title: One year of home-based daily FES in complete lower motor neuron paraplegia: recovery of tetanic contractility drives the structural improvements of denervated muscle.
abstract: OBJECTIVE
  Spinal cord injury (SCI) causes muscle atrophy, which is particularly severe, due to inability to perform tetanic contractions, when lower motor neurons (LMN) are involved. We performed a longitudinal study in 25 Europeans suffering from complete conus cauda syndrome from 0.7 to 8.7 years comparing functional and structural thigh muscle properties before and after 2 years of home-based daily training by functional electrical stimulation (FES). The mid-term results after 1 year and preliminary muscle biopsy observations at project end-point from a subset of subjects are here reported.
  
  
  METHODS
  Muscles were electrically stimulated at home by means of large surface electrodes and a custom-designed stimulator. The poor excitability of the LMN denervated muscles was first improved by twitch-contraction training. Then, tetanic contractions against progressively increased loading were elicited. Finally, standing-up exercises were daily performed. The bulk of thigh muscle was estimated by transverse computer tomography (CT) scan and force measurements. Needle biopsies of vastus lateralis were harvested before and after 2 years of FES.
  
  
  RESULTS
  The 1 year home-based daily FES training induced: (1) very similar increases in muscle excitability and contractility in right and left legs; (2) feasibility to elicit tetanic contractions by means of train-stimulation with about ten times improvement of muscle force; (3) increase in the 26% of muscle bulk, as shown by CT scan analyses, improving appearance of limbs and muscle cushioning; (4) myofiber size increase (+94%) in a small series of muscle biopsies obtained after 2 years of FES. None of the subjects that performed 1 year home-based daily FES training (20 persons) had worsened their functional class, while 20% (4/20) improved to functional class 4, that is, the ability to stand.
  
  
  CONCLUSIONS
  The European Union (EU) Project Rise shows that 'home-based daily FES training' is a safe and effective therapy that may maintain life-long physical exercise by active muscle contraction (FES is the only option for denervated muscle) as a procedure to recover the early-lost tetanic contractility of denervated muscle, and to counteract muscle atrophy in order to prevent clinical complications.
authors.affiliation: Ludwig Boltzmann Institute of Electrostimulation and Physical Rehabilitation, Department of Physical Medicine, Wilhelminenspital, Vienna, Austria.
authors.forename: Helmut
authors.initials: H
authors.lastname: Kern
authors.forename: Ugo
authors.initials: U
authors.lastname: Carraro
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Adami
authors.forename: Christian
authors.initials: C
authors.lastname: Hofer
authors.forename: Stefan
authors.initials: S
authors.lastname: Loefler
authors.forename: Michael
authors.initials: M
authors.lastname: Vogelauer
authors.forename: Winfried
authors.initials: W
authors.lastname: Mayr
authors.forename: Rudiger
authors.initials: R
authors.lastname: Rupp
authors.forename: Sandra
authors.initials: S
authors.lastname: Zampieri
mesh_terms: D000328:Adult; D004599:Electric Stimulation Therapy; D005060:Europe; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009046:Motor Neurons; D009119:Muscle Contraction / Q000502:physiology; D009121:Muscle Denervation; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging / Q000294:innervation / Q000473:pathology* / Q000502:physiology*; D009133:Muscular Atrophy; D026201:Musculoskeletal Manipulations; D010264:Paraplegia / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D020127:Recovery of Function; D013848:Thigh; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult