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Published on: February 1, 2018
Efficacy of neuromuscular electrical stimulation and interrupted serial casting in children with spastic diplegia
Yasser M Abd Elmonem1, Elham E Salem1, Mohamed A Elshafey1
1Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Egypt.
Insights
Neuromuscular electrical stimulation (NMES) combined with serial casting (SC) improved strength and gait in children with cerebral palsy (CP) more than SC alone. This approach enhances lower limb function without significant strength loss.
Area of Science:
- Pediatric Rehabilitation
- Neuromuscular Electrical Stimulation
- Cerebral Palsy Research
Background:
- Serial casting (SC) is used to improve range of motion (ROM) and reduce spasticity in children with cerebral palsy (CP).
- Potential strength deficits can arise from prolonged casting, impacting functional outcomes.
Purpose of the Study:
- To compare the efficacy of SC combined with neuromuscular electrical stimulation (NMES) versus SC alone in children with diplegic CP.
- To evaluate effects on lower limb function, including ROM, spasticity, strength, and gait.
Main Methods:
- A randomized comparative trial involving 33 children with diplegic CP.
- Interventions included SC with physical therapy, with one group also receiving NMES during casting for 8 weeks.
- Outcome measures comprised ROM, Modified Tardieu Scale, dynamometry, and Observational Gait Scale.
Main Results:
- Both groups showed significant improvements in ROM and spasticity.
- The group receiving NMES with SC demonstrated significantly greater improvements in dorsiflexor and knee extensor strength.
- The NMES + SC group also showed superior outcomes on the Observational Gait Scale.
Conclusions:
- Combining NMES with SC may mitigate strength loss associated with casting.
- This combined approach can improve ROM and reduce spasticity while preserving or enhancing muscle strength.
- NMES during SC leads to greater improvements in gait function for children with diplegic CP.
Objectives:
This research was aimed at comparing the effects of neuromuscular electrical stimulation (NMES) combined with interrupted serial casting (SC) versus SC alone on various aspects of lower limb function in children with diplegic cerebral palsy. SC is a clinical technique used to increase passive range of motion (ROM), decrease hypertonicity, and improve walking in children with cerebral palsy (CP).
Methods:
This randomized comparative trial involved 33 children with diplegic CP, who were randomly assigned to group A or group B at recruitment. Group A received SC along with a customized physical therapy program, whereas group B received the same interventions as group A along with NMES applied through cast windows during casting. Evaluations were based on ROM, the Modified Tardieu Scale, handheld dynamometer measurements, and the Observational Gait Scale. Assessments were conducted before and after 8 weeks of intervention.
Results:
Both groups exhibited significant improvements in dorsiflexion ROM, popliteal angle, gastrocnemius dynamic spasticity, and hamstring dynamic spasticity after the intervention (P = 0.0001 for all). However, significant differences (P < 0.05) in dorsiflexor strength, knee extensor strength, and observational gait scale score were observed between groups after the intervention, favoring group B.
Conclusions:
The use of NMES during SC may help overcome the substantial decrease in strength resulting from casting, thus achieving less reduction of tone, improving ROM without significantly decreasing strength, and attaining greater improvements in gait function.
