PTCase SeriesTopics in spinal cord injury rehabilitation2023

The Orthotic Effects of Different Functional Electrical Stimulation Protocols on Walking Performance in Individuals with Incomplete Spinal Cord Injury: A Case Series.

Shirin Tajali, Stephanie N Iwasa, Vivian Sin and 5 others

PMID 38174132

WHAT IT FOUND

Electrical stimulation during walking immediately improved toe clearance in people with incomplete spinal cord injury.

Stride length and speed changed differently depending on baseline walking ability.

Key findings

01Minimum toe clearance increased with FES compared with no-FES in each participant, including on the weaker side.

02Stride length and speed were inconsistent across participants: subject A had shorter and slower steps with FES, subject C had longer and faster steps, and subject B showed no clear stride length change.

03Hip range of motion increased with FES in subjects B and C, and knee range of motion increased with multi-muscle and drop foot stimulation in subject C.

STILL TO COME

How it was doneWhat they foundWhat it means for PTs

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What it does not show

Only three participants were studied, so the response pattern may reflect individual differences rather than a predictable treatment effect. Participants ranged from a community ambulator to limited household walkers, so results may not apply to all patients with incomplete spinal cord injury. The flexor withdrawal protocol could not be elicited in subject C, and subject C also had to use a finger switch for part of the multi-muscle protocol. Only immediate joint motion was measured, not walking stability, energy use, fall risk, or longer-term function. The paper did not identify a single primary outcome among several kinematic outcomes.

Declared interests

An author is a shareholder and director at MyndTec Inc., the company that manufactures the functional electrical stimulation device used in the study, and also consults for Fourier Intelligence.

The easy way to misread this

Do not conclude that FES improves walking speed or stride length for everyone with incomplete spinal cord injury. This case series had only three participants, and the fastest walker had shorter and slower steps with FES, while only the slowest walker had longer and faster steps.

Read it on PubMed →