A clinically meaningful training effect in walking speed using functional electrical stimulation for motor-incomplete spinal cord injury

Abstract

The results suggest that daily independent use of FES may produce clinically meaningful changes in walking speed which are significant for motor-incomplete SCI. Further research exploring the mechanism for the presence of a training effect may be beneficial in targeting therapies for future rehabilitation.

Supplemental Stimulation Improves Swing Phase Kinematics During Exoskeleton Assisted Gait of SCI Subjects With Severe Muscle Spasticity

“…In order to do so, the authors propose here to supplement an exoskeleton with stimulation of the common peroneal nerve with the intent of exciting the flexion withdrawal reflex. Common peroneal nerve stimulation has been shown to assist neurologically impaired individuals during the swing phase of gait by initiating a concerted flexion of the hip, knee, and ankle (Zehr et al, 1997 ; Bajd et al, 1999 ; Embrey et al, 2010 ; O'Dell et al, 2014 ; Street and Singleton, 2017 ). Stimulation of the common peroneal nerve activates the flexor withdrawal reflex, which comprises afferent neurons activating motor units responsible for flexion, as well as inhibitory interneurons that inhibit ipsilateral extensors while activating contralateral extensors (Sherrington, 1910 ).…”

Electrical Stimulation for Rehabilitation After Spinal Cord Injury

“…A randomized controlled trial of patients with incomplete SCI similarly showed FES, combined with conventional occupational therapy, had better FIM, SCIM, and hand function scores compared with patients who merely underwent conventional occupational therapy 7. Daily FES combined with rehabilitation has also been shown to increase walking speed in patients with incomplete SCI 8. Additionally, FES stimulation to the quadriceps, hamstrings, ankle dorsiflexors, and ankle plantar flexors while walking on the treadmill versus a non-FES exercise program demonstrated an improved mobility score on the SCIM 10…”

“…The patient's intention to move, along with sensory feedback from the FES-induced movement, produces neuroplastic changes that ultimately improve function. FES has been shown to increase functionality in both the upper and lower extremities 7,8…”

The role of electrical stimulation for rehabilitation and regeneration after spinal cord injury

“…[ 80 ] A clinically meaningful training effect in walking speed using functional electrical stimulation for motor-incomplete spinal cord injury Street et al. [ 81 ] Implanted functional electrical stimulation: an alternative for standing and walking in pediatric spinal cord injury Johnston et al. [ 82 ] Restoration of gait by functional electrical stimulation in paraplegic patients: a modified programme of treatment Maležič et al.…”

“…Multiple studies have validated the use of FES in helping to restore upper extremity function following SCI [ 77 – 80 ]. FES has also been used in rehabilitation of the lower extremity to improve gait parameters such as foot pulling acceleration, swing power, and ground impact force, ultimately resulting in improved walking speeds and more efficient system of muscle strength for gait [ 81 – 85 ]. A study using ankle weights to measure improvement in muscle strength after FES treatment for AIS A–C patients unable to stand demonstrated an average of 2–4× increase in power output in a 12 week study [ 76 ].…”