Functional electrical stimulation of the ankle dorsiflexors during walking in spastic cerebral palsy: a systematic review

Moll, Irene; Vles, J. S. H.; Soudant, Dan; Witlox, Adhiambo M.; Staal, Heleen; Speth, Lucianne; Janssen-Potten, Yvonne; Coenen, Marcel; Koudijs, Suzanne M.; Vermeulen, R. Jeroen

doi:10.1111/dmcn.13501

Cited by 46 publications

(36 citation statements)

References 57 publications

(224 reference statements)

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“…These include electrical stimulation [65,[92][93][94], hydrotherapy [108,110,111], taping [159][160][161][162][163][164], transcranial direct current stimulation [101,[166][167][168], and virtual reality serious gaming [33][34][35][36][37][38][39][40][41][42][43][44][45][46][47] (yellow lights, weak positive). These interventions warrant more research as children reported finding gaming interventions rewarding and normalizing, and preferred electrical stimulation to wearing ankle-foot orthoses from a comfort perspective [93]. Also, taping is better tolerated than traditional orthotics with children often reporting discomfort and dissatisfaction with these interventions or disliking the cosmetic effect [73,140].…”

Section: Motor Interventionsmentioning

confidence: 99%

State of the Evidence Traffic Lights 2019: Systematic Review of Interventions for Preventing and Treating Children with Cerebral Palsy

Novak

Morgan

Fahey

et al. 2020

Curr Neurol Neurosci Rep

669

611

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Purpose of Review Cerebral palsy is the most common physical disability of childhood, but the rate is falling, and severity is lessening. We conducted a systematic overview of best available evidence (2012-2019), appraising evidence using GRADE and the Evidence Alert Traffic Light System and then aggregated the new findings with our previous 2013 findings. This article summarizes the best available evidence interventions for preventing and managing cerebral palsy in 2019. Recent Findings Effective prevention strategies include antenatal corticosteroids, magnesium sulfate, caffeine, and neonatal hypothermia. Effective allied health interventions include acceptance and commitment therapy, action observations, bimanual training, casting, constraint-induced movement therapy, environmental enrichment, fitness training, goal-directed training, hippotherapy, home programs, literacy interventions, mobility training, oral sensorimotor, oral sensorimotor plus electrical stimulation, pressure care, stepping stones triple P, strength training, task-specific training, treadmill training, partial body weight support treadmill training, and weight-bearing. Effective medical and surgical interventions include anti-convulsants, bisphosphonates, botulinum toxin, botulinum toxin plus occupational therapy, botulinum toxin plus casting, diazepam, dentistry, hip surveillance, intrathecal baclofen, scoliosis correction, selective dorsal rhizotomy, and umbilical cord blood cell therapy. Summary We have provided guidance about what works and what does not to inform decision-making, and highlighted areas for more research.

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Section: Motor Interventionsmentioning

confidence: 99%

State of the Evidence Traffic Lights 2019: Systematic Review of Interventions for Preventing and Treating Children with Cerebral Palsy

Novak

Morgan

Fahey

et al. 2020

Curr Neurol Neurosci Rep

669

611

View full text Add to dashboard Cite

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“…This shift in NMES research toward a focused attention on single-channel stimulation of the tibialis anterior to augment dorsiflexion brought both benefits and potential missed opportunities. Such ubiquitous attention has allowed for the first credible systematic review to be attempted in the field (8). With a review question limited to the effect of functional electrical stimulation during walking on ankle dorsiflexors in children with CP, the reviewers concluded that improvements in active ankle dorsiflexion range of motion, strength, selective motor control, balance and gait kinematics could be achieved.…”

Section: Discussionmentioning

confidence: 99%

“…Stimulation of the tibialis anterior and augmentation of ankle DF is likely to be a critical component of such future systems; however, it appears unlikely that it alone will resolve gait deficits seen in this population. Interestingly, gait-specific NMES applied to the tibialis anterior was shown to only improve ankle kinematics (8), while the singular recent case study on gait-specific NMES applied to the quadriceps femoris showed only improvements in knee joint kinematics (28). This taken in conjunction with the findings of earlier studies that multi-channel stimulation can have additive beneficial effects, would suggest that normalization of more involved gait deficits, would require a multi-channel gait-specific NMES acting across multiple joints.…”

Section: Discussionmentioning

confidence: 99%

“…There is growing evidence that NMES may affect the four major neuromuscular deficits seen in spastic CP. NMES has been found to increase muscle fiber diameter and muscle size as well as strength in children with CP (8). In addition, increases in muscle fiber diameter may also increase overall muscle-tendon unit length due to the pennate angle of large lower limb muscles such as the rectus femoris and gastrocnemius.…”

Section: Introductionmentioning

confidence: 99%

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A Scoping Review of Neuromuscular Electrical Stimulation to Improve Gait in Cerebral Palsy: The Arc of Progress and Future Strategies

Mooney

Rose

2019

Front. Neurol.

