Exopulse Mollii Suit, Motor Functions & CP Children With Cerebral Palsy (EXOCEP2GER)

The Effects of EXOPULSE Mollii Suit on Motor Functions in Children With Cerebral Palsy (EXOCEP 2 GER)

Cerebral Palsy (CP) is is estimated to be around 1.5-3 per live birth, with prenatal factors accounting for 75% of cases. CP appears in early childhood and persists with age and is characterized by permanent lesions or abnormalities affecting the immature brain. It mainly occurs as a motor system disorder (e.g., abnormal movements or posture) with the presence of hemiplegia, diplegia or tetraplegia, and spastic, dyskinetic or atactic syndromes. .This study will explore the potential clinical benefits of the Molliimethod in children with cerebral palsy. Spasticity impacts balance and mobility, halts the patients quality of life and their ability to perform their activity of daily living, and could also increase the risk of fractures and falls. Available interventions that aim on improving spasticity are facing limitations such as varios side effects. Therefore, developing novel therapies such as the EXOPULSE Mollii Suit could help to overcome such limitations and noninvasively improve balance, mobility, quality of life and reduce spasticity and pain in children with CP.

Study Overview

• Status: Completed
• Conditions: Cerebral Palsy; Hemiplegia; Tetraplegia; Pain Syndrome; Spasticity; Balance; Muscle; Diplegia
• Intervention / Treatment: Device: Exopulse Mollii Suit; Device: Sham Exopulse Mollii Suit

Detailed Description

Cerebral Palsy is a heterogenous group of disorders that was first introduced in the literature in 1843 by Little who described musculoskeletal deformities and spastic limbs in the context of neonatal hypoxia. The clinical classification of CP could be based on several system. For instance, the classification by Balf and Ingram takes into account the type, lesion location and severity of the clinical symptoms, and entails the following CP types that could be further considered as mild, moderate or severe: diplegia, hemiplegia or tetraplegia with the presence of spastic syndromes, dyskinetic syndromes and ataxia. In the context of CP, spasticity is a frequent and debilitating symptom that could occur in 70-89% of individuals. Spasticity could subsequently alter the development of motricity, quality of life, patients' self-es-teem and seems to be associated with several health consequences, namely pain, infections, joint deformities, thrombosis and bedsores. Managing spasticity in CP include the combination of pharmacotherapy, motor rehabilitation, and surgical interventions. It is now widely accepted that spasticity impacts balance and mobility, halts the patients quality of life (e.g., urinary symptoms, sexual dysfunction, mood symptoms, low self-esteem) and their ability to perform their activity of daily living, and could also increase the risk of fractures and falls. The available interventions targeting spasticity are faced with some limitations. For instance, botulinum toxin injection does not seem to improve motor functions and quality of life as well as available oral agents are challenged by their potential side effects. Therefore, developing novel therapies would help to overcome the actual limitations. Transcutaneous Electrical Nerve Stimulation (TENS) has proven some efficacy in spasticity management. However, one should note that practical difficulties could arise when using TENS at home or in clinical practice (i.e., correctly attaching electrodes). To overcome these limitations, the Exopulse Mollii Suit has been developed by Exoneural Network AB (initially Inerventions AB), a Swedish medtech company. It represents an innovative approach for non-invasive electrostimulation to reduce spasticity and improve motor function. Based on the theoretical and practical background outlined above, this study will explore the potential clinical benefits of the Mollii-method in children with cerebral palsy. The overall aim of this study is to evaluate the short-term impact of Exopulse Mollii Suit on balance in pediatric patients with cerebral palsy who are suffering from spasticity as well as assessing the effects of Exopulse Mollii Suit on spasticity, mobility, pain, and quality of life.

• Study Type: Interventional
• Enrollment (Actual): 34
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Germany
  • Hanover, Germany
    • Medizinische Hochschule Hannover (MHH)
  • Bavaria
    • Traunstein, Bavaria, Germany
      • Pohlig GmbH

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

Patients will be included if they

• are between 5 and 12 years of age.
• have a clinical diagnosis of unilateraal or bilateral spastic CP by birth [15].
• have a PBS score between a minimum of 15 and a maxmimum of 44 points.
• are able to walk freely, with slight limitation or using ancillary equipment's (GMFCS score ≤3) [49].
• are German speakers, able to understand verbal instructions.
• have spasticity with a score of at least 1+ on the MAS

Exclusion Criteria:

Patients will not be included if they

• are included in another research protocol during the study period.
• are unable to undergo clinical procedures for the study purposes due to geographical or social reasons.
• have a cardiac stimulator, a ventriculoperitoneal shunt, intrathecal baclofen pump.
• have a change in their pharmacological therapy over the last three months or are planning to do so during the study.
• suffer from other somatic or neuropsychiatric diagnoses (e.g., arrhythmias, uncontrolled epilepsy, diseases causing osteoarticular and muscular pain).
• have a body mass index above 35 kg/m2,
• have contraindications to wearing Exopulse Mollii Suit, receive a medical device other than Exopulse Mollii during the study period.
• have received botulinum toxin (botox) therapy in the last 3 months before the start of the study

