Functional Electrical Stimulation (FES) for Upper Extremity Hemiplegia in Children With Cerebral Palsy
Condition: Cerebral Palsy
MeSH terms: Paralysis; Cerebral Palsy; Hemiplegia
Study type: Interventional

Summary: 
      The proposed pilot study seeks to explore the effectiveness of Functional Electrical
      Stimulation (FES) to improve upper limb function in children and youth (aged 6 to 18 years)
      with hemiplegic cerebral palsy, as measured by the QUEST grasp score and other secondary
      outcome measures obtained pre- and post-intervention in a case series study design.
    

Detailed description: 
      Functional electrical stimulation (FES) has increasingly gained interest as a therapeutic
      intervention for the improvement of motor function in individuals with disabilities. FES
      involves the administration of electrical pulses to stimulate motor neurons and initiate
      muscle contractions, It has been used primarily for individuals with spinal cord injury or
      those who have experienced a stroke leading to the loss of or decreased motor function of the
      limbs. The repeated application of FES to the affected limb has been shown to enable
      individuals with hemiplegia to voluntarily control movements of the affected upper limb. A
      new FES system, has recently been developed and indicated for use for the improvement of arm
      and hand function in patients with hemiplegia due to stroke or spinal cord injury. FES is a
      non-invasive therapy that involves transcutaneous delivery of electrical stimulation to the
      affected upper limb, patient participation and the assistance of therapists to improve
      voluntary arm and hand movements such as reaching and grasping.

      The new FES system has shown effectiveness in both adults with acute stroke and children with
      chronic acquired stroke. In a randomized controlled trial, FES paired with intensive therapy
      compared to intensive therapy alone was shown to significantly improve hand function for
      adults with acute stroke. Participants in the trial had limited mobility or complete
      immobility of the affected arm and those who received FES paired with intensive therapy had
      clinically significant improvements in hand movements compared to those who only received
      intensive therapy. Recently, transcutaneous FES paired with intensive hand therapy (3
      one-hour sessions per week for 16 weeks) has more recently been shown to improve hand
      function in children with chronic acquired stroke.

      The efficacy of FES seen in patients with stroke opens up the possibility for its use in
      other similar populations, including children with hemiplegic cerebral palsy (HCP). However,
      there is currently limited research on the efficacy of FES with this population. In a
      preliminary study, the use of FES alone over a treatment period of 6 weeks in children with
      HCP was shown to significantly improve wrist movement. However, most of the research to date
      on the effects of FES on children with HCP has been focused on gait and lower limb function.
      There is currently a lack of evidence on the effectiveness of FES paired with intensive
      therapy on hand function in children with HCP. FES paired with intensive therapy holds
      significant potential to improve the hand function of children with HCP and warrants further
      investigation.

      Therefore, the proposed research seeks to address two main objectives:

        1. To investigate the effectiveness of FES to improve upper limb function in children with
           HCP.

        2. To assess the effects of FES on upper limb function in children with HCP at six months
           post-intervention.
    

Intervention name(s): FES Therapy
Intervention type(s): Device
Intervention description(s): FES therapy will be administered over the course of 1 hour sessions that will be take place 3 times per week over 16 weeks, for a total of 48 sessions.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: cerebral palsy; hemiplegia; fes; grasping