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

Abstract

Background: Neuromuscular Electrical Stimulation (NMES) is an emerging assistive technology applied through surface or implanted electrodes to augment skeletal muscle contraction. NMES has the potential to improve function while reducing the neuromuscular impairments of spastic cerebral palsy (CP). This scoping review examines the application of NMES to augment lower extremity exercises for individuals with spastic CP and reports the effects of NMES on neuromuscular impairments and function in spastic CP, to provide a foundation of knowledge to guide research and development of more effective treatment.Methods: A literature review of Scopus, Medline, Embase, and CINAHL databases were searched from 2001 to 2 November 2021 with identified inclusion and exclusion criteria.Results: Out of 168 publications identified, 33 articles were included. Articles on three NMES applications were identified, including NMES-assisted strengthening, NMES-assisted gait, and NMES for spasticity reduction. NMES-assisted strengthening included the use of therapeutic exercises and cycling. NMES-assisted gait included the use of NMES to improve gait patterns. NMES-spasticity reduction included the use of transcutaneous electrical stimulation or NMES to decrease tone. Thirteen studies investigated NMES-assisted strengthening, eleven investigated therapeutic exercise and demonstrated significant improvements in muscle structure, strength, gross motor skills, walking speed, and functional mobility; three studies investigated NMES-assisted cycling and demonstrated improved gross motor skills and walking distance or speed. Eleven studies investigated NMES-assisted gait and demonstrated improved muscle structure, strength, selective motor control, gross motor skills, and gait mechanics. Seven studies investigated NMES for spasticity reduction, and five of the seven studies demonstrated reduced spasticity.Conclusion: A growing body of evidence supports the use of NMES-assisted strengthening, NMES-assisted gait, and NMES for spasticity reduction to improve functional mobility for individuals with spastic CP. Evidence for NMES to augment exercise in individuals with spastic CP remains limited. NMES protocols and parameters require further clarity to translate knowledge to clinicians. Future research should be completed to provide richer evidence to transition to more robust clinical practice.

Efficacy of neuromuscular electrical stimulation and interrupted serial casting in children with spastic diplegia

“…Furthermore, recent evidence from systematic reviews and other studies supports using NMES for strengthening in individuals with spastic CP, to improve mobility and gross motor function, and safely induce restorative changes. 43 , 44 , 45 , 46 …”

Effects of non-immersive virtual reality intervention on children with spastic cerebral palsy: a meta-analysis and systematic review

“…Children with SCP usually have increased lower limb muscle tone, decreased muscle strength, limited gross motor function, and impaired gait and balance. 58 These symptoms can severely affect a child's ability to walk and make it difficult for the child to participate in daily activities comparable with those of their typically developing peers. This study confirmed the effectiveness of nonimmersive VR in the rehabilitation of children with spastic cerebral palsy.…”

Rehabilitation in children with home invasive mechanical ventilation

“…NMES applications include the use of NMES-assisted strengthening, NMESassisted gait, and NMES spasticity reduction. [30][31][32]…”

“…Electrodes are commonly placed over the motor point where the motor nerve innervates the muscle. NMES applications include the use of NMES‐assisted strengthening, NMES‐assisted gait, and NMES spasticity reduction 30–32 …”