SpinalStim

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 , , , , , , , , , ,

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.

Example kinematics and muscles activity at each assessment timepoint for P03’s more-affected side. A) Sagittal-plane hip, knee, and ankle kinematics over the gait cycle. Horizontal colored lines indicate where there were significant changes in kinematics over each phase of the study based on statistical parametric mapping (p 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.

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 , , ,

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.

A) Short-burst interval locomotor treadmill training (SBLTT) with contact guard assist. B) Investigative spinal cord neuromodulation device (SpineX, Inc.) with stimulating electrodes on the T11 and L1 dorsal spinous processes and two ground electrodes on the anterior superior iliac spine (ASIS - not visible). C) Spinal stimulation waveform with 10 kHz carrier frequency. D) Protocol timeline including the assessments before and after each intervention and after 8-weeks of follow-up. tSCS = transcutaneous spinal cord stimulationAim: 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.