Electrical Stimulation Program Research Articles

Effects of therapeutic ultrasound and electrical stimulation program on pain, trunk muscle strength, disability, walking performance, quality of life, and depression in patients with low back pain: a randomized-controlled trial

The aim of this trial is to investigate and compare the effects of electrical stimulation (ES) program and ultrasound (US) therapy on pain, disability, trunk muscle strength, walking performance, spinal mobility, quality of life (QOL), and depression in the patients with chronic low back pain (CLBP). A total of 59 patients with definite CLBP were enrolled in this study. These patients were randomized into three groups. Group 1 (n = 20) was given an ES program and exercises. Group 2 (n = 19) was given an US treatment and exercises. Group 3 (n = 20) was accepted as the control group and was given only exercises. All of the programs were performed 3 days a week, for 6 weeks. The patients were evaluated according to pain, disability, walking performance, endurance, mobility, QOL, depression. The trunk muscle strength was measured with a hand-held dynamometer. All of the groups showed stastically significant improvements in pain, disability, muscle strength, endurance, walking performance, mobility, sub-scores of SF 36, and depression when compared with their initial status. The intergroup comparison showed significant difference in physical function, energy and social function sub-groups of SF-36, VAS pain, extensor muscle strength, between three groups. This difference was statistically significant in the groups 1 and 2 compared to the control group. There was also no significant difference between the groups 1 and 2. We observed that US treatment and ES treatment were effective in improving pain, isometric extensor muscle strength, and QOL in patients with CLBP.

Early Recovery of Urinary Continence After Radical Prostatectomy Using Early Pelvic Floor Electrical Stimulation and Biofeedback Associated Treatment

We analyzed the benefit of the early combined use of functional pelvic floor electrical stimulation and biofeedback in terms of time to recovery and rate of continence after radical prostatectomy. A total of 60 consecutive patients who underwent radical prostatectomy were included in the study. Patients were prospectively randomized to a treatment group (group 1) vs a control group (group 2). In group 1 a program of pelvic floor electrical stimulation plus biofeedback began 7 days after catheter removal, twice a week for 6 weeks. Each of the 12 treatment sessions was composed of biofeedback (15 minutes) followed by pelvic floor electrical stimulation (20 minutes). The evaluation of continence was performed at time 0, at 2 and 4 weeks, and at 2, 3, 4, 5 and 6 months during followup. Evaluations were performed using the 24-hour pad test and the incontinence section of the International Continence Society questionnaire. The mean leakage weight became significantly lower (p <0.05) in group 1 than in group 2 starting at 4 weeks until 6 months of followup. A significant difference (p <0.05) between groups 1 and 2 in terms of percentage of continent patients was achieved from 4 weeks (63.3% group 1 and 30.0% group 2) to 6 months (96.7% group 1 and 66.7% group 2). Early, noninvasive physical treatment with biofeedback and pelvic floor electrical stimulation has a significant positive impact on the early recovery of urinary continence after radical prostatectomy.

Effects of electrical stimulation program on trunk muscle strength, functional capacity, quality of life, and depression in the patients with low back pain: a randomized controlled trial

The aim of this clinical trial was to evaluate the effects of electrical stimulation (ES) program on trunk muscle strength, functional performance, quality of life (QOL) in the patients with chronic low back pain (CLBP). A total of 41 patients with definite CLBP were included in this study. These patients were randomized into two groups. Group 1 (n = 21) was given an ES program and exercises. Group 2 (n = 20) was accepted as the control group and given only exercises. Both the programs were performed 3 days a week, for 8 weeks in the out-patient department. The patients were evaluated according to pain, disability, functional performance, endurance, quality of life, depression. The muscle strengths were measured with a hand-held dynamometer. There were significant improvements for all the parameters in two groups after the treatment. Except depression and social function, the improvements for all the parameters were better in the ES group than in the control group. We observed that ES program was very effective in improving QOL, functional performance and isometric strength. In conclusion, we can say that ES therapy provides comfortable life functions by improving muscle strength, functional performance and QOL.

