The Effects of Prolonged Vibrotactile EMG-Based Biofeedback on Ankle Joint Range of Motion During Gait in Children with Spastic Cerebral Palsy: A Case Series

Abstract

Aims

The objective of this case series was to examine the feasibility of vibrotactile EMG-based biofeedback (BF) as a home-based intervention tool to enhance sensory information during everyday motor activities and to explore its effectiveness to induce changes in active ankle range of motion during gait in children with spastic cerebral palsy (CP).

Methods

Ten children ages 6 to 13 years with spastic CP were recruited. Participants wore two EMG-based vibro-tactile BF devices for at least 4 hours per day for 1-month on the ankle and knee joints muscles. The device computed the amplitude of the EMG signal of the target muscle and actuated a silent vibration motor proportional to the magnitude of the EMG.

Results

Our results demonstrated the feasibility of the augmented sensory information of muscle activity to induce changes of the active ankle range of motion during gait for 6 children with an increase ranging from 8.9 to 51.6% compared to a one-month period without treatment.

Conclusions

Preliminary findings of this case series demonstrate the feasibility of vibrotactile EMG-based BF and suggest potential effectiveness to increase active ankle range of motion, therefore serving as a promising therapeutic tool to improve gait in children with spastic CP.

Keywords:

• Ankle joint
• biofeedback
• cerebral palsy
• electromyography
• lower extremitiest

Acknowledgments

The authors thank Sandra W. Dennis for assistance with neurologic examinations and recruitment.

Disclosure statement

TDS is a co-inventor of the vibrotactile EMG-based biofeedback device and holds a patent (US 8,311,623) on the EMG filtering algorithm used in the device. The other authors report no conflict of interest.

Data availability statement

The data that support the findings of this study are available from the corresponding author, MB, upon reasonable request.

Additional information

Funding

We are grateful to the Southern California Clinical and Translational Science Institute [UL1TR000130] and the California Community Foundation for financial support for this project.

Notes on contributors

Matteo Bertucco

Dr. Matteo Bertucco is primarily interested to conduct research in the areas of motor control, motor learning and neuromechanics. His current research is focused on understanding the underlying neurophysiological mechanisms of postural control and motor skills acquisition in adulthood and childhood with particular attention to pediatric movement disorders.

Mauro Nardon

Mauro Nardon is a Ph.D. student studying the underlying mechanisms of human motor coordination and postural control in healthy population and individuals with sensorimotor impairments. In addition, he focuses on understanding the impact of neuromuscular fatigue on motor control and learning.

Nicole Mueske

Nicole Mueske is a board-certified physician assistant at the Children's Hospital Los Angeles and conducts research in different areas of pediatric orthopedics and the assessment and treatment of sports-related injuries in children and adolescents.

Sukhveer Sandhu

Sukhveer Sandhu is a research engineer with experience in applying the principles of optical, electrical and mechanical engineering in clinical environment and rehabilitation settings.

Susan A. Rethlefsen

Susan A. Rethlefsen is a physical therapist at the Children's Hospital Los Angeles conducting clinical research in pediatric musculoskeletal and neurological disorders with particular focus on cerebral palsy and children with spina bifida.

Tishya A.L. Wren

Dr. Tishya A.L. Wren is a biomedical engineer working in clinical environment. She conducts clinical and basic research in several different areas of orthopedics. Her primary areas are evaluation and treatment of movement abnormalities in children with neurologic deficits and assessment of bone and fractures in children.

Terence D. Sanger

Dr. Terence D. Sanger is a pediatric neurologist and electrical engineer. His research focuses on understanding the origins of pediatric movement disorders from both a biological and a computational perspective. The primary goal of his research is to discover new methods for treating children with movement disorders.