Balance training versus reciprocal electrical stimulation on knee joint alignment in spastic diplegic cerebral palsy children
Bulletin of Faculty of Physical Therapy volume 20, pages 146–153 (2015)
Background and purpose
Spastic diplegia is the most common pattern of motor impairment in patients with cerebral palsy (CP) because of a number of deficits, including poor muscle control, weakness, impaired balance, and spasticity, which cause malalignment of the knee joint during standing and walking. This study aimed to evaluate the effect of balance training (BT) versus reciprocal electrical stimulation (RES) of knee extensors and flexors on knee joint alignment in spastic diplegic CP children.
Materials and methods
Thirty children with spastic diplegic CP of both sexes were selected, ranging in age from 6 to 8 years. Children were divided randomly into two equal groups (I and II). Evaluation was performed before and after 12 weeks of treatment using a digital goniometer to measure range of motion of the knee joint, tape measurement to measure the distance between the buttock and the heel, and gross motor functional measure to provide functional evaluation of standing and walking abilities. Group I received a BT program on the Biodex balance system in addition to a selected physical therapy program. Group II received RES of knee extensors and flexors in addition to the same selected physical therapy program.
Both BT and RES for 12 weeks in spastic diplegic CP seem to yield a beneficial and statistically significant increase in adjusting knee alignment and improving the functional abilities in standing and walking (P < 0.05). However, BT seems to exert a more beneficially and statistically significant effect than RES.
BT and RES have a significant effect on improving knee alignment in spastic diplegic CP children.
Koman LA, Smith BP, Shilt JS. Cerebral palsy. Lancet 2004; 363: 1619–1631.
Colver AF, Sethumadhavan T. The term diplegia should be abandoned. Arch Dis Child 2003; 88:286–290.
Woollacott MH, Shumway-Cook A. Postural dysfunction during standing and walking in children with cerebral palsy: what are the underlying problems and what new therapies might improve balance? Neural Plast 2005; 12:211–219; discussion 263–272.
Davids JR, Bagley AM. Identification of common gait disruption patterns in children with cerebral palsy. J Am Acad Orthop Surg 2014; 22:782–790.
Galli M, Cimolin V, Pau M, Leban B, Brunner R, Albertini G. Foot pressure distribution in children with cerebral palsy while standing. Res Dev Disabil 2015; 5:52–57.
Wright M, Wallman L. Cerebral palsy. In: Campbell S, editor Physical therapy for children. Philadelphia: W.B Saunders; 2012. 591–615.
Daichman J, Johnston TE, Evans K, Tecklin JS. The effects of a neuromuscular electrical stimulation home program on impairments and functional skills of a child with spastic diplegic cerebral palsy: a case report. Pediatr Phys Ther 2003; 15:153–158.
Stackhouse SK, Binder-Macleod SA, Stackhouse CA, McCarthy JJ, Prosser LA, Lee SC. Neuromuscular electrical stimulation versus volitional isometric strength training in children with spastic diplegic cerebral palsy: apreliminary study. Neurorehabil Neural Repair 2007; 21:475–485.
Van der Linden ML, Hazlewood ME, Hillman SJ, Robb JE. Functional electrical stimulation to the dorsiflexors and quadriceps in children with cerebral palsy. Pediatr Phys Ther 2008; 20:23–29.
Durham S, Eve L, Stevens C, Ewins D. Effect of functional electrical stimulation on asymmetries in gait of children with hemiplegic cerebral palsy. Physiotherapy 2004; 90:82–90.
Dali C, Hansen FJ, Pedersen SA, Skov L, Hilden J, Bjørnskov I, et al. Threshold electrical stimulation (TES) in ambulant children with CP: a randomized double-blind placebo-controlled clinical trial. Dev Med Child Neurol 2002; 44:364–369.
Alabdulwahab SS. Electrical stimulation improves gait in children with spastic diplegic cerebral palsy. NeuroRehabilitation 2011; 29:37–43.
Glaviano NR, Langston WT, Hart JM, Saliba S. Influence of patterned electrical neuromuscular stimulation on quadriceps activation in individuals with knee joint injury. Int J Sports Phys Ther 2014; 9:915–923.
