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Electrical Stimulation Following Botulinum Toxin A in Children With Spastic Diplegia: A Within-Participant Randomized
Anita Mudge1, Lisa A Harvey2, Ann Lancaster1,3
1a 1 Physiotherapy Department, Sydney Children's Hospital , Sydney, Australia.
Insights
Electrical stimulation (ES) did not improve hamstring muscle extensibility in children with spastic diplegia when combined with botulinum toxin A (BoNT/A) injections. The study found no significant benefits of adding ES to standard stretching protocols.
Area of Science:
- Pediatric Rehabilitation
- Neuromuscular Disorders
- Biomedical Engineering
Background:
- Spastic diplegia commonly affects hamstring muscle extensibility.
- Botulinum toxin A (BoNT/A) injections are used to manage spasticity.
- The potential adjunctive role of electrical stimulation (ES) requires further investigation.
Purpose of the Study:
- To evaluate if electrical stimulation (ES) enhances hamstring passive extensibility in children with spastic diplegia post-botulinum toxin A (BoNT/A) injection.
- To compare the efficacy of ES plus stretching versus stretching alone.
Main Methods:
- A within-participant, single-blind, randomized controlled trial was conducted with six children.
- One hamstring received daily stretch and ES; the other received daily stretch only for 12 weeks.
- Passive hamstring extensibility was measured using popliteal angle via standardized torque and Modified Tardieu Scale.
Main Results:
- No significant difference in popliteal angle was observed between the ES and control groups at 4 weeks.
- The mean difference in popliteal angle (standardized torque) favored the ES leg by 2° (-2 to 5).
- Modified Tardieu Scale results showed no significant difference for R1 (0° [-4 to 3]) and a slight, non-significant difference for R2 (7° [0 to 14]).
Conclusions:
- Electrical stimulation (ES) does not appear to improve passive hamstring extensibility beyond the effects of botulinum toxin A (BoNT/A) and stretching alone at 4 weeks.
- Further research with larger sample sizes and longer follow-up periods may be warranted.
- Current evidence does not support the routine use of ES as an adjunct to BoNT/A for hamstring stretching in this population.
Aims:
To determine whether electrical stimulation (ES) following botulinum toxin A (BoNT/A) injection increases passive extensibility of the hamstring muscles in children with spastic diplegia.
Methods:
Six children undergoing bilateral BoNT/A injections to the hamstrings participated in this within-participant single blind randomized controlled trial. One leg of each child was randomised to the experimental condition and the other to the control condition. The experimental leg received daily stretch and ES to the hamstrings for 12 weeks, while the control leg received only daily stretch. The primary outcome was passive hamstring extensibility reflected by popliteal angle measured with a standardised torque. Secondary outcomes were two goniometric measures of popliteal angle using the Modified Tardieu Scale (R1 and R2), and parents' perceptions of treatment effectiveness. Outcomes were measured at baseline, 4 weeks, 12 weeks and 6 months.
Results:
The mean between-group difference (95% CI) at 4 weeks was 2° (-2 to 5) for popliteal angle measured with a standardised torque, favouring the experimental leg. Tardieu results for R1 and R2 were 0° (-4 to 3) and 7° (0 to 14), respectively.
Conclusion:
ES does not improve passive extensibility of the hamstring muscles at 4 weeks over any possible effects of BoNT/A alone.
