Effectiveness of Functional Electrical Stimulation - Cycling Treatment in Children with Cerebral Palsy

Abstract

AimThe purpose of this study was to evaluate the effects of functional electrical stimulation (FES) bicycle therapy system on motor function, gait pattern, spasticity, daily living activities, and aerobic capacity in children with cerebral palsy (CP) and to compare the results with sham stimulation and standard treatment.MethodsPatients with cerebral palsy who received botulinum toxin type-A injections to lower extremities and those with Gross Motor Function Measure Classification System (GMFCS) levels I – III, were included in the study. Twenty-five patients were randomly assigned into three treatment groups for 4-weeks: Group 1, FES-cycling and standard treatment; Group 2, Sham stimulus FES-cycling and standard treatment; Group 3, Standard treatment. Clinical assessment tools included the Modified Ashworth Scale (MAS), Modified Tardieu Scale (MTS), Pediatric Functional Independence Measure (WeeFIM), GMFCS, Gross Motor Function Measure-88 (GMFM-88), selective motor control tests, 6-minute walk test, and Visual Gait Analysis (VGA).ResultsIn all groups, there were significant improvements in MAS, MTS, WeeFIM, GMFM-88, 6-minute walk test, and VGA scores. No changes in GMFCS levels were observed in any group. At the end of the study, there was no significant difference among the groups in terms of any clinical assessment parameter.ConclusionsAll groups showed statistically significant improvements in motor function, walking pattern, spasticity, daily living activities, and aerobic capacity in patients with CP following the rehabilitation period. Although FES-cycling demonstrated no superiority over the other approaches and provided no additional benefit to the results, FES appears to be safe and well-tolerated in children with CP, at least as much as standard exercise treatment.

Neuromuscular electrical stimulation to augment lower limb exercise and mobility in individuals with spastic cerebral palsy: A scoping review

“…Studies also reported an increase in walking distance assessed with 6MWT ( Johnston and Wainwright, 2011 ; Özen et al, 2021 ) and speed assessed using the TUG ( Johnston and Wainwright, 2011 ). NMES was well-tolerated in one study ( Özen et al, 2021 ) and variable in two studies ( Johnston and Wainwright, 2011 ; Armstrong et al, 2020 ). See Tables 2 , 3 , 4 for details of each study’s NMES application and CDE outcomes.…”

“…Three studies reported NMES-assisted cycling for exercise, where multichannel NMES was applied using surface electrodes while the participant rode an indoor tricycle or stationary bicycle. One case report ( Johnston and Wainwright, 2011 ) and two RCTs ( Armstrong et al, 2020 ; Özen et al, 2021 ) reported on multichannel NMES used to target multiple muscles during cycling, including the gluteals, quadriceps, hamstrings, gastrocnemius, and/or anterior tibialis. NMES was applied during cycling alone or in addition to interventions, such as ROM, strengthening, and balance.…”

“…Three studies using NMES-assisted cycling reported boosting gross motor skills, walking distance, and speed ( Johnston and Wainwright, 2011 ; Armstrong et al, 2020 ; Özen et al, 2021 ). Two studies ( Armstrong et al, 2020 ; Özen et al, 2021 ) reported improvement in gross motor skills assessed with the GMFM. Studies also reported an increase in walking distance assessed with 6MWT ( Johnston and Wainwright, 2011 ; Özen et al, 2021 ) and speed assessed using the TUG ( Johnston and Wainwright, 2011 ).…”

“…Two studies ( Armstrong et al, 2020 ; Özen et al, 2021 ) reported improvement in gross motor skills assessed with the GMFM. Studies also reported an increase in walking distance assessed with 6MWT ( Johnston and Wainwright, 2011 ; Özen et al, 2021 ) and speed assessed using the TUG ( Johnston and Wainwright, 2011 ). NMES was well-tolerated in one study ( Özen et al, 2021 ) and variable in two studies ( Johnston and Wainwright, 2011 ; Armstrong et al, 2020 ).…”

“…Seven studies reported on the effects of NMES on spasticity. One case report ( Daichman et al, 2003 ), one prospective controlled study ( Karabay et al, 2015 ), one prospective trial ( Rajalaxmi et al, 2017 ), and four RCTs ( Khalili and Hajihassanie, 2008 ; AlAbdulwahab and Al-Gabbani, 2010 ; Pool et al, 2015 ; Özen et al, 2021 ). The targeted muscles for NMES included hip adductors, quadriceps, hamstrings, gastrocnemius, and tibialis anterior.…”