Multi-muscle Electrical Stimulation and Stand Training: Effects on Standing

OBJECTIVE:To examine the biomechanical and neuromuscular effects of a longitudinal multi-muscle electrical stimulation (submaximal intensities) training of the lower limbs combined with/without activity-based stand training, on the recovery of stability and function for one individual with spinal cord injury (SCI).DESIGN:Single-subject, longitudinal study.SETTING:Neuroplasticity laboratory.PARTICIPANT:A 34-year-old male, with sensory- and motor-complete SCI (C5/C6).INTERVENTIONS:Two consecutive interventions: 61 hours of supine, lower-limb ES (ES-alone) and 51 hours of ES combined with stand training using an overhead body-weight support system (ST + ES).OUTCOME MEASURES:Clinical measures, trunk stability, and muscle activity were assessed and compared across time points. Trunk Stability Limit (TSL) determined improvements in trunk independence.RESULTS:Functional clinical values increased after both interventions, with further increases post ST + ES. Post ES-alone, trunk stability was maintained at 81% body-weight (BW) loading before failure; post ST + ES, BW loading increased to 95%. TSL values decreased post ST + ES (TSLA/P=54.0 kg.cm, TSLM/L=14.5 kg.cm), compared to ES-alone (TSLA/P=8.5 kg.cm, TSLM/L=3.9 kg.cm). Trunk muscle activity decreased post ST + ES training, compared to ES-alone.CONCLUSION:Neuromuscular and postural trunk control dramatically improved following the multi-muscle ES of the lower limbs with stand training. Multi-muscle ES training paradigm of the lower limb, using traditional parameters, may contribute to the functional recovery of the trunk.