Activity-Based Electrical Stimulation Training in a Stroke Patient With Minimal Movement in the Paretic Upper Extremity

Background. Existing task-specific practice interventions do not increase movement in stroke patients exhibiting minimal distal movement in the paretic upper extremity. Although often used, an important limitation of conventional electrical stimulation is that it does not involve task-specific practice. Objective. To determine the impact of an activity-specific electrical stimulation program on paretic limb impairment, functional limitation, and ability to perform valued activities in a subacute stroke patient exhibiting minimal paretic wrist and hand movement. Method. A female subject exhibiting trace paretic hand and finger movement was administered, 9 months after stroke, the upper extremity section of the Fugl-Meyer Impairment Scale (FM), the Action Research Arm Test (ARAT), and the Arm Motor Ability Test (AMAT). She then engaged in paretic upper extremity, task-specific training incorporating an electrical stimulation neuroprosthesis. Training occurred 3 hours per day, 5 days per week for 3 weeks. The FM, ARAT, and AMAT were again administered. Results. After intervention, she exhibited reduced impairment (evidenced by an FM score change of 22 to 29), decreased functional limitation (evidenced by an ARAT score change of 4 to 10), and increased ability and speed in performing valued AMAT activities. She also reported using the paretic hand and fingers more and new abilities to perform valued activities such as playing piano. Conclusion. Although conventional paretic upper extremity training strategies are ineffective in patients at this level, electrical stimulation training incorporating a neuroprosthesis appears promising.

Effects of Two Types of Neuromuscular Electrical Stimulation Training on Vertical Jump Performance

This study examined the effects of different types of neuromuscular electrical stimulation (NMES) programs on vertical jump performance. Twenty seven healthy trained male students in sports-sciences were recruited and randomized into three groups. The control group (C group, n = 8) did not perform NMES training. Two other groups underwent 3 training sessions a week over 5 weeks on the quadriceps femoris muscle [F group (n = 9): stimulation with an 80 Hz current for 15 min for improving muscle strength; E group (n = 10): stimulation with a 25 Hz current for 60 min for improving muscle endurance]. The height of the vertical jump was measured before NMES training (test 1), one week (test 2) and five weeks (test 3) after the end of the programs. The results showed that the height of the vertical jump significantly increased in both the F and E groups between tests 1 and 2 (5 cm and 3 cm respectively). Results of test 3 showed that both groups preserved their gains. A NMES training program destined to improve muscle endurance does not interfere on vertical jump performance. It can even durably enhance it in the same way as a NMES training program destined to improve muscle strength. Thus, to improve muscle endurance without deteriorating muscle power, sportsmen can use electrical stimulation.

Cross-Education After One Session of Unilateral Surface Electrical Stimulation of the Rectus Femoris

Thirty-six adult men were randomly assigned to a remote stimulation group (RS; n = 18) or control group (CTL; n = 18). The RS group unilaterally performed a 10-minute surface electrical stimulation program (frequency 100 Hz, impulse 300 micros, 10 seconds on/10 seconds off) on the rectus femoris of the non-dominant leg. The subjects of the CTL group relaxed for 10 minutes without performing any training. Immediately before and after the surface electrical stimulation program, the isometric strength and the electromyographic (EMG) and mechanomyographic (MMG) response of the dominant leg was measured for all subjects. The dominant leg of the RS group showed a significant increase in the isometric force (5.11%; P < 0.001) and EMG activity of the agonist muscle (4.67%; P < 0.05), whereas a decrease in EMG activity of the antagonist muscles was observed (-10.27%; P < 0.05). The MMG activity did not show any alteration. No significant changes were observed for the CTL group. These results indicate that one unilateral surface electrical stimulation session on the rectus femoris improves the efficiency of the inactive leg. At a practical level, the results open a new way to rehabilitate muscle-skeletal injuries, especially weak members that cannot do any physical work. In this case, the muscle strength (and physical efficiency) can be improved by passive electrostimulation training on the healthy member.

Randomised controlled trial of electrical stimulation of the quadriceps after proximal femoral fracture

