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Updated: Jul 16, 2026
Assessment of Neuromuscular Function Using Percutaneous Electrical Nerve Stimulation
Published on: September 13, 2015
Neuromuscular electrical stimulation versus volitional isometric strength training in children with spastic diplegic
Scott K Stackhouse1, Stuart A Binder-Macleod, Carrie A Stackhouse
1Department of Physical Therapy, Arcadia University, Glenside, PA, USA.
Insights
Neuromuscular electrical stimulation (NMES) significantly improved muscle strength and walking speed in children with cerebral palsy (CP). This novel approach offers a promising avenue for enhancing physical function in pediatric CP populations.
Area of Science:
- Pediatric Rehabilitation
- Neuromuscular Electrical Stimulation
- Cerebral Palsy Research
Background:
- Limited research exists on using high-force, low-repetition neuromuscular electrical stimulation (NMES) to enhance muscle force in children with cerebral palsy (CP).
- Understanding the efficacy of NMES compared to traditional training is crucial for improving functional outcomes in pediatric CP.
Purpose of the Study:
- To assess if isometric NMES or volitional training can increase muscle strength and walking speed in children with CP.
- To investigate the underlying mechanisms contributing to enhanced force production following these training interventions.
Main Methods:
- Eleven children with spastic diplegia underwent a 12-week isometric strength-training program, divided into NMES and volitional training groups.
- The NMES group received percutaneous electrode stimulation of quadriceps and triceps surae, while the volitional group trained with maximal effort.
- Measurements included maximum voluntary isometric contraction (MVIC) force, voluntary muscle activation, muscle cross-sectional area (CSA), and walking speed.
Main Results:
- The NMES group demonstrated superior increases in normalized force production for both quadriceps and triceps surae muscles.
- Only the NMES group exhibited significant improvements in walking speed post-training.
- Increased voluntary muscle activation was a key factor in MVIC gains, particularly in the NMES group (67% contribution).
- Quadriceps femoris cross-sectional area (CSA) significantly increased in the NMES group.
Conclusions:
- This study provides the first quantitative evidence of strength gains using NMES in children with CP.
- NMES demonstrates potential as an effective intervention for improving muscle strength and functional mobility in this population.
- Further research is warranted to explore the clinical effectiveness and long-term benefits of NMES strength training in children with CP.
Background:
To date, no reports have investigated neuromuscular electrical stimulation (NMES) to increase muscle force production of children with cerebral palsy (CP) using high-force contractions and low repetitions.
Objective:
The aims of this study were to determine if isometric NMES or volitional training in children with CP could increase muscle strength and walking speed and to examine the mechanisms that may contribute to increased force production.
Methods:
Eleven children with spastic diplegia were assigned to an NMES training group or to a volitional training group. Participants in the NMES group had electrodes implanted percutaneously to activate the quadriceps femoris and triceps surae muscles. The volitional group trained with maximal effort contractions. Both groups performed a 12-week isometric strength-training program. Maximum voluntary isometric contraction (MVIC) force, voluntary muscle activation, quadriceps and triceps surae cross-sectional area (CSA), and walking speed were measured pre- and post-strength training.
Results:
The NMES-trained group had greater increases in normalized force production for both the quadriceps femoris and triceps surae. Similarly, only the NMES group showed an increase in walking speed after training. Changes in voluntary muscle activation explained approximately 67% and 37% of the changes seen in the MVIC of the NMES and volitional groups, respectively. Quadriceps femoris maximum CSA increased significantly for the NMES group only.
Conclusions:
This study was the first to quantitatively show strength gains with the use of NMES in children with CP. These results support the need for future experimental studies that will examine the clinical effectiveness of NMES strength training.
