Study design: Controlled, repeat-measures study. Objectives: To determine if functional electrical stimulation (FES) can affect bone atrophy in early spinal cord injury (SCI), and the safety, tolerance and feasibility of this modality in bone loss remediation. Setting: Spinal Injuries Units, Royal Adelaide Hospital and Hampstead Rehabilitation Centre, South Australia. Methods: Patients with acute SCI (ASIA A-D) were allocated to FES (n ¼ 23, 2879 years, C4-T10, 13 Tetra) and control groups (CON, n ¼ 10, 31711 years, C5-T12, four Tetra). The intervention group received discontinuous FES to lower limb muscles (15 min sessions to each leg twice daily, over a 5-day week, for 5 months). Dual energy X-ray absorptiometry (DEXA) measured total body bone mineral density (tbBMD), hip, spine BMD and fat mass (FM) within 3 weeks, and 3 and 6 months postinjury. Results: FES and CON groups' tbBMD differed significantly at 3 months postinjury (Po0.01), but not thereafter. Other DEXA measures (hip, spine BMD, FM) did not differ between groups at any time. No adverse events were identified. Conclusion: Electrically stimulated muscle activation was elicited, and tetanic effects were reproducible; however, there were no convincing trends to suggest that FES can play a clinically relevant role in osteoporosis prevention (or subsequent fracture risk) in the recently injured patient. The lack of an osteogenic response in paralysed extremities to electrically evoked exercise during subacute and rehabilitation/recovery phases cannot be fully explained, and may warrant further evaluation.Spinal Cord (2007) 45, 78-85.

Pressure ulcers are an important complication of spinal cord injury which place an enormous burden on society due to their ®nancial, psychosocial, and vocational implications. Although they are now rarely fatal, they can still have devastating consequences, often needing prolonged hospitalisation to be properly managed. This study reviews the use of electrical stimulation to overcome increasing debility due to sacral pressure ulcers and saddle soreness in a man with tetraplegia. After 24 months of regular cyclic stimulation he had increased circumferential dimensions across his buttocks by up to 21%, and increased his sitting tolerance.Keywords: NMES; FES; pressure ulcer; tetraplegia; care study General backgroundPressure ulcers have long been recognised as one of the more serious and costly complications of spinal cord injury, occurring in up to 80% of those with a spinal cord injury. 1 Their prevention and management is a constant demand on the individual concerned, other family members, carers, and hospital sta . 2 Signi®cant, negative psychological e ects of these complications have been recognised by a number of authors. 1,3 ± 5 The ®nancial burden of hospitalisation for pressure ulcers amounts to many thousands of dollars per year, and has been estimated to range from $US15 000 to $70 000 for each ulcer. 3 Another complication is a loss of physical condition associated with the imposed bed rest, 6 making return to the previous level of function a di cult, lengthy and arduous procedure.Despite these factors, there is little really known about the epidemiology of pressure ulcers ± those most at risk, the in¯uence of time since injury, and the in¯uence and inter-relationship of the multitude of risk and preventive factors. 3 Byrne and Salzberg (1996) identi®ed more than 50 risk factors, which they separated into categories. Their 15 major risk factors were divided into three categories 1. Severity of spinal cord injury; 2. Pre-existing conditions; and 3. Malnutrition and anaemia.Other potential risk factors identi®ed included medical factors, past history, gender and ethnicity, medications, and issues related to movement, socioeconomic, psychological and nutritional status. 1 This case study describes the use of neuromuscular electrical stimulation in the management of recurrent sacral pressure ulcers in a man with tetraplegia.