Threshold Electrical Stimulation and Cerebral Palsy


Children with cerebral palsy may respond to a variety of electrical stimulation therapies, as this type of treatment has the potential to impact musculature and motor function. Therapies like threshold electrical stimulation may provide results to cerebral palsy patients. Discover how threshold electrical stimulation works for patients with cerebral palsy and determine how this therapy could affect your child.

What Is Threshold Electrical Stimulation?

Although everyone needs electrical stimulation to move muscles, some people can’t rely on natural impulses alone. Generally, neurons, or cells in the nervous system, naturally transmit tiny impulses from the brain to various muscle groups. In some cases, children with cerebral palsy have the potential to benefit from additional electrical impulses.

Threshold electrical stimulation imitates the electrical signals that neurons transmit and sends similar impulses to spastic muscles. This type of therapy relies on low-intensity electrical impulses and doesn’t cause muscle contraction. Unlike many other electrical stimulation treatments, threshold electrical stimulation is typically administered while patients are asleep. It’s designed to treat cerebral palsy and other motor disorders in children.

How Threshold Electrical Stimulation Works

Before therapists recommend threshold electrical stimulation, they evaluate the patient and review related medical history. In most cases, therapists meet with cerebral palsy patients and their families to examine cognitive abilities, discuss any orthopedic issues, and review any history of seizures.

Although this treatment typically takes place overnight while patients sleep at home, therapists first demonstrate the method for patients and their caregivers. To administer this treatment, therapists place one or more electrodes on the patient’s skin around a certain muscle group. Wires connect the electrodes to an electrical generator, which produces the desired impulses. Because the stimulation is set just below the sensory threshold, patients can generally sleep through the low-intensity impulses.

As patients sleep, both blood flow and hormone secretion tend to increase. As a result, therapists believe that this is the ideal time to apply threshold electrical stimulation to enhance muscle growth and bulk.

With regular sessions of threshold electrical stimulation, cerebral palsy patients could experience positive changes in muscle tone and functioning. Some children may develop more muscle bulk and volume, but studies haven’t conclusively demonstrated benefits.

How Effective Is Threshold Electrical Stimulation?

Researchers haven’t yet determined how electrical stimuli may enhance motor function, and no clinical studies have demonstrated that threshold electrical stimulation is effective. As an alternative therapy, it isn’t considered a substitute for accepted treatments. In addition, this treatment doesn’t appear to be effective for treating motor function, joint mobility, or spasticity.

Over the past three decades, a number of randomized controlled trials have examined the effect of threshold electrical stimulation on children with cerebral palsy. Participants in a 1997 study received eight to 12 hours of threshold electrical stimulation each night for a year, while the control group received no electrical stimulation therapy. Because the patients and their families weren’t blinded and therefore knew whether or not they received the therapy, the study didn’t produce conclusive results.

Five years later, a double-blind, placebo-controlled study provided either threshold electrical stimulation or no therapy to 57 children with cerebral palsy. When the study concluded at the end of the 12-month period, neither group showed significant differences in outcomes like muscle size or motor function. As a result, researchers determined that threshold electrical stimulation wasn’t effective.

In 2006, a study examined the effect of threshold electrical stimulation and neuromuscular electrical stimulation in children with cerebral palsy. After 16 weeks, researchers saw no significant difference in terms of strength or motor function. However, researchers did observe that threshold electrical stimulation improved the impact of disability.

Also in 2006, the American Academy for Cerebral Palsy and Developmental Medicine led a systematic review of electrical stimulation therapies after botulinum toxin injection. The review determined that support for these treatments is poor, as there is no evidence that electrical stimulation therapy contributes to improved outcomes.

In 2016, a comprehensive literature review looked at 37 articles exploring the efficacy of electrical stimulation. The review determined that electrical stimulation has the potential to improve spasticity, walking speed, foot and ankle position, and muscle strength and mass. Overall, children with cerebral palsy tend to tolerate electrical stimulation therapy well with only rare adverse reactions. While the study noted that neuromuscular electrical stimulation (NMES) and functional electrical stimulation could provide positive results, it didn’t provide significant evidence for the benefits of threshold electrical stimulation.

As you consider treatment options for your child, it’s important to remember that your child’s condition and symptoms determine whether electrical stimulation is a viable choice. To get more information about how this type of therapy could affect your child, get advice from your healthcare team.

If you have concerns about medical negligence and whether it played a part in your child’s cerebral palsy, the experienced lawyers at Janet, Janet & Suggs can assist. Contact our medical malpractice team for more information about your case and options for legal recourse.



Claire Surles, RN
Reviewed by:
Claire Surles, RN
Registered Nurse

Claire comes to JJS after a 10-year career as a labor and delivery nurse. She dedicated her hospital efforts to advocating for families, providing the safest birthing environment possible as Newborn Admission Nurse at UMMC St. Joseph Medical Center in Towson, Maryland. Her passion for helping those who experienced losses at any stage of gestation led to her appointment as Coordinator of the hospital’s ROOTS perinatal loss program. READ FULL BIO

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