Advancing Recovery after Spinal Cord Injury utilizing Lower Extremity Neuromuscular Electrical Stimulation
1Oakley A, 2Herrity A, 1O'Brien K, 3Shogren C, 4Tefertiller C, 5Forrest G, 6Harkema S
1Frazier Rehabilitation Institute, Louisville, Kentucky, United states; 2University of Louisville Kentucky Spinal Cord Injury Research Center, Louisville, Kentucky, United states; 3Courage Kenny Rehabilitation Institute, Minneapolis, Minnesota, United states; 4Craig Hospital, Englewood, Colorado, United states; 5Kessler Foundation, West Orange, New jersey, United states; 6Frazier Rehabilitation Institute; University of Louisville Kentucky Spinal Cord Injury Research Center, Louisville, Kentucky, United states
Neuromuscular electrical stimulation (NMES) has emerged as a therapy to optimize sensory activity below the lesion level. Stimulation provided with a high frequency and wide pulse width parameter has been shown to evoke centrally-driven contractions, resulting in improvements in motor output. Thus, the objective of this study was to demonstrate the effectiveness of lower extremity (LE) NMES, a recovery-based rehabilitative strategy, on motor strength, balance and functional improvements in those with upper and lower motor neuron spinal cord injury.
Eight individuals, enrolled in the Christopher and Dana Reeve NeuroRecovery Network, received task-specific NMES to the muscles of the lower extremities. Therapy was provided five days a week for a minimum of 60 sessions, each session lasting 90 minutes. NMES was delivered via the SAGE RT60 stimulation XCite software to 12 different muscle groups based on the selected phase item from the Neuromuscular Recovery Scale (NRS). NMES was delivered with a pulse width of 1000 to 3000 µsec, frequency of 33.3 or 100 Hz intensity to individual tolerance. The individuals received NMES with dynamic lower extremity support to maintain appropriate lower extremity kinematics while adhering to the following activity-based therapy principles: maximizing weight bearing, minimizing compensation, providing appropriate sensory cues, and normalizing kinematics. Assessments included the following: International Standards for the Neurological Classification of Spinal Cord Injury (ISNCSCI) examinations to score the motor and sensory impairment and the severity of injury, Neuromuscular Recovery Scale (NRS) phasing to quantify stages of functional recovery without compensation and the Berg Balance Scale testing.
Following lower extremity NMES, individuals demonstrated significant increases in the the NRS scale and in the subscores of the “sit to stand” and the “stand” tasks. In addition, improvements in the overall Berg Balance Scale and ISNCSCI motor score were apparent.
The use of novel, sensory-driven, task-specific NMES in the outpatient setting may be a means of promoting functional recovery for this injury population. The clinical implications of the current stimulation parameters may be used to help treat spinal cord injury induced impairments such as motor strength as well as assist in achieving improved posture and mobility.
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