title: Neuromuscular Electrical Stimulation-Induced Resistance Training After SCI: A Review of the Dudley Protocol.
abstract: BACKGROUND
  Neuromuscular electrical stimulation (NMES), often referred to as functional electrical stimulation (FES), has been used to activate paralyzed skeletal muscle in people with spinal cord injury (SCI). The goal of NMES has been to reverse some of the dramatic losses in skeletal muscle mass, to stimulate functional improvements in people with incomplete paralysis, and to produce some of the health benefits associated with exercise.
  
  
  OBJECTIVE
  The purpose of this brief review is to describe a quantifiable resistance training form of NMES developed by Gary A. Dudley.
  
  
  METHODS
  People with motor complete SCI were first tested to confirm that an NMES-induced muscle contraction of the quadriceps muscle could be achieved. The contraction stimulus consisted of biphasic pulses at 35 Hz performed with increasing current up to what was needed to produce full knee extension. Four sets of 10 knee extensions were elicited, if possible. Training occurred biweekly for 3 to 6 months, with ankle weights being increased up to an added weight of 9.1 kg if the 40 repetitions could be performed successfully for 2 sessions.
  
  
  RESULTS
  Many participants have performed this protocol without adverse events, and all participants showed progression in the number of repetitions and/or the amount of weight lifted. Large increases in muscle mass occur, averaging 30% to 40%. Additional physiological adaptations to stimulated muscle have also been reported.
  
  
  CONCLUSIONS
  These results demonstrate that the affected skeletal muscle after SCI responds robustly to progressive resistance training many years after injury. Future work with NMES should determine whether gains in lean mass translate to improved health, function, and quality of life.
authors.affiliation: Departments of Physical Therapy.|UAB Center for Exercise Medicine, University of Alabama at Birmingham.
authors.forename: C Scott
authors.initials: CS
authors.lastname: Bickel
authors.affiliation: Nutrition Sciences.|UAB Center for Exercise Medicine, University of Alabama at Birmingham.
authors.forename: Ceren
authors.initials: C
authors.lastname: Yarar-Fisher
authors.affiliation: Department of Kinesiology, University of Georgia, Athens, Georgia.
authors.forename: Edward T
authors.initials: ET
authors.lastname: Mahoney
authors.affiliation: Department of Kinesiology, University of Georgia, Athens, Georgia.
authors.forename: Kevin K
authors.initials: KK
authors.lastname: McCully
mesh_terms: D000222:Adaptation, Physiological; D004558:Electric Stimulation; D004599:Electric Stimulation Therapy; D006801:Humans; D009119:Muscle Contraction; D053580:Muscle Strength; D052097:Quadriceps Muscle / Q000503:physiopathology; D055070:Resistance Training; D013119:Spinal Cord Injuries / Q000628:therapy*
keywords: electrical stimulation; muscle hypertrophy; spinal cord injury