Effect of treadmill gait on bone markers and bone mineral density of quadriplegic subjects

Abstract

Quadriplegic subjects present extensive muscle mass paralysis which is responsible for the dramatic decrease in bone mass, increasing the risk of bone fractures. There has been much effort to find an efficient treatment to prevent or reverse this significant bone loss. We used 21 male subjects, mean age 31.95 ± 8.01 years, with chronic quadriplegia, between C4 and C8, to evaluate the effect of treadmill gait training using neuromuscular electrical stimulation, with 30-50% weight relief, on bone mass, comparing individual dual-energy X-ray absorptiometry responses and biochemical markers of bone metabolism. Subjects were divided into gait (N = 11) and control (N = 10) groups. The gait group underwent gait training for 6 months, twice a week, for 20 min, while the control group did not perform gait. Bone mineral density (BMD) of lumbar spine, femoral neck, trochanteric area, and total femur, and biochemical markers (osteocalcin, bone alkaline phosphatase, pyridinoline, and deoxypyridinoline) were measured at the beginning of the study and 6 months later. In the gait group, 81.8% of the subjects presented a significant increase in bone formation and 66.7% also presented a significant decrease of bone resorption markers, whereas 30% of the controls did not present any change in markers and 20% presented an increase in bone formation. Marker results did not always agree with BMD data. Indeed, many individuals with increased bone formation presented a decrease in BMD. Most individuals in the gait group presented an increase in bone formation markers and a decrease in bone resorption markers, suggesting that gait training, even with 30-50% body weight support, was efficient in improving the bone mass of chronic quadriplegics. Correspondence

Electrical Stimulation During Gait Promotes Increase of Muscle Cross-sectional Area in Quadriplegics: A Preliminary Study

“…The positive muscle alterations provided by NMES also can benefit the oxygen consumption [5,10,12,17] and bone mass of individuals with spinal cord injury [2,6,19].…”

Impact of treadmill gait training with neuromuscular electrical stimulation on the urodynamic profile of patients with high cervical spinal cord injury

“…These patients also had an efficient increase in bone mineral density -in that, 81.8% of subjects presented a significant increase in bone formation and 66.7% had a marked decrease in bone resorption markers, thus reducing the risk of fractures in osteoporotic bones (6) . Although there is scientific evidence that patients with cerebral and spinal injuries benefit from NMES in the rehabilitation of muscular and cardio respiratory parameters (13) , to date there has been no report on the effects of NMES on the low urinary tract function.…”

“…Treadmill gait training with neuromuscular electrical stimulation (NMES) in quadriplegic subjects is capable of improving movements (even quadriplegics with complete lesions), metabolic and cardio respiratory responses and bone mineral density. It was reported that these findings are associated with a better coordination of voluntary and autonomic functions of muscles and nervous pathways; however, there is no unanimous understanding on how and why it happens (4)(5)(6) . To date, the effects NMES on the inferior urinary tract have never been studied.…”

Electrical stimulation and treadmill gait in tetraplegic patients: assessment of its effects on the knee with magnetic resonance imaging

“…It would be rather relevant to take a closer look on the knees of tetraplegic patients through magnetic resonance image (MRIs), in order to obtain a broader picture of their rehabilitation program, following previous studies showing the benefits obtained with treadmill gait and NMES. 1,6,18 …”