Proximal femoral fracture is often associated with long-term residual disability. Quadriceps weakness may be a factor in poor outcome. This study aimed to determine whether training of the quadriceps using electrical stimulation (ES) increases leg extensor power and decreases disability in elderly subjects rehabilitating after fracture. A single-blind randomized controlled trial of elderly postsurgical proximal femoral fracture patients, comparing 6 weeks of supplementary electrical stimulation of the quadriceps (15 patients) to usual physiotherapy alone (11 patients). The electrical stimulation on:off duty cycle was 7:23 seconds, with 36 cycles per session, given daily as an in-patient and twice weekly after discharge. The primary outcome measure was change in leg extensor power (Nottingham Power Rig). Functional mobility (Elderly Mobility Scale), disability (Barthel Index) and health status (Nottingham Health Profile) were also measured. There was no significant difference in change in leg extensor power, or any other outcome measure, in the ES group compared to usual care controls. Fractured leg extensor power increased by 10.9 (standard error of the mean 2.1) Watts at 6 weeks in the ES group compared to 15.3 (5.5) in the controls (mean adjusted difference -3.1, 95% CI -7.8, 1.6 Watts). Only 3 (20%) of the intervention patients tolerated sufficient stimulation intensity to produce repetitive knee extension, while 11 (73%) sustained palpable or visible contractions with no leg movement. A 6-week program of electrical stimulation of the quadriceps did not increase leg extensor power, or reduce disability, in elderly patients rehabilitating after surgical fixation of proximal femoral fracture. In many patients local discomfort limited the intensity of electrical stimulation that could be delivered.

Isolated Spinal Accessory Nerve Palsy After Coronary Artery Bypass: An Unusual Complication

Isolated spinal accessory nerve palsy after coronary artery bypass graft (CABG) surgery is a rare complication. We report a case of a 52-yr-old male patient who presented with right shoulder weakness, drooping of shoulder, and weakness of forward elevation after CABG. A program of neuromuscular electrical stimulation and exercises was started after the diagnosis of right isolated spinal accessory nerve palsy by physical examination and electromyographic study. Involved muscle function recovered after 6 mos of physical therapy and rehabilitation. This case report suggests that isolated spinal accessory nerve palsy should be considered in cases of shoulder pain or weakness after CABG, and conservative treatment is recommended if palsy develops.

Does cochlear implantation and electrical stimulation affect residual hair cells and spiral ganglion neurons?

Increasing numbers of cochlear implant subjects have some level of residual hearing at the time of implantation. The present study examined whether (i) hair cells that have survived one pathological insult (aminoglycoside deafening), can survive and function following long-term cochlear implantation and electrical stimulation (ES); and (ii) chronic ES in these cochleae results in greater trophic support of spiral ganglion neurons (SGNs) compared with cochleae devoid of hair cells. Eight cats, with either partial ( n = 4) or severe ( n = 4) sensorineural hearing loss, were bilaterally implanted with scala tympani electrode arrays 2 months after deafening, and received unilateral ES using charge balanced biphasic current pulses for periods of up to 235 days. Frequency-specific compound action potentials and click-evoked auditory brainstem responses (ABRs) were recorded periodically to monitor the residual acoustic hearing. Electrically evoked ABRs (EABRs) were recorded to confirm the stimulus levels were 3–6 dB above the EABR threshold. On completion of the ES program the cochleae were examined histologically. Partially deafened animals showed no significant increase in acoustic thresholds over the implantation period. Moreover, chronic ES of an electrode array located in the base of the cochlea did not adversely affect hair cells in the middle or apical turns. There was evidence of a small but statistically significant rescue of SGNs in the middle and apical turns of stimulated cochleae in animals with partial hearing. Chronic ES did not, however, prevent a reduction in SGN density for the severely deaf cohort, although SGNs adjacent to the stimulating electrodes did exhibit a significant increase in soma area ( p < 0.01). In sum, chronic ES in partial hearing animals does not adversely affect functioning residual hair cells apical to the electrode array. Moreover, while there is an increase in the soma area of SGNs close to the stimulating electrodes in severely deaf cochleae, this trophic effect does not result in increased SGN survival.

Effects of quadriceps electrical stimulation program on clinical parameters in the patients with knee osteoarthritis

The aim of this study was to evaluate the effects of electrical stimulation program on pain, disability, and quadriceps strength in the patients with knee osteoarthritis. Fifty women diagnosed as knee osteoarthritis were randomized into two groups as electrical stimulation and biofeedback-assisted isometric exercises. Both of the programs were performed 5 days a week, for a duration of 4 weeks. Outcome measures for pain were visual analogue scale pain score and Western Ontario McMaster osteoarthritis index (WOMAC) pain score. Disability and stiffness were assessed with WOMAC physical function and stiffness score. One repetition maximum (RM) and 10 RM were used for measuring quadriceps strength. In addition, 50 m walking time and 10 steps stairs climbing up-down time were evaluated. Both groups showed significant improvements in pain, physical function, and stiffness scores after the therapy. There were statistically significant improvements in 50 m walking time and 10 steps stairs climbing up-down time and 1 RM and 10 RM values indicating the improvement in muscle strength. In addition, there were no significant differences between the groups after the therapy. We conclude that electrical stimulation treatment was as effective as exercise in knee osteoarthritis and electrical stimulation treatment can be suggested especially for the patients who have difficulty in or contraindications to perform an exercise program.

