A randomized trial of functional electrical stimulation for walking in incomplete spinal cord injury

Multi-channel surface functional electrical stimulation (FES) for walking has been used to improve voluntary walking and balance in patients with spinal cord injury (SCI). This study aimed to investigate short- and long-term benefits of 16 weeks of thrice-weekly FES-assisted walking program, while ambulating on a body weight support treadmill and harness system, versus a non-FES exercise program, on improvements in gait and balance in individuals with chronic incomplete traumatic SCI, in a randomized controlled trial design. Individuals with traumatic and chronic (≥18 months) motor incomplete SCI (level C2 to T12, American Spinal Cord Injury Association Impairment Scale C or D) were recruited from an outpatient SCI rehabilitation hospital, and randomized to FES-assisted walking therapy (intervention group) or aerobic and resistance training program (control group). Outcomes were assessed at baseline, and following 4, 6, and 12 months. Gait, balance, spasticity, and functional measures were collected. Spinal cord independence measure (SCIM) mobility sub-score improved over time in the intervention group compared with the control group (baseline/12 months: 17.27/21.33 vs. 19.09/17.36, respectively). On all other outcome measures the intervention and control groups had similar improvements. Regardless of group allocation walking speed, endurance, and balance during ambulation all improved upon completion of therapy, and majority of participants retained these gains at long-term follow-ups.

Task-oriented training improves walking ability in individuals with incomplete SCI, even in the chronic stage. Additional randomized controlled trials, involving a large number of participants are necessary, to verify if FES-assisted treadmill training is superior to aerobic and strength training.