Evaluating the Effects of an Electrical Stimulator on Improving the Walking Ability of Children With Cerebral Palsy (CP)

Exploring the Effects of Multi-Joint Neuromuscular Electrical Stimulation on Training Gait of Children With Cerebral Palsy

The goal of this study is to see if gentle electrical stimulation can help children with cerebral palsy (CP) walk more easily. This stimulation, called neuromuscular electrical stimulation (NMES), sends small pulses to muscles to help them activate. Researchers will test different ways of using NMES to find out which method works best.

Participants will walk on a treadmill at a comfortable speed while NMES is applied to leg muscles. The study will compare different stimulation settings to see which one helps the most.

Study Overview

• Status: Not yet recruiting
• Conditions: Healthy Adults; Cerebral Palsy Children
• Intervention / Treatment: Device: Neuromuscular Electrical Stimulation (NMES)

Detailed Description

Children with cerebral palsy (CP) can have trouble with daily tasks such as walking. This raises their risk of disability as they age into their teens. Current treatments are not very effective. In this study, children with CP will walk on a treadmill while receiving neuromuscular electrical stimulation (NMES) on their lower limb muscles, using surface electrodes, while their gait dynamics are assessed, using Inertial Measurement Unit (IMU) sensors. Our proposed study aims to gather preliminary evidence to support the potential efficacy of NMES assistance to muscles across all lower limb joints during walking, i.e., multi-joint NMES assistance. Additionally, we aim to investigate the optimal level of intensity. We intend to quantify neuroprosthetic, i.e., immediate effects during NMES assistance on gait kinematics. 40 children between the ages of 7 to 18 who are diagnosed with spastic diplegic cerebral palsy and GMFCS level I-III, and 25 healthy adults will be recruited for this study. The study consists of one pilot session and two assessment sessions. During the pilot session, participants will walk on the treadmill at their self-selected speed while two IMU sensors measure their shank velocity and acceleration. No stimulation will be applied to the subjects during the pilot session, as we aim to only validate and improve the software that triggers the stimulation during the gait, i.e., our gait phase detection system. During assessment sessions, subjects will walk on a treadmill with and without NMES assistance at their self-selected walking speed. The assessment sessions consist of multiple NMES conditions. Each condition lasts about 1 minute and will be repeated 3 times, with 30 seconds rest between trials for each condition and 5 minutes between each condition. The total walking time will not exceed 30 minutes. Each visit will last about 3 hours. The first session will also include a consent process, which will add an extra 30 minutes. The assessment sessions will begin with a no-stimulation condition and will be followed by multiple NMES conditions consisting of NMES assistance to various lower limb muscle combinations.

• Study Type: Interventional
• Enrollment (Estimated): 65
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Ahad Behboodi, PhD; Phone Number: 402-554-7525; Email: abehboodi@unomaha.edu

Study Locations

• United States
  • Nebraska
    • Omaha, Nebraska, United States, 68182
      • University of Nebraska at Omaha, Biomechanics Research Building
      • Contact: Ahad Behboodi, PhD; Phone Number: 402-554-7525; Email: abehboodi@unomaha.edu

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult
• Accepts Healthy Volunteers: Yes

Description

*Inclusion Criteria*

CP Group:

• Age 7-18
• Diagnosis of spastic diplegic cerebral palsy (CP)
• GMFCS level I-III (be able to walk with or without assistive devices)
• MIGR < 40% femoral head covering in acetabulum
• Crouch, equinus, or jump gait
• At least 0° passive dorsiflexion range of motion (ROM)
• Sufficient visuoperceptual, cognitive, and communication skills
• Seizure-free or well-controlled seizures
• No other neurological or musculoskeletal disorders (e.g. dystonia, severe scoliosis, hip instability
• Ability to travel to the University of Nebraska at Omaha two times
• Ability to communicate pain or discomfort
• Ability to obtain child assent and obtain parent/guardian consent

Healthy adults (control) group:

• Adults aged 20 to 40
• Adults with good physical health
• Adults with the ability to follow verbal instructions
• Adults with the ability to walk on a treadmill for 15 minutes
• No orthopedic surgery on the lower limb within the past 3 months

*Exclusion Criteria*

CP Group:

