Flux Eline, Bar-On Lynn, Buizer Annemieke I, Harlaar Jaap, van der Krogt Marjolein M
Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands.
Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands; Ghent University, Department of Rehabilitation Sciences, Ghent, Belgium.
Gait Posture. 2023 May;102:10-17. doi: 10.1016/j.gaitpost.2023.02.012. Epub 2023 Feb 19.
Children with cerebral palsy often show deviating calf muscle activation patterns during gait, with excess activation during early stance and insufficient activation during push-off.
Can children with cerebral palsy improve their calf muscle activation patterns during gait using one session of biofeedback-driven gaming?
Eighteen children (6-17 y) with spastic cerebral palsy received implicit game-based biofeedback on electromyographic activity of the calf muscle (soleus or gastrocnemius medialis) while walking on a treadmill during one session. Biofeedback alternately aimed to reduce early stance activity, increase push-off activity, and both combined. Early stance and push-off activity and the double-bump-index (early stance divided by push-off activity) were determined during baseline and walking with feedback. Changes were assessed at group level using repeated measures ANOVA with simple contrast or Friedman test with post-hoc Wilcoxon signed rank test, as well as individually using independent t-tests or Wilcoxon rank sum tests. Perceived competence and interest-enjoyment were assessed through a questionnaire.
Children successfully decreased their electromyographic activity during early stance feedback trials (relative decrease of 6.8 ± 12.2 %, P = 0.025), with a trend during the combined feedback trials (6.5 ± 13.9 %, P = 0.055), and increased their electromyographic activity during push-off feedback trials (8.1 ± 15.8 %, P = 0.038). Individual improvements were seen in twelve of eighteen participants. All children experienced high levels of interest-enjoyment (8.4/10) and perceived competence (8.1/10).
This exploratory study suggests that children with cerebral palsy can achieve small within-session improvements of their calf muscle activation pattern when provided with implicit biofeedback-driven gaming in an enjoyable manner. Follow-up gait training studies can incorporate this method to assess retention and long-term functional benefits of electromyographic biofeedback-driven gaming.
脑瘫患儿在步态中常表现出小腿肌肉激活模式异常，在支撑初期激活过度，在蹬离期激活不足。
脑瘫患儿能否通过一次生物反馈驱动的游戏改善其步态中的小腿肌肉激活模式？
18名6至17岁的痉挛型脑瘫患儿在一次实验中，在跑步机上行走时接受基于游戏的小腿肌肉（比目鱼肌或内侧腓肠肌）肌电图活动的隐式生物反馈。生物反馈交替旨在减少支撑初期活动、增加蹬离期活动以及两者结合。在基线期和反馈行走期间确定支撑初期和蹬离期活动以及双峰指数（支撑初期活动除以蹬离期活动）。在组水平上使用带有简单对比的重复测量方差分析或带有事后威尔科克森符号秩检验的弗里德曼检验评估变化，以及在个体水平上使用独立t检验或威尔科克森秩和检验。通过问卷调查评估自我效能感和兴趣享受度。
患儿在支撑初期反馈试验期间成功降低了肌电图活动（相对降低6.8±12.2%，P = 0.025），在联合反馈试验期间有降低趋势（6.5±13.9%，P = 0.055），并且在蹬离期反馈试验期间增加了肌电图活动（8.1±15.8%，P = 0.038）。18名参与者中有12名出现个体改善。所有患儿都体验到了高度的兴趣享受度（8.4/10）和自我效能感（8.1/10）。
这项探索性研究表明，以愉快的方式为脑瘫患儿提供隐式生物反馈驱动的游戏时，他们可以在一次实验中实现小腿肌肉激活模式的小幅改善。后续的步态训练研究可以采用这种方法来评估肌电图生物反馈驱动游戏的保持效果和长期功能益处。
