Spinal Cord-injured Persons Research Articles

Experiences of spinal cord injury patients admitted to the rehabilitation unit at the national referral hospital in Khomas region, Namibia.

BackgroundSpinal cord injury (SCI) remains one of the major causes of disability globally. It results in permanent physical disability secondary to devastating neurological defects. When a person sustains SCI, substantial changes and challenges in their lives occur, regardless of their age or socioeconomic status. In Namibia, the knowledge on SCI experiences could be used to improve the care rendered to patients with this injury.ObjectivesThe purpose of this study was to explore and describe the experiences of patients with SCIs admitted to the rehabilitation unit at the national referral hospital in Khomas region, Namibia.MethodA qualitative, explorative and descriptive study design was used. Data were collected by means of in-depth, semi-structured, face-to-face interviews with 15 participants from the rehabilitation unit. Data were analyzed using thematic analysis.ResultsAnalysis of the data in this study identified three themes: negative experiences, positive experiences and measures to improve the lives of people living with SCI in the community. Participants experienced varied emotions from anger, stress, disbelief, frustration and sadness, which led to depression. In addition, participants experienced discrimination due to lack of community acceptance hence, improving awareness remains key.ConclusionThis study provided insight into the lived experiences of those living with SCI as they narrated their struggle from the onset of SCI to their reintegration into the community. The study’s findings can be used to develop self-care strategies and ongoing interventions that focus on maintaining physical and psychological health for spinal-cord injured persons throughout the course of living with disability.

Effect of strength and endurance training program on mental and physical health of spinal cord-injured persons

Background. The aim of the research was to examine the effects of eight weeks of strength and endurance training on the improvement of mental health and physical state of spinal cord-injured persons. Methods. Twelve persons with spinal cord injury (SCI) participated in an eight-week intervention program of mainly two training types: strength and wheelchair driving endurance training. Subjects with SCI represented the experimental and control groups. The mental (Ware, 2000) and physical (isometric strength of the hand grip, strength of the shoulders and arms bench press, aerobic endurance 12 min and anaerobic endurance 30 s driving the wheelchair tests) values were evaluated before and after the program. Results. After the primary questioning of the experimental group participants before organizing strength and endurance training program and the final questioning after the program, it was revealed that most values of mental health improved. The physical state characteristics of persons with spinal cord injury revealed differences between pre-test and post-test values. Conclusions. This study indicated that persons with spinal cord injury involved in eight weeks strength and endurance training program improved mental and physical health parameters in comparison with persons with spinal cord injury not participating in any training program. Isometric force and 12 min wheelchair driving are good markers for strength, power and endurance in persons with spinal cord injury.

Risk Analyses of Pressure Ulcer in Tetraplegic Spinal Cord-Injured : A French Long-Term Survey

To identify the long-term clinical, individual, and social risk factors for the development of pressure ulcers (PUs) in traumatic spinal cord-injured persons with tetraplegia (TSCIt).

Risk analyses of pressure ulcer in tetraplegic spinal cord-injured persons: A French long-term survey

To identify the long-term clinical, individual, and social risk factors for the development of pressure ulcers (PUs) in traumatic spinal cord-injured persons with tetraplegia (TSCIt). Cohort survey with self-applied questionnaires in 1995 and 2006. Thirty-five French-speaking European physical medicine and rehabilitation centers participating in the Tetrafigap surveys. A total of 1641 tetraplegic adults were surveyed after an initial post-traumatic period of at least 2 years. Eleven years later, a follow-up was done for 1327 TSCIt, among whom 221 were deceased and 547 could be surveyed again. Main outcome measure was the proportion of PUs documented at the various defined time points, relative to the medical and social situations of the TSCIt, by using univariate analyses followed by logistic regression. Of the participants, 73.4% presented with a PU during at least one period after their injury. Four factors had an effect on the occurrence of PU at the long-term. On the one hand, a protective feature for this population, persons with incomplete motor impairment (OR = 0.5) and moreover those who were able to walk (OR = 0.2); on the other hand, a strong predictive factor was the development of a PU during the initial post-trauma phase (OR = 2.7). Finally, a significant situational factor was the lack of social network (OR = 3.1). We believe that the highlighting of a motor incomplete feature of SCI, protective for the development of PU, and of a medical risk factor, an early PU, which served as a definitive marker of the trajectory of TSCIt, together with a social situational factor, indicates the crucial role of initial management and of long-term follow-up.

