The use of surface electromiography as a measure of physiotherapy outcomes in children with cerebral palsy: a systematic review

  • Bruna Garcia Schmidt Centro de Integração da Criança Especial; AACD – Associação de Assistência à Criança Deficiente, Porto Alegre, RS, Brasil
  • Laís Rodrigues Gerzson Programa de Pós-Graduação Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil
  • Carla Skilhan de Almeida Departamento de Educação Física, Fisioterapia e Dança, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil
Keywords: Cerebral palsy, Physiotherapy, Electromyography


Introduction: Cerebral palsy is the most common physical disability in childhood. Physical therapy plays a central role in managing the treatment of disease sequelae. However, it is always a challenge to quantify the results obtained in physical therapy interventions. Thus, surface electromyography has been increasingly used by physiotherapists because it is a quantitative method of evaluation and treatment of neuromuscular system dysfunctions.

Objective: To analyze the use of surface electromyography as a physical therapy outcome measure in children with cerebral palsy.

Methods: From the search in two important databases, clinical trials of physical therapy interventions that used surface electromyography as a physiotherapy outcome factor in children with cerebral palsy, published in Portuguese, English, French or Spanish until August 2019, were selected.

Results: A total of 166 articles were found in the databases searched. Of these, only 15 were included and classified with good methodological quality by PEDro and because they were related to surface electromyography. A flowchart with standardization of actions was built taking into account the most prevalent findings in the studies.

Conclusion: Surface electromyography has been applied by physiotherapists to evaluate the effects of the intervention, but it is necessary to improve its level of evidence.



Download data is not yet available.

Author Biography

Bruna Garcia Schmidt, Centro de Integração da Criança Especial; AACD – Associação de Assistência à Criança Deficiente, Porto Alegre, RS, Brasil

Fisioterapeuta, Kinder


1. Englander ZA, Sun J, Case L, Mikati MA, Kurtzberg J, Songa AW. Brain structural connectivity increases concurrent with functional improvement: Evidence from diffusion tensor MRI in children with cerebral palsy during therapy. Neuroimage Clin. 2015;7:315-24. DOI:

2. Centers for Disease Control and Prevention (CDC). Data and Statistics for Cerebral Palsy. [internet] 2016 [cited 2020 May 12] Available from:

3. Surveillance of Cerebral Palsy in Europe (SCPE). Surveillance of cerebral palsy in Europe: a collaboration of cerebral palsy surveys and registers. Dev Med Child Neurol. 2000;42(12):816-24. DOI:

4. Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Ações Programáticas Estratégicas. Diretrizes de atenção à pessoa com paralisia cerebral. Brasília: Ministério da Saúde, 2014.

5. Hegarty AK, Kurz MJ, Stuberg W, Silverman AK. Changes in Mobility and Muscle Function of Children with Cerebral Palsy after Gait Training: A Pilot Study. J Appl Biomech. 2016;32(5):469-86. DOI:

6. Anttila H, Autti-Rämö I, Suoranta J, Mäkelä M, Malmivaara A. Effectiveness of physical therapy interventions for children with cerebral palsy: A systematic review. BMC Pediatr. 2008;8:14. DOI:

7. Brown GT, Burns SA. The efficacy of neurodevelopmental treatments in Paediatrics: a systematic review. Br J Occupational Therapy. 2001;64(5):235-44. DOI:

8. Dodd KJ, Taylor NF, Damiano DL. A systematic review of the effectiveness of strength training programs for people with cerebral palsy. Arch Phys Med Rehabil. 2002;83(8):1157-64. DOI:

9. Moreau NG, Bodkin AW, Bjornson K, Hobbs A, Soileau M, Lahasky K. Effectiveness of Rehabilitation Interventions to Improve Gait Speed in Children With Cerebral Palsy: Systematic Review and Meta-analysis. Phys Ther. 2016;96(12):1938-54. DOI:

10. Park EJ, Baek SH, Park S. Systematic review of the effects of mirror therapy in children with cerebral palsy. J Phys Ther Sci. 2016;28(11):3227-31. DOI:

11. Saquetto M, Carvalho V, Silva C, Conceição C, Gomes-Neto M. The effects of whole body vibration on mobility and balance in children with cerebral palsy: a systematic review with meta-analysis. J Musculoskelet Neuronal Interact. 2015;15(2):137-44.

