Effect of Functional Electrical Stimulation on asymmetries in gait of children with hemiplegic cerebral palsy

Abstract

Background and purpose The gait of children with hemiplegic cerebral palsy is often characterised by toe walking and asymmetry in other temporal spatial parameters. Persistent toe walking impairs balance, resulting in shortening of the musculo-tendinous unit and reduced function. Current interventions to maintain range of movement at the ankle and improve walking patterns show mixed results. An alternative may be Functional Electrical Stimulation (FES), which is effective in assisting walking in adults, however there is limited research assessing its effectiveness or acceptability in children. The aims of this study were to quantify gait asymmetries, assess the effect of FES on these in an ambulant group of hemiplegic children and evaluate user perspective. Methods A ABA design was used, with stimulation applied in phase B, replacing any splint normally worn. Heel–toe contact pattern and other temporal spatial parameters of gait were measured in 12 children, before, during and after applying FES to the ankle dorsiflexors. Acceptability of the intervention and user perspective were investigated through use of a questionnaire. Results The greatest asymmetries were in heel–toe contact patterns and double stance times. Heel–toe contact pattern and symmetry were both improved with stimulation. There was a clear trend toward reduction in affected side pre-swing double stance time and a move toward symmetry. Mean swing and stance times were close to symmetry with and without stimulation. Electrical stimulation was generally well tolerated. Conclusions Electrical stimulation may be an effective intervention, when used functionally, to improve asymmetrical walking patterns. Further research is needed to refine selection criteria of subjects who may benefit and to optimize use of stimulation.