The Effect and Dose-Response of Functional Electrical Stimulation Cycling Training on Spasticity in Individuals With Spinal Cord Injury: A Systematic Review With Meta-Analysis

Abstract

Background: To investigate the effect and dose-response of functional electrical stimulation cycling (FES-cycling) training on spasticity in the individuals with spinal cord injury (SCI).Method: Five electronic databases [PubMed, Scopus, Medline (Proquest), Embase, and Cochrane Central Register of Controlled Trials (CENTRAL)] were searched before September 2021. The human trials and studies of English language were only included. Two authors independently reviewed and extracted the searched studies. The primary outcome measure was spasticity assessed by Modified Ashworth Scale or Ashworth Scale for lower limbs. The secondary outcome measures were walking abilities, such as 6 Min Walk Test (6MWT), Timed Up and Go (TUG), and lower limbs muscle strength (LEMS). A subgroup analysis was performed to investigate the efficacious threshold number of training sessions. A meta-regression analysis was used to examine the linear relationship between the training sessions and the effect on spasticity.Results: A total of 764 studies were identified. After screening, 12 selected studies were used for the qualitative synthesis, in which eight of them were quantitatively analyzed. Eight studies included ninety-nine subjects in total with SCI (male: female = 83:16). The time since injury was from less than 4 weeks to 17 years. The age ranged from 20 to 67 years. American Spinal Injury Association (ASIA) impairment level of the number of participants was 59 for ASIA A, 11 for ASIA B, 18 for ASIA C, and 11 for ASIA D. There were 43 subjects with tetraplegia and 56 subjects with paraplegia. Spasticity decreased significantly (95% CI = − 1.538 to − 0.182, p = 0.013) in favor of FES-cycling training. The walking ability and LEMS also improved significantly in favor of FES-cycling training. The subgroup analysis showed that spasticity decreased significantly only in more than 20 training sessions (95% CI = − 1.749 to − 0.149, p = 0.020). The meta-regression analysis showed training sessions and spasticity were not significantly associated (coefficient = − 0.0025, SE = 0.0129, p = 0.849, R2 analog = 0.37).Conclusion: Functional electrical stimulation-cycling training can improve spasticity, walking ability, and the strength of the lower limbs in the individuals with SCI. The number of training sessions is not linearly related to the decrease of spasticity. Twenty sessions of FES-cycling training are required to obtain the efficacy to decrease spasticity.

Neuroinflammation in the Evolution of Motor Function in Stroke and Trauma Patients: Treatment and Potential Biomarkers

“…ES also contributes significantly to the recovery of neural function. Specifically, in cases of SCI, a remarkable participation in the regeneration of spinal tissue through remyelination is observed [224]. This process is achieved by decreasing the activity of reactive glial cells [222].…”

Electrical Stimulation Exercise for People with Spinal Cord Injury: A Healthcare Provider Perspective

“…Fang et al [45] completed a twelve-study systematic review of the qualitative data involving spasticity after SCI and an eight-study meta-analysis on quantitative data regarding spasticity after SCI. The eight studies used in the meta-analysis included a total of 99 participants with SCI.…”

“…The systematic review and meta-analysis performed by Fang et al [45] included two studies that measured functional walking gains induced by FES cycling in individuals with SCI via the Six Minute Walk Test (6MWT) and the Timed Get Up and Go Test (TUG). The evidence displayed significantly improved scores in the 6MWT and TUG after FES cycling [54,55].…”

The effect of electrical stimulation on skin vulnerability to irritants

“…Numerous studies have investigated the clinical effects of electrical stimulation (ES) in humans. Studies have demonstrated that ES is an effective therapeutic modality for strengthening muscles, 1 reducing spasticity, 2 relieving pain, 3 promoting wound healing, 4 increasing skin blood flow, 5 and alleviating itching in certain dermatological conditions 6 …”