A New Technology for Gait Regulation in Children with Cerebral Palsy

It is known that neural networks of the human spinal cord can initiate the stepping pattern and control posture in the absence and with impaired supraspinal input. In the rehabilitation of children with spastic diplegia due to cerebral palsy, a new technology based on electrical transcutaneous spinal cord stimulation (tSCS) was used. Continuous and rhythmic tSCS was performed during walking. Continuous tSCS was performed at the level of C5–C6 and T11–T12 vertebrae. Rhythmic stimulation of the dorsal roots of the spinal cord was performed at the level of the T12 and L2 vertebrae to activate the motor pools of the flexor and extensor leg muscles in the swing and stance phases, respectively. Fourteen children with spastic diplegia, age 13 ± 2 years, participated in the study. Patients in the study were able to stand and walk independently with the help of a cane/walker or with the assistance of an adult. All patients received standard therapy and locomotor training (20 min per day, 10 days). During locomotor training, tSCS-based technology was used in patients in one group and no tSCS was used in patients in the other group. The effect of tSCS on the parameters of gait over flat surface (acute effect) was determined in all patients before the course. Before and after the course all patients were examined using clinical tests, kinematic characteristics of gait were analyzed. The acute effect of stimulation is manifested in a reduction in the duration of the stance phase, in an increase in the range of motion in the knee joint. After the course in the main group the scores on the motor function change assessment scale (GMFM-88) increased, spasticity decreased, and the distance passed in the 6-min walk test increased.