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


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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    • "The rehabilitation focus concentrated on compensation for the loss rather than restoration [15]. However, with the advent of the principle of neuroplasticity, healthcare providers have gradually moved toward the belief that intact but damaged spinal pathways and neural synapses may undergo restorative changes and that new connections may be developed through repetitive physical activities many years after injury [1] [2] [15]. While neuroplasticity had its original focus in the brain, this same principle provides impetus for rehabilitation of those with SCI. "
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    ABSTRACT: This manuscript is a review of the theoretical and clinical concepts provided during an inter-institutional training program on Activity-Based Restorative Therapies (ABRT) and the perceptions of those in attendance. ABRT is a relatively recent high volume and intensity approach toward the restoration of neurological deficits and decreasing the risk of secondary conditions associated with paralysis after spinal cord injury (SCI). ABRT is guided by the principle of neuroplasticity and the belief that even those with chronic SCI can benefit from repeated activation of the spinal cord pathways located both above and below the level of injury. ABRT can be defined as repetitive-task specific training using weight-bearing and external facilitation of neuromuscular activation. The five key components of ABRT are weight-bearing activities, functional electrical stimulation, task-specific practice, massed practice and locomotor training which includes body weight supported treadmill walking and water treadmill training. The various components of ABRT have been shown to improve functional mobility, and reverse negative body composition changes after SCI leading to the reduction of cardiovascular and other metabolic disease risk factors. The consensus of those who received the ABRT training was that ABRT has much potential for enhancement of recovery of those with SCI. Although various institutions have their own strengths and challenges, each institution was able to initiate a modified ABRT program.
    Aging and Disease 08/2015; 6(4):254-61. DOI:10.14336/AD.2014.1105 · 3.07 Impact Factor
    • "passive or active robotic systems are ideally placed to deliver these type of interventions. FES has been shown to be effective in augmenting strength in healthy people [6], stroke [7], [8] and spinal cord injury [9] and in reducing motor fatigue in MS [10]. In MS, the orthotic effect of FES is well documented as an effective treatment for foot drop [11], [12]. "

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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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