Epidural stimulation with locomotor training improves body composition in individuals with cervical or upper thoracic motor complete spinal cord injury: A series of case studies

Context: Four individuals with motor complete SCI with an implanted epidural stimulator who were enrolled in another study were assessed for cardiovascular fitness, metabolic function and body composition at four time points before, during, and after task specific training. Following 80 locomotor training sessions, a 16-electrode array was surgically placed on the dura (L1-S1 cord segments) to allow for electrical stimulation. After implantation individuals received 160 sessions of task specific training with epidural stimulation (stand and step). Outcome: measuresDual-energy X-ray absorptiometry (DXA), resting metabolic rate and peak oxygen consumption (VO(2)peak) were measured before locomotor training, after locomotor training but before epidural stimulator implant, at mid-locomotor training with spinal cord epidural stimulation (scES) and after locomotor training with scES. Findings: Participants showed increases in lean body mass with decreases on percentage of body fat, particularly android body fat, and android/gynoid ratio from baseline to post training; resting metabolic rate and VO(2)peak also show increases that are of clinical relevance in this population. Conclusions: Task specific training combined with epidural stimulation has the potential to show improvements in cardiovascular fitness and body composition in individuals with cervical or upper thoracic motor complete SCI.