Factors affecting the compliance with ventilatory assistance using positive pressure to treat sleep apnea for spinal cord-injured patients: Results of qualitative study

Sleep apnea is a frequent issue for the general population, with a prevalence between 2 and 4%. It is 2 to 5 times more frequent for the spinal cord-injured population. The night ventilation by positive pressure is the reference treatment but the compliance is still an issue. Its determinants are well studied in the general population, but we have limited data for the spinal cord-injured patients. The goal of this study is to elaborate a comprehensive model of compliance with ventilatory assistance using positive pressure for spinal cord-injured patients affected by sleep apnea. Qualitative, prospective, monocentric study based on semi-directed interview, which are based on Bandura social cognitive theory. Each interview is recorded and transcribed. Data are analysed by the working group according to the grounded theory: codification, categorisation and liking. We included 15 patients which allows to generate 90 codes. This code's categorisation is in process and highlights the fact that spinal cord-injured patients face the same compliance determinants than the general population (factors related to material, provider, medical team, patient belief) but also factors specific to the handicap situation of the spinal cord-injured patient in term of constraints, autonomy and priority of care. The model of compliance generated by this study will lead the practitioner in setting up the ventilatory assistance and its integration in the day-to-day functioning for a spinal cord-injured person.

Risk Analyses of Pressure Ulcer in Tetraplegic Spinal Cord-Injured Persons: A French Long-Term Survey

ObjectiveTo identify the long-term clinical, individual, and social risk factors for the development of pressure ulcers (PUs) in traumatic spinal cord–injured persons with tetraplegia (TSCIt). DesignCohort survey with self-applied questionnaires in 1995 and 2006. SettingThirty-five French-speaking European physical medicine and rehabilitation centers participating in the Tetrafigap surveys. ParticipantsTetraplegic adults (N=1641) were surveyed after an initial posttraumatic period of at least 2 years. Eleven years later, a follow-up was done for 1327 TSCIt, among whom 221 had died and 547 could be surveyed again. InterventionsNot applicable. Main Outcome MeasuresThe proportion of PUs documented at the various defined time points, relative to the medical and social situations of the TSCIt, by using univariate analyses followed by logistic regression. ResultsOf the participants, 73.4% presented with a PU during at least 1 period after their injury. Four factors had an effect on the occurrence of PUs in the long-term. Protective features for this population were incomplete motor impairment (odds ratio, 0.5) and the ability to walk (odds ratio, 0.2), whereas a strong predictive factor was the development of a PU during the initial posttrauma phase (odds ratio, 2.7). Finally, a significant situational factor was the lack of a social network (odds ratio, 3.1). ConclusionsWe believe that the highlighting of a motor incomplete feature of SCI (protective against the development of a PU) and of a medical risk factor, an early PU (which served as a definitive marker of the trajectory of TSCIt), together with a social situational factor, indicates the crucial role of initial management and long-term follow-up.

Walking with a powered robotic exoskeleton: Subjective experience, spasticity and pain in spinal cord injured persons.

Powered robotic exoskeletons represent an emerging technology for the gait training of Spinal Cord Injured (SCI) persons. The analysis of the psychological and physical impact of such technology on the patient is crucial in terms of clinical appropriateness of such rehabilitation intervention for SCI persons. To investigate the acceptability of overground robot-assisted walking and its effect on pain and spasticity. Twenty-one SCI persons participated in a walking session assisted by a powered robotic exoskeleton. Pain assessed using a Numeric Rating Scale (NRS) and muscle spasticity, assessed as subjective perception using an NRS scale and as objective assessment using the Modified Ashworth scale and the Penn scale, were evaluated before and after the walking experience. Positive and negative sensations were investigated using a questionnaire. The patient's global impression of change (PGIC) scale was administrated as well. After the walking session a significant decrease in the muscle spasticity and pain intensity was observed. The SCI persons recruited in this study reported (i) a global change after the walking session, (ii) high scores on the positive and (iii) low scores on the negative sensations, thus indicating a good acceptability of the robot-assisted walking. The overground robot-assisted walking is well accepted by SCI persons and has positive effects in terms of spasticity and pain reduction.

Assessment of Functional Improvement without Compensation for Human Spinal Cord Injury: Extending the Neuromuscular Recovery Scale to the Upper Extremities.

