Table 2

Details of studies in combined use of neuromuscular electrical stimulation and botulinum toxin type A (lower limb) section

ReferenceStudy designAge range (years)nMuscles stimulatedBTX-A sitesResults (differences with NMES)Session duration, frequency and mode
Detrembleur et al9Controlled (control n=6; NMES group n=6)4.75–612Soleus and GASoleus 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 injections30 min six times a day for 3 days, beginning on day of treatment with BTX-A. Exercise only
Kang et al10Controlled (control n=11; NMES group n=7)1.3–1018GASoleus 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 injection30 min twice a week for 2 weeks, immediately postinjection. Exercise only
Seifart et al11Single child3.3–6.35TA and GA‘Calf’ musclesTwo children did not use NMES. Trend towards increased isometric PF muscle strength. No changes in self-selected walking speeds or isometric DF muscle strength30 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.