Neuromuscular electrical stimulation of the gluteus medius improves the gait of children with cerebral palsy

Neuromuscular electrical stimulation (NMES) of the gluteus medius muscles using a surface electrode during functional walking training has never been reported as a management option to improve gait in spastic diplegic children. Purpose: This study was investigates the short and longer term effects of simultaneous continuous NMES of both hip abductors during walking on the temporal-spatial gait characteristics and hip adductor muscle tone in children with spastic diplegia caused by cerebral palsy (CP). Subjects: Three groups of subjects participated: an experimental group of twenty-one ambulant spastic diplegic children; a CP control group containing ten ambulant spastic diplegic children; and a healthy control group with twenty normal children. Method: The experimental group received three different NMES management programs. The first NMES program was designed to evaluate the immediate short-term effects of simultaneous continuous NMES of both gluteus medius muscles during walking. The second NMES program aimed to evaluate the effect of 15 minutes of simultaneous and continuous NMES of both gluteus medius muscles during walking, three sessions a day for a week. The third program was similar to the first and was designed to detect any additional changes in gait after full adaptation to NMES and completion of the second program. A dual channel stimulator with self-adhesive electrodes at the tolerable motor threshold level was used with a frequency of 20 Hz and pulse width of 50 mu s. The effect of NMES programs was assessed using a three-dimensional gait analysis system and the Modified Ashworth Scale. Results: Significant improvement in the temporal-spatial parameters and hip adductor muscle tone of the experimental group (p < 0.001-0.05) was observed. Conclusion: The NMES management programs used in this study improved the gait of spastic diplegic CP children.