Feasibility of Functional Repetitive Neuromuscular Magnetic Stimulation (frNMS) Targeting the Gluteal Muscle in a Child with Cerebral Palsy: A Case Report

Abstract

Background

Motor impairment due to spasticity, weakness, and insufficient selective motor control is a key feature of cerebral palsy (CP). For standing and walking, the gluteal muscles play an important role. Physical therapy represents an evidence-based treatment to promote strength and endurance but may be limited to address selective motor control. Treatment incorporating neurostimulating techniques may increase the therapeutic benefits in these situations.

Purpose

The aim of this case report was to evaluate the feasibility, safety and clinical effects of a customized protocol of functional repetitive neuromuscular magnetic stimulation (frNMS).

Methods

This case report describes a frNMS protocol applied to the gluteal muscles in an 8-year old boy with bilateral spastic CP. The protocol combines 12 sessions of customized physiotherapeutic exercises with simultaneous electromagnetic stimulation.

Results

frNMS protocol was adhered to as planned, no relevant adverse events were observed. At day fourafter the intervention the patient reported clinical benefits and improvements of standing and walking assessed by Gross Motor Function Measure dimensions D (+5.1%) and E (+4.2%) were documented. Body sway as measured by center of pressure displacement during posturography decreased.

Conclusion

Clinical studies are warranted to assess effects of frNMS and its mechanisms of action in a controlled setting.

Keywords:

• Cerebral palsy
• feasibility
• magnetic stimulation
• motor impairment
• physical exercise
• repetitive neuromuscular magnetic stimulation
• repetitive peripheral magnetic stimulation

Disclosure Statement

The magnetic stimulator used to treat the patient reported in this brief report was made available to the research group by the manufacturer Zimmer MedizinSysteme GmbH, Neu-Ulm, Germany. No potential conflict of interest was reported by the author(s).

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Additional information

Notes on contributors

Michaela V. Bonfert

Michaela V. Bonfert, MD, Department of Pediatrics – Dr. von Hauner Children’s Hospital, Division of Pediatric Neurology and Developmental Medicine & LMU Center for Children with Medical Complexity – iSPZ Hauner, LMU Hospital, Ludwig-Maximilians-Universität München, Munich, Germany.

Anne Meuche

Anne Meuche, Medical Student, Department of Pediatrics – Dr. von Hauner Children’s Hospital, Division of Pediatric Neurology and Developmental Medicine & LMU Center for Children with Medical Complexity – iSPZ Hauner, LMU Hospital, Ludwig-Maximilians-Universität München, Munich, Germany.

Giada Urban

Giada Urban, Medical Student, Department of Pediatrics – Dr. von Hauner Children’s Hospital, Division of Pediatric Neurology and Developmental Medicine & LMU Center for Children with Medical Complexity – iSPZ Hauner, LMU Hospital, Ludwig-Maximilians-Universität München, Munich, Germany.

Corinna Börner

Corinna Börner, MSc, Department of Pediatrics – Dr. von Hauner Children’s Hospital, Division of Pediatric Neurology and Developmental Medicine & LMU Center for Children with Medical Complexity – iSPZ Hauner, LMU Hospital, Ludwig-Maximilians-Universität München, Munich, Germany.

Ute Breuer

Ute Breuer, Physiotherapist, Department of Pediatrics – Dr. von Hauner Children’s Hospital, Division of Pediatric Neurology and Developmental Medicine & LMU Center for Children with Medical Complexity – iSPZ Hauner, LMU Hospital, Ludwig-Maximilians-Universität München, Munich, Germany.

Birgit Warken

Birgit Warken, MSc, Department of Pediatrics – Dr. von Hauner Children’s Hospital, Division of Pediatric Neurology and Developmental Medicine & LMU Center for Children with Medical Complexity – iSPZ Hauner, LMU Hospital, Ludwig-Maximilians-Universität München, Munich, Germany.

Christine Wimmer

Christine Wimmer, MSc, Specialist Centre for Paediatric Neurology, Neurorehabilitation and Epileptology, Schoen Clinic Vogtareuth, Vogtareuth, Germany.

Henriette Strattner

Henriette Strattner, Physiotherapist, Specialist Centre for Paediatric Neurology, Neurorehabilitation and Epileptology, Schoen Clinic Vogtareuth, Vogtareuth, Germany.

Tessa Müller

Tessa Müller, MD, Specialist Centre for Paediatric Neurology, Neurorehabilitation and Epileptology, Schoen Clinic Vogtareuth, Vogtareuth, Germany.

Matthias Hösl

Matthias Hösl, PhD, Gait and Motion Analysis Laboratory, Schoen Clinic Vogtareuth, Vogtareuth, Germany.

Florian Heinen

Florian Heinen, MD, Department of Pediatrics – Dr. von Hauner Children’s Hospital, Division of Pediatric Neurology and Developmental Medicine & LMU Center for Children with Medical Complexity – iSPZ Hauner, LMU Hospital, Ludwig-Maximilians-Universität München, Munich, Germany.

Steffen Berweck

Steffen Berweck, MD, Department of Pediatrics – Dr. von Hauner Children’s Hospital, Division of Pediatric Neurology and Developmental Medicine & LMU Center for Children with Medical Complexity – iSPZ Hauner, LMU Hospital, Ludwig-Maximilians-Universität München, Munich, Germany; Specialist Centre for Paediatric Neurology, Neurorehabilitation and Epileptology, Schoen Clinic Vogtareuth, Vogtareuth, Germany.

Sebastian A. Schröder

Sebastian A. Schröder, MD, Department of Pediatrics – Dr. von Hauner Children’s Hospital, Division of Pediatric Neurology and Developmental Medicine & LMU Center for Children with Medical Complexity – iSPZ Hauner, LMU Hospital, Ludwig-Maximilians-Universität München, Munich, Germany.