Bohannon RW, Smith MB. Inter-rater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther 1987; 67:206–207.
Ko J, Kim M. Reliability and responsiveness of the gross motor function measure-88 in children with cerebral palsy. Phys Ther 2013; 93:393–400.
Lundkvist Josenby A, Jarnlo GB, Gummesson C, Nordmark, E. Longitudinal construct validity of the GMFM-88 total score and goal total score and the GMFM-66 score in a 5-year follow-up study. Phys Ther 2009; 89:342–350.
Damiano DL. Meaningfulness of mean group results for determining the optimal motor rehabilitation program for an individual child with cerebral palsy. Dev Med Child Neurol 2014; 56:1141–1146.
Shumway-Cook A, Woollacott M. Motor control theory and practical applications. Baltimore: Lippincott Williams & Wilkins; 1995. 456–520.
Koop O, Green E. Early development of postural control. Physiotherapy 1992; 76:799–802.
Kern H, Horak F, Nashner L. Cerebral palsy. In: Campbell S, editor. Decision making in pediatric neurologic physical therapy. Philadelphia: Churchill Livingstone; 2000. 317–322.
Comerford MJ, Mottram SL. Functional stability re-training: principles and strategies for managing mechanical dysfunction. Manual Therapy 2001; 6:3–14.
Sterba J, Rogers B, France A, Vokes D. Horseback riding in children with cerebral palsy: effect on gross motor function. Dev Med Child Neurol 2000; 44:301–308.
Guerraz M, Bronstein AM. Ocular versus extraocular control of posture and equilibrium. Clin Neurophysiol 2008; 38:391–398.
Shaffer S, Harrison A. Aging of the somatosensory system: a translation perspective. Phys Ther 2007; 87:194–207.
Guerraz M, Day B. Expectation and the vestibular control of balance. J Cogn Sci 2005; 17:463–469.
Okai LA, Kohn AF. Changes in FDB and soleus muscle activity after a train of stimuli during upright stance. Rev Bras Fisioter 2012; 16:231–235.
Ijkema-Paassen J, Gramsbergen A. Development of postural muscles and their innervation. Neural Plast 2005; 12:141–151.
Khalili MA, Hajihassanie A. Electrical simulation in addition to passive stretch has a small effect on spasticity and contracture in children with cerebral palsy: a randomised within-participant controlled trial. Aust J Physiother 2008; 54:185–189.
Carmick J. Use of neuromuscular electrical stimulation and [corrected] dorsal wrist splint to improve the hand function of a child with spastic hemiparesis. Phys Ther 1997; 77:661–671.
Stackhouse SK, Binder-Macleod SA, Lee SC. Voluntary muscle activation, contractile properties, and fatigability in children with and without cerebral palsy. Muscle Nerve 2005; 31:594–601.
Mäenpää H, Jaakkola R, Sandström M, Von Wendt L. Does microcurrent stimulation increase the range of movement of ankle dorsiflexion in children with cerebral palsy? Disabil Rehabil 2004; 26:669–677.
Riemann BL, Lephart SM. The sensorimotor system, part II: the role of proprioception in motor control and functional joint stability. J Athl Train 2002; 37:80–84.
Tedroff K, Knutson LM, Soderberg GL. Co-activity during maximum voluntary contraction: a study of four lower-extremity muscles in children with and without cerebral palsy. Dev Med Child Neurol 2008; 50:377–381.
Camrick J. Clinical use of neuromuscular electrical stimulation for children with cerebral palsy, part I: lower extremity. Pediatr Phys Ther 1993; 73:505–513.
Reed B. The physiology of neuromuscular electrical stimulation. Pediatr Phys Ther 1997; 9:96–102.
Mittal R, Narkeesh A. Review study on effect of stimulation of vestibular apparatus on postural muscle tone in cerebral palsy. J Exerc Sci Physiother 2012; 8:11–19.
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Badawya, W.M., Ibrahimb, M.B. Balance training versus reciprocal electrical stimulation on knee joint alignment in spastic diplegic cerebral palsy children. Bull Fac Phys Ther 20, 146–153 (2015). https://doi.org/10.4103/1110-6611.174694
- cerebral palsy
- electrical stimulation
- knee joint