Table 1

Details of studies in neuromuscular electrical stimulation to assist with muscle strength and function (lower limb) section

ReferenceStudy designAge range (years)nMuscles stimulatedResultsSession duration, frequency and mode
Daichmann et al5Case study131Right QRIncrease in right QR strength, decrease in right HS spasticity, improvements in mobility elements of PEDI resultsApproximately 30 min every other day for 6 weeks. Exercise only
Al-Abdulwahab et al6Pre/post test design. Data compared with healthy (n=20) and control CP (n=10) groups7.4±221GM bilaterally↑↑Temporal spatial parameters (apart from step width) and ↓↓hip adductor tone of the treated group15 min three times per day for 7 days. Stimulation applied mainly during walking but not timed to the gait cycle
Postans and Granat7ABAB8.9–17.58DF, PF, QR (determined through gait analysis)For NMES to AF only group (n=5), clinically significant changes in stance phase kinematics for three childrenUsed functionally during testing on 2 days
Orlin et al8AB7.9–11.88Percutaneous stimulation of TA and GA of involved limb*Peak DF in swing (more affected extremity) and DF at initial contact (less affected extremity) for TA+GA condition. Trends of improvement in DF kinematics seen for TA and GA only conditionsUsed functionally for 1 week for each NMES set up (TA only, TA and GA, and GA only) for approximately 2 × 45 min daily.
Four-channel and two-channel stimulation used for diplegic and hemiplegic children, respectively
Pierce et al12Comparison of surface and percutaneous stimulation111DF with balanced eversion and inversionIncreases in DF at initial contact, peak in swing and mean in swing, greater with percutaneous stimulation. Ankle absorption work improved (decreased) with both types of stimulation. Ankle generation work increased only with percutaneous stimulation. Greater isometric force produced with percutaneous than surface stimulationAssessed functionally during walking (one test day)
Khalili and Hajihassanie18Randomised (within child), one child dropped out11.6–1411QRMarginal improvement in HS spasticity and passive knee extension30 min three times per week for 4 weeks. Exercise only
Katz et al19Case controlled2.8–4.15Right QR(Seated tests) ↑average motion velocity and a decrease in motion jerk and in knee torque after training; ↓QR–HS co-contraction following training, but not during stimulated assisted motion30 min daily for 3 months. Exercise only. Stimulation also used orthotically during tests
Stackhouse et al20Group comparisons.
NMES (n=6); volitional control (n=5); one child in NMES group excluded from analysis
8–1211Percutaneous stimulation of QS and TS↑TS maximum voluntary isometric contraction normalised to body weight for NMES group compared with volitional group, ns for QS. ↑Walking speed for NMES group, ns walking speed for volitional group following intervention15 min for each muscle group, three times per week for 12 weeks. Exercise only
Kerr et al21Randomised (NMES n=18; placebo n=22; and TES n=20)5–1660QR (vastus medialis) bilaterallyFor NMES: ns in strength or function compared with placebo; ↓impact of disability at end of treatment (not at 6-week follow-up)NMES: 1 h daily 5 days per week for 16 weeks. Exercise only
Van der Linden et al22Randomised (NMES n=7; control n=7); one child (NMES group, QS) dropped out5–1314DF with balanced eversion and inversion and QR↑Peak DF angle and foot–floor angle for both groups when comparing walking with and without FES. ↓Walking speed for both groups when comparing walking with and without FES; ns between NMES and control groups in deviation of gait pattern from normal, foot–floor angle, DF in swing angle, or passive DF when comparing before and after intervention resultsNMES: 1 h daily to either DF (n=5) or QS (n=2) 6 days per week for 2 weeks. Exercise only. Followed by FES of DF and QR during gait for 8 weeks.
Stimulation also used orthotically during tests for both NMES and control groups
Durham et al23ABA, two children dropped out6–1512DFHeel–toe contact pattern and symmetry both improved following intervention with FES (no statistical analysis)FES of DF during gait for 12 weeks
Johnston et al24Group comparisons. NMES with limited surgery (n=9); traditional surgery (n=8)6–1217BF, GM, Gmax, PAM, VL, VM, Sol, TA (not all used in all children)ns differences in passive range, temporal spatial parameters or gross motor function between groups before or 1 year after intervention. FES group underwent 4.5 fewer ablative procedures per child4-week (minimum) exercise for no more than 1 h per day, followed by functional use
Hazlewood et al26Randomised (NMES n=10; control n=10)5–1220TA of involved limb↑Passive DF in NMES group. ↑Active DF in NMES group compared with control group post intervention but not pre intervention. ↑TA muscle power in NMES group1 h daily for 35 consecutive days. Exercise only
Comeaux et al27ABCA (n=7), ACBA (n=7)9.1±3.814GA and TA*DF during gait for both ‘targeted’ FES interventions‘Targeted’ FES of GA during 15-min therapy session three times a week for 4 weeks followed/preceded by a similar programme with GA and TA
Van der Linden et al29Randomised (NMES n=11; control n=11)8.5±2.822GMaxFor NMES: ns in hip extensor strength, gait analysis, passive limits of hip rotation, section E of gross motor function measure when comparing NMES group with control groupNMES: 1 h a day 6 days per week for 8 weeks. Exercise only
Carmick31Case series1.6–103TA, TS, GA, Sol, Gmax, HS (not all used in all patients)Improvements in physiological cost index measured in two children together with observations of improved gait function and symmetryApproximately weekly sessions of unspecified duration of ‘targeted’ FES for between 6 weeks and 8 months
Carmick32Case series1.7–4.74TA, TS, Gmax, HS (not all used in all patients)Improvements in heel strike, foot alignment, function, balance, active and passive DF range of movement and walking speed. (Not all observed in all children)Unspecified frequency and duration of ‘targeted’ FES sessions as required
Bertoti et al33Case series percutaneous stimulation62Gmax, GM, VM, VL, GA, TAMeasured improvements in lower extremity ranges of motion, spatial gait characteristics, improved gross motor functionTwo 15-min sessions of FES 5 days per week for between 7 and 10 months. Children asked to ‘work with’ FES
  • Skin surface electrodes used unless stated otherwise.

  • ↑↑, ↑, ↑* indicates statistically significant (p<0.001, p<0.05 and p<0.0055, respectively) increase; ↓↓ and ↓ indicates statistically significant (p<0.001 and p<0.05, respectively) decrease; ns indicates no statistically significant difference (p>0.05); ± indicates plus or minus one SD.

  • AB, baseline-intervention; ABC, baseline-intervention1-Intervention2; ABAB, baseline1-intervention-baseline2-intervention; ABA, baseline-intervention-follow-up; ABCA, baseline-intervention1-intervention2-follow-up; AF, ankle flexors; BF, biceps femoris; CP, cerebral palsy; DF, dorsiflexion; FES, functional electrical stimulation; GA, gastrocnemius; GM, gluteus medius; Gmax, gluteus maximus; HA, hip adductors; HS, hamstrings; NMES, neuromuscular electrical stimulation; PAM, posterior adductor magnus; PEDI, pediatric evaluation of disability inventory; PF, plantarflexion; QR, quadriceps; Sol, soleus; TA, tibialis anterior; TES, threshold electrical stimulation; TS, triceps surae; VL, vastus lateralis; VM, vastus medialis.