Functional Electrical Stimulation

Cycling after SCI

Cheyenne Peters
St. Ambrose University
Patient 47 year old male
Description
Traumatic SCI
• biking accident

C7-T1 internal fusion, C5-T2 posterior fusion,

trach, lumbar drain

C7 ASIA B
Clinical Question
• In a patient with an incomplete
spinal cord injury, what effect
does lower extremity functional
electrical stimulation cycling have
on recovery?
 Rationale for Clinical Question
• LE and abdominal spasms
• Former boxer, active duty military
• Concerned about losing muscle mass
• Return to PLOF
• Access to RT300
• E-stim trial
 Search Strategy

Search Terms Results Relevant Results

Spinal cord injury AND functional electrical stimulation AND 341

cycling

Spinal cord injury AND functional electrical stimulation AND 109 13

cycling AND lower extremity

Spinal cord injury AND functional electrical stimulation AND 17 2- 1 new

cycling AND lower extremity AND recovery

Spinal cord injury AND functional electrical stimulation AND 3 2- same as previous
cycling
AND lower extremity AND recovery AND incomplete
Search
Strategy Paralyzed Veterans of America
Cont. • CPG

APTA
• Article Search
• Academy of Neurologic Physical
Therapy
 • Four weeks of functional electrical stimulation
cycling after spinal cord injury: a clinical cohort
Outcome of study

Search • Functional electrical stimulation cycling improves

body composition, metabolic and neural factors in
persons with spinal cord injury

• Lower extremity functional electrical stimulation

cycling promotes physical and functional recovery in
chronic spinal cord injury

• Exercise Recommendations for Individuals with

Spinal Cord Injury

• Based on methods, participants, inclusion/exclusion criteria

Kuhn, et al.- 2014
• Prospective clinical cohort
• 30 participants
• 13 cervical, 3 ASIA B
• 44 yrs old
• Acute care unit- average 2 months after injury
• Prior excitability testing
• 20 min, 2 days/week, 4 weeks
• PT/OT treatment on off days
 • Muscle cross-section- diagnostic
US
• Rectus femoris
• Leg circumference- tape measure
Kuhn, et al. • Spasticity- MAS
Outcomes • Walking ability- WISCI II
• MMT
• Additional outcomes
• Active pedaling time and distance
 Griffin, et al.-
2009
• 18 participants
• 13 male, 13 incomplete
• 40 years old
• Computerized system- stim and torque
• 140 mA max
• 30 min, 2-3x/week, 10 weeks
• 1 min warm-up, 2 min cooldown
• Quads, hs, glutes
 • Body comp- DEXA
• Muscle mass
• Bone density
• Fat
• Motor and sensory- ASIA
Griffin, et al.
• Other outcomes
Outcomes • Ride time
• Power
Sadowsky, et al.-
2013
• Retrospective cohort w/ cross-sectional evaluation
• 29.1 months
• Chronic
• 25 FES, 20 control
• 84% male
• 45-60 min, 3x/week, 3+ months (average 29.5)
• Parameters pt specific
• Quads, hs, glutes
 • Motor, sensory, CMSS- ASIA
• Muscle mass- MRI
• Quads, hs
• Fat- DXA
• Strength- isokinetic dynamometer,
Sadowsky, et al. resistance torque
Outcomes • Spasticity- isokinetic dynamometer,
surface electrodes
• QOL- Medical Outcomes Study 36-
Item Short Form, FIM
 Jacobs, Nash-
2004
• Electrically Stimulated Exercise- Leg Cycling Exercise
• Quads, hs, glutes
• Muscle mass, iso strength, endurance
• Altering strength, resistance to fatigue, contractile properties
• Circulation
• Bone density
• Body comp- lean muscle mass
EBP Application
• Prior experience
• Patient preference
• Decision
Reflection

Patient outcomes What I would change Future application

Spasms Evidence No negative effects
Muscle return Access and ease
Short stay
Citations
1. Kuhn D, Leichtfried V, Schobersberger W. Four weeks of functional electrical
stimulated cycling after spinal cord injury: a clinical cohort study. Int J Rehabil Res.
2014;37(3):243-250. doi:10.1097/MRR.0000000000000062
2. Griffin L, Decker MJ, Hwang JY, et al. Functional electrical stimulation cycling improves
body composition, metabolic and neural factors in persons with spinal cord injury. J
Electromyogr Kinesiol. 2009;19(4):614-622. doi:10.1016/j.jelekin.2008.03.002
3. Sadowsky CL, Hammond ER, Strohl AB, et al. Lower extremity functional electrical
stimulation cycling promotes physical and functional recovery in chronic spinal cord
injury. J Spinal Cord Med. 2013;36(6):623-631.
doi:10.1179/2045772313Y.0000000101
4. Jacobs PL, Nash MS. Exercise recommendations for individuals with spinal cord
injury. Sports Med. 2004;34(11):727-751. doi:10.2165/00007256-200434110-00003
Questions