Functional electrical stimulation-assisted walking for persons with incomplete spinal injuries: longitudinal changes in maximal overground walking speed.

This study investigated the changes in maximal overground walking speed (MOWS) that occurred during walking training with a functional electrical stimulation (FES) orthosis by chronic spinal cord injured persons with incomplete motor function loss. The average walking speed over a distance of 10 m was calculated while the participants (n = 14) used their FES orthosis with and without power as well as with the various ambulatory assistive devices available. Within the first year of use, walking with an FES orthosis facilitated use of more advanced ambulatory assistive devices (10/14), improvements in functional mobility (12/14) and increases in the combined (0.26 m/s) and therapeutic (0.25 m/s) MOWS that were correlated (combined: r = 0.57; therapeutic: r = 0.69) with their respective initial MOWS. A longitudinal analysis showed that increases in MOWS followed a pattern of changes best described by either an exponential association (8/12) or a linear (4/12) model. These changes were similar for the combined and therapeutic MOWS (7/11) as well as for the different ambulatory assistive devices (8/9). It is concluded that the increased MOWS during walking training using the FES orthosis is mostly due to a therapeutic effect, implying that mechanisms of plasticity occur during such a training paradigm.

[1]  R. Merletti,et al.  A control study of muscle force recovery in hemiparetic patients during treatment with functional electrical stimulation. , 1978, Scandinavian journal of rehabilitation medicine.

[2]  W. Donovan,et al.  The International Standards Booklet for Neurological and Functional Classification of Spinal Cord Injury , 1994, Paraplegia.

[3]  H Barbeau,et al.  Walking after spinal cord injury: evaluation, treatment, and functional recovery. , 1999, Archives of physical medicine and rehabilitation.

[4]  D. Kernell,et al.  Effects of physiological amounts of high- and low-rate chronic stimulation on fast-twitch muscle of the cat hindlimb. I. Speed- and force-related properties. , 1987, Journal of neurophysiology.

[5]  B. Andrews,et al.  The use of functional electrical stimulation to assist gait in patients with incomplete spinal cord injury. , 1992, Disability and rehabilitation.

[6]  Liberson Wt,et al.  Functional electrotherapy: stimulation of the peroneal nerve synchronized with the swing phase of the gait of hemiplegic patients. , 1961, Archives of physical medicine and rehabilitation.

[7]  R. Waters,et al.  International Standards for Neurological and Functional Classification of Spinal Cord Injury , 1997, Spinal Cord.

[8]  J. Donoghue.  Plasticity of adult sensorimotor representations , 1995, Current Opinion in Neurobiology.

[9]  J. F. Yang,et al.  Modification of reflexes in normal and abnormal movements. , 1993, Progress in brain research.

[10]  U. Bogataj,et al.  Enhanced rehabilitation of gait after stroke: a case report of a therapeutic approach using multichannel functional electrical stimulation. , 1997, IEEE transactions on rehabilitation engineering : a publication of the IEEE Engineering in Medicine and Biology Society.

[11]  H Barbeau,et al.  Recovery of walking after spinal cord injury. , 1997, Advances in neurology.

[12]  A. Kralj,et al.  Enhancement of hemiplegic patient rehabilitation by means of functional electrical stimulation , 1993, Prosthetics and orthotics international.

[13]  E. Isakov,et al.  Biomechanical and physiological evaluation of FES-activated paraplegic patients. , 1986, Journal of rehabilitation research and development.

[14]  E. Roth,et al.  Neuromuscular stimulation in spinal cord injury: I: Restoration of functional movement of the extremities. , 1992, Archives of physical medicine and rehabilitation.

[15]  P. Tugwell,et al.  50-foot walking time: a critical assessment of an outcome measure in clinical therapeutic trials of antirheumatic drugs. , 1988, British journal of rheumatology.

[16]  Leland Wilkinson,et al.  An Analytic Approximation to the Distribution of Lilliefors's Test Statistic for Normality , 1986 .

[17]  B. Andrews,et al.  The role of functional electrical stimulation in the rehabilitation of patients with incomplete spinal cord injury - observed benefits during gait studies , 1993, Paraplegia.

[18]  JoAnne K. Gronley,et al.  Classification of walking handicap in the stroke population. , 1995, Stroke.

[19]  J. Wolpaw,et al.  Memory traces in primate spinal cord produced by operant conditioning of H-reflex. , 1989, Journal of neurophysiology.

[20]  A Prochazka,et al.  Electrical systems for improving locomotion after incomplete spinal cord injury: an assessment. , 1993, Archives of physical medicine and rehabilitation.

[21]  R. Nakamura,et al.  Computer-assisted gait training (CAGT) of hemiparetic stroke patients: whose recovery is most predictable? , 1992, The Tohoku journal of experimental medicine.

[22]  T. Chalmers,et al.  Functional electrostimulation in poststroke rehabilitation: a meta-analysis of the randomized controlled trials. , 1996, Archives of physical medicine and rehabilitation.

[23]  A. Kralj,et al.  Use of functional electrical stimulation in the rehabilitation of patients with incomplete spinal cord injuries. , 1989, Journal of biomedical engineering.

[24]  J R Wolpaw,et al.  Therapeutic neural effects of electrical stimulation. , 1996, IEEE transactions on rehabilitation engineering : a publication of the IEEE Engineering in Medicine and Biology Society.

[25]  A. Kralj,et al.  Functional Electrical Stimulation: Standing and Walking after Spinal Cord Injury , 1989 .

[26]  J. Kurtzke,et al.  Epidemiology of spinal cord injury , 1975, Experimental Neurology.