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Functional Electrical Stimulation with Gait Training to Improve Locomotor Function

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Table 12: Studies Combining Functional Electrical Stimulation with Gait Training to Improve Locomotor Function

Discussion

Findings from five studies, including three high-quality RCTs (Hitzig et al. 2013; Field-Fote & Roach 2011; Field-Fote et al. 2005) and three pretest/posttest (Hesse et al. 2004; Field-Fote & Tepavac 2002; Field-Fote 2001) studies, demonstrated favourable outcomes when BWSTT was combined with FES in people with chronic, incomplete SCI. There was an overall enhancement of short-distance functional ambulation, as measured by overground gait speed over 6 meters, and walking distance when BWSTT was combined with FES of the common peroneal nerve. Hesse et al. (2004) found that BWSTT combined with FES to the quadriceps and hamstrings muscles enhanced functional ambulation. Hitzig et al. (2013) studied the effects of FES stimulation while ambulating on a BWS treadmill, and found a significant increase on SCIM mobility scores from baseline to 1-year follow-up compared to the control group.

The Kressler et al. (2013) study provides evidence for increased benefit of electrical stimulation over manual assistance and braces (driven gait orthosis). In this study, the transcutaneous electrical stimulation group and the overground locomotor training with electrical stimulation group had significantly higher walking speeds while the treadmill-training with manual assistance group and driven gait orthosis group had nonsignificant improvements in walking speed.

Triolo et al. (2012) explored use of an 8 channel neuroprosthesis with rehabilitation training and found that there were no statistically significant differences in walking outcomes. However, the safety and reliability of the neuroprosthesis system were supported.

Conclusion

There is level 1b and level 2 evidence (Field-Fote & Roach, 2011; Field-Fote et al. 2005; Field-Fote and Tepavac 2002; Field-Fote 2001) for an overall enhancement of short-distance functional ambulation, as measured by overground gait speed over 6 meters, and walking distance when BWSTT was combined with FES of the common peroneal nerve.

There is level 1b evidence (Kressler et al. 2013) for increased benefit of electrical stimulation over manual assistance and braces (driven gait orthosis).

There is level 1b evidence (Hitzig et al. 2013) for a significant increase in SCIM mobility scores when subjects are stimulated with FES while ambulating on a BWS treadmill.

There is level 4 evidence from one pretest/posttest study (Hesse et al. 2004) suggesting that BWSTT combined with FES to the quadriceps and hamstrings muscles enhances functional ambulation.

There is level 4 evidence from one case series study (Triolo et al. 2012) that while an 8 channel neuroprosthesis system is safe and reliable, its use with rehabilitation training shows no statistically significant difference in walking outcomes.

  • BWSTT combined with FES of the common peroneal nerve can lead to an overall enhancement of short-distance functional ambulation.

    Electrical stimulation is shown to be a more effective form of locomotor training than manual assistance and braces.

    Stimulation with FES while ambulating on a BWS treadmill can increase SCIM mobility scores.

    BWSTT combined with FES to the quadriceps and hamstrings muscles can enhance functional ambulation.

    While an 8 channel neuroprosthesis system is safe and reliable, its use with rehabilitation training showed no statistically significant difference in walking outcomes.