Effects of Neuromuscular Electrical Stimulation on Upper Extremity Recovery in Individuals with Spinal Cord Injury
1Nalle E, 1Pfeiffer J, 2Herrity A, 3Shogren C, 4Harkema S
1Frazier Rehab Institute, Louisville, KY, United states; 2Department of Neurological Surgery, University of Louisville, Louisville, KY, United states; 3Courage Kenny Rehabilitation Institute, a part of Allina Health, Minneapolis, MN, United states; 4Professor and Associate Director, Kentucky Spinal Cord Injury Research Center, University of Louisville Owsley B. Frazier Chair in Neurological Rehabilitation Research Director, Frazier Rehab Institute Director of the NeuroRecovery Network, Louisville, KY, United states
Objective: Neuromuscular electrical stimulation (NMES) is an emerging treatment for recovery of upper extremity (UE) function following a spinal cord injury (SCI).1 Improvements in strength and object manipulation have been reported following training with conventional NMES.1 However recovery of appropriate UE kinematics was not assessed. Wide-pulse high frequency (WPHF) NMES has been shown to elicit muscle contractions below the level of injury that are centrally-derived through recruitment of motoneurons.2 WPHF NMES may drive excitation and reorganization of the nervous system below the level of injury to promote recovery of appropriate kinematics in UEs. We hypothesized that individuals with a SCI, receiving WPHF NMES with activity based therapy (ABT) would demonstrate improvements in UE kinematics with task specific activities.
Design/Method: Individuals with UE deficits resulting from SCI received wide-pulse (500 or 1000 µsec) high frequency (100 Hz) NMES to both UE and trunk in conjunction with ABT. NMES was delivered through RTI units, using the Xcite program (Restorative Therapies, Inc (RTI), Baltimore, MD) for 60 minutes, 4-5 times per week, for a minimum of 20 sessions. Each session included repetitions of task specific activities with NMES including overhead press, forward reach and grasp, can open and manipulation, and door pull and open. The activity performed was the individual’s lagging item on the Neuromuscular Recovery Scale (NRS).3 Each session also included 30 minutes of community integration for carryover of the tasks. Evaluation and discharge assessments included the NRS, International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) and Monofilament Upper Extremity Test.
Results: Individuals with a cervical SCI who received WPHF NMES with ABT to both UE and trunk demonstrated improvements in UE kinematics during task specific activities. Following at least 20 sessions of NMES with ABT, UE NRS item scores improved, as well as their overall NRS score. The effect of WPHF NMES with ABT on UE sensation and motor scores are being evaluated as assessed by the Monofilament Upper Extremity Test and ISNCSCI.
Conclusion: WPHF NMES resulted in improvements in UE recovery not previously reported with conventional NMES. Individuals demonstrated improved kinematics executing task specific activities, more closely resembling how they performed pre-injury and decreased use of compensatory strategies.
Support: Since 2014, this project was funded by the Christopher & Dana Reeve Foundation. It was supported, in part, by cooperative agreement numbers 90PR3001 and 90PR3002, from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration for Community Living policy.
Prior to 2014, this project was funded by the Christopher & Dana Reeve Foundation through various cooperative agreements with the Centers for Disease Control and Prevention (cooperative agreement numbers 1U59DD000838, 1U59DD000338, and U10/CCU220379).
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