Exploratory Evaluation for Functional Changes of Six-Month Systematic Non-Invasive Electrical Stimulation in a Whole-Body Suit on Children with Cerebral Palsy GMFCS III-V

Abstract

Background/objectives: Spasticity in children with cerebral palsy (CP) can impair motor-related functions. The objective of this exploratory, prospective study was to examine if transcutaneous electrical nerve stimulation (TENS) in a whole-body suit leads to changes in spasticity and other related effects.

Methods: Thirty-one children with CP GMFCS III-V, with a median age of 11.0 years (age range of 7-17 years), were consecutively included, and they used the suit with TENS for 24 weeks. The primary outcome was spasticity measured using the Modified Ashworth Scale (MAS). Functional motor-related tasks were evaluated by the Goal Attainment Scale (SMART GAS). The Modified Tardieu Scale (MTS), passive Range of Motion (pROM), GMFM-66, and Posture and Postural Ability Scale (PPAS) assessments were performed.

Results: Seventeen subjects (17/31) completed the 24 weeks. Dropout was due to difficulty in donning the suit. The level of overall spasticity, most pronounced in the proximal arms and legs, was reduced according to the MAS, but not the MTS or pROM. Subject-relevant motor-related goals improved significantly in standing/walking and hand/arm function. Changes in the GMFM-66 and PPAS were not significant.

Conclusions: Although there were statistically significant but underpowered changes in the MAS after 24 weeks, there were no clinically relevant effects. Exploratorily, we found observer-reliant motor-related functional improvements, which, however, we were unable to detect when trying to quantify them. Donning the suit led to dropout throughout the study. Caregivers need to allocate time, mental capacity and have the physical skill set for donning the suit for long-term use.

Keywords: cerebral palsy; child; electrical stimulation; goals; movement disorder; muscle spasticity; neurorehabilitation; posture; prospective study; range of motion.

Figure 1

The Mollii suit (a) and a schematic drawing of the possible targeted muscles in tailored stimulations according to the pattern of spasticity of the subject using the 58 potential transcutaneous electrical nerve stimulations (b).

Figure 2

The distribution of achieved SMART GAS goals after 24 weeks of the whole-body suit intervention. The participants had two SMART GAS goals. (GAS Nr. 1 and Nr. 2). GAS scores of 0, +1, and +2 were considered as a goal achieved, and GAS scores of −1 and −2 were considered as goals not achieved.