Functional neuromuscular electrical stimulation while exergaming for toe-walking: a retrospective case report

A child receiving physical therapy for toe-walking with ARWell PRO and simultaneous task-specific electrical neuromuscular stimulation experienced:

• Increased number of functional heel-raises

• Increased overall balance and strength

• Improved gait function

Abstract

Individuals with cerebral palsy who present with toe-walking commonly receive physical therapy (PT) interventions aimed at promoting a more normalized gait pattern. Neuromuscular electrical stimulation (NMES) when used along with traditional PT can enhance intervention outcomes.

Case description: An 8-year old boy presenting with toe-walking and lower extremity muscle weakness underwent 10 PT sessions using traditional PT techniques, NMES, and an immersive exergaming platform (ARWell PRO (Augment Therapy®, Cleveland Ohio, USA)) to address standing and gait function.

Intervention: The intervention plan focused on strengthening the gastrocnemius muscles using task-specific NMES, with the ultimate goal of achieving flat-foot posture and functional movement. ARWell PRO provided interactive tasks that helped maintain motivation and provided immediate feedback to reinforce full plantar contact and controlled movement patterns. All exergame participation was completed with concurrent NMES.

Outcomes: By the final sessions, the child demonstrated improved plantarflexion strength demonstrated by a substantial increase in number of completed heel raises, along with improved gait function and balance.Heel raises increased from 3 and 0 for the right and left leg, respectively, to 15 and 14, and full plantar surface contact was observed during standing activities.

Conclusion: Combining novel exergaming with NMES may enhance engagement and tolerability of PT, thereby supporting therapeutic goals such as reduced toe-walking and improving functional outcomes overall.