Neuromotor Control During Walking in Children With Cerebral Palsy

Study Overview
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Brief Summary
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One out of every three children with cerebral palsy (CP) falls daily, with more than half of the falls occurring while walking. To avoid falling, the nervous system must continuously monitor how the body moves and, when an imbalance is detected, activate muscles for an appropriate correction. In this project, we will use small electrical stimulation of muscles and tendons that enhances the sense of body positioning, to allow children with CP to generate more accurate balance corrections.

Official Title
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Neuromotor Control During Walking in Children With Cerebral Palsy

Conditions
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Cerebral Palsy

Intervention / Treatment
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* Device: Stochastic Resonance (SR)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age 8 - 24 years Diagnosis of spastic diplegic or hemiplegic CP (for participants with CP group only) GMFCS classification level I or II (ability to walk independently with using any assistive device) Visual, perceptual, and cognitive/ communication skills to follow multiple step commands Seizure-free or well controlled seizures Ability to communicate pain or discomfort during testing procedures Parental/guardian consent and child assent/consent Exclusion Criteria: Diagnosis of athetoid, ataxic or quadriplegic CP Significant scoliosis (scoliometer angle > 9°) History of selective dorsal root rhizotomy Botox injections in the lower limb within the past 6 months Severe spasticity of the lower extremity muscles (e.g. a score of 4 on the Modified Ashworth Scale) Severely limited range of motion/ irreversible muscle contractures Lower extremity surgery or fractures in the year prior testing Joint instability or dislocation in the lower extremities Marked visual or hearing deficits

Ages Eligible for Study
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Minimum Age: 8 Years
Maximum Age: 8 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Basic Science
Allocation: Randomized
Intervention Model: Crossover Assignment
Interventional Model Description: Cross sectional study of responses to visual perturbations in two groups, children with CP and age-and sex- matched TD (typical development). Each group will undergo two stimulation conditions, stochastic resonance (SR) stimulation and a control / no stochastic resonance (noSR) condition while walking with and without visual perturbations.
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Stochastic Resonance (SR)<br>During this condition, participants will walk on the treadmill while receiving SR stimulation at their individual optimal intensity (SR) with and without visual perturbations. | Device: Stochastic Resonance (SR)<br>* The system consists of six linear isolated stimulators (STMISOLA, Biopac Systems, Inc., Goleta, USA). The SR signal (Gaussian White Noise, zero mean) will be generated through a 16 bit PCI 6733 National Instruments multifunction data acquisition card by a custom LabView program. The stimulation sites include the ankle, lateral soleus, peroneus longus, and tibialis anterior muscles and the hip.<br>|
| No Intervention: No Stochastic Resonance (noSR)<br>During this condition, participants will walk on the treadmill while receiving no SR stimulation (noSR) with and without visual perturbations. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Margin of Stability(MOS) | MOS refers to the distance between extrapolated center of mass (which includes center of mass position and velocity) and the base of support. It has been previously used to measure balance in children with cerebral palsy, patients with stroke, Parkinson Disease, and Multiple Sclerosis. We will measure center of mass using kinetics and kinematic computed through a motion capture system(Qualysis). For the visual perturbation conditions, we will use center of mass excursion as the primary outcome measure (since it has been used in prior studies in children and adults using visual perturbation protocols). | At the end of the session after 6 minutes of stimulation i.e Pre stimulation MOS - Post stimulation MOS. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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locomotor control, balance