Force dynamic response of tibialis anterior–ankle joint unit in humans

The aim of this study was to estimate the dynamic response of a human muscle joint unit by means of the analysis of the torque signal recorded during electrical stimulation of the tibialis anterior (TA). Ten subjects (age: 23–50 years, 7 males, 3 females) volunteered for the study. The leg was fixed in an ergometer designed for isometric contraction of the ankle dorsiflexors and the detection of the generated torque. The amplitude of a 30 Hz stimulation train administered at the TA motor point was varied sinusoidally, thus changing the number of the recruited motor units, and hence the tension at the tendon, in the same fashion. A sequence of 14 frequencies (0.4, 0.6, 0.8, 1.0, 1.2, 1.4, 1.6, 1.8, 2.0, 2.5, 3.0, 4.0, 5.0, and 6.0 Hz) was administered. Results: (a) at the 14 frequencies the sinusoidal responses presented distortions always below 2%; (b) from the Bode plots reporting the average gain attenuation and phase shift at each of the 14 input frequencies, it was possible to model the force dynamic response as the one of a critically damped II order system with two real coincident poles (at 2.04 Hz) and a pure time delay (15.6 ms). The possibility to obtain, by means of the system input–output transfer function, data regarding the in vivo mechanics of the muscle–joint unit may represent a novel tool to investigate the functional features of different muscle groups. It may be useful for designing functional electrical stimulation programs as well as training and rehabilitation procedures.

Torque and surface mechanomyogram parallel reduction during fatiguing stimulation in human muscles

The purpose of the study was to verify, by means of torque and mechanomyogram (MMG) compared analysis, the validity of MMG as a tool to investigate the contractile changes due to localized muscular fatigue induced by stimulation protocols usually employed for sport training and rehabilitation programs. Ten healthy sedentary subjects participated in the study. Torque produced by the dominant biceps brachii (BB) and vastus lateralis (VL) during transcutaneous stimulated contractions has been recorded by a load cell strapped to the subjects' wrist and distal one-third of the tibia, respectively. MMG was detected over the muscle bellies during a monopolar supramaximal stimulation of the main motor point. After potentiation, the fatiguing stimulation was administered. It consisted of 50 cycles, with 2 s of 50 Hz and 25 s of 2 Hz. Averaged normalized values of peak torque (pT) and MMG peak-to-peak (MMG-pp) of the subjects group decreased from their initial 100% values to 55% (pT) and 60% (MMG-pp) for BB and to 43% (pT) and 47% (MMG-pp) for VL. The pT% and MMG-pp% changes throughout the stimulation protocol presented high correlation (BB: R=0.95, P<0.001; VL: R=0.94, P<0.001). This correlation suggests that MMG could be used to follow muscle mechanical fatigue development when torque output is not or hardly detectable such as during electrical stimulation programs employed for sport training or rehabilitation protocols.

The Effects of an Electrical Muscle Stimulation Program on Chronic Knee Pain in the Elderly: Based on TE, SE, and SY

This study was to examine the effects of electrical muscle stimulation therapy on chronic knee pain in the elderly. The research design was a one-group pretest-posttest design. The subjects were 45 (TE: 17, SE: 15, SY: 13) elderly,65 years old and above with chronic knee pain. Pain was measured by the S-F McGill Pain Questionnaire (S-F MPQ) and Arthritis Impact Measurement Scale (AIMS). Electrical muscle stimulation therapy experimental treatment was applied for 12 weeks, 3 times/week, 15 min/time. Data was collected from March 2005 to February 2006. Data was analyzed using the SPSS PC+ 12 version. After receiving electrical muscle stimulation therapy, chronic knee pain in TE (S-F MPQ: t=-62.143, p=.000, t=-29.155, p=.000), SE (S-F MPQ: t=-76.345, p=.000, t=-39.323, p=.000), and SY (S-F MPQ: t=-43.691, p=.000, t=-30.306, p=.000) groups were significantly decreased. Electrical muscle stimulation therapy can be a better effective primary nursing intervention for chronic knee pain for community dwelling elderly people with TE, SE, and SY.