12. Whalen CN, Case-Smith J. Therapeutic Effects of Horseback Riding Therapy on Gross Motor Function in Children with Cerebral Palsy: A Systematic Review. Phys Occup Ther Pediatr. 2012;32(3):229-42. DOI:

13. Carr JH, shepherd RB. The changing face of neurological rehabilitation. Rev Bras Fisioter. 2006;10(2):147-56. DOI:

14. Ocarino JM, Silva PLP, Vaz DV, Aquino CF, Brício RS, Fonseca ST. Eletromiografia: interpretação e aplicações nas ciências da reabilitação. Fisioter Bras. 2005;6(4):305-10.

15. Shiwa SR, Costa LOP, Moser ADL, Aguiar IC, Oliveira LVF. PEDro: a base de dados de evidências em fisioterapia. Fisioter Mov. 2011;24(3):523-33. DOI:

16. McGibbon NH, Benda W, Duncan BR, Silkwood-Sherer D. Immediate and long-term effects of hippotherapy on symmetry of adductor muscle activity and functional ability in children with spastic cerebral palsy. Arch Phys Med Rehabil. 2009;90(6):966-74. DOI:

17. Fowler EG, Ho TW, Nwigwe AI, Dorey FJ. The effect of quadriceps femoris muscle strengthening exercises on spasticity in children with cerebral palsy. Phys Ther. 2001;81(6):1215-23.

18. Benda W, McGibbon NH, Grant KL. Improvements in muscle symmetry in children with cerebral palsy after equine-assisted therapy (hippotherapy). J Altern Complement Med. 2003;9(6):817-25. DOI:

19. Hodapp M, Vry J, Mall V, Faist M. Changes in soleus H-reflex modulation after treadmill training in children with cerebral palsy. Changes in soleus H-reflex modulation after treadmill training in children with cerebral palsy. Brain. 2009;132(Pt 1):37-44. DOI:

20. Stearns GE, Burtner P, Keenan KM, Qualls C, Phillips J. Effects of constraint-induced movement therapy on hand skills and muscle recruitment of children with spastic hemiplegic cerebral palsy. NeuroRehabilitation. 2009;24(2):95-108. DOI:

21. Reid S, Hamer P, Alderson J, Lloyd D. Neuromuscular adaptations to eccentric strength training in children and adolescents with cerebral palsy. Dev Med Child Neurol. 2010;52(4):358-63. DOI:

22. Liao HF, Gan SM, Lin KH, Lin JJ. Effects of weight resistance on the temporal parameters and electromyography of sit-to-stand movements in children with and without cerebral palsy. Am J Phys Med Rehabil. 2010;89(2):99-106. DOI:

23. Trócoli T, Oliveira L, Kanashiro M, Braga D, Cyrillo F. Electromyographic analysis of quadriceps muscle among children with cerebral palsy underwater and on dry ground. [internet] 2011 [cited 2020 May 12] Available from:

24. Bigongiari A, Souza FA, Franciulli PM, Neto Sel R, Araujo RC, Mochizuki L. Anticipatory and compensatory postural adjustments in sitting in children with cerebral palsy. Hum Mov Sci. 2011;30(3):648-57. DOI:

25. Arya BK, Mohapatra J, Subramanya K, Prasad H, Kumar R, Mahadevappa M. Surface EMG analysis and changes in gait following electrical stimulation of quadriceps femoris and tibialis anterior in children with spastic cerebral palsy. Conf Proc IEEE Eng Med Biol Soc. 2012;2012:5726-9. DOI:

