title: Children with cerebral palsy: a systematic review and meta-analysis on gait and electrical stimulation.
abstract: OBJECTIVE
  To conduct a systematic review and meta-analysis using the International Classification of Functioning to determine the summary effect of electrical stimulation on impairment and activity limitations relevant to gait problems of children with cerebral palsy.
  
  
  METHODS
  We identified 40 cerebral palsy and electrical stimulation studies, and 17 gait studies qualified for inclusion. Applying enablement classification methods to walking abnormalities created two subgroups: impairment (N = 14) and activity limitations (N = 15). Overall, 238 participants experienced electrical stimulation treatments and 224 served as a no stimulation control group. Calculations followed conventional data extraction and meta-analysis techniques: (a) individual standardized mean differences, (b) summary effect size, (c) I² heterogeneity test, (d) fail-safe N analysis and (e) moderator variable analyses.
  
  
  RESULTS
  Common outcome measures associated with impairment (n = 3) and activity limitations (n = 6) were submitted to separate random effects models meta-analyses, and revealed significant cumulative effect sizes: (a) impairment = 0.616 (SE = 0.10) and (b) activity limitations = 0.635 (SE = 0.14). I² indicated low and medium amounts of dispersion, whereas fail-safe analyses revealed high N-values for both disablement categories. Moderator variable analyses further confirmed the positive treatment effects from both functional and neuromuscular stimulation.
  
  
  CONCLUSIONS
  The present systematic review and meta-analyses determined medium effect sizes for electrical stimulation on walking impairment and activity limitations of children with cerebral palsy.
authors.affiliation: Applied Physiology and Kinesiology Department, Center for Exercise Science, University of Florida, Gainesville, FL 32611, USA. jcaura@hhp.ufl.edu
authors.forename: James H
authors.initials: JH
authors.lastname: Cauraugh
authors.forename: Sagar K
authors.initials: SK
authors.lastname: Naik
authors.forename: Wen Hao
authors.initials: WH
authors.lastname: Hsu
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Coombes
authors.forename: Kenneth G
authors.initials: KG
authors.lastname: Holt
mesh_terms: D002547:Cerebral Palsy / Q000503:physiopathology* / Q000534:rehabilitation*; D002648:Child; D004558:Electric Stimulation; D005684:Gait / Q000502:physiology*; D006801:Humans