The Neuromuscular Recovery Scale (NRS) is a tool for measuring functional recovery in spinal cord injured (SCI) persons based on tasks that test pre-injury functional capability. The NRS has been shown to be a valid, reliable, and responsive instrument for measuring functional recovery. The NRS has been updated to include three items measuring upper extremity function, and a new scoring mechanism has been defined. The purpose of this prospective, observational study was to explore the properties of the expanded NRS, introduce and evaluate the new scoring method, and to examine the score's relationship with other SCI outcome measures. The NRS and seven other SCI outcome measures were assessed at enrollment and after every 20 locomotor training sessions in 64 participants of the NeuroRecovery Network (NRN) of the Christopher and Dana Reeve Foundation (CDRF). The NRS exhibited a dominant first principal component that correlated strongly with the new NRS score, as well as a potential secondary component discriminating upper extremity function. The new NRS score and its empirical subscales were generally well-correlated with International Standards for the Neurological Classification of Spinal Cord Injury (ISNCSCI) motor scores and other established SCI functional measures, but exhibited substantial variability at their boundary values. The NRS score was more strongly correlated with other SCI functional measures than ISNCSCI motor scores were. The new NRS score was most responsive to change brought on by locomotor training. The expanded NRS appears to be a valuable tool in measuring functional recovery from SCI; further evaluation of its psychometric properties is warranted.

Modified Ashworth scale and spasm frequency score in spinal cord injury: reliability and correlation.

Intra- and inter-rater reliability study. To assess intra- and inter-rater reliability of the Modified Ashworth Scale (MAS) and Spasm Frequency Score (SFS) in lower extremities in a population of spinal cord-injured persons, as well as correlations between the two scales. Clinic for Spinal Cord Injuries, Rigshospitalet, Hornbaek, Denmark. Thirty-one persons participated in the study and were tested four times in total with MAS and SFS by three experienced raters. Cohen's kappa (κ), simple and quadratic weighted (nominal and ordinal scale level of measurement), was used as a measure of reliability and Spearman's rank correlation coefficient for correlation between MAS and SFS. Neurological level ranged from C2 to L2 and American Spinal Injury Association impairment scale A to D. Time since injury was (mean±s.d.) 3.4±6.5 years. Age was 48.3±20.2 years. Cause of injury was traumatic in 55% and non-traumatic for 45% of the participants. Antispastic medication was used by 61%. MAS showed intra-rater κsimple=-0.11 to 0.46 and κweighted=-0.11 to 0.83. Inter-rater κsimple=-0.06 to 0.32 and κweighted=0.08 to 0.74. SFS showed intra-rater κweighted=0.94 and inter-rater κweighted=0.93. Correlation between MAS and SFS showed non-significant correlation coefficients from-0.11 to 0.90. Reliability of MAS is highly affected by the weighting scheme. With a weighted-κ it was overall reliable and simple-κ overall unreliability. Repeated tests should always be performed by the same rater and in a very standardized manner. SFS was found reliable. MAS and SFS are poorly correlated, and ratings were inversely distributed and suggest that it assesses different aspects of spasticity.

‘SI‐SRH’ – a new model to manage sexual health following a spinal cord injury: our experience

To maximise involvement of the multidisciplinary team using a model of sexual health management for spinal cord-injured persons. Regaining sexual function is a priority following spinal cord injury, with the majority of people remaining sexually active with a satisfying sex life. Nevertheless, rehabilitation programmes often focus on activities related to mobility and elimination, with sexual health relegated to a secondary under-resourced position. Model creation and audit of current and desired status to identify required education. A four-tier model for sexual health management identified phases of management, increasing in complexity, from tier 1 to tier 4. The model was used to audit the current and desired status of the multidisciplinary team on a spinal injuries unit, identifying knowledge levels, barriers to involvement and education requirements. Fifty-nine questionnaires were completed (85%) by nurses and allied health professionals. Knowledge deficits and discomfort with the topic were the primary reasons prohibiting involvement with sexual health rehabilitation. Two thirds were willing to be involved with sexual health activities, mainly at an introductory level rather than providing education or problem-solving. However, following relevant education, the level of involvement changed: 90% (n = 53) desired involvement at more complex levels, and 10% (n = 6) were unwilling to be involved. Developing the necessary skills and knowledge creates potential to increase the resources available to participate in sexual health rehabilitation following a spinal cord injury and ensure that it is a core rehabilitation activity. The progressive model portrayed discrete phases of sexual health management, which collectively portray the whole. Team members identified a level of involvement to compliment their skills and knowledge. The audit demonstrated that the primary barriers to involvement were not culture, language or attitude as hypothesised, but inadequate knowledge, addressable through education.

