Functional Electrical Stimulation in Spinal Cord Injury: From Theory to Practice

The International Center for Spinal Cord Injury at Kennedy Krieger Institute , Baltimore , Maryland.
Topics in Spinal Cord Injury Rehabilitation 01/2012; 18(1):28-33. DOI: 10.1310/sci1801-28
Source: PubMed

ABSTRACT This article outlines steps to practical application of functional electrical stimulation (FES) within activity-based restorative therapy (ABRT). Drawing from current evidence, specific applications of FES intended to help restore function lost to spinal cord injury and associated neurologic disease are discussed. The medical and therapeutic indications, precautions, and contraindications are reviewed to help participants with appropriate patient selection, treatment planning, and assessment. Also included are the physiological implications of FES and alterable parameters, including dosing and timing, for a desired response. Finally, approaches to improve cortical representation and motor learning and to transition emerging movement into functional tasks are reviewed.

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Available from: Cristina L Sadowsky, Aug 13, 2014
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    ABSTRACT: There are nearly 12,000 new cases of spinal cord injury each year. About half of those involve some part of the arm and hand, representing significant disability and dependence for those patients. Restoration of upper limb function remains a high priority in rehabilitation; however, treatment protocols are widely variable and poorly defined. Recent research efforts fall into three main categories: therapeutic interventions, surgical reconstruction, and robotic developments. Therapeutic interventions involving high repetitions of motor and sensory input are under investigation but have limited support in the literature. Patients with incomplete injuries have a better prognosis. Surgical reconstruction techniques are evolving from advances in treatment of brachial plexopathy. Although these hold great potential for return of function, they are also high-risk techniques for which complications and inconsistent results have been reported. Finally, robotic developments, including exoskeletons and implants, show great promise but still have practical constraints. Management of the upper limb remains a complicated problem and more research efforts should be devoted to defining strategies for intervention.
    09/2013; 1(3). DOI:10.1007/s40141-013-0020-3
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    ABSTRACT: Objective To examine the effect of functional electrical stimulation (FES) cycling on disability progression in persons with multiple sclerosis (MS). Design Retrospective cohort, 40 participants with mean follow-up of 15 months. Setting International Center for Spinal Cord Injury at Kennedy Krieger Institute in Baltimore, a rehabilitation referral center. Participants Forty consecutive persons with MS undergoing rehabilitation from 2007 to 2011, with at least two evaluations based on the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI). Interventions FES cycling as part of activity-based restorative therapy interventions. Outcome measures Change in Expanded Disability Status Scale (EDSS) and ISNCSCI motor, light touch, and pin prick scores from baseline to latest evaluation. Results In 71% of patients, activity-based rehabilitation included FES cycling. There was no disability progression on the EDSS. Lower extremity motor scores improved or stabilized in 75% of patients with primary progressive MS (PPMS), 71.4% with secondary progressive MS (SPMS), and 54.5% with relapsing remitting MS (RRMS). Among patients with improved or stabilized lower extremity motor function, PPMS recorded a mean 9% improvement, SPMS 3% and RRMS 6%. In PPMS, use of FES showed trend towards improvement in motor scores (P = 0.070). Conclusions FES as part of activity-based rehabilitation may help preserve or improve neurological function in patients with MS.
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