Electrical stimulation therapy in children with muscle dysfunction: a systematic review

Background: Electrical stimulation (ES) has been widely used as an add on therapy to reduce atrophy and preserve muscle strength in adults unable to carry out active mobilization. Nevertheless, this therapeutic modality is still underutilized in children. Aim: To investigate the evidences of ES in children. Methods: Systematic review of randomized studies through research of Cochrane Library, SciELO, Pubmed and PEDro databases, until january 2017. The keywords utilized were “electrical stimulation”, “children” and “muscle weakness”. Methodological quality was measured through RevMan5. Results: Nine papers involving 304 participants (9,5±8 years old) were included. Predominantly, the electric current used was Functional Electric Stimulation (FES). ES sessions were well tolerated, without adverse effects. The main use of ES was in children9s neurological impairments (e.g., cerebral palsy). Six studies showed that ES combined with conventional physical therapy was more effective compared to SHAM, in spasticity, balance and gait. It was not reported the use of ES in respiratory muscles, however, a study involving 30 children with C4 to T11 injury levels showed an improvement (P=.035) in VO2 (16.2%+/-25.0%) with combination of cycling and FES. Conclusion: There are no international guidelines regarding electrical stimulation therapy in children, but few studies have used FES as electric current of choice. Until more evidence from randomized studies is available, ES may be used as a supplementary form in limb muscle dysfunctions. Moreover, the authors identified gaps in the literature about ES to ICU-acquired weakness in critically ill children and respiratory muscle dysfunctions.