What Is NMES/FES in Paediatric Therapy and How Does It Work?

Functional Electrical Stimulation (FES) and Neuromuscular Electrical Stimulation (NMES) are tools used in paediatric therapy to support muscle activation, postural alignment, movement and motor learning.

For children with Cerebral Palsy, electrical stimulation may help improve postural alignment, control and muscle activation. By providing sensory input and assisting muscle activation, electrical stimulation can support motor learning, strength and functional movement (Cobo-Vicente et al., 2021).

What Are FES and NMES?

Electrical stimulation involves delivering safe, controlled electrical impulses through electrodes placed over targeted muscles.

These impulses can provide sensory input and/or produce a muscle contraction, depending on the therapeutic goal and how the stimulation is being used.

FES and NMES can be incorporated into therapy for children with Cerebral Palsy for a variety of reasons, including:

• Supporting pelvic posture while sitting
• Improving trunk alignment and stability
• Strengthening muscles in four-point positions
• Supporting muscle activation during functional movements
• Promoting a more appropriate heel-to-toe gait pattern
• Reducing toe-walking

The way electrical stimulation is used will depend on the individual child, their movement patterns and their therapy goals.

Supporting Posture, Trunk Control and Alignment

Children with Cerebral Palsy can experience reduced postural control, including challenges with stability, alignment and scoliosis.

NMES can be used to promote trunk strength and alignment, helping to improve postural control and stability while sitting.

It may also help improve trunk balance and reduce spinal asymmetry in some children with Cerebral Palsy by encouraging more balanced activation of the muscles around the spine (Ko et al., 2018).

Improved postural stability can provide a stronger foundation for other functional activities, from sitting and reaching to transitions and movement.

Using Electrical Stimulation to Support Walking

Children with Cerebral Palsy can present with a range of differences in their gait cycle, including crouch gait, toe-walking and intoeing.

Electrical stimulation can be incorporated into therapy to target specific muscles involved in walking and support improved alignment and movement patterns (Mooney & Rose, 2019).

By identifying muscles that may be weak or underactive during a child’s gait cycle, therapists can tailor an electrical stimulation programme to the child’s individual movement patterns and goals.

What Is Functional Electrical Stimulation (FES)?

FES refers to the use of electrical stimulation during a functional activity.

Rather than stimulating a muscle in isolation, FES can be timed to activate particular muscles at appropriate points during movements such as:

• Walking
• Standing
• Transitions
• Stepping
• Other goal-directed movements

This allows the child to practise muscle activation as part of the movement they are working towards.

Combining Electrical Stimulation With Functional Movement

Approaches such as Task-Specific Electrical Stimulation (TASES) combine electrical stimulation with goal-directed movements.

The aim is to help children practise appropriate and efficient alignment during meaningful activities, rather than working on muscle activation separately from everyday movement.

Electrical stimulation can also be paired with other therapy approaches, such as Dynamic Movement Intervention (DMI), to support alignment and muscle activation while a child practises functional movements.

By combining targeted muscle stimulation with movement practice, therapists can work towards functional goals that are meaningful to the individual child.

Individualised Therapy for Children With Cerebral Palsy

Every child with Cerebral Palsy has different strengths, movement patterns and functional goals. For this reason, FES and NMES programmes should be tailored to the individual child rather than applied as a one-size-fits-all approach.

A therapist can assess a child’s posture, muscle activation, gait and functional movement to determine whether electrical stimulation may be appropriate and how it could be incorporated into their broader therapy programme.

When used alongside functional, goal-directed movement, FES and NMES can provide another way to support children as they develop strength, alignment, motor control and movement skills.

References

Bosques, G., Martin, R., McGee, L., & Sadowsky, C. (2016). Does therapeutic electrical stimulation improve function in children with disabilities? A comprehensive literature review. Journal of Pediatric Rehabilitation Medicine, 9(2), 83–99.

Cobo-Vicente, F., San Juan, A. F., Larumbe-Zabala, E., Estévez-González, A. J., Donadio, M. V. F., & Pérez-Ruiz, M. (2021). Neuromuscular electrical stimulation improves muscle strength, biomechanics of movement, and functional mobility in children with chronic neurological disorders: A systematic review and meta-analysis. Physical Therapy, 101(10), pzab170. https://doi.org/10.1093/ptj/pzab170

Ko, E. J., Sung, I., Yun, G., Kang, J.-A., Kim, J., & Kim, G. (2018). Effects of lateral electrical surface stimulation on scoliosis in children with severe cerebral palsy: A pilot study. Disability and Rehabilitation, 40, 1–7. https://doi.org/10.1080/09638288.2016.1250120

Mooney, J. A., & Rose, J. (2019). A scoping review of neuromuscular electrical stimulation to improve gait in cerebral palsy: The arc of progress and future strategies. Frontiers in Neurology, 10, 887. https://doi.org/10.3389/fneur.2019.00887