Therapeutic Electrical Stimulation, 11/2001

Therapeutic Electrical Stimulation (TES) is a technique that is used by some clinicians to improve muscle strength and muscle coordination in persons with muscle spasticity. The technique involves the administration of small electrical stimuli to the skin overlying selected "weakened" muscles (usually muscles opposite to spastic muscles); the stimulation is often done while the person is asleep or resting. The rationale is that by providing stimulation to these muscles, their metabolism will change and lead to an increase in this mass (size) and strength. Thus, these muscles should be able to more easily overcome the effects of the opposing spastic muscles and improve function.

A team of investigators in Norway has completed a carefully designed study to evaluate whether low amplitude TES applied during the night to antagonists of spastic muscles in the legs improves ambulatory performance, muscle strength, activities of daily living and neurological function in children with spastic cerebral palsy.

In a word, the results were negative. Skilled evaluators (neurologist and physiotherapist) found no meaningful differences in any of the outcome measures being studied. However, nearly all of the parents of the children reported their children were improved. One can only speculate why the parents reported improved function and the evaluators could not.

Comment:
Although individual case reports continue to support the use of TES in the treatment of muscle spasticity associated with cerebral palsy, carefully designed studies usually to find no benefit. However, the studies done to date are usually of relatively small groups of children. We need to recognize that a beneficial effect may be unrecognized unless larger numbers of children are studied. Nevertheless, at this time there continues to be little scientific evidence that TES is useful in helping to improve function in children with cerebral palsy.

¹ Sommerfelt K et al (2001) Therapeutic Electrical Stimulation in Cerebral Palsy: A Randomized, Controlled, Crossover Trial DMCN 43, 609-613