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Background: Neuromuscular deficits of children with spastic cerebral palsy (CP) limits mobility, due to muscle weakness, short muscle-tendon unit, spasticity, and impaired selective motor control. Surgical and pharmaceutical strategies have been partially effective but often cause further weakness. Neuromuscular electrical stimulation (NMES) is an evolving technology that can improve neuromuscular physiology, strength, and mobility. This review aims to identify gaps in knowledge to motivate future NMES research. Methods: Research publications from 1990- July 20th 2019 that investigated gait-specific NMES in CP were reviewed using the PubMed and Google Scholar databases. Results were filtered by the National Institute of Neurological Disorder and Stroke common data elements guidelines for CP. The Oxford Centre for Evidence Based Medicine guidelines were used to determine levels of evidence for each outcome. Gait-specific NMES research protocols and trends are described, with implications for future research. Results: Eighteen studies met inclusion criteria, reporting on 212 participants, 162 of whom received NMES while walking, average age of 9.8 years, GMFCS levels I–III. Studies included 4 randomized control trials, 9 cohort studies and 5 case studies. A historical trend emerged that began with experimental multi-channel NMES device development, followed by the commercial development of single-channel devices with inertial sensor-based gait event detection to facilitate ankle dorsiflexion in swing phase. This research reported strong evidence demonstrating improved ankle dorsiflexion kinematics in swing and at initial contact. Improved walking speed, step length, and muscle volume were also reported. However, improvements in global walking scores were not consistently found, motivating a recent return to investigating multi-channel gait-specific NMES applications. Conclusions: Research on single-channel gait-specific NMES found that it improved ankle motion in swing but was insufficient to address more complex gait abnormalities common in CP, such as flexed-knee and stiff-knee gait. Early evidence indicates that multi-channel gait-specific NMES may improve gait patterns in CP, however significantly more research is needed. The conclusions of this review are highly limited by the low level of evidence of the studies available. This review provides a historical record of past work and a technical context, with implications for future research on gait-specific NMES to improve walking patterns and mobility in CP.

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“…Emerging assistive exercise modes such as functional electrical stimulation show promise for improving muscular strength and function in individuals whose impairments may limit their ability to perform volitional exercise at intensities required to stimulate neuromuscular adaptation. 200 There were some minor variations to the original published protocol (Chapter 3) compared to the version included in this thesis. The original protocol was broad ranging and included all proposed outcome measures at the time of study design.…”

Section: Practical Recommendationsmentioning

confidence: 99%

FAST CP: The effect of Functional Anaerobic and Strength Training on muscle properties, functional capacity, and gait in adolescents and young adults with Cerebral Palsy

Gillett¹

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Cerebral palsy (CP) is the largest single cause of childhood physical disability. While the brain lesion responsible for CP is static, there is a cascade of secondary musculoskeletal adaptations including reduced muscle size, reduced joint range of motion, increased joint stiffness, and muscle weakness. These secondary alterations progress with age and contribute to a gradual loss of functional capacity into adulthood. Strength training has been used to increase muscle strength in individuals with CP, however it may not be an effective intervention for improving gross mobility-related measures, such as walking performance. It is also unknown whether skeletal muscle in young adults with CP can undergo hypertrophy or architectural adaptations in response to different exercise modes.The general aim of this thesis was to examine the effect of combined functional anaerobic and strength training (FAST) on muscle properties, functional capacity, and gait in adolescents and young adults with CP.A systematic review was undertaken (Chapter 2) to determine the effects of muscle strengthening interventions on skeletal muscle morphology and architecture in children and adolescents with CP. The analysis revealed preliminary evidence that strength training leads to increased muscle size in children and adolescents with CP, accompanied by an increase in muscle strength. Muscle hypertrophy findings may, however, be confounded by factors such as natural growth and concurrent therapies. The findings of this review informed the design of the FAST program and outcome measures used in the following studies to better understand the muscular responses to exercise training in this population.The full study protocol for the FAST intervention is described in Chapter 3. There have been no previous exercise trials conducted in young adults with CP using training parameters that meet established guidelines, that have measured muscle morphology and architecture outcomes. Details of the functional anaerobic and resistance training parameters and progressions according to established guidelines are set out, as well as establishing a-priori outcome measures and the data analysis plan for implementation of the intervention. iii A cross-sectional study was undertaken (Chapter 4) to investigate the relationships between muscle strength, stiffness, and functional capacity in a larger sample of adults with CP. The results of this study demonstrated that maximum isometric plantar flexion strength independently explained 50 -61% of variance in functional capacity outcome measures. Passive medial gastrocnemius muscle fascicle stiffness and ankle joint stiffness were not related to functional capacity measures. These findings suggest lower isometric muscle strength of the plantar flexor muscles contributes to the decline in functional capacity in adults with CP. Chapter 5 investigated the impact of the FAST intervention on lower limb muscle volumes, joint and muscle stiffness, muscle strength, and functional capacity in a sample of 17 young adults with CP...

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Functional electrical stimulation of the ankle dorsiflexors during walking in spastic cerebral palsy: a systematic review

Cited by 46 publications

References 57 publications

State of the Evidence Traffic Lights 2019: Systematic Review of Interventions for Preventing and Treating Children with Cerebral Palsy

State of the Evidence Traffic Lights 2019: Systematic Review of Interventions for Preventing and Treating Children with Cerebral Palsy

A Scoping Review of Neuromuscular Electrical Stimulation to Improve Gait in Cerebral Palsy: The Arc of Progress and Future Strategies

FAST CP: The effect of Functional Anaerobic and Strength Training on muscle properties, functional capacity, and gait in adolescents and young adults with Cerebral Palsy

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