Neuromuscular electrical stimulation for children with cerebral palsy: a review
- 1Department of Clinical Sciences and Medical Engineering, Salisbury District Hospital, Salisbury, Wiltshire, UK
- 2Douglas Bader Rehabilitation Centre, Queen Mary's Hospital, Roehampton, London, UK
- 3Centre for Biomedical Engineering, University of Surrey, Guildford, Surrey, UK
- 4School of Design, Engineering and Computing, University of Bournemouth, Bournemouth, Dorset, UK
- Correspondence to Dr Philip Wright, Department of Clinical Sciences and Medical Engineering, Salisbury District Hospital, Salisbury, Wiltshire SP2 8BJ, UK;
- Accepted 7 September 2011
The aim of this review paper is to consider the application of neuromuscular electrical stimulation (NMES) to improve gait or upper limb function in children with cerebral palsy (CP). Although most NMES research has been directed at adults with neurological conditions, there is a growing body of evidence supporting its use in children with CP. In line with a recent meta-analysis, the use of electrical stimulation to minimise impairment and activity limitations during gait is cautiously advocated. A detailed commentary on one of the most common lower limb NMES applications, tibialis anterior stimulation (either with or without gastrocnemius stimulation) is given. Although there is a lack of randomised controlled trials and a predominance of mainly small studies, this review further concludes that the balance of available evidence is in favour of upper limb exercise NMES offering benefits such as increased muscle strength, range of motion and function in children with CP. The use of dynamic splinting with NMES has been shown to be more effective than either treatment on its own in improving function and posture. There is at present little published work to support the application of botulinum toxin type A to temporarily reduce muscle tone as an adjunct intervention to NMES in this population, although the presence of parallel applications to manage similar symptoms in other muscular disorders is noted.
Competing interest The majority shareholder of Odstock Medical Limited is Salisbury NHS Foundation Trust. One author (IDS) is Clinical Director of Odstock Medical Limited.
Patient Consent Obtained.
Provenance and peer review Commissioned; externally peer reviewed.