Transcutaneous Spinal Stimulation and Short-burst Interval Treadmill Training Improve Spasticity and Walking Function in Children with Cerebral Palsy

Abstract

AbstractChildren with cerebral palsy (CP) experience spasticity that negatively affects their mobility. Current spasticity treatments reduce spasticity but do not improve walking function. The goal of this study was to evaluate the effect of transcutaneous spinal cord stimulation (tSCS) and short-burst interval locomotor treadmill training (SBLTT) on spasticity, neuromuscular coordination, and walking function in children with CP. In a crossover study design, four children with CP (4-13 years old), received 24 sessions each of SBLTT and SBLTT with tSCS (tSCS + SBLTT), with an 8-week washout in between. Spasticity, measured via the Modified Ashworth Scale, was significantly reduced in four lower-extremity muscles after tSCS + SBLTT (1.40 ± 0.22, p<0.001), 3-fold better than following SBLTT only (0.43 ± 0.39, p = 0.11). This was paralleled by improvements in one-minute walk test distance after both SBLTT (14.0 ± 6.0 m, p = 0.02) and tSCS + SBLTT (9.8 ± 6.7 m, p = 0.06). tSCS + SBLTT led to improvements in peak hip and knee extension (3.7 ± 10° and 7.6 ± 10°), that drove greater joint dynamic range of 3.4 ± 3.9° and 4.7 ± 7.2° at the hip and knee, respectively. Children and parents reported reduction in fatigue, and improved self-reported gait outcomes after tSCS + SBLTT. Improvements in spasticity and walking function were sustained during the 8-weeks of follow-up without any further stimulation. These results suggest that the tSCS + SBLTT improves spasticity while simultaneously improving walking function in the laboratory and community for ambulatory children with CP.