Open AccessEfficacy of Neuromuscular Electrical Stimulation in Improving Ankle Kinetics During Walking in Children with Cerebral Palsy
Author(s) -
Nerita N.C. Chan,
Andrew W. Smith,
Sing Kai Lo
Publication year - 2004
Publication title -
hong kong physiotherapy journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.343
H-Index - 15
eISSN - 1876-441X
pISSN - 1013-7025
DOI - 10.1016/s1013-7025(09)70050-8
Subject(s) - medicine , cerebral palsy , ankle , spastic diplegia , gait , physical therapy , treadmill , physical medicine and rehabilitation , diplegia , triceps surae muscle , periventricular leukomalacia , surgery , gestational age , pregnancy , biology , genetics
Neuromuscular electrical stimulation (NMES) applied to the triceps surae muscle is claimed to be effective in improving gait in children with cerebral palsy. The main aim of this study was to determine the effect of NMES on the triceps surae muscle in improving the gait and function of children with cerebral palsy. Twelve children with spastic diplegia or hemiplegia were recruited and randomly assigned to the two experimental groups. The period of the study was 8 weeks (2-4-2 week design). The initial 2 weeks was the control period, in which usual treatment was given to both groups of patients with a pre- and post-treatment assessment. The middle 4 weeks was the experimental period, in which the Treadmill+NMES group received NMES plus treadmill walking training and the Treadmill group underwent treadmill walking training only. Assessment was performed at 2-week intervals. The final 2 weeks was the carryover period, in which treatment to be tested was stopped and reassessment performed again at the end of week 8. An additional treatment and post-treatment assessment were given at weeks 2, 4 and 6 to test for the immediate effect of treatment. Altogether, eight repeated measures with three-dimensional gait analysis and five clinical measurements using the gross motor function measure (GMFM) were performed. Kinetic changes in ankle moment quotient (AMQ) and ankle power quotient (APQ) were not significant either immediately or cumulatively in both groups. Improvement in trend was observed in both groups immediately but not cumulatively. Using the GMFM, functional changes were detected in standing (GMST, p < 0.001) and in walking (GMWK, p = 0.003) using a “time” comparison. Significant interaction was also detected in GMWK using “treatment by time” (p = 0.035). The difference between the two groups was not significant on “treatment” comparison of both GMST and GMWK. Both groups showed improvement in GMST and GMWK cumulatively but there was no difference between the two groups. The effects in both groups could be carried over to 2 weeks after interventions stopped. Both the Treadmill+NMES and Treadmill groups showed improvement in functional outcomes. The trend in the changes of the GMFM score suggested that improvements were greater in the Treadmill+NMES group. There was also a trend showing some immediate improvement in AMQ and APQ