Functional Electrical Stimulation in Children with Hemiplegia

Hemiplegia is the impaired ability to move the arm, trunk and leg on one side of the body that results from injury to the central nervous system. These patients often demonstrate an inability to lift and clear the toes from the floor during walking, which can cause tripping and falling, poor balance, slow walking speed, and abnormal compensatory movements at the knee and hip.

The current standard of care for ankle impairment in hemiplegia is positional bracing, most commonly an ankle foot orthosis (AFO). While effective in preventing the toes from dropping during walking and minimizing tripping, AFOs restrict ankle motion, making some skills more difficult, such as propelling the body forward, running and jumping. AFOs also prevent active contraction of most ankle muscles, which may contribute to muscle atrophy and weakness. Additionally, there is often low patient compliance with positional bracing because of the movement restrictions they impose and because of issues with comfort, including skin irritation, or appearance of the brace. This is particularly true in children with relatively mild gait impairments and during adolescent years.

The WalkAide is a device newly tested in children that uses functional electrical stimulation (FES) to cause active contraction of the muscles that lift the foot only when needed. In contrast to an AFO, it facilitates ankle joint motion and causes active contraction of the deficient muscle group. Unlike other similar devices, all of the WalkAide components are self-contained in a cuff worn below the knee. This eliminates the need for external wires or switches in the shoe and allows the device to be used with sandals or in barefeet, making it particularly attractive for pediatric use.

CHOP’s Center for Rehabilitation recently had the opportunity to purchase a WalkAide clinician kit through a generous donation from CVS Caremark. Acquiring the WalkAide is part of the center’s recent efforts to implement developments in dynamic technology that may enhance patient recovery over traditional static approaches. Recent research in children and adolescents has shown that the WalkAide is accepted by a majority of those who may benefit from FES, that it lifts the foot when needed while allowing the opposite propulsion motion when needed, and that it can increase muscle growth.1,2 This suggests that FES may be a viable alternative to positional bracing in children with mild gait impairment from hemiplegia, particularly those children who are restricted during walking, running or athletic activity by a traditional AFO or those who choose to not wear an AFO for any reason.

The Center for Rehabilitation treats a number of children and adolescents each year who may benefit from the use of the WalkAide device, including those with hemiplegia or other ankle impairments from cerebral palsy, stroke, traumatic brain injury, spinal cord injury and multiple sclerosis. A core group of our therapists completed formal training in the clinical application of the WalkAide and will serve as resources for the examination and treatment of patients who may benefit.

1. Damiano DL, Prosser LA, Curatalo LA, Alter KE. Muscle plasticity and ankle control after repetitive use of a functional electrical stimulation device for unilateral foot drop in children with cerebral palsy. Neurorehabil Neural Repair. 2012 Oct 4. [Epub ahead of print]
2. Prosser LA, Curatalo LA, Alter KE, Damiano DL. Acceptability and potential effectiveness of a foot drop stimulator in children and adolescents with cerebral palsy. Dev Med Child Neurol. 2012;54(11):1044–1049.