Greve Kelly R, Joseph Christopher F, Berry Blake E, Schadl Kornel, Rose Jessica
Division of Occupational Therapy and Physical Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
Department of Rehabilitation, Exercise and Nutrition Sciences, University of Cincinnati, College of Allied Health Sciences, Cincinnati, OH, United States.
Front Physiol. 2022 Aug 30;13:951899. doi: 10.3389/fphys.2022.951899. eCollection 2022.
Neuromuscular Electrical Stimulation (NMES) is an emerging assistive technology applied through surface or implanted electrodes to augment skeletal muscle contraction. NMES has the potential to improve function while reducing the neuromuscular impairments of spastic cerebral palsy (CP). This scoping review examines the application of NMES to augment lower extremity exercises for individuals with spastic CP and reports the effects of NMES on neuromuscular impairments and function in spastic CP, to provide a foundation of knowledge to guide research and development of more effective treatment. A literature review of Scopus, Medline, Embase, and CINAHL databases were searched from 2001 to 2 November 2021 with identified inclusion and exclusion criteria. Out of 168 publications identified, 33 articles were included. Articles on three NMES applications were identified, including NMES-assisted strengthening, NMES-assisted gait, and NMES for spasticity reduction. NMES-assisted strengthening included the use of therapeutic exercises and cycling. NMES-assisted gait included the use of NMES to improve gait patterns. NMES-spasticity reduction included the use of transcutaneous electrical stimulation or NMES to decrease tone. Thirteen studies investigated NMES-assisted strengthening, eleven investigated therapeutic exercise and demonstrated significant improvements in muscle structure, strength, gross motor skills, walking speed, and functional mobility; three studies investigated NMES-assisted cycling and demonstrated improved gross motor skills and walking distance or speed. Eleven studies investigated NMES-assisted gait and demonstrated improved muscle structure, strength, selective motor control, gross motor skills, and gait mechanics. Seven studies investigated NMES for spasticity reduction, and five of the seven studies demonstrated reduced spasticity. A growing body of evidence supports the use of NMES-assisted strengthening, NMES-assisted gait, and NMES for spasticity reduction to improve functional mobility for individuals with spastic CP. Evidence for NMES to augment exercise in individuals with spastic CP remains limited. NMES protocols and parameters require further clarity to translate knowledge to clinicians. Future research should be completed to provide richer evidence to transition to more robust clinical practice.
神经肌肉电刺激（NMES）是一种新兴的辅助技术，通过表面电极或植入电极来增强骨骼肌收缩。NMES有潜力改善功能，同时减少痉挛型脑瘫（CP）的神经肌肉损伤。本范围综述探讨了NMES在增强痉挛型CP患者下肢运动方面的应用，并报告了NMES对痉挛型CP患者神经肌肉损伤和功能的影响，为指导更有效治疗的研究和开发提供知识基础。对Scopus、Medline、Embase和CINAHL数据库进行了文献综述，检索时间为2001年至2021年11月2日，确定了纳入和排除标准。在识别出的168篇出版物中，纳入了33篇文章。确定了关于三种NMES应用的文章，包括NMES辅助强化、NMES辅助步态训练以及用于减轻痉挛的NMES。NMES辅助强化包括使用治疗性运动和骑自行车。NMES辅助步态训练包括使用NMES改善步态模式。NMES减轻痉挛包括使用经皮电刺激或NMES降低肌张力。13项研究调查了NMES辅助强化，11项研究调查了治疗性运动，并证明在肌肉结构、力量、粗大运动技能、步行速度和功能活动能力方面有显著改善；3项研究调查了NMES辅助骑自行车，并证明粗大运动技能以及步行距离或速度有所改善。11项研究调查了NMES辅助步态训练，并证明肌肉结构、力量、选择性运动控制、粗大运动技能和步态力学有所改善。7项研究调查了用于减轻痉挛的NMES，其中7项研究中有5项证明痉挛有所减轻。越来越多的证据支持使用NMES辅助强化、NMES辅助步态训练以及用于减轻痉挛的NMES来改善痉挛型CP患者的功能活动能力。关于NMES增强痉挛型CP患者运动的证据仍然有限。NMES方案和参数需要进一步明确，以便将知识转化给临床医生。未来应完成更多研究，以提供更丰富的证据，从而过渡到更稳健的临床实践。
