Artificial Walking Technologies to Improve Gait in Cerebral Palsy: Multichannel Neuromuscular Stimulation

Cerebral palsy (CP) is the most common childhood motor disability and often results in debilitating walking abnormalities, such as flexed‐knee and stiff‐knee gait. Current medical and surgical treatments are only partially effective in improving gait abnormalities and may cause significant muscle weakness. However, emerging artificial walking technologies, such as step‐initiated, multichannel neuromuscular electrical stimulation (NMES), can substantially improve gait patterns and promote muscle strength in children with spastic CP. NMES may also be applied to specific lumbar‐sacral sensory roots to reduce spasticity. Development of tablet computer‐based multichannel NMES can leverage lightweight, wearable wireless stimulators, advanced control design, and surface electrodes to activate lower‐limb muscles. Musculoskeletal models have been used to characterize muscle contributions to unimpaired gait and identify high muscle demands, which can help guide multichannel NMES‐assisted gait protocols. In addition, patient‐specific NMES‐assisted gait protocols based on 3D gait analysis can facilitate the appropriate activation of lower‐limb muscles to achieve a more functional gait: stance‐phase hip and knee extension and swing‐phase sequence of hip and knee flexion followed by rapid knee extension. NMES‐assisted gait treatment can be conducted as either clinic‐based or home‐based programs. Rigorous testing of multichannel NMES‐assisted gait training protocols will determine optimal treatment dosage for future clinical trials. Evidence‐based outcome evaluation using 3D kinematics or temporal‐spatial gait parameters will help determine immediate neuroprosthetic effects and longer term neurotherapeutic effects of step‐initiated, multichannel NMES‐assisted gait in children with spastic CP. Multichannel NMES is a promising assistive technology to help children with spastic CP achieve a more upright, functional gait.