26. Santos CG, Pagnussat AS, Simon AS, Py R, Pinho AS, Wagner MB. Humeral external rotation handling by using the Bobath concept approach affects trunk extensor muscles electromyography in children with cerebral palsy. Res Dev Disabil. 2015;36C:134-41. DOI:

27. Simon AS, Pinho AS, Santos CG, Pagnussat AS. Facilitation handlings induce increase in electromyographic activity of muscles involved in head control of cerebral palsy children. Res Dev Disabil. 2014;35(10):2547-57. DOI:

28. Xu K, LuHe, Mai J, Yan X, Chen Y. Muscle Recruitment and Coordination following Constraint-Induced Movement Therapy with Electrical Stimulation on Children with Hemiplegic Cerebral Palsy: A Randomized Controlled Trial. PLoS One. 2015;10(10):e0138608. DOI:

29. Mukhopadhyay R, Lenka PK, Biswas A, Mahadevappa M. Evaluation of Functional Mobility Outcomes Following Electrical Stimulation in Children with Spastic Cerebral Palsy. J Child Neurol. 2017;32(7):650-6. DOI:

30. Ribeiro MF, Espindula AP, Lage JB, Bevilacqua Júnior DE, Diniz LH, Mello EC, et al. Analysis of the electromiographic activity of lower limb and motor function in hippotherapy practitioners with cerebral palsy. J Bodyw Mov Ther. 2019; 23(1):39-47. DOI:

31. Palisano R, Rosenbaum P,Walter S , Russell D, Wood E, Galuppi B. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol. 1997;39(4):214-23. DOI:

32. Eliasson AC, Krumlinde-Sundholm L, Rösblad B, Beckung E, Arner M, Ohrvall AM, et al. The Manual Ability Classification System (MACS) for children with cerebral palsy: scale development and evidence of validity and reliability. Dev Med Child Neurol. 2006;48(7):549-54. DOI:

33. Ferreira AS, Guimarães FS, Silva JG. Aspectos Metodológicos da Eletromiografia de Superfície: Considerações sobre os sinais e processamentos para estudo da função neuromuscular. Rev Bras Cienc Esporte. 2010;31(2):11-30.

34. Portney L, Roy SH. Eletromiografia e testes de velocidade de condução nervosa. Fisioterapia avaliação e tratamento. 4 ed. São Paulo: Manole, 2004; p. 213-56.

35. De Luca CJ. The Use of Surface Electromyography in Biomechanics. J Appl Biomech. 1997;13(2):135-63. DOI:

36. Damiano DL, Alter KE, Chambers H. New Clinical and Research Trends in Lower Extremity Management for Ambulatory Children with Cerebral Palsy. Phys Med Rehabil Clin N Am. 2009;20(3):469-91. DOI:

37. Tank FF, Silva GT, Oliveira CG, Garcia MAC. Influência da distância intereletrodos e da cadencia de movimento no domínio da frequência do sinal de EMG de superfície. Rev Bras Med Esporte. 2009;15(4):272-6. DOI:

38. Zhou J, Butler EE, Rose J. Neurologic Correlates of Gait Abnormalities in Cerebral Palsy: Implications for Treatment. Front Hum Neurosci. 2017;11:103. DOI:

39. Labarre-Vila A. Assessment of muscle function in pathology with surface electrode EMG. Rev Neurol (Paris). 2006;162(4):459-65. DOI:

40. Nielsen JLG, Holmgaard S, Jiang N, Englehart KB, Farina D, Parker PA. Simultaneous and proportional force estimation for multifunction myoelectric prostheses using mirrored bilateral training. IEEE Trans Biomed Eng. 2011;58(3):681-8. DOI:

41. Li H, Zhao G, Zhou Y, Chen X, Ji Z, Wang L. Relationship of EMG/SMG features and muscle strength level: an exploratory study on tibialis anterior muscles during plantar-flexion among hemiplegia patients. Biomed Eng Online. 2014;13:5. DOI: