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Functional electrical stimulation during walking in children with unilateral spastic cerebral palsy: A randomized
Irene Moll1,2,3, Rik G J Marcellis4, Sabine M Fleuren4
1School of Mental Health and Neurosciences, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.
Insights
Functional electrical stimulation (FES) did not significantly improve goals for children with cerebral palsy (CP) compared to conventional treatment. Careful patient selection is crucial for effective FES therapy in CP.
Area of Science:
- Neurology
- Rehabilitation Medicine
- Pediatric Orthopedics
Background:
- Unilateral spastic cerebral palsy (CP) affects motor function, impacting daily activities.
- Conventional treatments like ankle foot orthoses (AFO) aim to improve gait and function.
- Functional electrical stimulation (FES) offers a potential alternative for enhancing dorsiflexion and mobility.
Purpose of the Study:
- To evaluate the efficacy of FES in improving body functions, activities, and participation in children with unilateral spastic CP.
- To determine if FES is a viable alternative treatment to conventional orthotic management.
Main Methods:
- A randomized cross-over trial involving 25 children (ages 4-18) with unilateral spastic CP (GMFCS levels I-II).
- Two 12-week treatment blocks: conventional treatment (AFO/adapted shoes) and FES, separated by a 6-week washout.
- Outcome measures included Goal Attainment Scale (GAS), CP Quality of Life questionnaire, and 3D gait analysis.
Main Results:
- No significant difference in GAS goal achievement between FES and conventional treatment.
- FES showed a decrease in ankle dorsiflexion during mid-swing over time but maintained increased ankle range of motion compared to AFO.
- No significant changes in physical examination, orthosis satisfaction, or self-dressing ability were observed.
Conclusions:
- FES is not significantly inferior to AFO for children with unilateral spastic CP.
- Patient selection is critical for successful FES outcomes.
- A testing period and thorough follow-up are recommended for FES implementation.
Aim:
To study if functional electrical stimulation (FES) of the peroneal nerve, which activates dorsiflexion, can improve body functions, activities, and participation and could be an effective alternative treatment in individuals with unilateral spastic cerebral palsy (CP).
Method:
A randomized cross-over trial was performed in 25 children with unilateral spastic CP (classified in Gross Motor Function Classification System levels I and II) aged 4 to 18 years (median age at inclusion 9 years 8 months, interquartile range = 7 years-13 years 8 months), 15 patients were male. The study consisted of two 12-week blocks of treatment, that is, conventional treatment (ankle foot orthosis [AFO] or adapted shoes) and FES, separated by a 6-week washout period. Outcome measures included the Goal Attainment Scale (GAS), the Cerebral Palsy Quality of Life questionnaire, and a three-dimensional gait analysis.
Results:
Eighteen patients completed the trial. The proportion of GAS goals achieved was not significantly higher in the FES versus the conventional treatment phase (goal 1 p = 0.065; goal 2 p = 1.00). When walking while stimulated with FES, ankle dorsiflexion during mid-swing decreased over time (p = 0.006, average decrease of 4.8° with FES), with a preserved increased ankle range of motion compared to conventional treatment (p < 0.001, mean range of motion with FES +10.1° compared to AFO). No changes were found in the standard physical examination or regarding satisfaction with orthoses and feelings about the ability to dress yourself. In four patients, FES therapy failed; in 12 patients FES therapy continued after the trial.
Interpretation:
FES is not significantly worse than AFO; however, patient selection is critical, and a testing period and thorough follow-up are needed.
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