Journal of Rehabilitation Research & Development (JRRD)

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Volume 47 Number 1, 2010
   Pages 7 — 16

Abstract — Neurotherapeutic and neuroprosthetic effects of implanted functional electrical stimulation for ambulation after incomplete spinal cord injury

Stephanie Nogan Bailey, BSE;1* Elizabeth C. Hardin, PhD;1 Rudi Kobetic, MS;1 Lisa M. Boggs, MPT;1
Gilles Pinault, MD;1 Ronald J. Triolo, PhD1-2

1Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH; 2Departments of Orthopaedics and Biomedical Engineering, Case Western Reserve University, Cleveland, OH

Abstract — The purpose of this single-subject study was to determine the neurotherapeutic and neuroprosthetic effects of an implanted functional electrical stimulation (FES) system designed to facilitate walking in an individual with a long-standing motor and sensory incomplete spinal cord injury. An implanted pulse generator and eight intramuscular stimulating electrodes were installed unilaterally, activating weak or paralyzed hip flexors, hip and knee extensors, and ankle dorsiflexors during 36 sessions of gait training with FES. The neurotherapeutic effects were assessed by a comparison of pre- and posttraining volitional walking. The neuroprosthetic effects were assessed by a comparison of posttraining volitional and FES-assisted walking. Treatment resulted in significant (p < 0.005) volitional improvements in 6-minute walking distance and speed, speed during maximum walk, double support time, and 10 m walking speed. Posttraining FES-assisted walking resulted in significant additional improvements in all these measures, except 10 m walking speed. When the subject was using FES-assisted gait, maximum walking distance, peak knee flexion in swing, peak ankle dorsiflexion in swing, and knee extension moment also significantly increased. Neuroprosthetic gains were sufficient to enable the subject to advance from household ambulation to limited community ambulation. Additionally, the subject could perform multiple walks per day when using FES-assisted gait, which was impossible with volitional effort alone.

Key words: functional electrical stimulation, functional outcomes, gait, gait training, neurological gait disorders, neuroprosthetic, neurotherapeutic, rehabilitation, spinal cord injury, stimulation, walk.

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