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The Use of Functional Electrical Stimulation to Improve Function in People with Spinal Cord Injury

1 May 2007


1. Clinical Bottom Line: Currently there is no evidence to support the notion that in people with spinal cord injury, the use of FES as a physical therapy intervention results in improved functional outcomes. All of the articles we critically analyzed had significant threats to internal validity preventing us from generalizing the results to our clinical scenarios. Higher quality research including randomized-controlled trials with larger sample sizes and long-term follow-up are needed.

2a. Clinical Scenario One - Functional Electrical Stimulation as a Treatment to Increase Muscle Strength and Function in Someone with an Incomplete Spinal Cord Injury: A 25 year old male, Kevin, who is two years post incomplete T11 spinal cord injury (SCI) is currently being seen at our outpatient neuro-rehabiliation facility and has approached us about an article he had read in Science Technology. This article explained the technology behind new functional electrical stimulation (FES) systems being used to help regain mobility for people with SCI. Our patient was interested in using the device to assist him with transfers, standing to face peers and give speeches, and walk. Kevin is currently using a manual wheelchair for all mobility and has expressed his dissatisfaction with his recent increase in weight. Kevin also becomes frustrated when he needs assistance to get objects that are out of his reach, both in the community and in his home. Kevin is not interested in using long-leg braces (LLB) due to reports from friends and others in the SCI community regarding the difficulty of their use, their inefficiency, and their bulkiness. Our patient is American Spinal Cord Injury Association (ASIA) classification C (Appendix A) and has bilateral lower extremity involvement, with his right side more involved than his left. Kevin is currently able to stand and walk in the parallel bars with assistance of one physical therapist; however, his gait is not functional. Kevin is wondering if including FES as a treatment for his lower extremities (LE) would improve his ability to stand, transfer, and ambulate independently and efficiently.

3a. Our clinically answerable question number one: Population: People with an incomplete SCI Intervention: Functional electrical stimulation in addition to standard physical therapy Comparison: Standard physical therapy (PT) or occupational therapy (OT) Outcome: Gait speed, gait endurance, ability to ascend/descend stairs, ability to transfer and Functional Independence Measure (FIM).

2b. Clinical Scenario Two - Long-term Use of Functional Electrical Stimulation in Someone with a Complete Spinal Cord Injury: Cassy is an 18 year-old female who was born with a T12 spinal cord defect and is looking forward to her transition to college. She wants to room with a high-school friend in the college dormitory, which has limited wheelchair access. Cassy has been using LLB on and off throughout childhood and heard about implanted FES through a family friend. Cassy and her mother may be interested in the implanted FES procedure if it will make Cassy’s ambulation more functional and allow her to complete transfers efficiently in order to increase her participation in peer activities. Cassy is a long-time patient at this facility and is relying on us to help her and her mother make an educated decision about implanted FES before approaching a neurological specialist. Cassy has a complete T12 spinal cord injury, resulting in no active movement of bilateral lower extremities. Cassy understands that implanted FES will be a permanent intervention that will not have any carry-over if she stops using it.

3b. Our clinically answerable question number two (long-term use of FES): Population: People with a complete SCI Intervention: The use of FES via surface or implanted electrodes in lower extremity muscles Comparison: The use of lower extremity orthotic devices Outcome: Independence with walking, gait speed, energy consumption, time to complete donning equipment, transfers, ascending/descending stairs, and patient compliance.


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