Home-based functional electrical stimulation rescues permanently denervated muscles in paraplegic patients with complete lower motor neuron lesion.
BACKGROUND
Spinal cord injury causes muscle wasting and loss of function, which are especially severe after complete and permanent damage to lower motor neurons. In a previous cross-sectional study, long-standing denervated muscles were rescued by home-based functional electrical stimulation (h-bFES) training.


OBJECTIVE
To confirm results by a 2-year longitudinal prospective study of 25 patients with complete conus/cauda equina lesions.


METHODS
Denervated leg muscles were stimulated by h-bFES using a custom-designed stimulator and large surface electrodes. Muscle mass, force, and structure were determined before and after 2 years of h-bFES using computed tomography, measurements of knee torque during stimulation, and muscle biopsies analyzed by histology and electron microscopy.


RESULTS
Twenty of 25 patients completed the 2-year h-bFES program, which resulted in (a) a 35% cross-sectional increase in area of the quadriceps muscle from 28.2 ± 8.1 to 38.1 ± 12.7 cm(2) (P < .001), a 75% increase in mean diameter of muscle fibers from 16.6 ± 14.3 to 29.1 ± 23.3 μm (P < .001), and improvements of the ultrastructural organization of contractile material; and (b) a 1187% increase in force output during electrical stimulation from 0.8 ± 1.3 to 10.3 ± 8.1 N m (P < .001). The recovery of quadriceps force was sufficient to allow 25% of the subjects to perform FES-assisted stand-up exercises.


CONCLUSIONS
Home-based FES of denervated muscle is an effective home therapy that results in rescue of muscle mass and tetanic contractility. Important immediate benefits for the patients are the improved cosmetic appearance of lower extremities and the enhanced cushioning effect for seating.
Kern
Helmut
H
Ludwig Boltzmann Institute of Electrostimulation and Physical Rehabilitation, Vienna, Austria.
Carraro
Ugo
U
Adami
Nicoletta
N
Biral
Donatella
D
Hofer
Christian
C
Forstner
Claudia
C
Mödlin
Michaela
M
Vogelauer
Michael
M
Pond
Amber
A
Boncompagni
Simona
S
Paolini
Cecilia
C
Mayr
Winfried
W
Protasi
Feliciano
F
Zampieri
Sandra
S
D000328:Adult; D003430:Cross-Sectional Studies; D004599:Electric Stimulation Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007866:Leg / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009119:Muscle Contraction; D009121:Muscle Denervation / Q000534:rehabilitation*; D010264:Paraplegia / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D011446:Prospective Studies; D052097:Quadriceps Muscle / Q000294:innervation* / Q000503:physiopathology; D020127:Recovery of Function; D013119:Spinal Cord Injuries / Q000150:complications / Q000503:physiopathology / Q000534:rehabilitation*; D016896:Treatment Outcome