The problem of obtaining funding for Functional Electrical Stimulation is not confined to children’s therapy services. However, with a large number of the published literature and guidance drawing on adult stroke studies ours is further problematic.

The National Institute of Health and Clinical Excellence (NICE IPG278), published guidance in January 2009 and the Purchasing and Supply Agency, Centre for Evidence Based Purchasing, economic report (CEP10012) in 2010, both draw on adult studies of patients following a stroke to support the efficacy of intervention.

Children like adults, present with drop foot resulting from damage to the nervous system present from birth such as cerebral palsy or from an acquired injury such as stroke or traumatic brain injury. The differences with children are however, any injury is within a developing brain, in a body that has to accommodate the challenge of upwards growth, deal with factors of tolerance of stimulation secondary to age and those of a younger age are reliant on parents/ carers to assist with the use of any device.

In order to further supplement the adult evidence and add weight to funding cases, an electronic database search was carried out to focus on finding studies within the paediatric population for the use of FES.

For the purpose of this piece of work only those studies of drop foot were reviewed. In view of the lack of high level evidence and the specific nature of the population being researched, consideration was given to evidence from less reliable sources, such as single case studies and non randomised studies including observational studies. Following this procedure, 19 individual articles were highlighted and a descriptive narrative was completed.

All of these studies looked at children with CP of either a hemiplegic or diplegic presentation who were ambulatory. Large variances were seen between studies for the length of FES treatment time (from weeks to 12 months) and how often that stimulation was given (from daily to once weekly). All of the studies had relatively low sample sizes averaging between 10- 20 children.

All of the studies available have results that demonstrate a trend to positive outcomes when FES is used. There is however, a clear need for more rigorous research designs and larger studies.

Positive outcomes are also noted clinically at Birmingham Children’s Hospital following treatment of our current small case load over a number of years for children with both cerebral palsy and ABI. The stimulation appears to be well tolerated and have the positive effects of reducing the need for other orthotic devices, reducing the frequency of serial casting, increasing passive range and with time allowing the patient to access some active movement without the stimulation in place.