FES cycling may promote recovery of leg function after incomplete spinal cord injury

Donaldson, Nick; Perkins, Tim; Fitzwater, R; Wood, Duncan; Middleton, F

doi:10.1038/sj.sc.3101072

Cited by 74 publications

(44 citation statements)

References 4 publications

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“…6 Reciprocal movements similar to walking such as cycling may also lead to central activation via lower extremity reciprocal sensory feedback. 3 Based on these principles, FES cycling may have a potential therapeutic effect for functional recovery.…”

Section: Introductionmentioning

confidence: 99%

“…2 In this context, functional electrical stimulation (FES) cycling has been suggested to promote recovery after incomplete SCI. 3,4 External electrical stimulation has been shown to affect neural plasticity. 5 It was hypothesized that stimulation of the motor axons restore the nerve conduction by modifying the synaptic organization in the central nervous system.…”

Section: Introductionmentioning

confidence: 99%

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The effect of functional electrical stimulation cycling on late functional improvement in patients with chronic incomplete spinal cord injury

et al. 2015

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Study design: Prospective single-arm study. Objectives: To investigate the effect of functional electrical stimulation (FES) cycling on late functional recovery, spasticity, gait parameters and oxygen consumption during walking in patients with chronic incomplete spinal cord injury (SCI). Setting: Turkish Armed Forces Rehabilitation Center, Ankara, Turkey. Methods: Ten patients with chronic (duration of more than 2 years) incomplete SCI who could ambulate at least 10 m independently or with the assistance of a cane or walker, but no hip-knee-ankle-foot orthosis. The subjects underwent 1-h FES cycling sessions three times a week for 16 weeks. Outcome measures including the total motor score, the Functional Independence Measure (FIM) score, the Modified Ashworth Scale for knee spasticity, temporal spatial gait parameters and oxygen consumption rate during walking were assessed at baseline, 3 and 6 months after the baseline. Results: There were statistically significant improvements in total motor scores, the FIM scores and spasticity level at the 6-month follow-up (Po0.01). The changes in gait parameters reached no significant level (P40.05). Oxygen consumption rate of the patients showed significant reduction at only 6 months compared with baseline (Po0.01). Conclusion:The results suggest that FES cycling may provide some functional improvements in the late period of SCI.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The effect of functional electrical stimulation cycling on late functional improvement in patients with chronic incomplete spinal cord injury

et al. 2015

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“…However, with repetitive activation, the muscle will fatigue and an increase in either the frequency or the intensity of stimulation will be required to enable the targeted muscle force to be maintained. Interestingly, although both the stimulation intensity and frequency can be modulated, most current FES systems deliver a constant frequency and only increase the stimulation intensity to increase force output as the muscle fatigues (Donaldson et al, 2000;Petrofsky and Stacy, 1992;Raymond et al, 1999;Taylor et al, 1999). Previous studies on animal muscles show that compared to modulating either the pulse-duration or frequency, a simultaneous modulation of both stimulation pulse-duration and frequency produces improved control of isometric torque during FES (Chizeck et al, 1991).…”

Section: Introductionmentioning

confidence: 99%

Effects of stimulation frequency versus pulse duration modulation on muscle fatigue

Kesar

Chou

Binder‐Macleod

2008

Journal of Electromyography and Kinesiology

110

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During functional electrical stimulation (FES), both the frequency and intensity can be increased to increase muscle force output and counteract the effects of muscle fatigue. Most current FES systems, however, deliver a constant frequency and only vary the stimulation intensity to control muscle force. This study compared muscle performance and fatigue produced during repetitive electrical stimulation using three different strategies: (1) constant pulse-duration and stepwise increases in frequency (frequency-modulation); (2) constant frequency and stepwise increases in pulse-duration (pulse-duration-modulation); and (3) constant frequency and pulse-duration (no-modulation). Surface electrical stimulation was delivered to the quadriceps femoris muscles of 12 healthy individuals and isometric forces were recorded. Muscle performance was assessed by measuring the percent changes in the peak forces and force-time integrals between the first and the last fatiguing trains. Muscle fatigue was assessed by measuring percent declines in peak force between the 60 Hz pre-and post-fatigue testing trains. The results showed that frequency-modulation showed better performance for both peak forces and force-time integrals in response to the fatiguing trains than pulse-duration-modulation, while producing similar levels of muscle fatigue. Although frequencymodulation is not commonly used during FES, clinicians should consider this strategy to improve muscle performance.

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“…4,5 There is growing evidence that regular use of FES by people with neurological disabilities can result in recovery of voluntary muscle control and improved function after the stimulator is taken away. 6,7 A carryover effect in terms of overground walking speed has been demonstrated in a large population of incomplete SCI patients using a variety of neuroprostheses for walking. 8 Most surface FES systems for walking stimulate the flexor withdrawal reflex to induce simultaneous hip flexion, knee flexion and dorsiflexion.…”

Section: Introductionmentioning

confidence: 99%

Gait training regimen for incomplete spinal cord injury using functional electrical stimulation

2005

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Study design: Case series, and repeated assessments of the same individuals. Objective: To demonstrate the feasibility and efficacy of a multiweek intervention on walking function in people with chronic, incomplete spinal cord injuries. Setting: Rehabilitation hospital for spinal cord injury (SCI) in Toronto, Canada. Methods: A convenience sample of five subjects with chronic, incomplete SCI trained for 12-18 weeks using a new multichannel neuroprosthesis for walking. The following outcome measures were recorded throughout the training period: walking speed, step frequency and average stride length based on a 2-min walk test. Also identified were which walking aids and orthoses subjects preferred to use, and whether they employed a step-to or step-through gait strategy. Follow-up measurements of three subjects were made up to 10 weeks after treatment. Results: All subjects demonstrated significant improvements in walking function over the training period. Four of the subjects achieved significantly increased walking speeds, which were due to increases in both stride length and step frequency. The fifth subject experienced a significant reduction in preferred assistive devices. Follow-up measurements revealed that two subjects walked slightly slower several weeks after treatment, but they still walked significantly faster than at the start of treatment. Conclusion: The gait training regimen was effective for improving voluntary walking function in a population for whom significant functional changes are not expected. This application of functional electrical therapy is viable for rehabilitation of gait in incomplete SCI.

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FES cycling may promote recovery of leg function after incomplete spinal cord injury

Cited by 74 publications

References 4 publications

The effect of functional electrical stimulation cycling on late functional improvement in patients with chronic incomplete spinal cord injury

The effect of functional electrical stimulation cycling on late functional improvement in patients with chronic incomplete spinal cord injury

Effects of stimulation frequency versus pulse duration modulation on muscle fatigue

Gait training regimen for incomplete spinal cord injury using functional electrical stimulation

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