MANAGING EQUINUS IN CHILDREN WITH CEREBRAL PALSY: ELECTRICAL STIMULATION TO STRENGTHEN THE TRICEPS SURAE MUSCLE

A new therapeutic proposal for the management of equinus in children with cerebral palsy is to strengthen the calf muscles instead of weakening them surgically. Prior research indicates that in children with cerebral palsy the triceps surae muscle is weak and needs strengthening. Neuromuscular electrical stimulation (NMES) was used as an adjunct to physical therapy. A portable NMES unit with a hand‐held remote switch stimulated an active muscle gait cycle. Results are discusssed for four children, who showed improved gait, balance, posture, active and passive ankle range of motion, and foot alignment. The toe walkers became plantigrade and the equinovalgus posture of the foot decreased. Spasticity did not increase.

[1]  H. Graham,et al.  Lengthening of the calcaneal tendon in spastic hemiplegia by the White slide technique. A long-term review. , 1988, The Journal of bone and joint surgery. British volume.

[2]  E. Bleck,et al.  Locomotor Prognosis in Cerebral Palsy , 1975, Developmental medicine and child neurology.

[3]  K. Hayes,et al.  Maturation Of Postural Sway In Young Children , 1987, Developmental medicine and child neurology.

[4]  R. Olshen,et al.  The development of mature gait. , 1980, The Journal of bone and joint surgery. American volume.

[5]  S. Houtz,et al.  Electromyographic analysis of the functions of the muscles acting on the ankle during weightbearing with special reference to the triceps surae. , 1959, The Journal of bone and joint surgery. American volume.

[6]  J Quintern,et al.  Electrophysiological studies of gait in spasticity and rigidity. Evidence that altered mechanical properties of muscle contribute to hypertonia. , 1981, Brain : a journal of neurology.

[7]  C. Giuliani,et al.  Dorsal rhizotomy for children with cerebral palsy: support for concepts of motor control. , 1991, Physical therapy.

[8]  S. Kirsch,et al.  Neuromuscular approach to the motor deficits of cerebral palsy: a pilot study. , 1993, Journal of pediatric orthopedics.

[9]  L. Root Varus and Valgus Foot in Cerebral Palsy and its Management , 1984, Foot & ankle.

[10]  R. Norlin,et al.  Development of Gait in the Normal Child , 1981, Journal of pediatric orthopedics.

[11]  S. Simon,et al.  Role of the posterior calf muscles in normal gait. , 1978, The Journal of bone and joint surgery. American volume.

[12]  P. Grimaud [Cerebral palsy]. , 1972, Pediatrie.

[13]  J Carmick,et al.  Clinical use of neuromuscular electrical stimulation for children with cerebral palsy, Part 1: Lower extremity. , 1993, Physical therapy.

[14]  C. Richards,et al.  Use of an intensive task-oriented gait training program in a series of patients with acute cerebrovascular accidents. , 1992, Physical therapy.

[15]  V. Dietz,et al.  Normal and impaired development of children's gait. , 1984, Human neurobiology.

[16]  S. Õunpuu,et al.  Three-dimensional lower extremity joint kinetics in normal pediatric gait. , 1991, Journal of pediatric orthopedics.

[17]  NEUROPHYSIOLOGY OF LOWER‐LIMB FUNCTION IN HEMIPLEGIC CHILDREN , 1991, Developmental medicine and child neurology.

[18]  C. T. Leonard,et al.  THE DEVELOPMENT OF INDEPENDENT WALKING IN CHILDREN WITH CEREBRAL PALSY , 1991, Developmental medicine and child neurology.

[19]  J. Perry,et al.  Pathodynamics of Gait Alterations in Cerebral Palsy and the Significance of Kinetic Electromyography in Evaluating Foot and Ankle Problems , 1983, Foot & ankle.

[20]  A. McComas,et al.  Influence of joint position on ankle dorsiflexion in humans. , 1981, Journal of applied physiology: respiratory, environmental and exercise physiology.

[21]  V. Dietz,et al.  Normal and impaired regulation of muscle stiffness in gait: A new hypothesis about muscle hypertonia , 1983, Experimental Neurology.

[22]  R. Norlin,et al.  Development of Gait in Spastic Children with Cerebral Palsy , 1986, Journal of pediatric orthopedics.

[23]  D. Winter Energy generation and absorption at the ankle and knee during fast, natural, and slow cadences. , 1983, Clinical orthopaedics and related research.

[24]  J-P. Lin,et al.  PERIPHERAL AND CENTRAL MECHANISMS OF HINDFOOT EQUINUS IN CHILDHOOD HEMIPLEGIA , 1992, Developmental medicine and child neurology.

[25]  S. Olney,et al.  Work and power in hemiplegic cerebral palsy gait. , 1990, Physical therapy.

[26]  S. W. Atwater,et al.  Electromyography‐Triggered Electrical Muscle Stimulation for Children with Cerebral Palsy: A Pilot Study , 1991 .

[27]  G. Vrbová,et al.  IMPROVEMENT OF MUSCLE PERFORMANCE BY CHRONIC ELECTRICAL STIMULATION IN CHILDREN WITH CEREBRAL PALSY , 1988, The Lancet.

[28]  P. Schoenecker,et al.  Heel cord advancement for treatment of equinus deformity in cerebral palsy. , 1990, Journal of pediatric orthopedics.

[29]  J. Gage,et al.  Gait patterns in spastic hemiplegia in children and young adults. , 1987, The Journal of bone and joint surgery. American volume.

[30]  H. Banks Equinus and Cerebral Palsy—Its Management , 1983 .

[31]  B. Etnyre,et al.  Preoperative and postoperative assessment of surgical intervention for equinus gait in children with cerebral palsy. , 1993, Journal of pediatric orthopedics.

[32]  V. Alfieri Electrical treatment of spasticity. Reflex tonic activity in hemiplegic patients and selected specific electrostimulation. , 1982, Scandinavian journal of rehabilitation medicine.

[33]  J. Gage Gait analysis. An essential tool in the treatment of cerebral palsy. , 1993, Clinical orthopaedics and related research.

[34]  S. Sahrmann,et al.  The relationship of voluntary movement of spasticity in the upper motor neuron syndrome , 1977, Transactions of the American Neurological Association.

[35]  Philip Rowe,et al.  THE USE OF THERAPEUTIC ELECTRICAL STIMULATION IN THE TREATMENT OF HEMIPLEGIC CEREBRAL PALSY , 1994 .

[36]  A. McComas,et al.  Influence of joint position on ankle plantarflexion in humans. , 1982, Journal of applied physiology: respiratory, environmental and exercise physiology.

[37]  David N. Lee,et al.  Effect of Task on Movement Control in Cerebral Palsy: Implications for Assessment and Therapy , 1991, Developmental medicine and child neurology.

[38]  Norton Bj,et al.  The relationship of voluntary movement to spasticity in the upper motor neuron syndrome. , 1977 .

[39]  CHANGES OF SAGITTAL‐PLANE ANKLE MOTION AND GROUND REACTION FORCE (FORE‐AFT SHEAR) IN NORMAL CHILDREN AGED FOUR TO 10 YEAR , 1993, Developmental medicine and child neurology.

[40]  Richard W. Bohannon Relevance of Muscle Strength to Gait Performance in Patients with Neurologic Disability , 1989 .