Functional Electrical Stimulation
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Children living with cerebral palsy face a number of challenges, many of them physical and related to the use of their muscles. With stiff, over- or under-toned, spastic, painful, and sometimes uncontrollable muscles, these children often struggle to move, even just to walk in some cases. A technology originally developed to help people with paralysis, functional electrical stimulation (FES) is now being used to treat quite a few medical conditions, including cerebral palsy.
Using electrical pulses to stimulate muscles, FES is being tested in clinical trials for conditions ranging from stroke to multiple sclerosis and cerebral palsy. In children with CP, the treatment has been found to improve range of motion, muscle mass, muscle strength, walking speed, spasticity, gait, and foot and ankle positioning. While more research is needed, FES could be an exciting new therapy for so many children with cerebral palsy and other neuromuscular disorders.
What is Functional Electrical Stimulation?
FES is actually a fairly simple technology. It can be done with a small device that delivers an electrical impulse to a muscle. It is a low-energy current that acts like a tiny shock to activate nerves, which in turn cause the muscle to move. This can be used for a paralyzed muscle that the person cannot normally move. Because the electrical energy delivered is low, the procedure is safe and not expected to be painful. The person receiving the impulse may feel a little tingling or, at worst, a slight burning sensation.
Traditionally, FES technology has been developed and used for people who suffer paralysis from accidents. The stimulation can assist a person with small-scale muscle movements like voiding the bladder and swallowing, as well as with larger movements like walking, grasping objects, or standing up. FES has also been used in people recovering from a stroke who have lost some muscle function, and for those with neurological disorders or head injuries.
This therapy is described as functional because it restores function but also because it is not designed to be a lifelong mobility aid. It is only intended to be used as a short-term therapeutic modality to retrain muscles and restore some degree of voluntary muscle function. The technology is being developed further, though, with some paralyzed patients benefiting from implanted electrical stimulation devices that allow them to regain some muscle movement.
Improving Gait in Spastic Cerebral Palsy
Spastic cerebral palsy is the most common form of this condition, describing between 70 and 80 percent of all children with CP. It causes the muscles to be stiff and painful and the reflexes to be exaggerated. Most children with this form of CP will struggle to walk to some degree. They may also experience involuntary limb movement, continuous muscle spasms, joint contractures, and limited flexibility.
Studies are showing that FES can be used to help children with spastic cerebral palsy walk better and more easily. In one such study, the children received eight weeks of daily functional electrical stimulation to the muscles. The study involved 32 children with an average age of 10 years. There was a control group along with the group that received the FES treatment.
All of the children were evaluated at the beginning of the study, again at the end of the eight weeks of treatment, and then six weeks after that. They were assessed for their walking ability along with their own perceptions of how they were walking.Those who received the treatment showed significant improvements in how they perceived their ability to walk. These children felt that they could walk better and with less pain.
In another study involving children with hemiplegic spastic cerebral palsy, FES treatment was shown to improve gait abnormalities . Hemiplegic CP occurs when the disability is only on one side of the body, left or right. This can cause the child to toe-walk and have other asymmetrical gait issues that disturb balance. Over time, these often cause more challenges with flexibility, coordination, pain, and movement.
The children in this study were all able to walk, but many used braces. They received FES instead of braces or splints. The children were evaluated before and after the treatment, and there were significant improvements in toe-walking and other asymmetries. All of the children were able to move more symmetrically as a result of the treatment.
These studies are more examples of research demonstrating similar improvements for children with spastic cerebral palsy treated with FES.
Correcting Foot Drop
Some children with cerebral palsy develop a type of movement called foot drop. They have difficulty picking up their feet to take steps, and the toe tends to drag while they move through each step. To avoid this, they lift the knee up higher or swing it outward to help elevate the foot off the ground while walking. It is an awkward movement to keep the foot from dragging, and it can cause pain and other issues later on. Foot drop is most often corrected with braces or orthotics, but these can limit a child’s movement.
A study that used FES to treat foot drop in children with cerebral palsy showed promising results. A group of children used an FES device for four months, and their gaits were evaluated periodically. While none of them saw increased walking speed, they did have improved flexion in the ankle and foot with reduced awkward movements to avoid dragging the toes.
Clinical Trials Ongoing for Children with Cerebral Palsy
While the studies using FES to help children with cerebral palsy are coming up with positive results, it is not yet accepted as a common treatment. One way that a child can benefit from this therapy is to get involved in clinical trials. These are usually government-funded, and involve actual patients in testing the safety and effectiveness of treatments that are not yet approved for general use. You can talk to your child’s doctor or do a search online to find out more about ongoing clinical trials for FES and cerebral palsy that are recruiting for patients.
Functional electrical stimulation shows great promise for giving some children back a degree of movement free from awkwardness and pain. While the treatment is not widely available, its apparent effectiveness and safety mean that its use will likely become more widespread. FES has already helped a significant number of people with other conditions, including stroke and paralysis, and it may be only a matter of time before its use is expanded to include more children with cerebral palsy.