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Functional electrical stimulation of the upper limb in children with hemiplegia cerebral palsy: evaluation of efficacy by a 3D kinematic analysis

Paediatric Orthopaedics, `V Buzzi” Children’s Hospital, Milano, Italy

Background/Objectives: Electrical stimulation is a passive, non-invasive, home-based therapy and causing minimal side effects. It has been use in patients with a variety of neurological impairments. In literature there have been few studies on functional electrical stimulation (FES) on the upper limb of children with cerebral palsy (CP). The aim of this study was to investigate the effect of FES on upper limb in children with hemiplegic CP.

Design: Case series

Participants and Setting: Ten children with spastic hemiplegia CP aged between 8 and 17 years treated with FES and ten control children (age 7-16 years). Inclusion criteria were a diagnosis of spastic hemiplegia cerebral palsy and aged between 6 and 18 years. Subjects were excluded if they had elbow or wrist joint contractures in the affected upper limb; or they had upper limb surgery or botulinum toxin A injection in the affected upper limb in the previous 12 months.

Materials/Methods: Children received electrical stimulation, applied by their parents, for 30 minutes on alternate days on the wrist extensor muscle, to the affected arm, for 3 months. No occupational therapy was combined in this study period. Patients completed 3- Dimensional kinematic analysis (pointing- reach- hand to mouth) at baseline and 3 months after the FES therapy was done. For the each tasks the minimum and maximum active ROMs were determined for shoulder, elbow and wrist motion across the sagittal, frontal and tansverse plane

Results: There were significant improvements (p<0.005) in active movements occurred in all 3 tasks examined. In particular, children significantly reduce the wrist flexion and showed an increased elbow extension capability. No change was observed in control groups.

Conclusions/Significance: The results indicated that FES has beneficial effects on active movements of upper limb. The study suggests that functional electrical stimulation could become an additional therapy for this patient population and suggest a potential use of 3D kinematics in clinical practice.

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