Hong Kong Physiotherapy Journal
Volume 22, Issue 1 , Pages 50-56, 2004

Efficacy of Neuromuscular Electrical Stimulation in Improving Ankle Kinetics During Walking in Children with Cerebral Palsy

  • Nerita N.C. Chan, MSc

      Affiliations

    • Physiotherapy Department, Tuen Mun Hospital, Hong Kong SAR, China
    • Corresponding Author InformationReprint requests and correspondence to: Nerita Chan, Physiotherapy Department, Tuen Mun Hospital, Tuen Mun, Hong Kong SAR, China
    • ,
  • Andrew W. Smith, PhD

      Affiliations

    • Department of Sport & Exercise Science, University of Auckland, New Zealand,
    • ,
  • Sing Kai Lo, PhD

      Affiliations

    • Institute for International Health, University of Sydney, Australia

Received 10 September 2003; accepted 1 November 2004.

Article Outline

Abstract 

Neuromuscular electrical stimulation (NMES) applied to the triceps surae muscle is claimed to be effective in improving gait in children with cerebral palsy. The main aim of this study was to determine the effect of NMES on the triceps surae muscle in improving the gait and function of children with cerebral palsy. Twelve children with spastic diplegia or hemiplegia were recruited and randomly assigned to the two experimental groups. The period of the study was 8 weeks (2-4-2 week design). The initial 2 weeks was the control period, in which usual treatment was given to both groups of patients with a pre- and post-treatment assessment. The middle 4 weeks was the experimental period, in which the Treadmill+NMES group received NMES plus treadmill walking training and the Treadmill group underwent treadmill walking training only. Assessment was performed at 2-week intervals. The final 2 weeks was the carryover period, in which treatment to be tested was stopped and reassessment performed again at the end of week 8. An additional treatment and post-treatment assessment were given at weeks 2, 4 and 6 to test for the immediate effect of treatment. Altogether, eight repeated measures with three-dimensional gait analysis and five clinical measurements using the gross motor function measure (GMFM) were performed. Kinetic changes in ankle moment quotient (AMQ) and ankle power quotient (APQ) were not significant either immediately or cumulatively in both groups. Improvement in trend was observed in both groups immediately but not cumulatively. Using the GMFM, functional changes were detected in standing (GMST, p < 0.001) and in walking (GMWK, p = 0.003) using a “time” comparison. Significant interaction was also detected in GMWK using “treatment by time” (p = 0.035). The difference between the two groups was not significant on “treatment” comparison of both GMST and GMWK. Both groups showed improvement in GMST and GMWK cumulatively but there was no difference between the two groups. The effects in both groups could be carried over to 2 weeks after interventions stopped. Both the Treadmill+NMES and Treadmill groups showed improvement in functional outcomes. The trend in the changes of the GMFM score suggested that improvements were greater in the Treadmill+NMES group. There was also a trend showing some immediate improvement in AMQ and APQ.

