Impact of Functional Electrical Stimulation on Lower Limb Strength among Children with Cerebral Palsy

Muhammad Talha Nadeem; Tehreem Mukhtar; Muhammad Shoaib; Zulaikha; Asima Hussain; Maham Iqbal; Zernain Sughra

doi:10.55735/a3mrar47

Authors

Muhammad Talha Nadeem Faculty of Allied Health Sciences, Superior University, Lahore, Pakistan
Tehreem Mukhtar Faculty of Allied Health Sciences, Superior University, Lahore, Pakistan https://orcid.org/0000-0002-8213-7742
Muhammad Shoaib Faculty of Allied Health Sciences, Superior University, Lahore, Pakistan
Zulaikha Faculty of Allied Health Sciences, Superior University, Lahore, Pakistan
Asima Hussain Faculty of Allied Health Sciences, Superior University, Lahore, Pakistan
Maham Iqbal Faculty of Allied Health Sciences, Superior University, Lahore, Pakistan
Zernain Sughra Faculty of Allied Health Sciences, Superior University, Lahore, Pakistan

DOI:

https://doi.org/10.55735/a3mrar47

Keywords:

Cerebral palsy, Functional electrical stimulation, Gait and postural stability, Gross motor function, Lower limb strength

Abstract

Background: Cerebral palsy is caused mainly by upper motor neuron injury and is characterized by spasticity, muscle weakness, reduced selective motor control, and secondary musculoskeletal impairments. Functional electrical stimulation has been proposed to improve lower-limb strength and functional outcomes in children with cerebral palsy. Objective: To evaluate the impact of functional electrical stimulation on lower limb strength in children with cerebral palsy. Methodology: A narrative review was conducted using a custom search strategy in Google Scholar for studies published between 2020 and 2025. Randomized controlled trials and crossover studies examining functional electrical stimulation as an independent intervention or adjunct to conventional therapy were included. Eligible studies involved children with cerebral palsy who received lower limb functional electrical stimulation and reported outcomes on muscle strength, gait, postural stability, and gross motor function. Due to heterogeneity in study designs, outcome measures, and intervention protocols, a quantitative meta-analysis was not conducted. Study characteristics, including Gross Motor Function Classification System level, cerebral palsy subtype, stimulation parameters, and comparisons with orthoses or therapeutic garments, were extracted. Results: Functional electrical stimulation may improve lower-limb strength and functional performance, particularly when combined with conventional therapy. Gains in muscle strength, range of motion, Gross Motor Function Measure scores, and reduced energy expenditure were reported. Improvements in gait and postural stability were seen, especially in hemiplegic and diplegic cerebral palsy. Results varied across studies, and functional electrical stimulation did not consistently outperform conventional orthotic interventions. Evidence on sustained benefits after discontinuation remains limited. Conclusion: Functional electrical stimulation is a promising adjunct intervention for lower-limb weakness and functional limitations in children with cerebral palsy. Variability in protocols and outcomes highlights the need for further high-quality research to determine optimal application strategies and long-term benefits.

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References

1. Moll I, Marcellis RG, Fleuren SM, et al. Functional electrical stimulation during walking in children with unilateral spastic cerebral palsy: A randomized crossover trial. Developmental Medicine & Child Neurology 2024; 66(5): 598–609.

https://doi.org/10.1111/dmcn.15779

2. Arsovski D, Jovanova NC, Jovanovska T. Advancing forward: the role of functional electrical stimulation in enhancing lower limb function in children with cerebral palsy. Futurity Medicine 2025; 4(2): 61–78.

https://doi.org/10.57125/FEM.2025.06.30.06

3. Moll I, Marcellis RG, Coenen ML, et al. A randomized crossover study of functional electrical stimulation during walking in spastic cerebral palsy: the FES on participation (FESPa) trial. BMC Pediatrics 2022; 22(1): 37.

https://doi.org/10.1186/s12887-021-03037-9

4. Moll I, Essers JMN, Marcellis RGJ, et al. Lower limb muscle fatigue after uphill walking in children with unilateral spastic cerebral palsy. PloS One 2022; 17(12): e0278657.

https://doi.org/10.1371/journal.pone.0278657

5. Elmalah HM, Elnagmy EH, Ali MS. Does functional electrical stimulation improve power and reduce mild equines in children with diplegia? NeuroQuantology 2022; 20(15): 70–78.

