Non-Pharmacologic Therapy: Rehabilitation Modalities

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Rehabilitation options for bone health after SCI focus on stimulating muscles and encouraging weight-bearing. This section includes six modalities: functional electrical stimulation (FES), electrical stimulation (ES), standing and walking, treadmill training, ultrasound and physical activity.  FES is an important option to stimulate muscle with the goal of increasing regional BMD, and involves the use of surface or implanted electrodes to facilitate stimulation-induced standing, ambulation or bicycling (cycle ergometry).  An FES cycle ergometer uses a series of electrodes placed over the hamstrings, quadriceps and gluteal muscles of the legs to stimulate a cycling pattern.  Weight-bearing activities are also used for bone health after SCI; these modalities include either passive (tilt-table or standing frame) or active weight-bearing activities with or without assistance from FES.  Many FES studies have enrolled participants with both acute and chronic injuries and are therefore difficult to classify as pure prevention or treatment interventions.  For the purpose of this review, studies that enrolled participants that ranged from the acute phase to > 1 year were included with the treatment literature, as the majority of their participants were in the chronic phase.