ToCUEST: a task-oriented client-centered training module to improve upper extremity skilled performance in cervical spinal cord-injured persons

Given (a) the importance of upper extremity skill performance in persons with cervical spinal cord injury (C-SCI), (b) the limited number of studies on arm hand functioning in C-SCI and (c) the discrepancy between the importance of client centeredness and the lack of a theoretical framework and practical guidelines on how to apply client centeredness into practice, the aim of the present study is to (1) develop a training concept in which rehabilitation of the upper extremity focuses on patient's needs and wishes and (2) to put this concept into practice for tetraplegic persons. The training concept contains two main components. The client-centered component includes both extracting individual goals and defining and objectifying these goals. The task-oriented component incorporates a task analysis and the composition of an individual training program. A task-oriented client-centered training aimed at improving upper extremity skilled performance in tetraplegic persons is described step by step. The Canadian Occupational Performance Measure is used to identify patient's specific needs. The Goal Attainment Scale is applied to define and objectify individual goals. A task analysis is essential to map limiting and facilitating factors of the person, the task and the environment and to identify which aspects should be trained. An individual task-oriented training program is composed, based on principles of motor learning and training physiology and the use of assistive devices. Each step is explained and illustrated using a case example.

Acute and Chronic Training Responses In Spinal Cord Injured (SCI) Persons

SCI persons often defy physiologic responses - cardiovascular, blood lactate concentration (BLC), etc., typical for able-bodied persons. PURPOSE: To elucidate the acute and chronic physiologic changes during either 60 min of ACE or FESC over the course of 16 weeks of training. METHODS: 12 motor complete SCI persons, T1 and below were randomized into either ACE (2 men, 3 women) or FESC (5 men, 2 women) intervention and performed a VO2 peak test, % body fat (%BF) determined via DXA prior to training. Subjects exercised ∼60 min, 5 d·wk-1 for 16 wk using ACE or FESC. HR was continuously monitored and VO2 during sessions 1, 41 and 80, while 5 μl blood lactate was measured from the earlobe at 0, 10, 20, 30, 40 min. Results were analyzed with Jump statistical software (v 8.0, SAS, Inc) and significance level set at 0.05; all data are expressed as mean (± SE). SUMMARY OF RESULTS: There were no group differences in Age (35±3.4 yr), Hgt (168.8± 2.5 cm) and Wgt (80.2±6.3 kg), VO2 peak (14.9±1.1 ml·kg-1.min-1), or %BF (41.7±1.5). Selected data from sessions 1 and 80 are in the table below. CONCLUSIONS:While ACE may provide a greater cardiovascular stimulus in SCI persons, FESC appears to produce an uncharacteristically high BLC due to physiologic adaptations in SCI and a localized response to FES that may have implications on SCI metabolism and training adaptation. These data may lead to greater understanding of the exercise response and training prescription in persons with SCI.Table

Health-related quality of life of primary caregivers of persons with paraplegia

A cross-sectional descriptive study was performed with structured questionnaires and interviews conducted with 60 primary caregivers of persons with paraplegia (T1 to S2) owing to traumatic spinal cord injury (SCI). The purpose of this study was the assessment of the health-related quality of life (HRQoL) of primary caregivers of persons with paraplegia owing to traumatic SCI. São Paulo, SP, Brazil. The HRQoL was assessed by the Short Form-36 (SF-36) health survey questionnaire and caregiver burden was evaluated by the Caregiver Burden Scale (CBS). Among 60 caregivers evaluated, 49 (81.7%) were female, with mean age of 35.8 (SD=12.91) years, 16 (26.6%) being wives and 14 (23.4%) sisters of persons with paraplegia. It was found that the caregivers spend an average of 11.3 h/day caring for individuals with paraplegia. Twenty-three caregivers (38.3%) had a chronic disease and 32 (53.3%) were sole caregivers taking upon themselves the full responsibility of caring for the persons with paraplegia. The subjects reported lower scores on bodily pain and vitality than the other dimensions of the SF-36. The mean global CBS score was 1.71 (SD=0.50) and mean scores for each dimension ranged from 1.39 (SD=0.64) for emotional involvement to 2.44 (SD=0.79) for environment dimension. The primary caregivers of spinal cord-injured persons reported low scores on all of the SF-36 and CBS dimensions, bodily pain and vitality being the SF-36 dimensions that received the lowest scores.

