Is EMG-based Serious Games Effective in Improving Gait in Children With Cerebral Palsy ? Interest of Electromyography Feedback (EMG)
Condition: Cerebral Palsy
MeSH terms: Cerebral Palsy
Study type: Interventional

Summary: 
      Cerebral palsy (CP) is a major motor dysfunction manifesting early in childhood, with severe
      consequences to performance in daily functions. CP children are typically unable to
      voluntarily activate individual muscles, hindering motor coordination and therefore the
      ability to produce movements as smooth as those seen in control cohorts. Muscles spanning
      distal joints are more likely affected by CP, resulting in abnormal gait patterns.

      While commercially available and customised games have been considered for CP rehabilitation
      in the last decade, they are mainly based on the analysis of movement kinematics and none
      seems to deal directly with the key source of motor impairment: the skeletal muscle. Surface
      electromyograms (EMGs), on the other hand, provide clinicians with the possibility of
      directly assessing and controlling the neural drive or command to muscles.

      The benefits of surface EMG as a feedback tool for improving posture control and for stroke
      rehabilitation are well established.

      The treatment with EMG-based "serious games" is expected to assist CP children in activating
      the ankle muscles in both paretic and healthy limbs at similar instants within the gait
      cycle. Given such EMG-oriented rehabilitation applies directly to the muscle, its effect on
      muscle and therefore gait function is likely to be greater than that achieved with
      conventional means. If this hypothesis is verified, it will be further expect to observe a
      smoother gait, that is smoother changes in gait kinematics and morphology of the paretic
      foot, in CP children treated with EMG-based serious game than otherwise.

      Primary objective consists in verifying whether Surface electromyography (sEMG)-based games
      are effective in reducing the degree of muscular hyperactivity in the ankle plantar flexor
      and thus improve the ankle dorsi flexor function in children with cerebral palsy.

      The study design is an open, prospective, monocentric, randomized and controlled trial.
      Participants will be randomly assigned to either the first group or to the second group.

      For the first group, the design will be: "physical therapy + serious games" during the first
      month then "physical therapy" during the second month.

      For second group, the the design will be: "physical therapy" during the first month then
      "physical therapy + serious games" during the second month.
    


Intervention name(s): Serious Game; physical therapy
Intervention type(s): Device; Other
Intervention description(s): Surface EMG detection for the myoelectric control of the EMG-based serious games and for the EMG assessment during gait will be performed with a wireless system.This device is composed of seven modules (sensor units), each detecting and transmitting two bipolar EMGs at 2 kilo Hertz (kHz). During the evaluation protocol EMGs will be detected from peroneus longus, gastrocnemius medialis, soleus and tibialis anterior muscles of both limbs using pre-gelled electrodes.; Children receive the regular rehabilitation for the treatment of ankle plantar flexor muscle overactivity and the paresis of ankle dorsal flexor muscle
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: None (Open Label)
Primary purpose: Treatment