Abstract
BackgroundThe purpose of this study was to determine the orthotic and therapeutic effects of daily community applied FES to the ankle dorsiflexors in a randomized controlled trial. We hypothesized that children receiving the eight-week FES treatment would demonstrate orthotic and therapeutic effects in gait and spasticity as well as better community mobility and balance skills compared to controls not receiving FES.MethodsThis randomized controlled trial involved 32 children (mean age 10 yrs 3 mo, SD 3 yrs 3 mo; 15 females, 17 males) with unilateral spastic cerebral palsy and a Gross Motor Function Classification System of I or II randomly assigned to a FES treatment group (n = 16) or control group (n = 16). The treatment group received eight weeks of daily FES (four hours per day, six days per week) and the control group received usual orthotic and therapy treatment. Children were assessed at baseline, post FES treatment (eight weeks) and follow-up (six weeks after post FES treatment). Outcome measures included lower limb gait mechanics, clinical measures of gastrocnemius spasticity and community mobility balance skills.ResultsParticipants used the FES for a mean daily use of 6.2 (SD 3.2) hours over the eight-week intervention period. With FES, the treatment group demonstrated a significant (p < 0.05) increase in initial contact ankle angle (mean difference 11.9° 95 % CI 6.8° to 17.1°), maximum dorsiflexion ankle angle in swing (mean difference 8.1° 95 % CI 1.8° to 14.4°) normalized time in stance (mean difference 0.27 95 % CI 0.05 to 0.49) and normalized step length (mean difference 0.06 95 % CI 0.003 to 0.126) post treatment compared to the control group. Without FES, the treatment group significantly increased community mobility balance scores at post treatment (mean difference 8.3 units 95 % CI 3.2 to 13.4 units) and at follow-up (mean difference 8.9 units 95 % CI 3.8 to13.9 units) compared to the control group. The treatment group also had significantly reduced gastrocnemius spasticity at post treatment (p = 0.038) and at follow-up (dynamic range of motion mean difference 6.9°, 95 % CI 0.4° to 13.6°; p = 0.035) compared to the control group.ConclusionThis study documents an orthotic effect with improvement in lower limb mechanics during gait. Therapeutic effects i.e. without FES were observed in clinical measures of gastrocnemius spasticity, community mobility and balance skills in the treatment group at post treatment and follow-up. This study supports the use of FES applied during daily walking activities to improve gait mechanics as well as to address community mobility issues among children with unilateral spastic cerebral palsy.Trial registrationAustralian New Zealand Clinical Trials Register ACTRN12614000949684. Registered 4 September 2014.Electronic supplementary materialThe online version of this article (doi:10.1186/s12887-015-0472-y) contains supplementary material, which is available to authorized users.
Highlights
The purpose of this study was to determine the orthotic and therapeutic effects of daily community applied Functional Electrical Stimulation (FES) to the ankle dorsiflexors in a randomized controlled trial
Unilateral spastic cerebral palsy (USCP) is the most common presentation of Cerebral palsy (CP) and children are typically classified as having a Gross Motor Function Classification System (GMFCS) and Winters Gage and Hicks gait classification of I or II [2,3,4]
This paper focuses on the results pertaining to the effects of FES on the domains of body structure and function and activity
Summary
The purpose of this study was to determine the orthotic and therapeutic effects of daily community applied FES to the ankle dorsiflexors in a randomized controlled trial. Unilateral spastic cerebral palsy (USCP) is the most common presentation of CP and children are typically classified as having a Gross Motor Function Classification System (GMFCS) and Winters Gage and Hicks gait classification of I or II [2,3,4]. This means that despite impairments such as spasticity and muscle contracture at the ankle joint, children remain functionally ambulant. Principles of motor learning require treatments to be activity based or task specific that is frequently repeated and challenged in contextually relevant environments [7,8,9]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
