title: Strengthening of partially denervated knee extensors using percutaneous electric stimulation in a young man with spinal cord injury.
abstract: OBJECTIVE
  To evaluate the effects of percutaneous electric stimulation on knee extensor strength and muscle hypertrophy, gait, and energy cost of walking in a young man with partial denervation of the knee extensors.
  
  
  METHODS
  One-way repeated measures.
  
  
  METHODS
  Pediatric orthopedic hospital.
  
  
  METHODS
  A man in his early twenties, who had an L2 American Spinal Injury Association class D spinal cord injury, presented with strength deficits in his left knee extensors and reported falling frequently. When walking, his left knee remained locked in extension throughout stance. Electromyographic testing revealed chronic denervation and reinnervation changes.
  
  
  METHODS
  Because of sensory difficulties with surface stimulation, a percutaneous electrode was surgically implanted near the femoral nerve. The subject exercised isometrically with a research grade stimulator for 1 hour a day until his strength plateaued.
  
  
  METHODS
  Quadriceps femoris strength and hypertrophy, gait, and energy cost of walking were recorded preintervention, every 2 months during the strengthening phase, and 2 months after withdrawal.
  
  
  RESULTS
  Voluntary isometric torque improved from 7 to 14.8Nm (112%) and decreased to 8.5Nm after stimulation was withdrawn. Mean circumferential measures of the thigh improved from 12.3 to 13.5cm (9.8%) and then decreased to 13.1cm. Gait kinematics and kinetics were unchanged, although the subject reported greater stability in his left knee and fewer falls.
  
  
  CONCLUSIONS
  The study indicates that percutaneous electric stimulation could be used to strengthen partially denervated muscle and to affect function. However, gains in strength may not be maintained once treatment is withdrawn.
authors.affiliation: Shriners Hospitals for Children, Philadelphia, PA, USA. tjohnston@shrinenet.org
authors.forename: Therese E
authors.initials: TE
authors.lastname: Johnston
authors.forename: Brian T
authors.initials: BT
authors.lastname: Smith
authors.forename: Randal R
authors.initials: RR
authors.lastname: Betz
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D006801:Humans; D007717:Knee; D008297:Male; D009121:Muscle Denervation; D018482:Muscle, Skeletal / Q000294:innervation* / Q000502:physiology*; D009133:Muscular Atrophy; D013119:Spinal Cord Injuries / Q000503:physiopathology* / Q000534:rehabilitation*; D019415:Torque; D004561:Transcutaneous Electric Nerve Stimulation; D016138:Walking / Q000502:physiology*