Key words:  cerebral palsy , electrical stimulation , gait

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References 

  1. Renshaw TS , Green NE , Griffin PP , et al.   Cerebral palsy: orthopaedic management . J Bone Joint Surg . 1995;77A:1590–1606
  2. Alfier V . Electrical treatment of spasticity . Scand J Rehabil Med . 1982;14:177–182
  3. Menkveld SR , Wuinn JR , Ancheta B . Functional electrical stimulation in pediatric patients with spasticity . Orthop Trans . 1986;10:376–377
  4. Seib TP , Price R , Reyes MR , et al.   The quantitative measurement of spasticity: effect of cutaneous electrical stimulation . Arch Phys Med Rehabil . 1994;75:746–750
  5. Enoka RM . Muscle strength and its development: new perspectives . Sports Med . 1988;6:146–168
  6. Delitto A , Brown M , Strube MJ , et al.   Electrical stimulation of quadriceps femoris in an elite weight lifter: a single subject experiment . Int J Sports Med . 1989;10:187–191
  7. Delitto A , Snyder-Mackler L . Two theories of muscle strength augmentation using percutaneous electrical stimulation . Phys Ther . 1990;70:158–164
  8. Levin MF , Hui-Chan CWY . Relief of hemiparetic spasticity by TENS is associated with improvement in reflex and voluntary motor functions . Electroencephalogr Clin Neurophysiol . 1992;85:131–142
  9. Dubowitz L , Finnie N , Hyde SA , et al.   Improvement of muscle performance by chronic electrical stimulation in children with cerebral palsy . Lancet . 1988;i:587–588
  10. Hazelwood ME , Brown JK , Rowe PJ , et al.   The use of therapeutic electrical stimulation in the treatment of hemiplegic cerebral palsy . Dev Med Child Neurol . 1994;36:661–673
  11. Carmick J . Clinical use of neuromuscular electrical stimulation for children with cerebral palsy. Part 1: lower extremity . Phys Ther . 1993;73:505–513
  12. Carmick J . Managing equinus in children with cerebral palsy: electrical stimulation to strengthen the triceps surae muscle . Dev Med Child Neurol . 1995;37:965–975
  13. Gage JR , Minnesota P , Deluca PA , et al.   Gait analysis: principles and applications . J Bone Joint Surg . 1995;10:1607–1623
  14. Perry J . Gait Analysis: Normal and Pathological Function . Thora-fare, NJ: Slack Inc; 1992;
  15. Ounpuu S , Gage JR , Davis RB . Three dimensional lower extremity joint kinetics in normal pediatric gait . J Pediatr Orthop . 1991;11:341–349
  16. Olney SJ , MacPhail HA , Hedden DM , et al.   Work and power in hemiplegic cerebral palsy gait . Phys Ther . 1990;70:431–438
  17. Brown J , Walsh EG , Wright GW . Neurophysiology of lower-limb function in hemiplegic children . Dev Med Child Neurol . 1991;33:1037–1047
  18. Gage JR . In: Gait Analysis in Cerebral Palsy . London: MacKeith Press; 1991;p. 101–117
  19. Boyd RN , Pliatsios V , Starr R , et al.   Biomechanical transformation of the gastroc-soleus muscle with botulinum toxin A in children with cerebral palsy . Dev Med Child Neurol . 2000;42:32–41
  20. Rose SA , Deluca PA , Davis RB , et al.   Kinematic and kinetic evaluation of the ankle after lengthening of the gastrocne-mius fascia in children with cerebral palsy . J Pediatr Orthop . 1993;13:727–732
  21. Steinbok P , Reiner A , Kestle JRW . Therapeutic electrical stimulation following selective posterior rhizotomy in children with spastic diplegic cerebral palsy: a randomized clinical trail . Dev Med Child Neurol . 1997;39:515–520
  22. Bertoti DB , Stanger M , Betz RR . Percutaneous intramuscular functional electrical stimulation as an intervention choice for children with cerebral palsy . Pediatr Phys Ther . 1997;9:123–127
  23. Carmick J . Guidelines for the clinical application of neu-romuscular electrical stimulation (NMES) for children with cerebral palsy . Pediatr Phys Ther . 1997;9:128–136
  24. Comeaux P , Patterson N , Rubin M , et al.   Effect of neuromus-cular electrical stimulation during gait in children with cerebral palsy . Pediatr Phys Ther . 1997;9:103–109
  25. Gardner MB , Holden MK , Leikauskas JM , et al.   Partial body weight support with treadmill locomotion to improve gait after incomplete spinal cord injury: a single-subject experimental design . Phys Ther . 1998;78:361–374
  26. Cupp T , Oeffinger D , Tylkowski C , et al.   Age-related kinetic changes in normal pediatrics . J Pediatr Orthop . 1999;19:475–478
  27. Steinwender G , Saraph V , Scheiber S , et al.   Intrasubject repeatability of gait analysis data in normal and spastic children . Clin Biomech . 2000;15:134–139
  28. Sutherland DH , Cooper L , Daniel D . The role of the ankle plantar flexors in normal walking . J Bone Joint Surg Am . 1980;62:354–363
  29. Katoh M , Mochizuki T , Moriyama A . Changes of sagittal-plane ankle motion and ground reaction force (fore-aft shear) in normal children aged four to 10 years . Dev Med Child Neurol . 1993;35:417–423

PII: S1013-7025(09)70050-8

doi:10.1016/S1013-7025(09)70050-8

Hong Kong Physiotherapy Journal
Volume 22, Issue 1 , Pages 50-56, 2004

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