Abstract
Background
In children with hemiplegic cerebral palsy, upper limb motor deficits often impede functions like reaching and grasping. Electrical neuromodulation targets these deficits using electrical stimulation (ES) to modulate neuromuscular activity, changing muscle recruitment patterns, which can lead to improved motor outcomes.
Objective
This review seeks to evaluate the effectiveness of ES in improving upper limb function in children with hemiplegic cerebral palsy.
Methods
A systematic literature search from inception until May 2023 was conducted in the following databases: CINAHL, Cochrane, EMBASE, PEDro, PsycINFO, PubMed, Scopus, Ovid Medline, and Web of Sciences. Due to the amount of heterogeneity between the studies, a narrative synthesis was used to review the included studies. A range of study designs (e.g., randomised control trial, ABA design and pretest-posttest design) comparing the effect of various ES techniques (e.g., functional electrical stimulation; FES, transcutaneous electrical nerve stimulation; TENS, neuromuscular electrical stimulation; NMES, and transcranial direct-current stimulation; TDCS) on upper limb function in children (from infancy up to 21 years old) with hemiplegic cerebral palsy were included. A modified version of the Cochrane Risk of Bias tool 2 was used to assess the methodological quality of the studies.
Results
A total of 11 studies were selected for review and quality assessment. Seven studies were randomised controlled clinical trials (RCT), two were ABA design, and two were pre-test/post-test design studies. The systematic review included a total of 298 participants, with participant sample sizes ranging from 8 to 68 across included studies. A total of 13 outcome measures were used across all 11 studies to examine the effects of ES on upper limb function in patients with hemiplegic cerebral palsy. Three studies showed a low risk of bias, four studies raised some concerns, and another four studies demonstrated a high risk of bias. Four studies utilized TDCS, three employed TENS, and two studies each implemented FES and NMES. This review indicated that ES is an effective adjunct therapy for upper limb rehabilitation in children with hemiplegic cerebral palsy. Studies showed that multiple TDCS enhanced upper limb function. Both NMES and FES present the potential for upper limb improvement, though the quality of the four studies indicates the need for more robust research designs. Moreover, TENS interventions consistently resulted in significant enhancements in at least one upper limb outcome but were always paired with intensive physiotherapy.
Conclusions
ES, including TDCS, FES, NMES, and TENS, show promise as adjunct therapies for upper limb rehabilitation, especially when combined with intensive physiotherapy. Future high-quality research should evaluate the effects of NMES and FES, validate specific TDCS parameters, and isolate the impact of TENS when used either alone or in combination with other therapies.