title: Cycling with functional electrical stimulation in an adult with spastic diplegic cerebral palsy.
abstract: OBJECTIVE
  Adults with cerebral palsy (CP) are at risk for decreased mobility and health complications, and exercise may combat some of these negative changes. Because people with CP have difficulty generating sufficient muscle force, exercise augmented with functional electrical stimulation (FES) is an option for increasing exercise intensity. This mixed-method (quantitative-qualitative) case report describes the effects-across the International Classification of Functioning, Disability and Health (ICF) model-of cycling with FES (FES cycling) in an adult with CP.
  
  
  METHODS
  An ambulatory 49-year-old man with spastic diplegic CP cycled with FES at home for 30 minutes, 3 times per week, for 12 weeks. Volitional efforts were augmented by FES of the bilateral quadriceps, gastrocnemius, and gluteal muscles. Testing was performed before and after the intervention and 4 weeks after intervention withdrawal.
  
  
  RESULTS
  After training, quadriceps muscle strength (force-generating capacity) improved by 22.2%, hamstring muscle strength improved by 18.5%, and the Timed "Up & Go" Test time decreased from 11.9 to 9.0 seconds. The patient reported increased performance and satisfaction for self-identified goals at the ICF level of participation, and his score on the Medical Outcomes Study 36-Item Health Survey questionnaire increased from 62.1 to 77.6. However, he reported increased back pain, which he attributed to positioning while cycling. Qualitative interviews provided context (the patient's perspective) for some of the quantitative results.
  
  
  CONCLUSIONS
  The patient made gains in body structure and function, activity, and participation (ICF levels) after FES cycling. The mixed-method approach provided insight into his experiences and perceptions about the measures assessed quantitatively. Further investigation on FES cycling in this population as well as positioning during cycling is warranted.
authors.affiliation: Department of Physical Therapy, University of the Sciences in Philadelphia, Philadelphia, PA 19104, USA. t.johnston@usp.edu
authors.forename: Therese E
authors.initials: TE
authors.lastname: Johnston
authors.forename: Susan F
authors.initials: SF
authors.lastname: Wainwright
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control; D001642:Bicycling; D002547:Cerebral Palsy / Q000503:physiopathology / Q000534:rehabilitation*; D004599:Electric Stimulation Therapy; D005081:Exercise Therapy / Q000379:methods*; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength; D055070:Resistance Training; D016896:Treatment Outcome