Spinal Neuromodulation and Gait Training for Children with Cerebral Palsy: From Laboratory to Community

Abstract

Abstract Spinal Neuromodulation and Gait Training for Children with Cerebral Palsy: From Laboratory to Community Siddhi R. Shrivastav Chair of the Supervisory Committee: Chet T. Moritz Department of Rehabilitation Medicine, Electrical & Computer Engineering, and Physiology & Biophysics Cerebral Palsy (CP) is a movement disorder that is caused due to an injury to the developing brain around the time of birth. CP leads to abnormal posture, muscle tone and movement, that negatively affects physical function. Children with CP are less active than typically developing children. They experience participation restrictions due to impaired mobility. Currently, there are no non-invasive medical or surgical treatments that can improve children’s muscle tone along with mobility. Moreover, the effects of current physical therapy, medical and surgical interventions on children’s community walking, participation and quality of life is less known.Non-invasive neuromodulation, such as transcutaneous spinal cord stimulation (tSCS) may improve children’s muscle tone, walking function and mobility. tSCS, when combined with appropriate task-specific exercises, can harness neuroplasticity and thereby lead to long-term improvement in function. There is growing evidence of functional recovery in people with spinal cord injuries. tSCS may normalize the brain-spinal cord connectivity in CP, thereby leading to positive changes in movement and function. These functional gains may translate into children’s community walking, participation and on quality of life. First, we review background on CP and discuss about impairments associated with CP. We then present on current medical and surgical standard of care for muscle tone management, and discuss physical therapy and rehabilitation practices to improve function in children with CP. We also summarize evidence on high-intensity treadmill training, the short burst interval treadmill training or SBLTT to improve walking function in children with CP. We discuss the potential mechanisms of tSCS in CP and summarize previous evidence of this technique for CP rehabilitation. We provide evidence on the effects of tSCS combined with SBLTT on improving muscle tone, while simultaneously improving lab-based walking function in two children with CP. We then demonstrate the long-term effects of the combination of tSCS and SBLTT on muscle tone, walking function, along with a pre- post-treatment comparison of self-reported walking and health-related outcomes. Lastly, we explore the use of StepWatch device to measure community walking performance after two interventions, SBLTT only and tSCS combined with SBLTT in children with CP. Specifically, we evaluate six variables of walking performance: (1) average strides per day, (2) percent time and (3) number of strides intensities at low, moderate, and high stride rates, (4) percentage of total strides at low, medium, and high intensities, (5) average peak stride rate, and (6) activity index.