Impact of Task-Specific Electrical Stimulation on Upper Limb Functional Motor Skills in Children With Spastic Quadriplegia

Cerebral palsy is a non-progressive lesion of the brain occurring before 2 years of age resulting in disorders of posture and movement.( Ostensjo S, 2004)( Keles MN, 2018) . Although non-progressive, motor impairments develop as the child grows leading to activity and participation restriction. For children with CP, body function and structure impairments include changes in muscle tone and strength that affect the ability to control movement, specifically in regard to postural responses, selective control, regulation of activity, ability to learn unique movements, and inappropriate sequencing.(Ross SA, 2007)( Ostensjo S, 2004) . Lack of proper loading and maladaptive muscle pulls over time causes the skeletal system to adapt to positions of malalignment, malformation, and overall bone weakness (Beckung E, 2007) (Elbasan B, 2018) . These changes lead to delays in the natural progression of gross motor skills. As the child falls behind in motor function, they also fall behind in cognitive stimulation and development.( Akaya KU, 2018) . Understanding the anatomical and physiological implications that CP has on the developing child is necessary for physical therapists to treat this population, especially when utilizing electrical stimulation. Spastic quadriplegia Is a type of cerebral palsy that affects all four limbs and typically involves significant motor impairment. It results from brain damage that occurs before, during, or shortly after birth, affecting the areas of the brain responsible for movement and coordination. Electrical stimulation is a mode of physical therapy that can be utilized in the treatment of various nerve and muscle injuries, in addition to patients with acute and chronic pain. It involves an electrical pulse applied to a muscle or nerve that activates excitable tissue utilizing internal or external electrodes to build muscle strength, reduce pain, as well as create or support limb movement (Kerr C, 2007) .

Inclusion Criteria: * Their age will be ranged from 4 to 7 years. * Their grade of spasticity will be from 1+ to 2 according to Modified Ashworth scale * They will be on Level III and IV according to Gross Motor Functional Classification System (GMFCS). * Parents/legals representatives consenting to their child's participation * Diagnosed with Spastic Quadriplegic cerebral palsy Exclusion Criteria: 1. Previous neurological or orthopedic surgery in the upperextremities. 2. Fixed deformity in the joints of upper limb. 3- Severe hearing and visual defect. 4-Irregular attendance at assessments or therapy sessions