Orthotic comparisons.
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Analysis of Variance↗
Biomedical subjects
J Carmick
Publications and source records attributed to J Carmick.
Use of neuromuscular electrical stimulation and [corrected] dorsal wrist splint to improve the hand function of a child with spastic hemiparesis.
This case report describes a program for a child with spastic hemiparesis who had previously received physical therapy with neuromuscular electrical stimulation (NMES). After a year without physical therapy, he returned to continue to receive NMES to strengthen muscles, increase sensory awareness, and improve hand function. The child quickly regained his previous level of functioning and made additional progress. After 38 sessions, he still lacked adequate wrist stability for independent hand function. A dorsal wrist splint was used to stabilize the wrist while NMES facilitated muscle activity of the hand and wrist. While wearing the splint, the child could use his hand independently without adult interference or "assistance," thus allowing motor learning to occur. After 24 additional sessions (i.e., 9 months of using the splint), the child could use the hand for activities such as tying his shoelaces without the splint. No increase in spasticity was seen in spite of strengthening the spastic finger flexors.
Activities of Daily Living↗
Managing equinus in children with cerebral palsy: electrical stimulation to strengthen the triceps surae muscle.
A new therapeutic proposal for the management of equinus in children with cerebral palsy is to strengthen the calf muscles instead of weakening them surgically. Prior research indicates that in children with cerebral palsy the triceps surae muscle is weak and needs strengthening. Neuromuscular electrical stimulation (NMES) was used as an adjunct to physical therapy. A portable NMES unit with a hand-held remote switch stimulated an active muscle gait cycle. Results are discussed for four children, who showed improved gait, balance, posture, active and passive ankle range of motion, and foot alignment. The toe walkers became plantigrade and the equinovalgus posture of the foot decreased. Spasticity did not increase.
Cerebral Palsy↗
Managing equinus in a child with cerebral palsy: merits of hinged ankle-foot orthoses.
A comparison of hinged versus solid ankle orthoses in a child with moderate spastic diplegia demonstrated that solid ankle braces blocked needed foot and ankle mobility. The loss of movement forced the child to use extraneous movement patterns in order to move the upper body over the foot. These iatrogenically induced deviations were considered reasons for surgery. When ankle and foot mobility were increased by the use of hinged ankle braces, the gait improved and with physical therapy the reasons for surgery were removed. This case study shows that significant biomechanical changes can be achieved by simply switching from solid to articulated or hinged ankle-foot orthoses.
Ankle↗
Clinical use of neuromuscular electrical stimulation for children with cerebral palsy, Part 1: Lower extremity.
This report, part 1 of a two-part case report on the clinical use of neuromuscular electrical stimulation (NMES) for children with cerebral palsy, documents the functional changes that occurred with the application of NMES to the lower extremity of three male children, 1.6, 6.7, and 10 years of age, all with hemiplegia due to cerebral palsy. Neuromuscular electrical stimulation was used in conjunction with a dynamic-systems, task-oriented model of motor learning. The children tolerated NMES well and at times demonstrated carryover after the removal of NMES. The youngest child showed immediate change in the ability to walk and run symmetrically. The two older boys demonstrated significant improvement in locomotor efficiency in a short time, although they were of an age when this improvement was not expected. One boy's Physiological Cost Index (PCI) measurement (a measure of locomotor efficiency) improved fourfold, and the other boy's PCI measurement improved by a factor of two. The results show preliminary evidence for the usefulness of NMES as an adjunct to the physical therapy program for improving function in children with cerebral palsy.
Cerebral Palsy↗
Clinical use of neuromuscular electrical stimulation for children with cerebral palsy, Part 2: Upper extremity.
This report, part 2 of a two-part case report on the clinical use of neuromuscular electrical stimulation (NMES) for children with cerebral palsy, documents the functional changes that occurred with the application of NMES to the upper extremity of two children, 1.6 and 6.7 years of age, with hemiplegia due to cerebral palsy. The NMES was used as an adjunct to a dynamic-systems, task-oriented physical therapy program. The youngest child showed immediate improvement in the ability to crawl and use both hands together. The older child demonstrated increased sensory awareness and use of the nonfunctional hand. Preliminary findings suggest that NMES may be a useful physical therapy tool for enhancing muscle strength increasing sensory awareness, and assisting motor learning and coordination.
Activities of Daily Living↗