The Effect of Functional Electrical Stimulation and Therapeutic Exercises on Trunk Muscle Tone and Dynamic Sitting Balance in Persons with Chronic Spinal Cord Injury: A Crossover Trial

Abstract

Background and objectives: Functional electrical stimulation (FES) has shown good results in improving static and dynamic sitting balance in persons with spinal cord injuries. There is limited information about how regular surface FES combined with therapeutic exercise (TE) affect dynamic sitting balance and muscle tone. The objective of this study was to evaluate the effectiveness of a six-week physical therapy program consisting of FES and TE on muscle tone and sitting balance in persons with spinal cord injury (SCI). It was also important to explore the relationship between muscle tone and dynamic sitting balance. The third objective was to assess the change of characteristics over a six month period, when no intervention was carried out. Material and methods: Five men with SCI were alternately allocated to two study groups: SCI_FES+TE and SCI_TE. Eight healthy control group participants were recruited to collect reference data. SCI participants’ intervention lasted for six weeks in their homes. SCI_FES+TE conducted exercises with FES applied on erector spinae (ES) and rectus abdominis (RA) muscles. SCI_TE conducted exercises only. Muscle oscillation frequency (MOF; characterizing muscle tone) and limits of stability (LOS; characterizing sitting balance) were measured. A crossover study design was used. The time between the initial intervention and the crossover was seven months (ClinicalTrials registration ID NCT03517787). Results: MOF in SCI_FES+TE increased by 6.0% for ES and 6.1% for RA muscles. LOS of flexion increased 30.1% in SCI_FES+TE. Increase in lateral directions was similar for both study groups. Moderate to high negative correlation was found between MOF and LOS. After seven months, MOF of ES decreased 0.8%, MOF or RA decreased 1.4%, LOS of flexion decreased 31.9%, and LOS of lateral flexion to the left decreased 46.4%. Conclusions: The six-week therapy program combining FES and TE increased trunk muscle tone and dynamic sitting balance in flexion more than TE alone. Higher antagonist muscle tone negatively affects dynamic sitting balance and center of pressure (COP) trajectory distance in various directions. After seven months, a slight decline in trunk muscles tone values and an extensive decrease in sitting balance values were noticed.

Epidural Electrical Stimulation of the Lumbosacral Spinal Cord Improves Trunk Stability During Seated Reaching in Two Humans With Severe Thoracic Spinal Cord Injury

“…Neuromuscular electrical stimulation (NMES) is an intervention that induces motor activation patterns that mimic neurologically intact functional performance with an overarching goal of leveraging intrinsic neuroplasticity to retrain impaired neurocircuitry and improve function in individuals with upper motor neuron damage. Over the past several decades, NMES has been identified as a reliable intervention to improve trunk stability and is suggested as a standard of care along with therapeutic exercise after SCI (Ho et al, 2014;Bergmann et al, 2019). The application of NMES during functional tasks via skin surface or implanted stimulating electrodes, described as functional electrical stimulation (FES), has been shown to improve trunk stability and seated posture during reaching tasks for individuals with SCI (Kukke and Triolo, 2004;Triolo et al, 2013a;Bergmann et al, 2019).…”

“…Over the past several decades, NMES has been identified as a reliable intervention to improve trunk stability and is suggested as a standard of care along with therapeutic exercise after SCI (Ho et al, 2014;Bergmann et al, 2019). The application of NMES during functional tasks via skin surface or implanted stimulating electrodes, described as functional electrical stimulation (FES), has been shown to improve trunk stability and seated posture during reaching tasks for individuals with SCI (Kukke and Triolo, 2004;Triolo et al, 2013a;Bergmann et al, 2019). However, the magnitude of electrically stimulated muscle activation is modest compared to that of the non-injured population under typical physiological conditions (Collins, 2007;Triolo et al, 2013a).…”

Treinamento físico de paciente com a síndrome de Hallervorden-Spatz: um relato de caso

“…A estimulação elétrica funcional (FES) utiliza corrente elétrica de baixa frequência para provocar contração de músculos paralisados ou enfraquecidos decorrentes de lesão do neurônio motor superior. 13 Tal aparato foi aqui empregado por possibilitar a contração muscular funcional, por estimulação elétrica, despolarizando o nervo motor e produzindo resposta sincrônica em todas as unidades do músculo, permitindo movimentos úteis à locomoção.…”

Developing Peri-Operative Rehabilitation in Degenerative Cervical Myelopathy [AO Spine RECODE-DCM Research Priority Number 6]: An Unexplored Opportunity?

“…However, therapeutic adjuncts such as BWSTT/robotics and FES may be highly beneficial in facilitating greater active practice and increased dosage. 19 , 50 , 55 , 112 - 116 Additionally, virtual/augmented reality incorporated into rehabilitation may help to reverse the known overreliance on vision for balance in DCM and improve the “reality” of gait training. 29 , 73 , 117 - 119 Virtual reality, or mechanical, balance training combined with gait training may have a combinatorial benefit for balance and walking without increasing therapy time.…”