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A randomized trial of functional electrical stimulation for walking in incomplete spinal cord injury: effects on body composition.

ABSTRACT: To evaluate the effects of functional electrical stimulation (FES)-assisted walking on body composition, compared to a non-FES exercise program in individuals with a spinal cord injury (SCI).Parallel-group randomized controlled trial.Individuals with chronic (? 18 months) incomplete SCI (level C2 to T12, AIS C or D) were recruited and randomized to FES-assisted walking (intervention), or aerobic and resistance training (control) sessions thrice-weekly for 16 weeks. Whole body and leg lean mass and whole body fat mass, measured with dual-energy X-ray absorptiometry, and lower-limb muscle cross-sectional area (CSA) and fat CSA, measured with peripheral computed tomography were assessed at baseline, 4 months, and 12 months. Intention-to-treat analyses using repeated measures general linear models were used to assess between-group differences.Thirty-four individuals were randomized (17 per group); 27 remained at 12 months. There were no significant main effects of FES-assisted walking on body composition variables in intention-to-treat analyses with group means. There was a significant group-by-time interaction for muscle area from baseline to 12 months (P = 0.04). Intention-to-treat analysis of muscle area change scores between baseline and 12 months revealed a significant difference between groups (mean (SD) muscle area change score 212 (517) mm(s) for FES, -136 (268) mm(s) for control, P = 0.026). There were 13 side effects or adverse events deemed related to study participation (7 intervention, 5 control); most were resolved with modifications to the protocol. One fainting episode resulted in a hospital visit and study withdrawal.Thrice-weekly FES-assisted walking exercise over 4 months did not result in a change in body composition in individuals with chronic, motor incomplete C2 to T12 SCI (AIS classification C and D). However, longer-term follow-up revealed that it might maintain muscle area.

SUBMITTER: Giangregorio L

PROVIDER: S-EPMC3459564 | biostudies-literature | 2012 Sep

REPOSITORIES: biostudies-literature

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A randomized trial of functional electrical stimulation for walking in incomplete spinal cord injury: effects on body composition.

Giangregorio Lora L Craven Catharine C Richards Kieva K Kapadia Naaz N Hitzig Sander L SL Masani Kei K Popovic Milos R MR

The journal of spinal cord medicine 20120901 5

<h4>Objective</h4>To evaluate the effects of functional electrical stimulation (FES)-assisted walking on body composition, compared to a non-FES exercise program in individuals with a spinal cord injury (SCI).<h4>Design</h4>Parallel-group randomized controlled trial.<h4>Methods</h4>Individuals with chronic (≥ 18 months) incomplete SCI (level C2 to T12, AIS C or D) were recruited and randomized to FES-assisted walking (intervention), or aerobic and resistance training (control) sessions thrice-we ...[more]

PMID: 23031172

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Project description:IntroductionThe prevalence of cardiometabolic disease following spinal cord injury is known to be high. However, it is unknown whether engaging in high-intensity exercise, which is advocated by recent guidelines, is beneficial or feasible for these individuals.ObjectiveTo assess the effects of high-intensity, whole-body exercise on the prevalence of cardiometabolic disease in individuals with spinal cord injury.DesignCombination of a randomized controlled trial and an open label intervention study of functional electrical stimulation legs plus arms rowing.SettingOutpatient academic rehabilitation hospital.ParticipantsForty individuals with spinal cord injury, with American Spinal Injury Association (ASIA) impairments scales A-D and neurological levels of injury C1-T12.InterventionSix months of high-intensity, hybrid-functional electrical stimulation rowing.Main outcome measuresChange in VO2max , serum lipids, and insulin resistance, prevalence of cardiometabolic disease.ResultsIndividuals averaged 42.1 ± 22.0 minutes of hybrid-functional electrical stimulation rowing a week over an average of 1.69 sessions per week over the 6 months of intervention. This amounted to an average of 170.9 ± 100 km rowed, at a mean heart rate of 82.7% of individualized maximum. Only one of 40 individuals met current exercise guidelines for the full 6 months. VO2max increased significantly (P < .001), yet prevalence of cardiometabolic disease did not change significantly (decrease from 22.5% to 20%, P = .70). Hemoglobin A1c did decrease significantly over this time (P = .01), although serum lipids and fasting glucose/insulin levels were unchanged. In exploratory subanalyses assessing individuals injured ≤12 months, those with more chronic injuries decreased their triglyceride-to-high-density lipoprotein (HDL) ratio (P = .04), a marker of cardiac mortality. Stratifying by neurological level of injury, individuals with paraplegia had worsened low-density lipoprotein (LDL) level (P = .02) and total cholesterol-to-HDL ratio (P = .04) over the 6-month intervention.ConclusionsSustained high-intensity exercise with hybrid functional electrical stimulation rowing does not decrease the prevalence of cardiometabolic disease after spinal cord injury.

Project description:Gait rehabilitation following incomplete spinal cord injury (iSCI) often aims to enhance speed and stability. Concurrently increasing both may be difficult though as certain stabilization strategies will be compromised at faster speeds. To evaluate the interaction between speed and lateral stability, we examined individuals with (n = 12) and without (n = 12) iSCI as they performed straight walking and lateral maneuvers at Preferred and Fast treadmill speeds. To better detect the effects of speed on stability, we challenged lateral stability with a movement amplification force field. The Amplification field, created by a cable-driven robot, applied lateral forces to the pelvis that were proportional to the real-time lateral center of mass (COM) velocity. While we expected individuals to maintain stability during straight walking at the Fast speed in normal conditions, we hypothesized that both groups would be less stable in the Amplification field at the Fast speed compared to the Preferred. However, we found no effects of speed or the interaction between speed and field on straight-walking stability [Lyapunov exponent or lateral margin of stability (MOS)]. Across all trials at the Fast speed compared to the Preferred, there was greater step width variability (p = 0.031) and a stronger correlation between lateral COM state at midstance and the subsequent lateral foot placement. These observations suggest that increased stepping variability at faster speeds may be beneficial for COM control. We hypothesized that during lateral maneuvers in the Amplification field, MOS on the Initiation and Termination steps would be smaller at the Fast speed than at the Preferred. We found no effect of speed on the Initiation step MOS within either field (p > 0.350) or group (p > 0.200). The Termination step MOS decreased at the Fast speed within the group without iSCI (p < 0.001), indicating a trade-off between lateral stability and forward walking speed. Unexpectedly, participants took more steps and time to complete maneuvers at the Fast treadmill speed in the Amplification field. This strategy prioritizing stability over speed was especially evident in the group with iSCI. Overall, individuals with iSCI were able to maintain lateral stability when walking fast in balance-challenging conditions but may have employed more cautious maneuver strategies.

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A randomized trial of functional electrical stimulation for walking in incomplete spinal cord injury: effects on body composition.

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A randomized trial of functional electrical stimulation for walking in incomplete spinal cord injury: effects on body composition.

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