Cerebral palsy is a disorder characterized by abnormal tone, posture and movement clinically classified based on the predominant motor syndrome−spastic diplegia, spastic hemiplegia, spastic quadriplegia and extrapyramidal or dyskinetic. On the other hand, the incidence of CP is 2 to 3 per, 1000 live births. Prematurity and low birth weight are important risk factors for CP, however multiple other factors have been associated with an increased risk for CP, including maternal infections, and multiple gestation. In most cases in CP the initial injury to the brain occurs during early-fetal–brain development, intracerebral hemorrhage and periventicul at leukomalacia are the main pathologic findings found in preterm infants who develop CP. Moreover, the diagnosis of CP is primarily based on clinical findings. Early diagnosis is possible based on a combination of clinical history, use of standardized neuromotor assessment and findings on magnetic resonance imaging, however, in most clinical setting CP are more reliably recognized by 2 years age. MRI scan is indicated to delineate the extent of brain lesions and to identify congenital brain malformations.
Children and young people with neurological conditions can also benefit from ‘FES treatment’ but there is gap in clinical knowledge, awareness and evidence which needs addressing. Some of the known benefits of FES include safe walking with facilitation and exercise of normal movement, muscle strengthening, joint range and proprioceptive improvements as well as spasticity reduction. FES is considered an affordable, secure, and effective treatment for assisting patients to reach their rehabilitation objectives. Given that their neurological disabilities affect muscle activation and learning of movement, children with CP.
Aim: The aim of the present study was to assess the effectiveness of functional electrical stimulation in upper limb rehabilitation (U L Rehab) in children with cerebral palsy. Moreover, this article aims to share our clinical experience in using FES for children in spastic diplegia with CP to assist in addressing this knowledge gap.
Methods:168 children with spastic cerebral palsy age between 4 years to 18 years old were randomized into 2 groups. On the other hand, 45 children represented the control group, performed conventional physical therapy. In addition to the control group, the experimental group received functional electrical stimulation interventions with postural control on the affected upper-limb.
Objective: To investigate the effectiveness of functional electrical stimulation (FES) to improve upper limb function in children with spastic diplegia of CP in children.
To assess the effect of FES on upper limb (UL) function in children with spastic diplegia of CP at six months post-intervention.

Clinical consideration for applying FES to children: There are important challenges when providing FES for children compared to adults. Moreover, the developmental stages of the neurological system, its neuroplasticity and the lack of learned function are the main difference. More frequent FES reviews are necessary due to constant growth and neuro-developmental changes. Children with CP require education of an activity or function they may not have ever experienced or felt. They lack understanding of normal movement patterns which their peers will have.
Methodology: Design and Study setting: 40 children with spastic cerebral palsy, age between 4 to 18 years old, were randomized into 2 groups. 45 children represented the control group, performed conventional physiotherapy treatment. This study employed a prospective pre/post-test, follow-up design in Spinal Life Physiotherapy Clinic www.spinallife.in . All participants received up to 40 FES therapy session applied to the spastic diplegia CP children in UL. Assessment was made at pretest (i.e before FES), and post-test (within one week after completion of the last therapy session) and follow-up (six months after the intervention period had ended).
The study was registered with ClinicalTrial.gov (OMB No. 0925-0586). Moreover, written informed assent /consent was obtained from all participants/ parents.
Results: Participant recruitment target was not met but adherence was high, and functional electrical stimulation was found to be safe and comfortable. Of the three participants, two of them improved in grasp at post-test, whereas one child’s ability deteriorated. Only one child met success criteria on most outcomes at post-test.
Discussion and Conclusion: The study concluded and emphasis, that functional electrical stimulation intervention was found to be an effective manner to improve motor performance, in terms of coordination, range of motion, three-fingered grasp strength, visibly reducing functional-limitation and improving performance in activities of daily living (ADL). Moreover, the results suggest that FES is effective in increasing impulse during walking but not in decreasing stiffness. The effect on increasing impulse does not result in more typical spatiotemporal gait parameters.
A future case comparison investigation with a larger but more selected sample is suggested.
FES offers promising potential as an adjunct therapy to complement existing treatments for upper limb dysfunction in children with spastic diplegic CP (SCP). Current evidence suggests it can improve a range of motor functions, but more research is necessary to refine treatment protocols and confirm its efficacy across different populations and settings. Evidence Based Treatment Approach: Any approach which is evidence based might be more attractive in the society.
Scientific-novelty: In this study it synthesizes updated evidence regarding lower limb functional electrical stimulation parameters and patient characteristics. Moreover, it also discusses emerging trends in individualized and home based application.

Keywords:Cerebral Palsy; Functional Electrical Stimulation; Manual Ability Classification System Spastic Diplegia Of CP; GMFCS.