Funktionelle Rehabilitation von Querschnittgel�hmten durch Neuroprothetik

Recent technological advancements in microelectronics have led to the establishment of systems for restoration of basic functions in spinal cord injured (SCI) persons using functional electrical stimulation (FES). FES systems for the restoration of bladder and diaphragm function are well established in clinical practice. While FES systems in the lower extremities for standing/walking have not yet achieved widespread clinical acceptance, devices which enhance or restore the grasp function in tetraplegic patients with missing control of hand and fingers are demonstrably successful. Especially with the use of implantable systems a reliable, easy to handle application is possible. The most recent developments in micromechanical engineering are aimed at providing minimally invasive, subminiature systems for functional support in incomplete SCI persons. The possibility of direct brain control of FES systems will expand the application of neuroprostheses for patients with injury of the high cervical spinal cord.

Recent Trends in Spinal Cord Injury Rehabilitation Practices and Outcomes

As health care has evolved in the United States, so has the acute care, rehabilitation, and postdischarge treatment of acutely spinal cord-injured persons. Advances in trauma care and the arrival of managed care health insurance plans have impacted inpatient and outpatient spinal cord injury rehabilitation practices. This article examines the changes in inpatient rehabilitation, length of stay, use of outpatient rehabilitation services, and treatment outcomes between 1995 and 2000. Inpatient lengths of stay have been stable, but use of outpatient rehabilitation therapy has increased in recent years. However, this has not produced any demonstrable improvement in treatment outcomes. Speculation is offered as to why this may be the case.

Potential impact of orthotic gait exercise on natural killer cell activities in thoracic level of spinal cord-injured patients.

Prospective before-after trial. To examine the changes of natural killer (NK) cell activity in response to orthotic gait exercise in thoracic level of spinal cord-injured (SCI) patients. National Rehabilitation Center for Persons with Disabilities, Japan. In all, 10 thoracic level of SCI patients (ranging Th5-Th12), who experienced orthotic gait training, participated in this study. NK cell activity at an effector:target (E/T) ratio (20:1) was examined in a sample of peripheral blood taken before and just after orthotic gait exercise for 20 min. On a separate day, to evaluate the physical intensity of the orthotic gait exercise, cardiorespiratory responses at rest and during exercise were measured. The resting value of the NK cell activity in our SCI patients was remarkably lower than that in normal subjects reported in previous studies. The NK cell activity was significantly increased through a 20 min orthotic gait exercise (pre versus post; 12.7+/-5.28 versus 17.76+/-6.71, P<0.05). The steady-state value of oxygen (VO2) and heart rate (HR) were 18.13+/-3.92 ml/kg and 142.53+/-19.84 b/min, respectively. It was noteworthy that a patient who showed decrement of NK cell activity in response to exercise had the highest level of injury (Th5), and showed the higher energy cost of orthotic gait. These findings suggested that the orthotic gait exercise has the potential to enhance the immune function for SCI persons, although patients with a higher level of SCI may have some difficulties. Mitsui Sumitomo Insurance Welfare Foundation

Locomotor activity in spinal cord-injured persons

After a spinal cord injury (SCI) of the cat or rat, neuronal centers below the level of lesion exhibit plasticity that can be exploited by specific training paradigms. In individuals with complete or incomplete SCI, human spinal locomotor centers can be activated and modulated by locomotor training (facilitating stepping movements of the legs using body weight support on a treadmill to provide appropriate sensory cues). Individuals with incomplete SCI benefit from locomotor training such that they improve their ability to walk over ground. Load- or hip joint-related afferent input seems to be of crucial importance for both the generation of a locomotor pattern and the effectiveness of the training. However, it may be a critical combination of afferent signals that is needed to generate a locomotor pattern after severe SCI. Mobility of individuals after a SCI can be improved by taking advantage of the plasticity of the central nervous system and can be maintained with persistent locomotor activity. In the future, if regeneration approaches can successfully be applied in human SCI, even individuals with complete SCI may recover walking ability with locomotor training.

