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Updated: May 25, 2026
Repeated Transcranial Magnetic Stimulation Combined with Action Observation Training in Children with Spastic Cerebral Palsy
Published on: August 9, 2024
A combination of Botulinum Toxin A therapy and Functional Electrical Stimulation in children with cerebral palsy--a
Sujay Galen1, Laura Wiggins, Robert McWilliam
1Bioengineering Unit, University of Strathclyde, Royal Hospital for Sick Children, Yorkhill Hospitals, Glasgow, UK. sujay.galen@strath.ac.uk
Insights
This study found that combining Functional Electrical Stimulation (FES) and Botulinum Toxin A (BTXA) therapy is feasible and improves ankle dorsiflexion and foot contact in children with spastic cerebral palsy (CP).
Area of Science:
- Pediatric Neurology
- Rehabilitation Medicine
- Biomedical Engineering
Background:
- Dynamic equinus is a common gait deviation in ambulant children with spastic cerebral palsy (CP).
- Effective interventions are needed to improve gait in this population.
Purpose of the Study:
- To investigate the combined effects of Functional Electrical Stimulation (FES) and Botulinum Toxin A (BTXA) therapy.
- To assess the feasibility of this combined therapeutic approach in children with spastic CP.
Main Methods:
- A single-subject design with repeated measures was used.
- Eight children with spastic CP (hemiplegic or diplegic) participated over 20 weeks.
- Ankle angle at swing phase end and foot contact pattern were primary and secondary outcome measures.
Main Results:
- The combined intervention (FES + BTXA) led to increased ankle dorsiflexion in most subjects (6/8).
- Improvements in foot contact patterns were observed concurrently with enhanced dorsiflexion.
Conclusions:
- Combining Botulinum Toxin A (BTXA) therapy with Functional Electrical Stimulation (FES) is a feasible approach.
- This combination therapy shows promise for improving gait deviations in ambulant children with spastic CP.
Background:
Among the ambulant population of children with spastic cerebral palsy (CP), dynamic equinus is one of the most common form of gait deviation that is encountered.
Objective:
To investigate the combined effects of Functional Electrical Stimulation (FES) and Botulinum Toxin A (BTXA) therapy in children with spastic CP, and to demonstrate the feasibility of this combination therapy.
Methods:
A single-subject design with repeated measures was adopted. Eight children (six males, two females; mean age 7 y 9 mo, SD 1 y 5 mo; range 7 y to 11 y) diagnosed with hemiplegic (n=6) or diplegic (n=2) spastic CP completed the study. Each subject participated in the study for twenty weeks. This period consisted of baseline (one week), BTXA phase (three weeks), first FES phase (four weeks), first control phase (four weeks), second FES phase (four weeks) and second control phase (four weeks). Subjects were assessed at the end of each phase. The ankle angle at the end of swing phase was selected as the primary outcome measure. The secondary outcome measure recorded was the foot contact pattern.
Results:
There was an increase in ankle dorsiflexion at the end of the combined intervention in most subjects (n=6), accompanied by an improvement in foot contact pattern.
Conclusions:
This pilot study demonstrated that it is feasible to combine BTXA therapy with FES in ambulant children with spastic CP.
