News Archives - Neuromechanics & Mobility Lab

CR DeVol, SR Shrivastav, VM Landrum, KF Bjornson, D Roge, CT Moritz, KM Steele (2025) “Effects of spinal stimulation and short-burst treadmill training on gait biomechanics in children with cerebral palsy”

Katie Landwehr JournalArticle, News, SpinalStim March 31, 2025March 17, 2025Biomechanics, Cerebral Palsy, Electromyography, EMG, Gait, Gait Training, Kinematics, Motor Control, Rehabilitation, Spasticity, Spinal Stimulation

Journal article in Gait & Posture

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.

Aim: 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).

Interpretation: 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.

APTA CSM 2025 Conference Recap

Katie Landwehr EarlyMobility, News, Presentation March 24, 2025March 28, 2025Accessibility, assistive technology, Cerebral Palsy, DIY Assistive Technology, Early Intervention

Neuromechanics & Mobility Lab member, Mia Hoffman, attended the 50th Annual American Physical Therapy Association Combined Sections Meeting (APTA CSM) in Houston, TX on Feb 13-15, where thousands of PTs, PTAs, and students came together to learn, connect, and celebrate 50 years of innovation in physical therapy.

Mia, alongside IMPACT Collaboratory members Heather A. Feldner, PT, MPT, PhD and Tiffany Li, SPT, presented a workshop on “Co-Designing a Switch Accessible Digital Play Environment for Children in Partnership with Clinicians and Families“.

Three women stand together at a conference center. The women in the center is holding a bag containing the "switch kit" supplies.

KA Ingraham, NL Zaino, C Feddema, ME Hoffman, L Gijbels, A Sinclair, AN Meltzoff, PK Kuhl, HA Feldner, KM Steele (2025) “Quantifying Joystick Interactions and Movement Patterns of Toddlers With Disabilities Using Powered Mobility With an Instrumented Explorer Mini”

Katie Landwehr EarlyMobility, JournalArticle, News, Publications March 17, 2025Accessibility, assistive technology, Early Intervention, mobility, Pediatric, powered mobility

Journal Article in IEEE Transactions on Neural Systems and Rehabilitation Engineering

Powered mobility technology can be a powerful tool to facilitate self-initiated exploration and play for toddlers with motor disabilities. The joystick-controlled Permobil Explorer Mini is currently the only commercially available powered mobility device for children ages 1-3 years in the United States. However, many open questions persist regarding how joystick-based mobility technologies should be designed to optimally suit the developmental needs of toddlers.

Aim: The purpose of this study was to quantify how toddlers with motor disabilities use the Explorer Mini during free exploration and play.

Methods: For this work, we developed a custom-instrumented Explorer Mini with embedded sensors to measure joystick interactions and wheel rotations. Nine children with motor disabilities (ages 12-36 months) participated in 12 in-lab visits, and during each visit they engaged in two 15-20 minute play sessions. For each session, we calculated several quantitative outcome metrics, including the time spent using the joystick, distance traveled, and the number, duration, and complexity of joystick interactions.

Results: Every participant independently interacted with the joystick and moved the Explorer Mini during every session. Over 12 visits, participants significantly increased their distance traveled and the time spent with the joystick active. Surprisingly, we found that only 48% of joystick interactions resulted in device movement, which has important implications for learning.

Interpretation: These results can serve as a benchmark for caregivers and clinicians to understand early device use patterns. Furthermore, this knowledge can be used to inform the design of new powered mobility technologies for toddlers with disabilities or support the refinement of existing devices.

SR Shrivastav, CR DeVol, VM Landrum, KF Bjornson, D Roge, KM Steele, CT Moritz (2024) “Transcutaneous Spinal Stimulation and Short-burst Interval Treadmill Training in Children with Cerebral Palsy: A Pilot Study”

Katie Landwehr JournalArticle, News, Publications, SpinalStim February 3, 2025March 17, 2025Cerebral Palsy, Rehabilitation, Spasticity, Spinal Stimulation

Journal Article in IEEE Transactions on Biomedical Engineering

Non-invasive neuromodulation may be an alternative approach that can improve outcomes in CP when combined with physical therapy. Transcutaneous spinal cord stimulation (tSCS) is a novel, non-invasive neuromodulation technique that can modulate spinal and supraspinal circuits especially when implemented with physical therapy.

Aim: The purpose of this pilot study was to evaluate the effects of transcutaneous spinal cord stimulation (tSCS) and short-burst interval locomotor treadmill training (SBLTT) on spasticity and mobility in children with cerebral palsy (CP).

Methods: We employed a single-arm design with two interventions: SBLTT only, and tSCS + SBLTT, in four children with CP. Children received 24-sessions each of SBLTT only and tSCS + SBLTT. Spasticity, neuromuscular coordination, and walking function were evaluated before, immediately after, and 8- weeks following each intervention.

Results: Spasticity, measured via the Modified Ashworth Scale (MAS), reduced in four lower extremity muscles after tSCS + SBLTT (1.40 ± 0.22,) more than following SBLTT only (0.43 ± 0.39). One-minute walk test (1-MWT) distance was maintained during both interventions. tSCS + SBLTT led to improvements in peak hip and knee peak extension (4.9 ± 7.3° and 6.5 ± 7.7°), that drove increases in joint dynamic range of 4.3 ± 2.4° and 3.8 ± 8.7° at the hip and knee, respectively. Children and parents reported reduction in fatigue and improved gait outcomes after tSCS + SBLTT. Improvements in spasticity and walking function were sustained for 8-weeks after tSCS + SBLTT.

Interpretation: These preliminary results suggest that tSCS + SBLTT may improve spasticity while simultaneously maintaining neuromuscular coordination and walking function in ambulatory children with CP. This work provides preliminary evidence on the effects of tSCS and the combination of tSCS + SBLTT in children with CP.

KA Ingraham, HA Feldner, KM Steele (2024) “Forward first: Joystick interactions of toddlers during digital play”

Katie Landwehr JournalArticle, News, Publications January 17, 2025January 17, 2025Accessibility, assistive technology, Early Intervention, Pediatric, Technology

Journal Article in PLoS ONE

Computers and technology are essential tools for supporting the development of toddlers with and without disabilities. Developmentally appropriate access to technology can support toddlers in learning and play. While touch screens are a popular interaction modality for children under the age of three, they may not be appropriate for all children or all tasks.

Aim: We know comparatively little about how toddlers interact with joystick-based technology, and more fundamental research is required to understand joystick interactions at different ages and developmental stages.

Methods: We quantified how 36 nondisabled toddlers used a joystick to play a cause-and-effect game on a computer.

Results: Children demonstrated a strong preference for moving the joystick forward first, regardless of the target direction. On average, the oldest children navigated the joystick to the target 5 seconds faster than the youngest children, and were nearly twice as efficient in their joystick path.

Interpretation: These findings inform the design of assistive algorithms for joystick-enabled computer play and developmentally appropriate technologies for toddlers.

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