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Randomized trial of functional electrical stimulation therapy for walking in incomplete spinal cord injury: effects on quality of life and community participation.

ABSTRACT: BACKGROUND:Functional electrical stimulation (FES) therapy has been applied to achieve functional benefits post spinal cord injury (SCI), but little is known about its effects on well-being. OBJECTIVE:Using a parallel-group randomized controlled trial (RCT) design (NCT00201968), the effects of a FES-assisted walking intervention on quality of life and participation post SCI were compared to a non-FES exercise program. METHODS:Individuals with chronic (?18 months) incomplete SCI (level C2 to T12, AIS C or D) were randomized to a FES-assisted walking (intervention) or aerobic/resistance training (control) sessions 3 times a week for 16 weeks. The Spinal Cord Independence Measure (SCIM), Satisfaction With Life Scale, Lawton Instrumental Activities of Daily Living, Craig Handicap and Assessment Reporting Technique, Reintegration to Normal Living Index, and perceptions of intervention(s) outcomes were completed at baseline, 4, 6, and 12 months. Repeated measures general linear models were used to assess between-group differences. Perceptions of intervention(s) were analyzed using qualitative content analysis. RESULTS:Thirty-four individuals were randomized (17 per group); 27 remained at 12 months. The FES group had a significant increase (P < .01) on SCIM mobility subscores (mean [SD] = 17.27 [7.2] to 21.33 [7.6]) compared to the exercise group (mean [SD] = 19.9 [17.1] to 17.36 [5.5]). Although no significant between-group differences were detected for other outcomes, both groups reported positive gains in well-being from trial participation. CONCLUSIONS:The present study provides insight into the perceived benefits acquired by participating in an RCT comparing exercise to FES therapy and serves as a model for pinpointing domains of well-being that could be targeted for assessment in future SCI trials.

SUBMITTER: Hitzig SL

PROVIDER: S-EPMC3816719 | biostudies-literature | 2013

REPOSITORIES: biostudies-literature

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Randomized trial of functional electrical stimulation therapy for walking in incomplete spinal cord injury: effects on quality of life and community participation.

Hitzig Sander L SL Craven B Catharine BC Panjwani Aliza A Kapadia Naaz N Giangregorio Lora M LM Richards Kieva K Masani Kei K Popovic Milos R MR

Topics in spinal cord injury rehabilitation 20130101 4

<h4>Background</h4>Functional electrical stimulation (FES) therapy has been applied to achieve functional benefits post spinal cord injury (SCI), but little is known about its effects on well-being.<h4>Objective</h4>Using a parallel-group randomized controlled trial (RCT) design (NCT00201968), the effects of a FES-assisted walking intervention on quality of life and participation post SCI were compared to a non-FES exercise program.<h4>Methods</h4>Individuals with chronic (≥18 months) incomplete ...[more]

PMID: 24244090

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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.

Project description:Deficient ankle control after incomplete spinal cord injury (iSCI) often accentuates walking impairments. Transcutaneous electrical spinal cord stimulation (tSCS) has been shown to augment locomotor activity after iSCI, presumably due to modulation of spinal excitability. However, the effects of possible excitability modulations induced by tSCS on ankle control have not yet been assessed. This study investigated the immediate (i.e., without training) effects during single-sessions of tonic tSCS on ankle control, spinal excitability, and locomotion in ten individuals with chronic, sensorimotor iSCI (American Spinal Injury Association Impairment Scale D). Participants performed rhythmic ankle movements (dorsi- and plantar flexion) at a given rate, and irregular ankle movements following a predetermined trajectory with and without tonic tSCS at 15 Hz, 30 Hz, and 50 Hz. In a subgroup of eight participants, the effects of tSCS on assisted over-ground walking were studied. Furthermore, the activity of a polysynaptic spinal reflex, associated with spinal locomotor networks, was investigated to study the effect of the stimulation on the dedicated spinal circuitry associated with locomotor function. Tonic tSCS at 30 Hz immediately improved maximum dorsiflexion by +4.6° ± 0.9° in the more affected lower limb during the rhythmic ankle movement task, resulting in an increase of +2.9° ± 0.9° in active range of motion. Coordination of ankle movements, assessed by the ability to perform rhythmic ankle movements at a given target rate and to perform irregular movements according to a trajectory, was unchanged during stimulation. tSCS at 30 Hz modulated spinal reflex activity, reflected by a significant suppression of pathological activity specific to SCI in the assessed polysynaptic spinal reflex. During walking, there was no statistical group effect of tSCS. In the subgroup of eight assessed participants, the three with the lowest as well as the one with the highest walking function scores showed positive stimulation effects, including increased maximum walking speed, or more continuous and faster stepping at a self-selected speed. Future studies need to investigate if multiple applications and individual optimization of the stimulation parameters can increase the effects of tSCS, and if the technique can improve the outcome of locomotor rehabilitation after iSCI.

Dataset Information

Randomized trial of functional electrical stimulation therapy for walking in incomplete spinal cord injury: effects on quality of life and community participation.

Publications

Randomized trial of functional electrical stimulation therapy for walking in incomplete spinal cord injury: effects on quality of life and community participation.

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