Lower extremity functional electrical stimulation cycling promotes physical and functional recovery in chronic spinal cord injury

• Published in: The journal of spinal cord medicine 2013-11, Vol.36 (6), p.623-631
• Main Authors: Sadowsky, Cristina L., Hammond, Edward R., Strohl, Adam B., Commean, Paul K., Eby, Sarah A., Damiano, Diane L., Wingert, Jason R., Bae, Kyongtae T., McDonald, John W.
• Format: Article
• Language: English
• Subjects: Activity-based restorative therapy; Adult; Assistive technology; Cross-Sectional Studies; Cycle ergometry; Electric Stimulation Therapy - methods; Exercise Therapy - methods; Female; Functional electrical stimulation; Humans; Lower Extremity - physiopathology; Male; Muscle Spasticity - physiopathology; Muscle Spasticity - rehabilitation; Muscle Strength - physiology; Muscle, Skeletal - physiopathology; Paraplegia; Physical muscle strength; Quality of life; Recovery of Function; Rehabilitation; Retrospective Studies; Spasticity; Spinal Cord Injuries - complications; Spinal Cord Injuries - physiopathology; Spinal Cord Injuries - rehabilitation; Spinal cord injury; Tetraplegia
• ISSN: 1079-0268; 2045-7723
• DOI: 10.1179/2045772313Y.0000000101

Objective To examine the effect of long-term lower extremity functional electrical stimulation (FES) cycling on the physical integrity and functional recovery in people with chronic spinal cord injury (SCI). Design Retrospective cohort, mean follow-up 29.1 months, and cross-sectional evaluation. Setting Washington University Spinal Cord Injury Neurorehabilitation Center, referral center. Participants Twenty-five people with chronic SCI who received FES during cycling were matched by age, gender, injury level, and severity, and duration of injury to 20 people with SCI who received range of motion and stretching. Intervention Lower extremity FES during cycling as part of an activity-based restorative treatment regimen. Main outcome measure Change in neurological function: motor, sensory, and combined motor-sensory scores (CMSS) assessed by the American Spinal Injury Association Impairment scale. Response was defined as ≥1 point improvement. Results FES was associated with an 80% CMSS responder rate compared to 40% in controls. An average 9.6 CMSS point loss among controls was offset by an average 20-point gain among FES subjects. Quadriceps muscle mass was on average 36% higher and intra/inter-muscular fat 44% lower, in the FES group. Hamstring and quadriceps muscle strength was 30 and 35% greater, respectively, in the FES group. Quality of life and daily function measures were significantly higher in FES group. Conclusion FES during cycling in chronic SCI may provide substantial physical integrity benefits, including enhanced neurological and functional performance, increased muscle size and force-generation potential, reduced spasticity, and improved quality of life.