Functional electrical stimulation cycling, goal‐directed training, and adapted cycling for children with cerebral palsy: a randomized controlled trial

Abstract

AIM To test the efficacy of functional electrical stimulation (FES) cycling, goal-directed training, and adapted cycling, compared with usual care, to improve function in children with cerebral palsy (CP). METHOD The intervention was delivered between 2017 and 2019 and included three sessions per week for 8 weeks (291h sessions at a children's hospital, and 1h home programme/ week). Hospital sessions included 30 minutes of FES cycling and 30 minutes of goal-directed training. Home programmes included goal-directed training and adapted cycling. The comparison group continued usual care. Primary outcomes were gross motor function assessed by the Gross Motor Function Measure (GMFM) and goal performance/satisfaction assessed using the Canadian Occupational Performance Measure (COPM). Secondary outcomes were sit-to-stand and activity capacity, participation in home, school, and community activities, and power output. Linear regression was used to determine the between-group mean difference immediately post-training completion after adjusting for baseline scores. RESULTS This randomized controlled trial included 21 participants (mean age=10y 3mo, standard deviation [SD]=3y; Gross Motor Function Classification System level: II=7, III=6, IV=8) who were randomized to the intervention (n=11) or usual care group (n=10). Betweengroup differences at T2 favoured the intervention group for GMFM-88 (mean difference=7.4; 95% confidence interval [CI]: 2.3-12.6; p=0.007), GMFM-66 (mean difference=5.9; 95% CI: 3.1-8.8; p<0.001), COPM performance (mean difference=4.4; 95% CI: 3.9-5.3; p<0.001) and satisfaction (mean difference=5.2; 95% CI: 4.0-6.4; p<0.001). INTERPRETATION Children with CP achieved meaningful functional improvements after FES cycling, goal-directed training, and adapted cycling training. Cycling programmes for children with CP should be individualized and goal directed.

Task‐specific training for bicycle‐riding goals in ambulant children with cerebral palsy: a randomized controlled trial

“…A recently published trial that tested the efficacy of functional electrical stimulation and adapted cycling in children classified in GMFCS levels II to IV helps address the knowledge gap across the spectrum of CP. 47 In the context of the focus on goals in paediatric rehabilitation 48 and the goal-directed disability insurance funding model in Australia, 49 findings have the potential to translate well into clinical practice. To optimize knowledge translation, it will also be important to direct efforts to school and community settings.…”

The Effect of Physical Exercise on Gross Motor Function in Children with Cerebral Palsy: A Meta-Analysis

“…Finally, ten studies were included in the systematic review and meta-analysis (see Figure 1). [25,29,30,34], where conventional physiotherapy included stretching, strengthening, walking balance, or active movement of the lower extremities, weight-bearing, bridging, kneeling/half-kneeling, and perturbation in all positions [35,36,37]. In terms of intervention duration and frequency, the majority of physical exercise interventions in the ten studies were 5-12 weeks and 15-90 minutes, with the frequency of interventions between 3-5 times per week, except for Park et al [27] and Herrero [28], who were one time per week.…”

“…In terms of participants, most of the studies had small sample sizes (14-55 participants), except for Kwon et al [31], who had a sample size of 91 participants, and most of the studies were conducted with children aged 6-15 years. In this study, Jeong et al [25], Lee et al [26], Polat et al [29], and Seniorou et al [34] mainly selected children with GMFCS I-III as subjects; Park and Kwon et al's [26,30] studies selected children with GMFCS I-IV as subjects; the remaining Herrero et al [28], Armstrong et al [30], Kwon et al [32], Lee et al [33] studies used children with GMFCS I-V, GMFCS II-IV, GMFCS I-II, and GMFCS II-III as subjects, respectively. Different physical exercise modalities were compared in these studies with conventional or other treatments with moderate intensity, the number of activities, and in some studies, altered GMFCS levels in children with CP.…”

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

“…Cycling with functional electrical stimulation (FES) has been used primarily for people with spinal cord injury; improvements in bone mineral density, muscle strength (force-generating capacity), and cardiorespiratory measures were observed 7 . FES-cycling is a relatively new technology, and very few studies have been conducted on the effect of this method in children with CP 8,9,10 . The present study aimed to evaluate the effects of FEScycling therapy on motor function, walking pattern, spasticity, daily living activities, and aerobic capacity in patients with CP.…”