The Feasibility of Functional Electrical Stimulation to Improve Upper Extremity Function in a Two-year-old Child with Perinatal Stroke: A Case Report

ABSTRACT

Aims: To evaluate the effectiveness and feasibility (i.e. tolerability, adherence) of functional electrical stimulation (FES) for the upper extremity (UE) in a two-year-old child with perinatal stroke. Methods: Forty hours of FES over eight weeks was prescribed. FES to the hemiplegic triceps, extensor carpi radialis longus and brevis, extensor carpi ulnaris and extensor digitorum was timed with reaching during play. Assessments were performed before, during, and two months post-intervention. UE function (Melbourne Assessment 2 (MA2), Assisting Hand Assessment (AHA)) and spasticity (Modified Tardieu with electrogoniometry and electromyography) were measured. The mother completed a semi-structured interview post-intervention. Descriptive statistics were used for adherence and UE measures. A repeated-measures ANOVA compared Modified Tardieu parameters (e.g. catch angle) over time. Conventional content analysis was used for the interview data. Results: The child completed 39.2/40 hours. Immediately post-intervention, improvements were observed on MA2's Range of Motion subscale and catch angle (Modified Tardieu, p < 0.001). Two months post-intervention, improvements were observed on MA2's Accuracy and Fluency subscales. No change in AHA score occurred. Three themes emerged from the interview: (1) Ingredients for program success; (2) Information about the FES device; and (3) The child's response. Conclusions: UE FES was feasible in a two-year-old child with hemiplegia.

KEYWORDS:

• Functional electrical stimulation
• pediatric
• upper extremity
• hemiplegia
• perinatal stroke
• case report

Acknowledgments

We thank the child participant, her mother and family for their dedication and effort.

Declaration of Interests

The authors report no declarations of interest.

About the Authors

Kristin E. Musselman, PT, PhD, is a Scientist at the Toronto Rehabilitation Institute-University Health Network (TRI-UHN) and an Assistant Professor in the Department of Physical Therapy at the University of Toronto, in Toronto, Canada. Patricia Manns, PT, PhD, is a Professor in the Department of Physical Therapy at the University of Alberta in Edmonton, Canada. Jaclyn Dawe, OT, Master's student, is associated with the Rehabilitation Sciences Institute, University of Toronto, and the TRI-UHN, in Toronto, Canada. Rhina Delgado is an occupational therapist who has worked in hospital and community settings in Edmonton, Canada. Jaynie F. Yang, PT, PhD, is a Professor in the Department of Physical Therapy and the Neuroscience and Mental Health Institute at the University of Alberta in Edmonton, Canada.

Additional information

Funding

Funding for this study came from a Start-up Award to KEM from the College of Medicine, University of Saskatchewan, and funds from the Canadian Institutes of Health Research (JFY).