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Crossover Assignment
• Masking: Triple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Active Stimulation; Active sessions will last 1 hour of stimulation per day for 2 weeks. The following parameters will be used for electric stimulation: low frequency (20 Hz), low current intensity (2 mA), with a small pulse width of 25-170 microseconds.	Device: Exopulse Mollii Suit; Exopulse Mollii suits consists of a body Garments (Jacket and Pants) and a control unit. The body Garments (Jacket and Pants) is a suit with 58 embedded electrodes that can stimulate 40 groups of muscles, conductive wires and connectors to a detachable control unit, whose intended purpose is to transmit electric pulses from the control unit to key nerves and corresponding muscle groups throughout the body. The control unit is a battery powered electrical device which sends low intensity electric pulses through connectors to the Body Garments which in turn transmits the pulses from the connectors to key nerves and corresponding muscle groups throughout the body.
Sham Comparator: Sham Stimulation; In the sham condition, subjects will be asked to wear the device for 1 hour per day for 2 weeks. During 1 hour use per day, the actual stimulation will last only 1 minute and then will shut off.	Device: Sham Exopulse Mollii Suit; In the sham condition, the control unit will be programmed to start stimulating for 1 minute then it will shut off.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Changes in Pediatric Balance Scale (PBS)	Pediatric patients with CP, the PBS has a minimum detectable change (MDC) of 1.59 for the total score and 0.79 (static) and 0.96 (dynamic) for the subscores. Furthermore, the PBS has a minimally clinically important difference (MCID) for the cohort mentioned of 5.83 for the otal score and 2.92 (static) and 2.92 (dynamic) for the subscores.	Visit 1 = Immediately before and after 1h stimulation; Visit 2 = 2 weeks after visit 1; Visit 3 = Immediately before and after 1h stimulation, 4 weeks after visit 1; Visit 4 = 6 weeks after visit 1

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Changes in Modified Ashworth Scale (MAS)	The modified Ashworth Scale measures spasticity in patients with lesions of the Central Nervous System. It tests resistance to passive movement in a joint with varying degrees of velocity. Scores range from 0-4 with 5 choices. A score of 1 indicates no resistance, and a 5 indicates rigidity.	Visit 1 = Immediately before and after 1h stimulation; Visit 2 = 2 weeks after visit 1; Visit 3 = Immediately before and after 1h stimulation, 4 weeks after visit 1; Visit 4 = 6 weeks after visit 1
Changes in Timed Up and Go (TUG)	In the chair with his/her back against the chair back. On the command "go", the patient rises from the chair, walks 3Visit 1 = Immediately before and after first 1h stimulation; Visit 2 = 2 weeks after visit 1; Visit 3 = 4 weeks after visit 1. Immediately before and after first 1h stimulation; Visit 4 = 6 weeks after visit 1 meters at a comfortable and safe pace, turns, walks back to the chair and sits down. Timing begins at the instruction "go" and stops when the patient is seated.	Visit 1 = Immediately before and after 1h stimulation; Visit 2 = 2 weeks after visit 1; Visit 3 = Immediately before and after 1h stimulation, 4 weeks after visit 1; Visit 4 = 6 weeks after visit 1

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Patient Diary	4. Patient Diary A patient diary is provided to patiets to record information during the 14-day homeuse phase. If the child is not able to do this him/herself, the parent or cargicer can support this process. The use of the Exopulse Mollii Suit should be recorded, whether the stimulation duration of 1 hour is adhered every day. In addition, comfort/satisfaction, pain/discomfort and possible incidents such as mild adverse events should be documented.	Visit 1; Visit 2 = 2 weeks after visit 1; Visit 3 = 4 weeks after visit 1. Visit 4 = 6 weeks after visit 1
Blinding Questionnaire	Evaluation of patient's blinding to the type of stimulation will be performed by asking for their perception which treatment they received: "(a) Treatment/ (b) Placebo/ (c) I don' know" and "if (c) I don't know" which they would by chance choose "(a) Treatment/ (b) Placebo.	Visit 2 = 2 weeks after visit 1; Visit 4 = 6 weeks after visit 1
Changes in Functional Gait Assessment (FGA)	(optional)	Visit 1 = Immediately before and after 1h stimulation; Visit 2 = 2 weeks after visit 1; Visit 3 = Immediately before and after 1h stimulation, 4 weeks after visit 1. ; Visit 4 = 6 weeks after visit 1

Collaborators and Investigators

• Sponsor: Exoneural Network AB
• Collaborators: Hannover Medical School; Ottobock SE & Co. KGaA; Pohlig GmbH

Study record dates

Study Major Dates

• Study Start (Actual): April 17, 2023
• Primary Completion (Actual): December 31, 2025
• Study Completion (Actual): December 31, 2025

Study Registration Dates

• First Submitted: April 20, 2023
• First Submitted That Met QC Criteria: May 31, 2023
• First Posted (Actual): June 1, 2023

Study Record Updates

• Last Update Posted (Actual): August 5, 2026
• Last Update Submitted That Met QC Criteria: August 3, 2026
• Last Verified: August 1, 2026

More Information

Terms related to this study

• Keywords: Spasticity; Neurostimulation; Exopulse; Mollii Suit
• Additional Relevant MeSH Terms: Neurologic Manifestations; Musculoskeletal Diseases; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Muscular Diseases; Muscle Hypertonia; Neuromuscular Manifestations; Mental Disorders; Brain Damage, Chronic; Paralysis; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Muscle Spasticity; Somatoform Disorders; Cerebral Palsy; Quadriplegia; Hemiplegia
• Other Study ID Numbers: PS00011278C-001

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No