• Diagnosis of athetoid or ataxic cerebral palsy (CP)
• Scoliosis with primary curve > 49%
• Spinal fusions extending into the pelvis
• Lower Extremity (LE) joint instability or dislocation
• Severe tactile hypersensitivity
• LE botulinum injections in the past 6 mo
• Implanted medical device contraindicative of functional electrical stimulation (FES)
• Pregnancy
• Severe LE spasticity (Modified Ashworth Scale score of 4 or greater)
• History of pulmonary disease limiting exercise tolerance (Asthma Control Test screen)
• History of cardiac disease (American Heart Association, AH,) screen)
• Excessive LE joint pain during walking
• Severely limited range of joint motion/ irreversible muscle contractures, i.e.> 10° knee flexion, >15° hip flexion contractures, or >5° plantarflexion contractures
• LE surgery or significant injury within 1 yr.

Healthy adults (control) group:

• Adults with any chronic illnesses or medical conditions that could impact their health.
• Adults with significant behavioral or emotional issues that could indicate developmental disorders or psychological conditions.
• Adults with diagnosed developmental disorders (e.g., autism, ADHD, learning disabilities)
• Adults with surgery on their lower limb within the past 3 months.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Non-Randomized
• Interventional Model: Sequential Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Cerebral Palsy Group; The Cerebral Palsy Group (CP), intervention group, will receive a low power electrical stimulation, Neuromuscular Electrical Stimulation (NMES), on different combination of their lower limb muscles while walking on the treadmill.	Device: Neuromuscular Electrical Stimulation (NMES); Children with CP can have trouble with daily tasks such as walking. This raises their risk of disability as they age into their teens. Current treatments are not very effective. In this study, children with CP will walk on a treadmill while receiving NMES on their lower limb muscles, using surface electrodes, while their gait dynamics are assessed. Our proposed study aims to gather preliminary evidence to support the potential efficacy of NMES assistance to muscles across all lower limb joints during walking, i.e., multi-joint NMES assistance. Additionally, the investigators aim to investigate the optimal level of intensity.
Active Comparator: Healthy Adults Group; The Healthy Adults Group (HA) will receive a similar low power electrical stimulation, Neuromuscular Electrical Stimulation (NMES), as that received by the Cerebral Palsy Group. However, they will will only receive NMES in specific muscle groups and the only variable across conditions will be the power of stimulation.	Device: Neuromuscular Electrical Stimulation (NMES); Children with CP can have trouble with daily tasks such as walking. This raises their risk of disability as they age into their teens. Current treatments are not very effective. In this study, children with CP will walk on a treadmill while receiving NMES on their lower limb muscles, using surface electrodes, while their gait dynamics are assessed. Our proposed study aims to gather preliminary evidence to support the potential efficacy of NMES assistance to muscles across all lower limb joints during walking, i.e., multi-joint NMES assistance. Additionally, the investigators aim to investigate the optimal level of intensity.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Gait Variable Index (GDI)	Gait Variable Index (GDI) is an index of gait pathology based on 15 different kinematic measures (bilaterally) or nine unilaterally. The GDI score ranges from 0 to 100 where 100 represents atypically developing's (TD) normal GDI score.	Baseline (enrollment) and the end of assessment at 3 weeks

Collaborators and Investigators

• Sponsor: University of Nebraska
• Collaborators: National Institute of General Medical Sciences (NIGMS)
• Investigators: Principal Investigator: Ahad Behboodi, PhD, University of Nebraska

Study record dates

Study Major Dates

• Study Start (Estimated): May 1, 2026
• Primary Completion (Estimated): June 1, 2029
• Study Completion (Estimated): July 1, 2029

Study Registration Dates

• First Submitted: January 31, 2025
• First Submitted That Met QC Criteria: January 31, 2025
• First Posted (Actual): February 6, 2025

Study Record Updates

• Last Update Posted (Actual): May 8, 2026
• Last Update Submitted That Met QC Criteria: May 6, 2026
• Last Verified: September 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Brain Damage, Chronic; Cerebral Palsy
• Other Study ID Numbers: 0406-24-FB; P20GM109090 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: Yes
• product manufactured in and exported from the U.S.: Yes