Electrical simulation in addition to passive stretch has a small effect on spasticity and contracture in children with cerebral palsy: a randomised within-participant controlled trial

Question: Does electrical stimulation in addition to passive stretching reduce spasticity and contracture more than passive stretching alone in children with cerebral palsy? Design: Randomised with in-participant controlled trial with concealed allocation, assessor blinding, and intention-to-treat analysis. Participants: Eleven (one dropout) children with cerebral palsy and bilateral knee flexor spasticity aged 13 years (SD 1). Intervention: One leg in each participant received the experimental intervention for four weeks which consisted of 30 min of electrical stimulation of the quadriceps 3 times per week and passive stretching of the hamstrings 5 times per week. The other leg received the control intervention for four weeks which consisted of passive stretching of the hamstrings 5 times per week. Outcome measures: Spasticity of the hamstrings was measured using the modified Ashworth scale. Contracture was measured as maximum passive knee extension using goniometry. Results: The mean difference in decrease in the modified Ashworth score due to the addition of electrical stimulation to the stretching regimen was 0.8 points (95% Cl 0.1 to 1.5). The mean difference in increase in passive knee extension due to the addition of electrical stimulation to the stretching regimen was 4 degrees (95% Cl 0 to 7). Conclusion: Electrical stimulation combined with passive stretching is marginally more effective than passive stretching alone for spastic limbs of children with cerebral palsy.