Short-Term Effects of Neuromuscular Electrical Stimulation on Muscle Architecture of the Tibialis Anterior and Gastrocnemius in Children with Cerebral Palsy Preliminary Results of a Prospective Controlled Study

Objective The aim of this study was to explore the short-term effects of neuromuscular electrical stimulation application on tibialis anterior (stimulated muscle) and gastrocnemius (antagonist) muscles' size and architecture in children with cerebral palsy by using ultrasound. Design This prospective, controlled study included 28 children diagnosed with spastic diplegic cerebral palsy. Participants were treated either with neuromuscular electrical stimulation application and conventional physiotherapy (group A) or with conventional physiotherapy alone (group B). Outcome was evaluated by clinical (gross motor function, selective motor control, range of motion, spasticity) and ultrasonographic (cross-sectional area, pennation angle, fascicle length of tibialis anterior and gastrocnemius muscles) measurements before and after treatment in both groups. Results Cross-sectional area values of tibialis anterior (238.7 +/- 61.5 vs. 282.0 +/- 67.1 mm(2)) and gastrocnemius (207.9 +/- 48.0 vs. 229.5 +/- 52.4 mm(2)) (P < 0.001 and P = 0.008, respectively) muscles were increased after treatment in group A. Cross-sectional area values of tibialis anterior muscle were decreased (257.3 +/- 64.7 vs. 239.7 +/- 60.0 mm(2)) after treatment in group B (P < 0.001), and the rest of the measurements were found not to have changed significantly in either group. Conclusions These results have shown that cross-sectional area of both the agonist and antagonist muscles increased after 20 sessions of neuromuscular electrical stimulation treatment. Future studies with larger samples and longer follow-up are definitely awaited for better evaluation of neuromuscular electrical stimulation application on muscle architecture and its possible correlates in clinical/functional outcome.