Twelve year old Ethan Touchton loves sports like other boys his age but until this summer, he had a little difficulty keeping up with them on the basketball court. Born with cerebral palsy that affects the muscle tone on his right side, Ethan always had a slight bit of trouble lifting up his foot all the way when walking and running, causing him to trip. But in the summer of 2014, his physical therapist asked if he would like to try a new device that might help improve his gait. It turned out to be a game changer.
“He said, ‘Mom, I love it. Can we please get this?’” says his mother, Victoria Touchton. “I started crying because I had never seen him walk in a normal pattern. It was remarkable.”
Ethan is one of a few kids using the Bioness L300 system at Wolfson Children’s Rehabilitation in Mandarin. The center started offering it in 2012 when the device’s manufacturer introduced it in a smaller, kid-friendly size. The adult version has been out on the market for several years to help those who have suffered a stroke or other brain injury. The device comes in three parts: a leg cuff that fits right below the knee, a gait sensor that attaches to the side of the shoe, and a wireless control unit that is either worn in a pocket or around the neck. When the electrical signals that are sent from the brain to the muscles in the leg are interrupted due to a neurological impairment caused by injury or a disease like cerebral palsy, children like Ethan suffer from muscle weakness and even paralysis in the limb. The device works to restore a connection by replacing natural electronic signals from the brain with stimulation to the nerves in the lower leg that activate the muscles to lift the foot. The gait sensor communicates with the leg cuff to let it know whether foot is on the ground or in the air, and when to activate the electrodes.
Most kids with foot drop wear a plastic orthotic brace to stabilize the leg, which hampers their range of motion and over time, causing muscle atrophy. But the device not only increases their mobility, it builds muscle strength as well and, in some cases, helps the brain relearn how to lift the foot again.
“The majority of patients who benefit from this device have cerebral palsy,” says Suzanne Barje, PT, clinical supervisor of Wolfson Children’s Rehabilitation in Mandarin. “Overall it gives them more independence and ability to be more functional in the community. Plus, knowing they’re building muscle boosts their confidence, and good self-esteem is a big thing for boys and girls.”
It also helps that they get to wear any shoes they want to since the device clips on the side. With an orthotic, kids often have to wear a shoe one size larger on that foot, which means buying specialized shoes or shoes in two different sizes. The kid-sized cuffs come in a small but have adjustable straps that help accommodate the calf width on children from about 2 to 12 years old.
There is a screening process with the Bioness L300 device that rules out patients who have seizures or pacemakers. Once they’ve received medical clearance and their doctors have written a letter confirming medical necessity for the device, children can be referred to the Wolfson Children’s Rehabilitation Center in Mandarin for a trial to see how they like it. Suzanne says that some kids need a few sessions to get used to it because while it’s not painful, it’s different from what they’re used to and it creates a “tickling” sensation in the leg as the electrodes stimulate the muscle. Initially, the device is worn for 15-minute increments so the skin can acclimate to the electric stimulation. The time gradually is increased with the goal of wearing it for eight hours a day with a 20 minute break to allow the skin to breathe. The electrodes are mounted on the skin with water to help conduct the stimulation, and need to be moistened about every four hours. Kids also are required to use a training mode help build the muscles, which consists of exercises like toe and heel raises.
Currently, Wolfson Children’s Rehabilitation in Mandarin is the only center in Jacksonville offering the Bioness L300 pediatric-sized cuff for children. Right now there are three using the device, and three awaiting insurance approval.
“Most of the kids I see have grins and smiles when they wear it for the first time,” says Suzanne. “They say they love it, and it’s comfortable.”
Ethan likes it because it helps him keep up with his friends, and it attracts less attention than his brace did. And it makes him quicker on the court.
“It’s made a huge difference for Ethan. He doesn’t trip as much as he did, especially on uneven ground,” says Victoria. “Plus he won’t grow out of it for a long time. He’s been through his share of braces.”