https://doi.org/10.14704/NQ.2022.20.15.NQ88005

6. Durham S, Eve L, Stevens C. et al. Effect of functional electrical stimulation on asymmetries in gait of children with hemiplegic cerebral palsy. Physiotherapy 2004; 90(2): 82–90.

https://doi.org/10.1016/j.physio.2004.02.003

7. Segal I, Khamis S, Sagie L, et al. Functional benefit and orthotic effect of dorsiflexion-FES in children with hemiplegic cerebral palsy. Children (Basel, Switzerland) 2023; 10(3): 531.

https://doi.org/10.3390/children10030531

8. Türker D, Yakut Y, Yaşar E, et al. The effects of functional electrical stimulation cycling on gait parameters in diplegic cerebral palsy: a single-blind randomized controlled trial. Somatosensory & Motor Research. 2023; 40(2): 62–71.

https://doi.org/10.1080/08990220.2022.2157393

9. El-Shamy SM, El Kafy EM. Effect of functional electrical stimulation on postural control in children with hemiplegic cerebral palsy: a randomized controlled trial. Bulletin of Faculty of Physical Therapy 2021; 26(1): 22.

https://doi.org/10.1186/s43161-021-00040-0

10. Armstrong EL, Boyd RN, Horan SA, et al. Maintenance of functional gains following a goal-directed and FES-assisted cycling program for children with cerebral palsy. Pediatric Physical Therapy 2022; 34(4): 480–87.

https://doi.org/10.1097/PEP.0000000000000942

11. Lindskov L, Huse AB, Johansson M et al. Muscle activity in children with spastic unilateral cerebral palsy when walking with ankle-foot orthoses: an explorative study. Gait & Posture 2020; 80: 31–36.

https://doi.org/10.1016/j.gaitpost.2020.05.011

12. Sharma P, Gupta M, Kalra R. Recent advancements in interventions for cerebral palsy: A review. Journal of Neurorestoratology 2023; 11(3): 100071.

https://doi.org/10.1016/j.jnrt.2023.100071

13. Postans NJ, Granat MH. Effect of functional electrical stimulation, applied during walking, on gait in spastic cerebral palsy. Developmental Medicine & Child Neurology 2004; 47(1): 46–52.

https://doi.org/10.1111/j.1469-8749.2005.tb01039.x

14. Zhu Q, Gao G, Wang K, et al. Effect of functional electrical stimulation on gait parameters in children with cerebral palsy: a meta-analysis. Computational and Mathematical Methods in Medicine; 2022: 3972958.

https://doi.org/10.1155/2022/3972958

15. Özen N, Unlu E, Karaahmet OZ, et al. Effectiveness of Functional Electrical Stimulation - Cycling Treatment in Children with Cerebral Palsy. Malawi Medical Journal: The Journal Of Medical Association Of Malawi 2021; 33(3): 144–152.

https://doi.org/10.4314/mmj.v33i3.1

16. Lieber RL, Theologis T. Muscle-tendon unit in children with cerebral palsy. Developmental Medicine and Child Neurology 2021; 63(8): 908–913.

https://doi.org/10.1111/dmcn.14807

17. El-Shamy SM, El Kafy EMA. Effect of functional electrical stimulation versus TheraTogs on gait and balance in children with hemiplegic cerebral palsy: a randomized controlled trial. Bulletin of Faculty of Physical Therapy 2021; 26: 38.

https://doi.org/10.1186/s43161-021-00058-4

18. Seifart A, Unger M, Burger M. The effect of lower limb functional electrical stimulation on the gait of children with cerebral palsy. Pediatric Physical Therapy 2009; 21(1): 23–30.

https://doi.org/10.1097/pep.0b013e31818de3ea

19. Ricardo D, Raposo MR, Cruz EB, et al. Effects of ankle foot orthoses on the gait patterns in children with spastic bilateral cerebral palsy: a scoping review. Children (Basel, Switzerland) 2021; 8(10): 903.

https://doi.org/10.3390/children8100903

20. Smith J, DiVito M, Fergus A. Reliability and discriminant validity of the quantitative timed up and go in typically developing children and children with cerebral palsy GMFCS levels I-II. Journal of Pediatric Rehabilitation Medicine 2023; 16(1): 25–35.

https://doi.org/10.3233/PRM-210034