“Effectiveness of functional electrical stimulation (FES) of knee extensors and hip extensors in paraplegic participants at a specialized rehabilitation unit

Abstract

Introduction: Spinal cord injury (SCI) constitutes a substantial portion of the worldwide injury load. In the year 2016, there were 27.04 million instances of SCI on a global scale, encompassing 0.93 million newly emergent cases. Within China, the incidence of traumatic SCI displayed an ascending trajectory spanning from 2009 to 2018, approximating 66.5 cases per one million individuals. The ramifications of SCI are profound, encompassing substantial physical, psychological, and economic encumbrances for afflicted individuals, their families, and the broader societal framework. The clinical presentations of spinal cord injury encompass conditions such as paralysis, diminished sensation, and disruptions in bladder or bowel management. Surgical interventions primarily focus on reinstating the volume of the spinal canal, achieved through the extraction of bone fragments, ligaments, and hematomas that exert pressure on the spinal cord. Despite decompressive procedures, a noteworthy proportion of patients do not exhibit amelioration in their neurological status. Purpose: The purpose of the study is to explore the effectiveness of functional electrical stimulation (FES) in hip extensors and knee extensors muscles in paraplegic patients. Methodology: This research constituted a randomized controlled trial, characterized by a single-blinded design. The study cohort comprised a total of 40 patients, selected based on predefined inclusion and exclusion criteria, and subsequently allocated into two distinct groups: a control group and an experimental group. Each group encompassed 20 patients. Across a span of four weeks, both groups underwent 20 treatment sessions. The control group received conventional physiotherapy, whereas the experimental group underwent a combination of Functional Electrical Stimulation (FES) alongside conventional physiotherapy. Assessment of all participants involved the utilization of various metrics, including the Modified Ashworth Grade Scale, Manual Muscle Test and the Walking Index for Spinal Cord Injury II (WISCI II), a metric employed for quantifying ambulatory capabilities in spinal cord injury cases. Results: The investigation employed the Wilcoxon Rank Test and the Kruskal- Wallis test to analyze the outcomes. The average age of participants in the experimental group was determined to be 28.85, while the control group exhibited an average age of 32.95. Notably, there was a statistically significant improvement in the tone of the lower limb, as assessed by the Ashworth Grade Scale, with a significance level below 0.05. Additionally, the enhancement in muscle power, evaluated through manual muscle testing, was found to be statistically significant, with a p-value below 0.05. The assessment of ambulatory function, conducted using the WISCI II scale, also yielded statistically significant results, with a p-value below 0.05. Conclusion: This study is conducted to find out the effectiveness of FES, along with conventional therapy. Effectiveness is shown without any contradiction. Further research should be conducted with both male and female participants in large population. Keywords: Mannual muscle testing, ashworth grade scale, WISCI II scale, tone, ambulation.