National Rehabilitation Hospital

Investigation into the Effects of Electrical Stimulation Training in a Spinal Cord Injured Population

Title:  Investigation into the Effects of Electrical Stimulation Training in a Spinal Cord Injured Population

Authors: Amanda Carty, M.Sc, MISCP, Kirsti McCormack, B.Sc, MISCP, Dr. Garrett Coughlan, Ph.D, MISCP, Dr. Brian Caulfield, Ph.D

Objective: To investigate the effects of a new method of electrical stimulation training on aerobic fitness, body composition and spasticity in individuals with a spinal cord injury.

Design: Before and After Study

Setting: Institute of Sport and Health High Performance Laboratory,University College Dublin.  Training took place in the participants’ homes.

Participants: Sixteen volunteer adults with motor complete spinal cord injury between T4 and T11.

Intervention: Electrical stimulation was delivered through a hand held electrical stimulator (NT 2010, BMR,Galway,Ireland). Participants completed 60 mins of training, five days a week for eight weeks. 

Main Outcomes: 1) VO2 peak and maximum heart rate 2) Body composition 3) Spasticity

Results: Statistically significant improvements in VO2 peak (22.65%, p=0.001), maximum heart rate (2.6%, p=0.032) and lower limb lean body mass (8.65%, p=0.22) were observed. There was a significant reduction in percentage regional body fat (1.65%, p=0.035). Spasticity as recorded by the SCATs tool reduced significantly (43.6%, p<0.001) but there were no significant changes to self reported spasticity.

Conclusion: The results demonstrated increased aerobic fitness with increased muscle mass in the lower limbs.  They also demonstrate reduced body fat in the trained region i.e. lower limbs and reduced spasticity. These results present the potential for this system to positively influence health in the spinal cord injured population. Larger studies are required.

2. Main Author and contact details:

Dr. Amanda Carty, MISCP 

amanda.carty@nrh.ie

3.  Ethical Approval was granted by the Human Research Ethics Committee of University College Dublin and the Ethics Committee of the National Rehabilitation Hospital, Co.Dublin.

Funding: The research was funded Biomedical Research Galway and Enterprise Ireland

Main Contributors:

Amanda Carty, MISCP

Kirsti McCormack

Brian Caulfield

Submission for publication:

Publications:

1)      Carty, McCormack, Coughlan et al., (2012) Increased Aerobic Fitness after Neuromuscular Electrical Stimulation Training in Adults with Spinal Cord Injury.  Archives of Physical Medicine and Rehabilitation, 93 (5): 790 -795

2)  Carty, Coughlan, Crowe et al., (2011) Neuromuscular Electrical Stimulation for Aerobic Training in Spinal Cord Injury.  Topics in Spinal Cord Injury Rehabilitation: 2011 International Congress on Spinal Cord Medicine and Rehabilitation Conference Abstracts, 16 (6): 41

3)  Carty, Coughlan, Crowe et al., (2011) Alterations in Body Composition and Spasticity following Neuromuscular Electrical Stimulation Training in Spinal Cord Injury. Topics in Spinal Cord Injury Rehabilitation: 2011 International Congress on Spinal Cord Medicine and Rehabilitation Conference Abstracts, 16 (6): 36

4)  McCormack, K., Carty, A., Coughlan G., et al., (2011). The effects of a neuromuscular electrical stimulation training intervention on physiological measures in a spinal cord injured male: a case study. Physiotherapy Ireland, 31 (2): 30-35

5)  Carty et al., 2012: Alterations in Body Composition and Spasticity Following Sub–tetanic Neuromuscular Electrical Stimulation Training in Spinal Cord Injury. Journal of Rehabilitation Research and Development – next available publication date

Declaration of competing Interests

Amanda Carty and Kirsti McCormack’s work for Ph.D and M.Sc awards repectively, was supported by a grant that was partially funded by Biomedical Research Ltd. Biomedical Research Ltd. is the manufacturer of the stimulator used in this research. Dr.Brian Caulfield declares no conflict of interest.

4.  What is already known on this topic and what this study adds:

Technology has been employed to manage some of the physical changes that occur post SCI i.e. reduced aerobic fitness, unfavourable body composition changes and spasticity. Neuromuscular electrical stimulation (NMES) is a  research and clinical modality that has been applied to address these changes.  However, these devices e.g.FESbike, may require assistance for use, and can be very costly.  Therefore, not all of those individuals who could benefit from them can access them.  A new method of delivering NMES has recently been developed and shown to increase aerobic fitness in various clinical populations who present with barriers to exercise e.g. obese, chronic heart failure. This method is cheaper and hand held and this study was the first to investigate the effectiveness in a spinal cord injured population.  The results of this study show the potential for more individuals withSCIto achieve fitness and reverse undesirable body composition changes, through the use of a new, more accessible technology.

Final Report presented to the NRH Ethics Committee – March 2012