Life situation of spinal cord-injured persons in Central Finland

Individual interview and questionnaire of a regional spinal cord-injured (SCI) population. Local health care centres are mainly responsible for the SCI patients health care and rehabilitation after initial hospitalization in Finland. The purpose of the present study was to study aspects of the SCI patients life situation and their opinion of the health care services after 1 year since the injury. Regional study in Central Finland. Subjects were individually interviewed in their homes using a semi-structured questionnaire, the Functional Independence Measure (FIM) and the Beck Depression Inventory (BDI). The female/male ratio was 1:4. The mean age at the time of injury was 34 years in female and 40 in male. Traffic accidents accounted for 46% of the injuries. In all, 48 subjects (63%) used electrical or manual wheelchair or both. Most subjects regarded their living conditions as good having enough personal assistance in their everyday life. Only 10% of the subjects were employed. Half of the subjects had had out-patient physiotherapy, but no other therapies after 1 year since the injury. More than half of the subjects were dissatisfied with the current health care services. Many had experienced complications after the initial hospitalization, especially urinary tract infections, decubitus ulcers and neurogenic-type pain. FIM classified well according to the disability groups. The motor complete tetraplegic group had the lowest mean scores (63) and the recovered group the highest ones (122). There was no association between the FIM and the BDI results. There was a correlation between the BDI and the subject's age at the time of the injury and the year of the injury. The older the subjects were when injured, the higher were the BDI scores, that is, they had more depressive symptoms. Those injured in the 1990s had the highest BDI scores. Nearly one-third of the subjects had mild, moderate or severe depression. The reported medical complications, depression and dissatisfaction with the health care services support a life-long care for SCI patients in Jyväskylä Central hospital, not in the local health care centres. The psychological services, for example, prevention and treatment of depression, in particular, require more attention.

Time course of arterial vascular adaptations to inactivity and paralyses in humans.

The aim of the present study was to assess the time course of vascular adaptations to inactivity and paralyses in humans. The spinal cord-injured (SCI) population offers a unique "human model of nature" to assess peripheral vascular adaptations and its time course to extreme inactivity and paralyses. Arterial diameters and red blood cell velocity of the carotid artery (CA), common femoral artery (FA), and brachial artery (BA) were measured using echo Doppler ultrasound. Fifteen SCI persons with lesions varying from 6 wk to 13 months postinjury participated in a cross-sectional study (SCI-CS), 6 SCI individuals were included for longitudinal measurements (SCI-L) at weeks 6, 8, 12, 16, 20, and 24 after the trauma, and 16 able-bodied individuals served as a control group (C). Within 6 wk after the SCI, diameter (SCI-CS: 0.68 +/- 0.09 cm, SCI-L: 0.67 +/- 0.04 cm, C: 0.95 +/- 0.07 cm) and blood flow (SCI-CS: 299 +/- 112 mL x min(-1), SCI-L 279: +/- 52 mL x min(-1), C: 405 +/- 97 mL x min(-1)) of the femoral artery were significantly reduced (P < 0.001), and local femoral wall shear rate was almost doubled in SCI-CS and SC-L compared with C (P < 0.001). No further changes in femoral arterial properties were observed between week 6 and 13 months postinjury in SCI-L as well as SCI-CS. Carotid and brachial artery diameter and flow were similar in SCI and C and did not change between 6 wk and 13 months after the injury. We conclude that the process of vascular adaptations to inactivity and paralyses in humans seems to be largely completed within weeks.

FES Gait Re-education: The Swing Phase Estimation

This paper presents the use of multiple sensors for walking assessment and provision of cognitive feedback during early re-education of incomplete spinal cord injured (SCI) humans. The paper is focused on the swing phase estimation as an important part of the Functional Electrical Stimulation (FES) gait re-education system for incomplete spinal cord injured persons. The proposed sensory system comprises four accelerometers, one gyro placed at the shank of the paretic leg, and two goniometers placed at the knee and ankle joints, respectively. The data from the sensors are input in the mathematical algorithm applied for swing quality estimation. The output from the algorithm is a numerical value. The calculated output is divided into three levels, each defining the swing quality in terms of good, sufficient, and poor. This information is provided to the patient as an auditory signal. The patient is taught to maximize his efforts to improve the quality of walking, that is, to move the more affected leg in a way that will generate the auditory output corresponding to the level "good". The preliminary measurements were performed in healthy subjects walking on even terrain and in an incomplete SCI person with C6 lesion during walking on the treadmill. FES in the latter case was triggered manually by a physiotherapist. The results showed that the timing of FES triggering played an important role in sensory-supported FES-assisted walking, that is, the auditory feedback was also a cue to the therapist controlling the FES. The swing quality estimation enabled patients to voluntarily improve their walking, consequently the intensity of FES assistance was decreased. This suggests that the use of an FES multisensor system for cognitive feedback is efficient rehabilitative method in early stage of rehabilitation of walking.