Activity-based recovery training with spinal cord epidural stimulation improves standing performance in cervical spinal cord injury.
Claudia A Angeli, Enrico Rejc, Beatrice Ugiliweneza and 7 others
PMID 40301929WHAT IT FOUND
People with chronic cervical SCI in a spinal stimulation program showed more unassisted knee and trunk standing time.
The different training groups did not show a clear winner, and standing was not the trial's primary outcome.
Key findings
01Across 3,524 training days, 70% reached the 2-hour standing goal and 93% surpassed 1 hour.
02All 30 participants achieved unassisted lower-limb extension, ranging from 10 minutes of single-knee independence to 118 minutes of bilateral-knee independence within a training day.
03Seventeen participants achieved unassisted hip, bilateral-knee and trunk independence, and the paper reports full independent standing ranging from less than a minute in 2 participants to 107 hours throughout all sessions.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The trial was designed to test cardiovascular stimulation for blood pressure, not standing, so the standing results are secondary. All participants received daily cardiovascular or voluntary movement stimulation in addition to standing training and standing-targeted stimulation, so the contribution of any single component cannot be separated. The paper states that the low number of participants in each group limited statistical comparison of standing outcomes. The primary cardiovascular outcome was not reported in this paper. Fatigue was the most common reason sessions ended early, and the study did not actively explore how each person defined fatigue. Assessment conditions differed from training conditions, including different standing frames and added EMG and motion capture instrumentation, which could alter performance. Participants needed upper extremity balance assistance for many standing bouts, so these results do not show unsupported standing in daily life.
Declared interests
The named funders were Medtronic, the Christopher and Dana Reeve Foundation, and UofL Health - University of Louisville Hospital. The paper does not say whether any funder designed the study, analyzed the data, or wrote the manuscript.
The easy way to misread this
Do not read the standing gains as proof that Stand-ABRT and Stand-scES alone caused them. Every participant also received daily cardiovascular stimulation or voluntary movement stimulation, in addition to standing-targeted stimulation and standing training, and the parent trial's primary outcome was blood pressure regulation, not standing.