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Published on: August 9, 2024
Electrical simulation in addition to passive stretch has a small effect on spasticity and contracture in children
Mohammad A Khalili1, Abdulhamid Hajihassanie
1Faculty of Rehabilitation, Semnan University (Medical Sciences), Semnan, Iran. moh35ir@yahoo.co.UK
Insights
Electrical stimulation combined with passive stretching offers a marginal benefit over passive stretching alone for reducing spasticity and improving knee extension in children with cerebral palsy.
Area of Science:
- Pediatric Rehabilitation
- Neuromuscular Disorders
- Biomedical Engineering
Background:
- Cerebral palsy (CP) frequently causes spasticity and contractures, particularly in the knee flexors.
- These conditions significantly impair motor function and quality of life in affected children.
- Current management often involves passive stretching, but its efficacy can be limited.
Purpose of the Study:
- To investigate the efficacy of adding electrical stimulation to passive stretching for managing spasticity and contractures in children with CP.
- To compare the combined intervention against passive stretching alone.
Main Methods:
- A randomized, within-participant controlled trial was conducted.
- Eleven children with cerebral palsy and bilateral knee flexor spasticity participated.
- Interventions included four weeks of either passive stretching alone or passive stretching combined with quadriceps electrical stimulation.
Main Results:
- The addition of electrical stimulation resulted in a marginally greater decrease in spasticity (Modified Ashworth Scale difference: 0.8 points).
- Electrical stimulation also led to a slightly larger increase in passive knee extension (4 degrees).
- Both differences showed statistical significance within the tested confidence intervals.
Conclusions:
- Electrical stimulation, when combined with passive stretching, demonstrates a marginal but statistically significant benefit over passive stretching alone.
- This combined approach may offer an improved therapeutic option for children with cerebral palsy experiencing spasticity and contractures.
- Further research could explore optimal parameters and long-term effects.
Question:
Does electrical stimulation in addition to passive stretching reduce spasticity and contracture more than passive stretching alone in children with cerebral palsy?
Design:
Randomised within-participant controlled trial with concealed allocation, assessor blinding, and intention-to-treat analysis.
Participants:
Eleven (one dropout) children with cerebral palsy and bilateral knee flexor spasticity aged 13 years (SD 1).
Intervention:
One leg in each participant received the experimental intervention for four weeks which consisted of 30 min of electrical stimulation of the quadriceps 3 times per week and passive stretching of the hamstrings 5 times per week. The other leg received the control intervention for four weeks which consisted of passive stretching of the hamstrings 5 times per week.
Outcome Measures:
Spasticity of the hamstrings was measured using the modified Ashworth scale. Contracture was measured as maximum passive knee extension using goniometry.
Results:
The mean difference in decrease in the modified Ashworth score due to the addition of electrical stimulation to the stretching regimen was 0.8 points (95% CI 0.1 to 1.5). The mean difference in increase in passive knee extension due to the addition of electrical stimulation to the stretching regimen was 4 degrees (95% CI 0 to 7).
Conclusion:
Electrical stimulation combined with passive stretching is marginally more effective than passive stretching alone for spastic limbs of children with cerebral palsy.
