Functional electrical stimulation for incomplete spinal cord injury

Proc (Bayl Univ Med Cent), 2014 · DOI: · Published: October 1, 2014

Spinal Cord Injury Neurology Rehabilitation

Simple Explanation

Functional electrical stimulation (FES) cycle ergometry uses electrical current to stimulate peripheral motor units during a functional task such as cycling. Although FES cannot reverse denervation, it can assist with the conversion of type II fast-twitch muscle fi bers back to type I slow-twitch muscle fi bers. Repeated use of FES can lead to sensorimotor improvements as well as cortical reorganization, changes that cannot be accomplished with passive range of motion alone due to lack of sensory or motor input or activation of motor units, which is essential for motor relearning and neuromuscular reeducation. When movement is generated in paralyzed musculature, cortical reorganization begins to take place and may lead to long-term eff ects, such as ultimately assisting with return to ambulation. Th is case study describes the use and response of FES in an individual with incomplete SCI.

Study Duration

8 weeks

Participants

A 32-year-old woman

Evidence Level

Level 4, Case Report

Key Findings

1
Early FES cycling following SCI may facilitate conversion from sensory incomplete to motor incomplete, thus increasing the probability of returning to ambulation.
2
With continued FES use, this patient was able to develop volitional muscle contractions and move against gravity in bilateral quadriceps muscles and hamstrings.
3
She also progressed to supporting her own body weight and ultimately returned to ambulation at home. Four months after discharge, she was ambulating in the community using a standard cane.

Research Summary

This case report describes the early use of functional electrical stimulation on an individual with an incomplete spinal cord injury to assist with motor recovery and a return to ambulation. Results from this case report indicate that early FES cycling following SCI may facilitate conversion from sensory incomplete to motor incomplete, thus increasing the probability of returning to ambulation. Th e success of the FES intervention presented in this case study indicates that further research is needed to develop standardized treatment protocols and recommended practices for acute motor relearning in the incomplete SCI patient population.

Practical Implications

Early Intervention

Early FES cycling following SCI may facilitate conversion from sensory incomplete to motor incomplete, thus increasing the probability of returning to ambulation.

Personalized Treatment

For patients to benefit from FES, they must be able to feel the electrical stimulation, and/or muscle tetany should be achieved. If neither of these factors is produced, then the likelihood of the individual’s developing any motor changes is signifi cantly decreased.

Further Research

Further research is needed to develop standardized treatment protocols and recommended practices for acute motor relearning in the incomplete SCI patient population.

Study Limitations

1
The inability to examine how manual muscle testing scores changed from week to week with continued use of FES
2
The absence of standardized outcome measures such as Timed Up and Go, fi ve-time sit-stand test, Berg Balance Scale assessment, and 6-minute walk test.
3
It would have been benefi cial to look at the results of outcome measures, manual muscle testing scores, and modifi ed Ashworth scores in addition to functional independence measure scores to see how continued use of FES aff ected this patient’s func-tional mobility

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