Electrical stimulation plus progressive resistance training for leg strength in spinal cord injury: A randomized controlled trial

Abstract

Study design: A randomized controlled trial. Objectives: To determine the effectiveness of electrical stimulation (ES)-evoked muscle contractions superimposed on progressive resistance training (PRT) for increasing voluntary strength in the quadriceps muscles of people with spinal cord injuries (SCI). Setting: Sydney, Australia. Methods: A total of 20 people with established SCI and neurologically induced weakness of the quadriceps muscles participated in the trial. Participants were randomized between experimental and control groups. Volunteers in the experimental group received ES superimposed on PRT to the quadriceps muscles of one leg thrice weekly for 8 weeks. Participants in the control group received no intervention. Assessments occurred at the beginning and at the end of the 8-week period. The four primary outcomes were voluntary strength (Nm) and endurance (fatigue ratio) as well as the performance and satisfaction items of the Canadian Occupational Performance Measure (COPM; points). Results: The between-group mean differences (95% confidence interval (CI)) for voluntary strength and endurance were 14 Nm (1-27; P ¼ 0.034) and 0.1 (À0.1 to 0.3; P ¼ 0.221), respectively. The between-group median differences (95% CI) for the performance and satisfaction items of the COPM were 1.7 points (À0.2 to 3.2; P ¼ 0.103) and 1.4 points (À0.1 to 4.6; P ¼ 0.058), respectively. Conclusion: ES superimposed on PRT improves voluntary strength, although there is uncertainty about whether the size of the treatment effect is clinically important. The relative effectiveness of ES and PRT is yet to be determined.

Short-term Maximal-Intensity Resistance Training Increases Volitional Function and Strength in Chronic Incomplete Spinal Cord Injury

“…5 Long-standing data in neurologically intact individuals suggest that various strength training regimens can increase lower extremity muscle strength using maximum volitional effort (MVE) contractions. 6,7 The highly atrophied and fatigable neuromuscular system with various degrees of spasticity often makes volitional strength training regimens less practical and rewarding for rehabilitation focused on ambulation. 6,7 The highly atrophied and fatigable neuromuscular system with various degrees of spasticity often makes volitional strength training regimens less practical and rewarding for rehabilitation focused on ambulation.…”

Body composition modifications in people with chronic spinal cord injury after supervised physical activity

“…Thus, associated resistance training and sports are key to positive responses in the rehabilitation process. 14,16,[29][30][31] When comparing the subgroups TT, HP, and LP, there was no significant difference for the variables in the first assessment. Similar results were found in another study, 20 in which the TT group did not differ from the paraplegia group.…”

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

“…Reports of increased muscle size after FES-training have typically implemented resistance training regimens aimed at increasing strength, or FES-cycling, which often requires moderate-to-high force production. 7,18,19,23,25,33,34,35 Our intervention may also have been too short to demonstrate a noticeable effect of FES-assisted walking on muscle size. Although a few case series have reported increases in muscle size after 8 weeks of intervention, 7,12,14 case reports of improved body composition after 6 or 12 months of FES training are more credible.…”

“…16,19,33 It is expected that increases in strength would precede increases in size, and small increases in strength have been observed after 8 weeks of FESinduced quadriceps training in individuals with SCI. 35 However, the intent was to investigate whether a shortterm intervention could improve walking function, and whether improvements in walking function would lead to longer-term benefits, such as improved body Table 3 Body composition outcomes used per-protocol analyses, reported as mean (SD), for intervention and control groups at baseline, after 4 months of intervention/control activities and at 12-month follow-up *Two pQCT scans were not performed at this site due to spasms or oedema, so n is 2 less than noted.…”

“…7,8,16,18,19,[23][24][25]33,34 Only one other randomized trial of FES training in the lower extremities of individuals with SCI has been reported; FES-assisted quadriceps strength training over 8 weeks (n = 10 per group) demonstrated small increases in strength, but the authors speculated that they may not be large enough to be clinically important. 35 Knowledge syntheses and physical activity guidelines promote FES as a tool for increasing physical activity based on health-related benefits, including improved body composition. [36][37][38] FES has the added theoretical benefit of improving function, and patients and their families often have high expectations of FES therapy.…”