Invasive and Non-Invasive Approaches of Electrical Stimulation to Improve Physical Functioning after Spinal Cord Injury

Journal of Clinical Medicine, 2021 · DOI: https://doi.org/10.3390/jcm10225356 · Published: November 17, 2021

Spinal Cord Injury Neurology Rehabilitation

Simple Explanation

This review explores how electrical stimulation can help people with spinal cord injuries regain movement and improve their lives. It looks at different ways to use electrical stimulation, both with devices inside the body and those used on the skin. The review covers how electrical stimulation can build muscle strength and improve body composition, making daily tasks easier. It also discusses how it can improve specific skills like reaching, grasping, standing, and walking. Additionally, the article summarizes the effects of epidural stimulation on cardiovascular performance and provides a mechanistic explanation to the current research ﬁndings.

Study Duration

Not specified

Participants

Individuals with spinal cord injuries

Evidence Level

Review

Key Findings

1
Neuromuscular electrical stimulation (NMES) and functional electrical stimulation (FES) can increase muscle mass, decrease fat mass, and decrease BF%, which can help ameliorate the obesity barrier to increased functional abilities and to improve cardiometabolic health.
2
High-intensity resistance training with NMES produces strong muscle contractions, leading to significant gains in muscle strength and mass in individuals with SCI.
3
Epidural stimulation may positively impact upper extremity function, resulting in an increase in grip strength during stimulation.

Research Summary

This review article presented the latest evidence on targeting function with invasive and non-invasive approaches using electrical stimulation in people with SCI. The routine uses of FES/NMES in combination with other therapies, such as standing frames and treadmill training, could maximize muscle health, aerobic ﬁtness, and cardiometabolic outcomes. Whether it be through NMES, FES cycling, or task-speciﬁc movement training enhanced by epidural electrical stimulation, the beneﬁts of using invasive and non-invasive electrical stimulation for targeting function have the potential to enhance functional mobility and increase the quality of life of people with SCI.

Practical Implications

Clinical Applications

Clinicians should consider the evidence-based information, including the clinical applications of FES/NMES, to optimize its use for different treatment goals.

Home Therapy

Portable and inexpensive NMES/FES devices could be used as home therapy, implemented with add-on training packages to target the lack of confidence and acceptance from clinicians and patients.

Future Research

Future research should focus on high-quality studies using patient-centered approaches, targeting areas such as pressure injuries, chronic pain, urinary tract infections, and subjective well-being related to FES cycling.

Study Limitations

1
Lack of conﬁdence and acceptance from clinicians and patients.
2
Expenditure of time and money.
3
Lack of research quality on the effects of FES cycling in the following outcomes: pressure injuries, chronic pain, urinary tract infections, and subjective well-being

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