Effectiveness of Electrical Stimulation versus Exercise Therapy in Children with Cerebral Palsy: A Systematic Review

Background: Cerebral palsy (CP) is a leading cause of motor disability in childhood. Electrical stimulation (ES) has emerged as a supplementary approach to enhance motor outcomes when used alongside exercise-based therapies.
Objective: This review aimed to systematically study published randomized controlled trials (RCTs) evaluating the effectiveness of electrical stimulation compared to conventional exercise therapy in improving motor outcomes in children with cerebral palsy.
Methods: This systematic review adhered to PRISMA guidelines. A comprehensive literature search was conducted in PubMed, EMBASE, Cochrane CENTRAL, PEDro, and Scopus for Cerebral palsy, Electrical stimulation, NMES, FES, Physiotherapy, Motor function and Internal medicine rehabilitation. Only the most recent or thorough investigation, from 2001 to 2023, was taken into account. Only published RCTs comparing ES [Including neuromuscular electrical stimulation (NMES), functional electrical stimulation (FES), and threshold electrical stimulation (TES)] to exercise-based therapy in Internal Medicine CP populations were included. Data extraction, risk of bias assessment using the RoB 2.0 tool, and evidence quality evaluation via GRADE were conducted independently by two reviewers. Documents written in languages other than English have been ignored. Papers that were not regarded as significant scientific research including dissertations, oral presentations, conference abstracts, and unpublished manuscripts were excluded.
Conclusion: Twelve published RCTs with a total of 387 participants were included. ES interventions varied but predominantly featured NMES and FES targeting lower limb and trunk muscles. Most studies demonstrated improvements in gross motor function, particularly gross motor functional measure (GMFM) dimensions B (sitting) and D (standing), as well as enhancements in gait parameters such as stride length and walking speed. Strength improvements were reported inconsistently. ES was generally well tolerated with minimal adverse effects. Electrical stimulation, particularly as an adjunct to exercise therapy, appears effective in improving gross motor function and gait in children with CP. Standardization of intervention parameters and long-term follow-up studies are recommended to better elucidate ES’s therapeutic role.