Abstract
Study design:
Controlled, repeat-measures study.
Objectives:
To determine if functional electrical stimulation (FES) can affect bone atrophy in early spinal cord injury (SCI), and the safety, tolerance and feasibility of this modality in bone loss remediation.
Setting:
Spinal Injuries Units, Royal Adelaide Hospital and Hampstead Rehabilitation Centre, South Australia.
Methods:
Patients with acute SCI (ASIA A–D) were allocated to FES (n=23, 28±9 years, C4–T10, 13 Tetra) and control groups (CON, n=10, 31±11 years, C5–T12, four Tetra). The intervention group received discontinuous FES to lower limb muscles (15 min sessions to each leg twice daily, over a 5-day week, for 5 months). Dual energy X-ray absorptiometry (DEXA) measured total body bone mineral density (tbBMD), hip, spine BMD and fat mass (FM) within 3 weeks, and 3 and 6 months postinjury.
Results:
FES and CON groups' tbBMD differed significantly at 3 months postinjury (P<0.01), but not thereafter. Other DEXA measures (hip, spine BMD, FM) did not differ between groups at any time. No adverse events were identified.
Conclusion:
Electrically stimulated muscle activation was elicited, and tetanic effects were reproducible; however, there were no convincing trends to suggest that FES can play a clinically relevant role in osteoporosis prevention (or subsequent fracture risk) in the recently injured patient. The lack of an osteogenic response in paralysed extremities to electrically evoked exercise during subacute and rehabilitation/recovery phases cannot be fully explained, and may warrant further evaluation.
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Acknowledgements
We acknowledge the excellent technical support of Ms Trish Wesley, of the Department of Nuclear Medicine, Royal Adelaide Hospital and Ms Sheelagh Donohoe, Ms Julie Wheeler, Ms Marie Hogg and Ms Annette van den Broek of the FES Clinic, Hampstead Rehabilitation Centre. The study was funded by a grant from the Motor Accident Commission of South Australia and the State Government of South Australia. The protocol was approved by the Royal Adelaide Hospital Human Research Ethics Committee, and conducted in accordance with the guidelines of the Declaration of Helsinki.
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Clark, J., Jelbart, M., Rischbieth, H. et al. Physiological effects of lower extremity functional electrical stimulation in early spinal cord injury: lack of efficacy to prevent bone loss. Spinal Cord 45, 78–85 (2007). https://doi.org/10.1038/sj.sc.3101929
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DOI: https://doi.org/10.1038/sj.sc.3101929
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