Pediatric Rheumatology Online Journal → June 2003 → Rehabilitation→ Abstract #70

THERAPEUTIC ELECTRICAL STIMULATION AND HOME EXERCISE IN CHILDREN WITH JUVENILE IDIOPATHIC ARTHRITIS

J. C. Olson,¹ J. R. McGuire,⁵ M. E. Urban,² R. G. Hoffmann,⁶ M. J. Butler,^3,4 J. J. Nocton.¹

¹Pediatrics, Medical College of Wisconsin, Milwaukee, WI; ²Health and Family Services, State of Wisconsin, Madison, WI; ³PT, Children's Hospital of Wisconsin, Milwaukee, WI; ⁴PT, Curative Care Network, Milwaukee, WI; ⁵PM&R, Medical College of Wisconsin, Milwaukee, WI; ⁶Biostatistics, Medical College of Wisconsin, Milwaukee, WI

Children with Juvenile Idiopathic Arthritis (JIA) most commonly, have knee joint involvement, which can result in long-term or permanent quadriceps atrophy. Nocturnal therapeutic electrical stimulation (TES) is a low intensity subthreshold electrical stimulation used for muscle strengthening in neuromuscular conditions. We hypothesized that TES would result in improvements in strength and muscle size of the treated leg when used in conjunction with routine medical management and a supervised home exercise program (HEP). Eighteen children with JIA and bilateral knee arthritis that was either active or inactive with residual quadriceps atrophy were randomized to receive unilateral TES to the quadriceps muscle. The unit was worn during sleep for a minimum of 5 hours, 6 nights/week. Outcome measures at baseline and monthly for 6 months included: isometric knee extensor force by computerized dynamometer and manual muscle testing (MMT), knee extension range of motion (ROM), CHAQ, and thigh circumference. The evaluating physical therapist was blind to the site of the TES. After 6 mos. of TES and HEP; bilateral improvements were seen in isometric knee extensor force (mean 7.5 Nm or 15%, p.0001), quadriceps MMT (mean 0.2, p.012), ROM (mean 2.7 deg., p.023) and thigh circumference (mean 1.4 mm, p.01). CHAQ improved (mean 0.25, p.0021) and this was mostly due to the domains affecting lower extremity function (mean 0.36, p.0001). While there were bilateral improvements in strength and thigh circumference, there were no statistically significant differences between TES treated and untreated legs. There was 1 unit malfunction and no reported complications. While we did not see greater changes on the TES treated leg, the combination of TES and HEP safely and effectively improved lower extremity strength and function. Further study is needed to determine if the benefits are from HEP alone, or the combination of HEP and TES.