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

Abstract

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.

Keywords:

• Spinal cord injury
• Activity-based restorative therapy
• Functional electrical stimulation
• Rehabilitation
• Cycle ergometry
• Assistive technology
• Paraplegia
• Tetraplegia
• Rehabilitation
• Physical muscle strength
• Spasticity
• Quality of life

Acknowledgements

This work was supported by funding from the Deans Fund at Washington University School of Medicine (J.W.M.), Barnes-Jewish Hospital Foundation (J.W.M.), the Barnes-Jewish Hospital Auxiliary Foundation (J.W.M.), Christopher Reeve Paralysis Foundation (C.S., J.W.M.), the Nextsteps Foundation (St. Louis, MO; J.W.M.), the Sam Schmidt Foundation (Las Vegas, NV; C.S., J.W.M.), Gateway to a Cure Foundation (St. Louis, MO; J.W.M.), and the Eric Westacott Foundation (St. Louis, MO; J.W.M.) and, in part, by the Intramural Research Program at the NIH Clinical Center. Our appreciation to Anna Schneider for technical assistance. Author J.W.M. had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.