Children living with cerebral palsy face a number of challenges, many of them physical and related to muscles. With stiff, over- or under-toned, spastic, and painful muscles, these children often struggle to move in many ways, even just to walk in some cases. A technology that was developed originally to help people with paralysis, functional electrical stimulation (FES) is now being used to treat a number of conditions, including cerebral palsy.
Using electrical pulses to stimulate muscles, FES is being tested in studies and clinical trials for conditions ranging from stroke to multiple sclerosis to cerebral palsy. In children with CP the treatment is being found to help improve range of motion, muscle mass, muscle strength, walking speed, spasticity, gait, and foot and ankle positioning. While more research is needed to improve it, FES could be an exciting new therapy for so many children with cerebral palsy.
What is Functional Electrical Stimulation?
FES is actually a fairly simple technology. It can be used with just a small device that delivers an electrical impulse to a muscle. It is a low energy impulse that acts like a shock to activate nerves, which in turn cause a muscle to move. This can be done in a paralyzed muscle that a person cannot otherwise move. Because the electrical energy delivered is low, the procedure is safe and not usually painful. The person receiving the impulse may feel a little tingle, or at worst may feel a slight burning sensation.
Traditionally FES technology has been developed and used for people who suffer paralysis from accidents. The stimulation can help a person with various kinds of muscle movements, like voiding the bladder, swallowing, and bigger movements like walking, grasping objects, or standing up from a sitting position. FES has also been used for people recovering from a stroke and have lost some muscle function, and for people with neurological disorders or head and brain 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 supposed to be used as a short-term therapy to retrain muscles and restore some degree of voluntary muscle function. The technology is being developed further, though, with some paralyzed patients benefitting from implanted electrical stimulation devices that allow them to regain some 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. Spastic cerebral palsy causes muscles to be stiff and painful and 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 contractions, contracted joints, 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 study, children received eight weeks of daily functional electrical stimulation and then were evaluated for their walking and gait and their own perceptions of how they walk. The study involved 32 children with an average age of ten years old. There was a control group and a group that received the FES treatment.
All the children were evaluated at the beginning of the study, at the end of the eight weeks of treatment, and then six weeks after that. Those who received the treatment showed significant improvements in how they perceived the 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 abnormal gait. Hemiplegic CP occurs when the disability is only on one side of the body, left or right. This can cause a child to walk on his toes and to have other asymmetrical gait issues that disturbs balance, and over time, causes more challenges with gait, pain, and movement.
The children in this study could all walk, but many used braces. For the study they received FES instead of braces or splints. The toe stepping and other asymmetries were improved in all the children evaluated before and after the treatment. All children were able to move more symmetrically as a result of the treatment. Both of these studies are examples of several studies that showed 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. To avoid dragging their toes on the ground, they lift their knees up higher or they swing their knees outward to lift the foot up higher. It is an awkward way of moving to correct the dropping foot, and it can cause pain and other issues later on. Foot drop is most often corrected with a brace 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 see improved flexion in the ankle and foot, and 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 a common treatment. One way that a child can benefit from this treatment is to get involved in clinical trials. These are trials, usually government funded, that involve actual patients to test the safety and effectiveness of treatments that are not yet approved for general use. You can talk to your doctor or pediatrician or do a search online to find out more about ongoing and recruiting clinical trials for FES and cerebral palsy.
Functional electrical stimulation shows great promise for stimulating muscles and nerves and giving some children back a degree of movement free from awkwardness and pain. While the treatment is not widely available, its effectiveness and safety mean that it will likely soon be used for more children and more applications. It has already helped many people with other conditions, including stroke and paralysis, and it may be only a matter of time before FES is expanded to include more patients and more conditions.