Lower extremity functional electrical stimulation improved function for patients with SCI

Patients with chronic spinal cord injury who participated in long-term lower extremity functional electrical stimulation cycling as part of a rehabilitation regimen had neurological and functional gains, as well as enhanced physical health demonstrated by decreased fat, increased muscle mass and improved lipid profile.

"Exercise has not been commonly advocated for individuals with paralysis because of the assumption that it is of little benefit and it is challenging to exercise limbs that an individual cannot voluntarily move", John W. McDonald, MD, PhD, director of the International Center for Spine Cord Injury at the Kennedy Krieger Institute, stated. "However, we found that [functional electrical stimulation] FES cycling is a practical form of exercise that provides substantial benefits, including improved physical integrity, enhance neurological and functional performance, increased muscle size and strength, reduced muscle spasticity and improved quality of life."

Researchers enrolled 45 patients with chronic spinal cord injury (SCI), 25 of which were assigned to FES cycling group at the Washington University Spinal Cord Injury Program and matched by age, gender, injury level and duration of injury to 20 control patients who received no active physical therapy.

Overall, 80% of patients in the FES group had improved motor function compared to 45% of the control group. Response in pinprick sensation was observed in 56% of the FES group compared with 25% of the control group. According to study results, 14 of the 25 FES patients responded to light touch scores vs. six of the 20 controls.

The FES cycling enhanced muscle strength without increasing spasticity and improved quality of life and health. The FES and control groups showed no significant difference in total thigh volume; however, total thigh fat, measured by MRI, was 44.2% less in the FES group than in the controls. McDonald stated this is a key finding because intramuscular fat is associated with glucose intolerance, a complication affecting nearly two-thirds of patients with chronic SCI.

Researchers also found that the FES group was on fewer anti-spasticity medications with lower doses compared with the control group. This suggests that the lower level of spasticity observed in the FES group was not due to medication differences between participants, the researchers concluded.

The study was published online ahead of print in the Journal of Spinal Cord Medicine.

Reference:

Recio AC. J Spinal Cord Med. 2012;doi:10.1179/2045772311Y.0000000044.

Disclosure: The study was funded by the Deans Fund at Washington University School of Medicine, Barnes-Jewish Hospital Foundation, The Barnes-Jewish Hospital Auxiliary Foundation, Christopher Reeve Paralysis Foundation, the Nextsteps Foundation, the Sam Schmidt Foundation, Gateway to a Cure Foundation, the Eric Westacott Foundation and, in part, by the Intramural Research Program at the NIH Clinical Center.