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Percutaneous Intramuscular Functional Electrical Stimulation as an Intervention Choice for Children with Cerebral Palsy

The purpose of this paper is to discuss the emergent application of percutaneous intramuscular functional electrical stimulation (FES) for children with cerebral palsy (CP). Viewing CP as a multidimensional clinical syndrome that is primarily characterized by deficits in motor control with simultaneous secondary musculoskeletal impairments challenges the therapist to be broad-based in management approaches and intervention choices. Effective interventions for children with CP must impact on peripheral, central, and compensatory mechanisms to affect change in the child's functional abilities. Intramuscular FES may be uniquely able to activate weak or inaccurate muscle responses to achieve strengthening and functional improvements through coordinated, sequenced muscle activation. Two children with spastic diplegia underwent bilateral implantation of percutaneous intramuscular electrodes into the gluteus maximus, gluteus medius, vastus lateralis, vastus medialis, gastrocnemius, and tibialis anterior. Intervention with FES consisted of the creation of stimulation programs for strengthening key antigravity muscles during stance as well as exercise programs to activate weak muscles during appropriate gait subtasks, such as stable stance, unilateral limb loading, weight transfer, and limb advancement. The children were asked to work with the stimulation, using the stimulated input as a motor learning assist. Both children showed clinical improvements in lower extremity range of motion and spatial gait characteristics, but, more importantly, there were improvements in gross motor function. The improvements seen continued to be evident whether the stimulation was on or off, perhaps an effect of carryover and motor learning. These results are promising and suggest that the simultaneous activation, strengthening, and training of multiple muscle groups afforded by FES may offer an intervention approach that uniquely addresses both the peripheral and central problems contributing to impairment in children with CP.