title: Neuromuscular electrical stimulation-assisted gait increases muscle strength and volume in children with unilateral spastic cerebral palsy.
abstract: OBJECTIVE
  To determine if neuromuscular electrical stimulation (NMES) applied to the ankle dorsiflexors during gait improves muscle volume and strength in children with unilateral spastic cerebral palsy (CP).
  
  
  METHODS
  Thirty-two children (15 females, 17 males; mean age 10y 8mo, age range 5y 5mo-18y 1mo) with unilateral spastic CP and a Gross Motor Function Classification System of level I or level II were randomly assigned to either the 8-week daily NMES treatment group or control group (usual or conventional treatments). Outcomes at week 8 (post-NMES) and week 14 (carryover) included magnetic resonance imaging for muscle volumes (tibialis anterior, anterior compartment, and gastrocnemius), strength (hand-held dynamometry for isometric dorsiflexion strength and heel raises for functional strength), and clinical measures for lower limb selective motor control.
  
  
  RESULTS
  At week 8, the treatment group demonstrated significantly (p<0.05) increased muscle volumes for tibialis anterior, anterior compartment, medial and lateral gastrocnemius, and dorsiflexion strength not only when compared to their baseline values but also when compared to the control group at week 8. At week 14, both tibialis anterior and lateral gastrocnemius volumes in the treatment group remained significantly increased when compared to their baseline values. However, only lateral gastrocnemius volumes had significantly greater values when compared to the control group at week 14. There were no between group differences in the clinical measures for lower limb selective motor control at week 8 and 14.
  
  
  CONCLUSIONS
  Eight weeks of daily NMES-assisted gait increases muscle volume and strength of the stimulated ankle dorsiflexors in children with unilateral spastic CP. These changes are use-dependent and do not carry over after the 8-week treatment period. Gastrocnemius volume also increased post-treatment with carryover at week 14.
authors.affiliation: Department of Physiotherapy and Paediatric Rehabilitation, Princess Margaret Hospital for Children, Perth, WA, Australia.|School of Sport Science Exercise and Health, The University of Western Australia, Perth, WA, Australia.
authors.forename: Dayna
authors.initials: D
authors.lastname: Pool
authors.affiliation: Faculty of Health Science, Curtin University of Technology, Perth, WA, Australia.
authors.forename: Catherine
authors.initials: C
authors.lastname: Elliott
authors.affiliation: Department of Physiotherapy and Paediatric Rehabilitation, Princess Margaret Hospital for Children, Perth, WA, Australia.
authors.forename: Natasha
authors.initials: N
authors.lastname: Bear
authors.affiliation: School of Sport Science Exercise and Health, The University of Western Australia, Perth, WA, Australia.
authors.forename: Cyril J
authors.initials: CJ
authors.lastname: Donnelly
authors.affiliation: School of Sport Science Exercise and Health, The University of Western Australia, Perth, WA, Australia.
authors.forename: Caroline
authors.initials: C
authors.lastname: Davis
authors.affiliation: Department of Orthopaedics, Princess Margaret Hospital for Children, Perth, WA, Australia.
authors.forename: Katherine
authors.initials: K
authors.lastname: Stannage
authors.affiliation: Department of Paediatric Rehabilitation, Princess Margaret Hospital for Children, Perth, WA, Australia.
authors.forename: Jane
authors.initials: J
authors.lastname: Valentine
mesh_terms: D000293:Adolescent; D002547:Cerebral Palsy / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D004599:Electric Stimulation Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005684:Gait / Q000502:physiology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009128:Muscle Spasticity; D053580:Muscle Strength / Q000502:physiology*; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D017063:Outcome Assessment, Health Care