Article 3: The Effects of Functional Electric Stimulation Cycling for Children With Spinal Cord Injury

Abstract

Objective: To determine the musculoskeletal and cardiovascular effects of cycling with functional electric stimulation (FES) for children with spinal cord injury (SCI). Design: Before-after intervention trial. Setting: Pediatric referral hospital. Participants: A convenience sample of 9 children, ages 9.0±2.1 years, with C4-T11 motor complete SCI of 4.8±2.1 years in duration. Intervention: Children exercised with an FES cycle for 1 hour, 3 times a week, for 6 months at home. Stimulation was provided to the quadriceps, hamstrings, and gluteal muscles during cycling. Main Outcome Measures: Measures included stimulated quadriceps and hamstrings isometric muscle strength, hip and knee bone mineral density (BMD), peak oxygen uptake (Vo2peak) during progressive upper-extremity ergometry testing, and a fasting lipid profile. Data were analyzed using 1-tailed paired t tests due to directional hypotheses. Results: Children completed 90.3% of the required sessions. There were significant improvements in stimulated quadriceps strength (P<.001), distal femur BMD (P=.05), and triglyceride levels (P=.04), but no change in stimulated hamstrings strength (P=.46), BMD of the hip (P=.21) or proximal tibia (P=.17), Vo2peak (P=.07), total cholesterol levels (P=.39), high-density lipoprotein (HDL) cholesterol levels (P=.08), or low-density lipoprotein cholesterol levels (P=.34). Conclusions: Children in this study showed musculoskeletal and cardiovascular improvements following a 6-month program of FES cycling. While nonsignificant, there were also clinical improvements in Vo2peak (P=.07) and HDL cholesterol levels (P=.08), which are commonly reported as benefits of exercise. With an increased number of subjects, these values may become significant. The finding of increased distal femur BMD without an increase in hip BMD is consistent with literature on adults with SCI following FES cycling.