Functional electrical stimulation in paraplegic spastic patients.

Abstract

We are reporting on the clinical and physiological effects of 8 months of functional electrical stimulation (FES) of the quadriceps femoris muscle on 10 paraplegic patients. Each patient had muscle biopsies, computed tomography (CT) muscle diameter measurements, and knee extension strength testing both before and after 8 months of FES training. Skin perfusion was documented through infrared telethermography and xenon clearance; muscle perfusion was recorded through thallium scintigraphy. After 8 months of FES training, the baseline skin perfusion showed an 86% increase; muscle perfusion was augmented by 87%. Muscle fiber diameters showed an average increase of 59% after 8 months of FES training. Muscles in patients with spastic paresis showed an increase in aerobic and anaerobic muscle enzymes up to the normal range of healthy humans. The increment in muscle area, as visible on CT scans of the quadriceps femoris muscle, was 30%. Using FES, we were able to improve metabolism and to induce positive trophic changes in our patients' lower extremities. In spastic paraplegics, rising and walking achieved through FES are much better training than FES ergometer training. Larger muscle masses are activated, and the heart rate is increased; therefore, the impact on cardiovascular fitness and metabolism is much greater. This effectively addresses and prevents the problems that result from inactivity in paraplegic patients.