Functional Electrical Stimulation Cycling for Spinal Cord Injury
Overview[edit | edit source]
Functional electrical stimulation (FES) uses electrical pulses to stimulate motor neurons or denervated muscle fibers directly to elicit a contraction during a functional activity [1]. FES has an extensive history for its treatment of orthopedic and neurological conditions.[2]For example, FES can be used to activate tibialis anterior to help dorsiflex the foot throughout the gait cycle in patients with foot drop or to strengthen the quadriceps following a total knee arthroplasty.
FES cycling applies the electrical stimulation to the muscles and/or nerves to contract the muscles associated with cycling. After a full rotation, each of the muscles will have been stimulated once with the appropriate timing and magnitude appropriate for cycling. For example, lower extremity cycling would activate the hamstring, quadricep, glute and calf muscles.[1] The muscles that are activated with upper extremity FES cycling include the biceps, triceps to name a few. [1]The FES bicycle will detect changes in the muscle’s power output and will activate a motor when the muscles begin to fatigue to assist in the cycling. Over time, progress can be tracked by monitoring the amount of motor contribution.[3]
FES cycling may maximize the amount of function that is recovered through activity dependent neuroplasticity as a result of the repeated exposure and stimulation of the nerves and muscles during the activity[2]. Griffin et al. (2009) observed 10 weeks of FES cycling 2-3 times per week with individuals with spinal cord injury (SCI). Results showed increased total cycling power, endurance, lean muscle, and improvements in lower extremity ASIA Impairment Scales scores for motor and sensory which is particularly important in individuals who experience the effects of chronic paralysis[4].
Individuals with a SCI face many barriers to participating in physical activity which increases their risk for chronic conditions associated with a sedentary lifestyle[5] .FES cycling provides an accessible form of exercise for individuals limited in the ability to participate in other forms of exercise to evoke both the physical and psychological benefits that exercise can have.
Benefits and Risks[edit | edit source]
Physical
- Increased cardiovascular fitness[2]
- Metabolic influences by means of increases in capillary number, and increase in glucose metabolism[2]
- Muscles increase in size, strength, and increases in overall fiber area[2]
- Increases in bone density and the ability to recover bone mass[2]
- Improves and maintains AROM[6]
- Increased power output
Protocols[edit | edit source]
- ↑ 1.0 1.1 1.2 Berkelmans R. Fes cycling. Journal of Automatic Control. 2008;18(2):73-6
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 Martin R, Sadowsky C, Obst K, Meyer B, McDonald J. Functional electrical stimulation in spinal cord injury: from theory to practice. Topics in spinal cord injury rehabilitation. 2012 Jan 1;18(1):28-33
- ↑ Canada's first arm cycling program at Parkwood Institute for patients with a spinal cord injury [Internet]. Parkwood Institute | St. Joseph's Health Care London. St Joseph's Health Care London; [cited 2018May8]. Available from: https://www.sjhc.london.on.ca/our-stories/canada’s-first-arm-cycling-program-parkwood-institute-patients-spinal-cord-injury
- ↑ Griffin L, Decker MJ, Hwang JY, Wang B, Kitchen K, Ding Z, Ivy JL. Functional electrical stimulation cycling improves body composition, metabolic and neural factors in persons with spinal cord injury. Journal of Electromyography and Kinesiology. 2009 Aug 1;19(4):614-22.
- ↑ Ginis KA, Jörgensen S, Stapleton J. Exercise and sport for persons with spinal cord injury. PM&R. 2012 Nov 1;4(11):894-900
- ↑ Bremner LA, Sloan KE, Day RE, Scull ER, Ackland T. A clinical exercise system for paraplegics using functional electrical stimulation. Spinal Cord. 1992 Sep;30(9):647
