Scope of FES methodology for cerebral palsy

Cerebral palsy (CP) is one of the most frequent causes of disability in children and adolescents. According to a study of Disability in Chile (4) about 18% of new cases each year correspond to CP. In Teletón, a referential center that attends about 85% of the cases of child disability, 32% of the patients correspond to this pathology.

CP occurs early in development, is a permanent motor disorder attributable to a non-progressive brain injury or defect, and involves a set of signs that can compromise gait performance, e.g., spasticity and contractures, muscle weakness, bone deformity, impaired motor control, and altered proprioception. One weakness typically seen is dropfoot, in which there is insufficient control of ankle dorsiflexion during gait (when the foot is lifted when stepping) causing a series of compensations to prevent falls.

Various types of treatment are used to improve the quality of life of these patients, including physical therapy, which helps the child's psychomotor development, or orthopedic orthoses to improve the inadequate alignment of the ankles by fixing the subtalar joint. These orthoses allow dorsiflexion during the stance phase of gait and prevent plantar flexion in the swing phase but do not allow free movement of the joint, which could lead to decreased range of motion (ROM), so they exert a passive correction and may weaken or even shorten the musculature involved.

Functional electrostimulation (FES), used with devices during walking, allows correction of compensatory patterns while walking, helping to correct subtalar joint misalignment and strengthening the musculature involved. A study conducted in children with severe cerebral palsy also showed that locomotor training and the use of FES could contribute to improve vertical postural control. In a systematic review made by Irene Moll in 2017 it is concluded that the use of FES, increased the active ankle dorsiflexion angle, strength and improved selective motor control, balance and gait kinematics, so it is proposed as an alternative to traditional orthoses.

WalkFES is a neuroprosthesis that adapts to the needs of patients with dropfoot. It consists of an electrostimulator that is programmed from an application on a mobile device and with an inertial sensor adjusted to the footwear, and allow to stimulate the muscles at the exact moment when it is required, making an adjustment in real time and improving the gait pattern while strengthening the muscles.

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