Fall 2005Alexandra CabralDecember 7, 2005IPHY 3700ARGDoes Electrical Stimulus aid in the improvement of motor functions in children withspastic cerebral Palsy.An Argumentative paper for Families and Patients with CPAlexandra CabralFall 2005A paper for some magazineThe purpose of this paper is to provide an argument for the management of Cerebral Palsy (CP) in children called Electrical stimulation. Cerebral palsy is the term for a range of non progressive syndrome of posture and motor impairment that results from trauma to the developing central nervous system which can occur in utero, during delivery or during the first 2 years of life. The treatments of CP are directed at repairing the injured brain and the management of impairments and disabilities resulting from developmental brain injury [8]. This paper is based on nine research papers and two reviews. The studies collected cover the past twelve years in their research. The research questionbeing addressed in this paper is Does Electrical Stimulus aid in the improvement of motor functions in children with spastic cerebral Palsy. All the experiments tested children that have been diagnosed with diplegic, hemiplegic or quadriplegic spastic cerebral palsy. The muscles stimulated in the studies were the gluteus maximus, the lower leg muscles, the abdomen and posterior back muscles, the quadriceps and finally the wrist extensor muscles. The session duration ranged from 30 minutes to 9 hours/day. The 1number of subjects ranged from 1 to 57 participants. The age range from all the studies was 5-18 years of age except for the two studies, one whose subjects were 8-16 months of age and the others whose subjects were 3 to 5 [7, 10, 11].EI Currently, there are no interventions that can successfully repair existing damage to the brain areas that control muscle coordination and movement. However, there are several interventions available to diminish the degree of impairment and to increase participation in activities of daily living [4]. The collected studies are split five to four on whether ES aid in the improvement of motor functions in children with CP. Three out of the nine studies say that the use of Electrical stimulation (ES) does aid in the improvement of motor skills in children with Cerebral Palsy (CP). Another two of the nine studies have mixed results, meaning that alltests performed did not show a significant difference but they did conclude that ES is a beneficial therapeutic technique. And lastly four of the nine studies say that ES does not aid children with CP, however one of the four does show some improvement, just not significant improvement [3, 5, 9, 10, 11, 12, 13, 14, 15]. However, the findings of the studies must be interpreted with caution becausethey generally had insufficient statistical power to provide conclusive evidence for or against these modalities. This subject is 2unresolved because further studies are needed that employ more rigorous study designs and follow-up, larger sample sizes, and all the same patent groups for the explicit support of the use of electrical stimulation.RC One intervention that is new, developing and has limited evaluations in its role in the treatment of cerebral palsy is Electrical stimulation. The study of electrical stimulation continues to grow because it has potential as a passive, non-invasive, home-based therapy, which claims to result in gains in strength and motor function [7]. If proved effective it might provide an alternative to resistive exercise techniques for children with poor selective muscle control, or indeed it might improve treatment compliance in those children who find exercise programs difficult.There are two types of electrical stimulation most commonly studied and used. The first is Neuromuscular Electrical Stimulation, NMES, which is the application of an electrical current of sufficient intensity to get a muscle contraction. The other is Threshold Electrical Stimulation or Therapeutic Electrical Stimulation, TES, has been described as a low-level, sub contraction electrical stimulus applied at home during sleep. All of the studies used one of the two variations of electrical stimulation: NMES or TES.The counterargument for this paper is that ES does not aid 3children with CP. However, upon further review of the collected data it can be argued that ES does aid in the improvement of motor functions in children with spastic CP. In four of the studies, the parents of the children with CP were taught how to administer the electrical stimulation [3, 10, 13, 14]. They were instructed on how to place the electrode leads, adjust thestimulator and check that the stimulator was working properly. The studies that concluded that ES did not have a significant effect on the motor functions of children with CP share the fact that the parents are the ones that administered the treatment. A drawback for this is that parents may not have kept up with the regimen assigned by the researchers. An advantage for this would be that the parents would want their children to improve so they would make sure they were applying the stimulation correctly in order for their children to get the full effect. However, each of the studies hadan assessment period where they made sure whether the parents were correctly applying the electrode. They had an experienced physiotherapist go to the homes of the children or each time the children went in for assessment, the parents had to demonstrate how they placed the electrodes to make sure they were doing it correctly. So, the studies made sure that there was proper placement and correct application of the stimulation. 4Age is another factor that may play a role in whether or not ESworks. It has been presented that younger children (<5 years of age) may benefit more from electrical stimulation treatment more than older children (>5 years of age). Another study also found that younger children respond more rapidly to electrical stimulation [1]. It was suggested that abnormal movement demonstrated by most CP children are not as normal in younger children and changesin muscle characteristics have not yet occurred, making a treatmenteffect easier to obtain. Two of the studies had subjects who were considerably younger than the other studies and found that ES is beneficial therapeutic technique [10, 11]. One stimulated the lower leg muscles as well as the quadriceps in 37-58 months old children with Diplegic and