Femoral Artery Blood Flow and Microcirculatory Perfusion During Acute, Low-Level Functional Electrical Stimulation in Spinal Cord Injury

Abstract

Low-intensity FES acutely increased blood flow during stimulation, with a progressive increase across subsequent FES bouts. These observations suggest that continuous, low-intensity FES may represent a practical and effective strategy to improve perfusion and reduce the risk of vascular complications.

Twelve-Week Daily Gluteal and Hamstring Electrical Stimulation Improves Vascular Structure and Function, Limb Volume, and Sitting Pressure in Spinal Cord Injury

“…26 In a previous study, ES induced an acute increase in femoral artery blood flow. 14 The repeated exposure to this increase in flow (and therefore shear stress) may contribute to vessel remodeling, whereby the increased levels of shear are normalized by an increase in luminal diameter. Taken together, the findings of our study suggest that daily ES using this practical, home-based method is effective in improving (macro)vasculature structure, most likely through repeated exposure to elevations in blood flow and shear stress.…”

“…Electrical stimulation was applied with an adapted wearable clothing garment 14 connected to a portable battery operated stimulator (Neuropro; Berkelbike, Nijmegen, the Netherlands). The clothing garment was a pair of specially developed elasticated Velcro shorts with embedded surface electrodes (Axiobionics, Ann Arbor, MI).…”

“…denervated muscle fibers and increase muscle mass, 10,11 improve muscle oxidative capacity, 12 enhance capillary supply, 13 and improve cutaneous microcirculation. 14 Collectively, ES is an effective and clinically significant tool for improving the health of individuals with SCI. Despite the many reported benefits, the need for specialist equipment, facilities, and trained staff for ES interventions makes regular application expensive and impractical for many individuals with SCI.…”

“…Reactivating the paralyzed muscles by electrically stimulated muscle contractions (partly) reverses many of these complications in SCI individuals. For example, electrical stimulation (ES) has been found to increase artery diameter, 8 improve arterial compliance, 9 restore contractility in denervated muscle fibers and increase muscle mass, 10,11 improve muscle oxidative capacity, 12 enhance capillary supply, 13 and improve cutaneous microcirculation 14 . Collectively, ES is an effective and clinically significant tool for improving the health of individuals with SCI.…”

“…Using an acute bout of ES, this method has demonstrated many important benefits relevant to pressure ulcer prevention, such as reducing sitting pressure over the ischial tuberosity and an increase in transcutaneous oxygen levels 15,16 . In addition, previous work has shown that applying acute bouts of low-intensity ES using a wearable clothing garment leads to incremental increases in blood flow in the conduit and skin microcirculation, an effect that is sustained in the minutes after ES 14 . Currently, however, no study has examined the effects of long-term, daily home-based low-intensity ES in individuals with SCI.…”