Effects of a Hybrid Exercise on the Activities of Myogenic Enzymes in Plasma

"Hybrid" exercise uses forces generated by an electrically stimulated muscle to resist the motion of a volitionally contracting agonist. This approach is effective in increasing muscle bulk and strength. Its safety, however, has not been studied and the purpose of this study was to address this lack by assessing the impact of a hybrid strengthening regimen on the serological markers of exercise associated muscle damage. Twelve healthy, sedentary men between the ages of 20 and 27 years were divided into two groups of 6. The members of each group completed an exercise session that consisted of 10 sets of 10 reciprocal elbow flexor and extensor contractions separated by 1-minute rest intervals. In one group, the subjects underwent a hybrid exercise protocol. Subjects in the second group underwent a conventional isometric electrical stimulation program with the same stimulation intensities. Plasma creatine kinase (CK), aspartate aminotransferase (AST), and lactate dehydrogenase (LDH) activities were determined immediately before and after the exercise session as well as at follow-up 1, 2, and 7 days later. Secondary variables included active and passive range of motion and the subjects' perceived levels of "soreness" . Evaluation revealed that neither enzymatic activities nor range of motion changed in a statistically significant manner with time within the groups or between the groups. In conclusion, the stimulation intensities involved in hybrid exercise programs of the upper extremity do not appear to be associated with either overt or covert signs of muscle injury.

Hipertrofia muscular en sujetos hemofílicos tras estimulación eléctrica muscular

The principal aim of this study was quantify the changes produced in the cross-sectional section of the rectus femoris of the quadriceps femoris, in patients affected of haemophilia A, after a treatment of muscular electrical stimulation (EEM). Twelve men affected of haemophilia A clinically serious, took part in the present investigation, being put under an unilateral protocol on the left thigh of EEM (a rectangular symmetrical biphasic compensated waveform was used; frequency 45 Hz; impulse of 300 μs; and a duty cycle of 12 s on and 8 s off; time 30 min) during 6 weeks, 3 sessions/week. The musculoskeletal problems of all subjects were evaluated of previous form to the treatment in the scales of Pettersson and Gilbert. Measures were taken from the quadriceps femoris of both thighs, through a computerized axial tomography, before and after the period of treatment. During the period of six weeks that lasted the treatment, no patient had bled due to the EEM protocol. The analysis of difference of averages made shows to anincrease of the muscular diameter of the previous rectus femoris of 23,04 % (p < 0,05) after the EEM treatment. No significant difference was found, in the thighno treated, after the six weeks of treatment. In conclusion, the results of the present study indicate that the program of EEM applied on the quadriceps femoris in subjects affected of haemophilia A has a significant impact on the muscular trophism. Also this treatment shows a good adaptation to the clinical characteristics of these subjects.

Electrical Stimulation of Denervated Muscles: First Results of a Clinical Study

To evaluate the effects of electrical stimulation on denervated muscles in spinal cord injured humans, the EU Project RISE was started in 2001. The aims of this project are: to design and build sufficient stimulators; to develop stimulation protocols by means of mathematical models, animal experiments, and practice in humans with denervated lower limbs; to develop examination methods and devices for evaluation of electrical stimulation training effects; and to acquire basic scientific knowledge on denervated and stimulated denervated muscle. In the clinical study 27 spinal cord injured individuals were included, furthermore 13 pilot patients participated. After a series of initial examinations they underwent an electrical stimulation program for their denervated lower limb muscles. Some of the patients have already follow up examinations. A marked increase of muscle mass and quality was observed, the trophic situation of the denervated lower limbs had improved obviously.

A Home Program of Sensory and Neuromuscular Electrical Stimulation With Upper-Limb Task Practice in a Patient 5 Years After a Stroke

This case report describes a person with upper-extremity (UE) hemiparesis who participated in a home program that included sensory amplitude electrical stimulation (SES) to his involved arm and performance of task-specific exercises with the assistance of neuromuscular electrical stimulation (NMES). The patient was a 67-year-old man with stable sensory and motor deficits 5 years after a stroke. Sensory amplitude electrical stimulation was delivered for 2 hours per day. A daily, 15-minute course of NMES was used to help him perform UE tasks. This home program was carried out for 18 weeks and included 6 physical therapist home visits. The patient's UE score on the Stroke Rehabilitation Assessment of Movement (STREAM) improved from 10/20 to 17/20. The score on the Action Research Arm Test (ARAT) improved from 27/57 to 42/57. The patient reported that he was now able to button buttons, use a knife and fork, and tie simple fishing knots. A home program combining SES and NMES may be an effective method to increase UE function even 5 years after a stroke.

