Neuromuscular electrical stimulation for children with cerebral palsy: a review.

The aim of this review paper is to consider the application of neuromuscular electrical stimulation (NMES) to improve gait or upper limb function in children with cerebral palsy (CP). Although most NMES research has been directed at adults with neurological conditions, there is a growing body of evidence supporting its use in children with CP. In line with a recent meta-analysis, the use of electrical stimulation to minimise impairment and activity limitations during gait is cautiously advocated. A detailed commentary on one of the most common lower limb NMES applications, tibialis anterior stimulation (either with or without gastrocnemius stimulation) is given. Although there is a lack of randomised controlled trials and a predominance of mainly small studies, this review further concludes that the balance of available evidence is in favour of upper limb exercise NMES offering benefits such as increased muscle strength, range of motion and function in children with CP. The use of dynamic splinting with NMES has been shown to be more effective than either treatment on its own in improving function and posture. There is at present little published work to support the application of botulinum toxin type A to temporarily reduce muscle tone as an adjunct intervention to NMES in this population, although the presence of parallel applications to manage similar symptoms in other muscular disorders is noted.

A six degrees-of-freedom marker set for gait analysis: repeatability and comparison with a modified Helen Hayes set.

Kinematic gait analysis is limited by simplified marker sets and related models. The majority of sets in clinical use were developed with low resolution imaging systems so required various assumptions about body behaviour. Further major limitations include soft tissue artefact and ambiguity in landmark identification. An alternative is the use of sets based on six degrees-of-freedom (DOF) principles, primarily using marker clusters for tracking. This study evaluates performance of a 6DOF set, based largely on CAST/ISB recommendations, through comparison with a conventional set and assessment of repeatability. Ten healthy subjects were assessed in treadmill walking, with both sets applied simultaneously on two occasions. Data were analysed using repeatability coefficients, correlation of key features, and comparison of joint angle curves and difference curves with confidence bands. Apart from pelvic tilt all segment and joint angles from both sets showed high within and between session repeatability (CMC>0.80). Hip rotations showed clear differences between the two sets with indications in support of the 6DOF set. Knee coronal angles showed evidence of cross-talk in the conventional set, highlighting difficulties with anatomical identification despite control measures such as a foot alignment template. Knee transverse angles showed inconsistent patterns for both sets. At the ankle the conventional set only allowed true measurement in two planes so with high repeatability the 6DOF set is preferable. The 6DOF set showed comparable performance to the conventional set and overcomes a number of theoretical limitations, however further development is needed prior to clinical implementation.

Protein adsorption on materials for recording sites on implantable microelectrodes.

Implantable microelectrodes have the potential to become part of neural prostheses to restore lost nerve function after nerve damage. The initial adsorption of proteins to materials for implantable microelectrodes is an important factor in determining the longevity and stability of the implant. Once an implant is in the body, protein adsorption takes place almost instantly before the cells reach the surface of an implant. The aim of this study was to identify an optimum material for electrode recording sites on implantable microelectrodes. Common materials for electrode sites are gold, platinum, iridium, and indium tin oxide. These, along with a reference material (titanium), were investigated. The thickness and the structure of adsorbed proteins on these materials were measured using a combination of atomic force microscopy and ellipsometry. The adsorbed protein layers on gold (after 7 and 28 days of exposure to serum) were the smoothest and the thinnest compared to all the other substrate materials, indicating that gold is the material of choice for electrode recording sites on implantable microelectrodes. However, the results also show that indium tin oxide might also be a good choice for these applications.