Details of studies in combined use of neuromuscular electrical stimulation and botulinum toxin type A (lower limb) section
| Reference | Study design | Age range (years) | n | Muscles stimulated | BTX-A sites | Results (differences with NMES) | Session duration, frequency and mode |
|---|---|---|---|---|---|---|---|
| Detrembleur et al9 | Controlled (control n=6; NMES group n=6) | 4.75–6 | 12 | Soleus and GA | Soleus and medial and lateral GA. HA in 7 patients (3 NMES and 4 control) | For a range of clinical and gait variables, combined treatment not superior to BTX-A alone at 1, 3 and 6 months post BTX-A injections | 30 min six times a day for 3 days, beginning on day of treatment with BTX-A. Exercise only |
| Kang et al10 | Controlled (control n=11; NMES group n=7) | 1.3–10 | 18 | GA | Soleus and medial and lateral GA. HS and PT in two children | ↑#Passive ankle ROM after 2 weeks in NMES group only (in both groups at 3 months). ↑#Total PRS and foot equinus scores in NMES group at 3 months after injection | 30 min twice a week for 2 weeks, immediately postinjection. Exercise only |
| Seifart et al11 | Single child | 3.3–6.3 | 5 | TA and GA | ‘Calf’ muscles | Two children did not use NMES. Trend towards increased isometric PF muscle strength. No changes in self-selected walking speeds or isometric DF muscle strength | 30 min 5 days a week for 4 weeks. Used functionally—timed to foot switches. Five different start times used: 3, 7, 14, 32 and 35 days postinjection |
Skin surface electrodes used unless stated otherwise.
↑#Indicates statistically significant (p<0.01) increase.
BTX-A, botulinum toxin type A (lower limb); DF, dorsiflexion; GA, gastrocnemius; HA, hip adductors; HS, hamstrings; NMES, neuromuscular electrical stimulation; PF, plantarflexion; PRS, physician rating scale; PT, posterior tibial muscles; ROM, ranges of motion; TA, tibialis anterior.