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Children with cerebral palsy: a systematic review and meta-analysis on gait and electrical stimulation
James H Cauraugh1, Sagar K Naik, Wen Hao Hsu
1Applied Physiology and Kinesiology Department, Center for Exercise Science, University of Florida, Gainesville, FL 32611, USA. jcaura@hhp.ufl.edu
Insights
Electrical stimulation shows medium effect sizes for improving walking impairment and activity limitations in children with cerebral palsy. This systematic review and meta-analysis confirms positive treatment effects for gait problems.
Area of Science:
- Rehabilitation Medicine
- Pediatric Physical Therapy
- Neuroscience
Background:
- Cerebral palsy (CP) often leads to gait abnormalities and activity limitations.
- Electrical stimulation (ES) is a potential therapeutic intervention for improving motor function in children with CP.
- The International Classification of Functioning (ICF) provides a framework for assessing functional outcomes.
Purpose of the Study:
- To systematically review and meta-analyze the effect of ES on impairment and activity limitations related to gait in children with CP.
- To determine the summary effect size of ES interventions for gait problems in pediatric CP populations.
Main Methods:
- Systematic review and meta-analysis of 40 CP and ES studies, including 17 gait-focused studies.
- Classification of outcomes into impairment and activity limitations subgroups based on ICF principles.
- Inclusion of 238 participants receiving ES and 224 in control groups, employing standardized mean differences and random-effects models.
Main Results:
- Significant cumulative effect sizes were found for both impairment (0.616) and activity limitations (0.635).
- Low to medium heterogeneity (I²) and high fail-safe N-values indicated robust findings.
- Moderator analyses confirmed positive effects from both functional and neuromuscular ES.
Conclusions:
- Electrical stimulation demonstrates medium effect sizes for improving walking impairment and activity limitations in children with cerebral palsy.
- The findings support the use of ES as an effective intervention for enhancing gait function in pediatric CP.
Objective:
To conduct a systematic review and meta-analysis using the International Classification of Functioning to determine the summary effect of electrical stimulation on impairment and activity limitations relevant to gait problems of children with cerebral palsy.
Methods:
We identified 40 cerebral palsy and electrical stimulation studies, and 17 gait studies qualified for inclusion. Applying enablement classification methods to walking abnormalities created two subgroups: impairment (N = 14) and activity limitations (N = 15). Overall, 238 participants experienced electrical stimulation treatments and 224 served as a no stimulation control group. Calculations followed conventional data extraction and meta-analysis techniques: (a) individual standardized mean differences, (b) summary effect size, (c) I² heterogeneity test, (d) fail-safe N analysis and (e) moderator variable analyses.
Results:
Common outcome measures associated with impairment (n = 3) and activity limitations (n = 6) were submitted to separate random effects models meta-analyses, and revealed significant cumulative effect sizes: (a) impairment = 0.616 (SE = 0.10) and (b) activity limitations = 0.635 (SE = 0.14). I² indicated low and medium amounts of dispersion, whereas fail-safe analyses revealed high N-values for both disablement categories. Moderator variable analyses further confirmed the positive treatment effects from both functional and neuromuscular stimulation.
Conclusions:
The present systematic review and meta-analyses determined medium effect sizes for electrical stimulation on walking impairment and activity limitations of children with cerebral palsy.
