The Effect of Electrical Passive Cycling on Spasticity in War Veterans with Spinal Cord Injury

Abstract

Introduction: Muscle atrophy, spasticity, and deformity are among long term complication of spinal cord injury (SCI) veterans. There are numerous studies evaluating effect of functional electrical stimulation on muscle properties of SCI people, but less research has focused on the benefits of passive cycling in the management of spasticity and improving ROM of lower limbs in individuals with SCI. Aims: To evaluate the effect of electrical passive cycling on passive range of movement spasticity and electrodiagnostic parameters in SCI veterans. Methods: Sixty-four SCI veterans referred to two clinical and research center in Tehran were recruited in this prospective clinical trial. The subjects were divided into two groups according to electrical passive cycling usage: (1) patients who did not use pedal exercise (control group), (2) patients used Electrical passive cycling up to optimal level (intervention group). Main outcome measures included hip, knee, and ankle range of motion, spasticity scale, and electrodiagnostic parameters including F-Wave Consistency, F-Wave Amplitude, H/M Ratio, F/M Ratio, H-Reflex Onset Latency, and H-Reflex Amplitude. Data were recorded at the time of receiving and 1 year after pedal exercise usage. Results: Sixty-four SCI patients including 95.3% male, 4.7% female with mean age 43 years old were included in this study. All patients except one suffered from complete SCI. The involved spinal levels were cervical (17.2%), upper thoracic (34.4%), lower thoracic (45.3%), and lumbar (3.1%). Spasticity scale decreased significantly after passive cycling in group 2. Also hip, knee, and ankle ROM in group 2 were significantly improved after pedal exercise. There was a significant difference in H max/M max (RT&LT) and F/M ratio after versus before electric passive cycling system in group 2. Conclusion: These findings suggest that passive rhythmic leg exercise can lead to decrease in spasticity, increase in passive ROM of lower limbs and improvement in electrodiagnostic parameters of spasticity in patients with SCI.

The effect of functional electrical stimulation cycling on late functional improvement in patients with chronic incomplete spinal cord injury

“…In the present study, FES cycling led to a decrease in spasticity, which was consistent with previous studies. 17,21,22 Increase in muscle strength may allow to counteract spasticity in a more effective manner. FES-induced neural activity may change the balance of excitation in favor of inhibition in spinal cord by inducing neuroanatomical plasticity.…”

Exercise Training Promotes Functional Recovery after Spinal Cord Injury

“…Moreover, exercise can affect post-SCI remodeling of the brain function, through generation of systemic changes, such as improving blood circulation and neuroendocrine regulation and reducing spasticity [15]. Studies have confirmed that in animals with passive exercise training after spinal cord transection injury, the plasticity related neurotrophic factor, adenylate cyclase type 1 (ADCY1), and brain-derived neurotrophic factor (BNDF) increase in the somatosensory cortex, at levels significantly higher than in animals without training [16].…”

Effects of robotic-locomotor training on stretch reflex function and muscular properties in individuals with spinal cord injury

“…Given that alternative physical therapies have been shown to reduce hypertonia, for example passive cycling with and without functional electrical stimulation (Kakebeeke et al, 2005, Krause et al, 2008, Rayegani et al, 2011), we hypothesized that RAST would similarly have a positive effect on reducing hypertonia. One preliminary study found that a single session of RAST could yield a significant reduction in joint stiffness in children with spastic cerebral palsy (Schmartz et al, 2011).…”