Functional Electrical Stimulation and Spinal Cord Injury

Phys Med Rehabil Clin N Am, 2014 · DOI: 10.1016/j.pmr.2014.05.001 · Published: August 1, 2014

Spinal Cord Injury Neurology Rehabilitation

Simple Explanation

Spinal cord injuries disrupt communication between the brain and body, leading to loss of control over muscles. Electrical stimulation (ES) can help restore function by taking advantage of intact neuromuscular systems. ES can provide therapeutic exercise, restore functions, and manage medical complications after SCI. Many ES devices are commercially available and should be considered for lifelong rehabilitation care. Neuroprostheses employing ES can postpone or prevent secondary medical complications and improve functional independence by providing a means to exercise and negotiate physical barriers.

Study Duration

Not specified

Participants

Individuals with spinal cord injuries

Evidence Level

Not specified

Key Findings

1
FES can restore upper extremity function, enabling activities of daily living for individuals with cervical SCI. Neuroprostheses make use of the patient’s own paralyzed musculature to provide the power for grasp and the patient’s voluntary musculature to control the grasp.
2
For individuals with thoracic-level complete SCI, stimulated contractions of the lower extremity muscles can enable standing and stepping, increase personal mobility, and improve general health and quality of life.
3
Electrical stimulation can improve respiratory muscle function, which is discussed in depth in the section entitled “Diaphragm Pacing in Spinal Cord Injury”

Research Summary

Functional electrical stimulation (FES) of the central and peripheral nervous system can take advantage of these intact neuromuscular systems to provide therapeutic exercise options, to allow functional restoration, and even to manage or prevent many medical complications following SCI. Many of the ES devices are already commercially available and should be considered by all SCI clinicians routinely as part of the lifelong rehabilitation care plan for all eligible individuals with SCI. Intermittent electrical stimulation (IES) was developed for the prevention of DTI. This method applies brief ES through surface electrodes to muscles around bony prominences that are loaded during sitting or lying down (e.g., the gluteus maximus muscles) every few minutes causing them to contract.

Practical Implications

Upper Extremity Restoration

FES can enable individuals with cervical SCI to perform ADL such as eating, personal hygiene, and office tasks.

Lower Extremity Restoration

FES can help individuals with thoracic-level SCI to stand and step, increasing mobility and improving quality of life.

Pressure Ulcer Prevention

Electrical stimulation, both intermittent and implanted, can prevent pressure ulcers and deep tissue injuries, reducing healthcare costs and improving patient outcomes.

Study Limitations

1
Invasiveness of implanted electrodes and the potential risk of infection
2
Time-dependent failure of neural interfaces in vivo due to encapsulation
3
Limited availability of implanted standing and walking systems; currently only available on a research basis

Your Feedback

Was this summary helpful?

Back to Spinal Cord Injury