Single-blind, randomized trial of pelvic floor muscle training, biofeedback-assisted pelvic floor muscle training, and electrical stimulation in the management of overactive bladder

Objectives To compare the efficacy of pelvic floor muscle training (PFMT), biofeedback-assisted PFMT (BAPFMT), and electrical stimulation (ES) in the management of overactive bladder (OAB). Methods The interventions for the 12-week treatment period, conducted by the physiotherapist who was unaware of the progress and outcome, included (a) a PFMT program tailored to the subject's PERFECT (power, endurance, repetitions, and fast [1-second] contractions, with every contraction timed) scheme, used for training at home; (b) an electromyography BAPFMT program and home program tailored to the subject's PERFECT scheme; and (c) an ES program using biphasic symmetric probe current with 10-Hz frequency, 400-μs pulse width, 10/5 duty cycle, and varying intensity. Identical preintervention and postintervention assessment included King's Health Questionnaire, as well as outcomes of urge incontinence and other urinary symptoms. Results Of the 103 women who completed this study, 34 were in the PFMT group, 34 in the BAPFMT group, and 35 in the ES group. The changes in the three parameters of King's Health Questionnaire revealed statistically significant differences, except for the total score, between ES and BAPFMT (domain 7, P = 0.003; domain 9, P = 0.029; and total score, P = 0.952). These same parameters were significantly different between ES and PFMT (domain 7, P = 0.007; domain 9, P = 0.001; and total score P = 0.004). The change in total score was significantly different between BAPFMT and PFMT ( P = 0.003). The subjective improvement/cure rate of OAB was 51.4% for ES, 50.0% for BAPFMT, and 38.2% for PFMT ( P = 0.567). Conclusions ES had the greatest subjective reduction rate of OAB and was the most effective of the three treatments. BAPFMT was more effective than PFMT.

Pelvic Floor Exercises, Electrical Stimulation and Biofeedback After Radical Prostatectomy: Results of a Prospective Randomized Trial

We assessed the effect of pelvic muscle exercises (PMEs), electrical stimulation (ES) and biofeedback (BFB) on urinary incontinence after radical retropubic prostatectomy. We randomized 139 patients who underwent radical retropubic prostatectomy into 3 groups. Group 1 received instructions about postoperative PMEs. Group 2 received the same instructions and ES for 15 minutes twice daily. Patients in group 3 were also treated with BFB for 15 minutes twice daily. Treatment was started immediately after catheter removal and performed for 3 months. The outcome was assessed using the 20-minute pad test and a urine symptom inventory. Results at baseline, and 3 and 12 months postoperatively were available for 139, 120 and 128 (questionnaire), and 116, 79 and 124 (pad test) patients, respectively. An overall subjective spontaneous continence rate (questionnaire) 1 day after catheter removal of 21.4% increased within the first 3 months up to 59.2%. There was no significant difference among the 3 groups. The continence rate increased from 3 to 12 months postoperatively from 59.2% to 85.9%. An overall objective spontaneous continence rate (pad test) 1 day after catheter removal of 32.9% increased within the first 3 months up to 65% and up to 83% after 12 months without any significant difference in all 3 groups. A treatment program of ES and BFB enhanced PMEs did not affect continence after radical prostatectomy after 3 or 12 months. Up to 711 euro can be saved per patient.

Getting the spinal cord to think for itself.

Despite the interruption in communication between the brain and lower centers by spinal cord injury, many of the neurons engaged in generating locomotion survive. Several strategies have been used to activate spinal cord circuitry independent of the higher centers, including direct electrical stimulation, pharmacological agents, and training programs that involve moving the legs through the motions of walking. Ambulatory leg movements are achieved by these interventions, leading to substantial functional improvements in the subset of patients with incomplete spinal cord injury. The neurobiological basis for these phenomena likely involves activity-dependent reconfiguration of synaptic connections within the spinal cord. Fostering this process may lead to further benefits for individuals with spinal cord injury.