Cristina L Sadowsky1, Edward R Hammond2, Adam B Strohl3, Paul K Commean4, Sarah A Eby5, Diane L Damiano6, Jason R Wingert7, Kyongtae T Bae8, John W McDonald9. 1. The International Center for Spinal Cord Injury and the Hugo W. Moser Research Institute at Kennedy Krieger, Baltimore, MD, USA; and Department of Physical Medicine and Rehabilitation, Department of Neurology (JWM), John Hopkins, Baltimore, MD USA. 2. The International Center for Spinal Cord Injury and the Hugo W. Moser Research Institute at Kennedy Krieger, Baltimore, MD, USA. 3. Division of Plastic and Reconstructive Surgery, Mount Sinai Medical Center, NY, USA. 4. Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA. 5. Department of Physical Medicine and Rehabilitation, Sinai Hospital, Baltimore, MD, USA. 6. National Institutes of Health, Bethesda, MD, USA. 7. Department of Health and Wellness, University of North Carolina, Asheville, NC, USA. 8. Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. 9. The International Center for Spinal Cord Injury and the Hugo W. Moser Research Institute at Kennedy Krieger, Baltimore, MD, USA; and Department of Neurology, Neurological Surgery, Anatomy and Neurobiology, Washington University School of Medicine, St Louis, MO, USA.
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.
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.
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