Physiotherapy 90 (2004) 82–90 Effect of Functional Electrical Stimulation on asymmetries in gait of children with hemiplegic cerebral palsy S. Durham a,* , L. Eve b , C. Stevens c , D. Ewins a,c a Gait Laboratory, Rehabilitation Centre, Queen Mary’s Hospital, Roehampton Lane, London SW15 5PN, UK b One Small Step Gait Laboratory, Guy’s Hospital, London, UK c Centre for Biomedical Engineering, University of Surrey, Guildford, UK Abstract Background and purpose The gait of children with hemiplegic cerebral palsy is often characterised by toe walking and asymmetry in other temporal spatial parameters. Persistent toe walking impairs balance, resulting in shortening of the musculo-tendinous unit and reduced function. Current interventions to maintain range of movement at the ankle and improve walking patterns show mixed results. An alternative may be Functional Electrical Stimulation (FES), which is effective in assisting walking in adults, however there is limited research assessing its effectiveness or acceptability in children. The aims of this study were to quantify gait asymmetries, assess the effect of FES on these in an ambulant group of hemiplegic children and evaluate user perspective. Methods A ABA design was used, with stimulation applied in phase B, replacing any splint normally worn. Heel–toe contact pattern and other temporal spatial parameters of gait were measured in 12 children, before, during and after applying FES to the ankle dorsiflexors. Acceptability of the intervention and user perspective were investigated through use of a questionnaire. Results The greatest asymmetries were in heel–toe contact patterns and double stance times. Heel–toe contact pattern and symmetry were both improved with stimulation. There was a clear trend toward reduction in affected side pre-swing double stance time and a move toward symmetry. Mean swing and stance times were close to symmetry with and without stimulation. Electrical stimulation was generally well tolerated. Conclusions Electrical stimulation may be an effective intervention, when used functionally, to improve asymmetrical walking patterns. Further research is needed to refine selection criteria of subjects who may benefit and to optimize use of stimulation. © 2004 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved. Keywords: Cerebral palsy; Electrical stimulation; Gait; Symmetry Introduction The gait of children with hemiplegic cerebral palsy is of- ten characterised by asymmetry in heel–toe foot contact pat- tern and other temporal and spatial parameters of walking. Typically the toe of the affected leg contacts the floor before the heel or there may be a complete absence of heel contact. Toe walking (equinus) adversely affects balance [1] and stability by altering the base of support on one side. The instability can result in asymmetry in stance time, step length, swing time, double support time and stride length [2]. Equinus in the swing phase compromises foot clearance * Corresponding author. Tel.: +44-20-8355-2175; fax: +44-20-8355-2953. E-mail address: sally.durham@swlondon.nhs.uk (S. Durham). and results in compensatory adjustments such as vaulting or increased knee and hip flexion. Current physiotherapy practice (e.g. exercises and stretches), attempts to correct the equinus and asymme- tries, encourages a heel–toe walking pattern and maintains muscle length. Other interventions including serial casting, splinting, botulinum toxin injections and surgery are also directed towards this end [3]. However, outcomes from all these interventions are mixed with some having temporary results and some being poorly tolerated. Electrical stimulation is an alternative intervention, whereby electrical pulses are applied through surface elec- trodes using a small, lightweight, battery powered unit, causing muscle contractions. Electrical stimulation has been used successfully in adults with hemiplegia to correct foot drop during the swing phase of gait [4] and to improve 0031-9406/$ – see front matter © 2004 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.physio.2004.02.003