CP used a more upright, less crouched posture during gait after tSCS+SBLTT. Large reductions in spasticity after tSCS+SBLTT were only weakly correlated with changes in kinematics and PROM. Understanding the mechanisms by which tSCS may affect gait for children with CP is critical to optimize and inform the use of tSCS for clinical care.

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脊髓刺激和短脉冲跑步机训练对脑瘫儿童步态生物力学的影响。

背景：脑瘫（CP）患儿在出生时就有中枢神经系统损伤，影响大脑和脊髓的发育。这种损伤导致步态神经力学的改变，包括肌肉活动和关节运动学。经皮脊髓刺激（tSCS）是一种新型的神经调节技术，与靶向物理治疗相结合，可以改善CP患儿的运动和协调能力。研究问题：tSCS和短时间歇运动跑步机训练（SBLTT）的结合如何影响CP患儿的个体步态神经力学？方法：4例CP患儿（4-13岁），分别接受SBLTT和SBLTT联合tSCS （tSCS+SBLTT）治疗，各24次。在地上赤脚行走时，记录痉挛和被动活动范围（PROM）的临床评估，以及关节运动学、肌肉肌腱长度和肌肉活动的生物力学评估。在每次干预之前和之后以及8周后进行评估。结果：在3名参与者中，tSCS+SBLTT联合治疗比仅SBLTT治疗导致髋关节和膝关节伸展的增加更大。与仅进行SBLTT相比，在tSCS+SBLTT后，有3名儿童在站立期间踝关节的跖屈程度更高。虽然tSCS+SBLTT减少了痉挛，但这些变化与步态或早破肌时肌腱长度的变化仅呈弱相关，其中快走和腓肠肌痉挛时腓肠肌操作肌腱长度的变化（R2 = 0.26）与跖腱早破肌和腓肠肌痉挛的变化（R2 = 0.23）相关性最大。意义：CP患儿在tSCS+SBLTT后的步态中更直立，更少蹲伏。tSCS+SBLTT后痉挛的大量减少与运动学和PROM的变化仅弱相关。了解tSCS可能影响CP患儿步态的机制对于优化tSCS在临床护理中的应用至关重要。

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来源期刊

Gait & posture 医学-神经科学

CiteScore

4.70

自引率

12.50%

发文量

616

审稿时长

6 months

期刊介绍： Gait & Posture is a vehicle for the publication of up-to-date basic and clinical research on all aspects of locomotion and balance. The topics covered include: Techniques for the measurement of gait and posture, and the standardization of results presentation; Studies of normal and pathological gait; Treatment of gait and postural abnormalities; Biomechanical and theoretical approaches to gait and posture; Mathematical models of joint and muscle mechanics; Neurological and musculoskeletal function in gait and posture; The evolution of upright posture and bipedal locomotion; Adaptations of carrying loads, walking on uneven surfaces, climbing stairs etc; spinal biomechanics only if they are directly related to gait and/or posture and are of general interest to our readers; The effect of aging and development on gait and posture; Psychological and cultural aspects of gait; Patient education.