Functional electric stimulation to augment partial weight-bearing supported treadmill training for patients with acute incomplete spinal cord injury: A pilot study

Objective: To study the application of partial weight-bearing (PWB) supported treadmill gait training augmented by functional electric stimulation (FES) in subjects with acute incomplete spinal cord injury (SCI). Design: Before-after crossover trial with control (A) and intervention (B) periods. Setting: Physiotherapy (PT) department of a spinal injuries unit in Scotland. Participants: Fourteen inpatients with acute incomplete SCI with American Spinal Injury Association class C or D injury. Intervention: Training consisted of treadmill walking with PWB support augmented by FES. Subjects walked on the treadmill for up to 25 minutes a day, 5 days a week for 4 weeks. The intervention was compared with a 4-week control period in which standard PT was given. Main Outcome Measures: Overground walking endurance and speed, cadence, stride length, and observational gait analysis and walking speed, distance, and percentage PWB support on the treadmill. Results: A greater increase in overground walking endurance was achieved after the intervention (AB group mean, 72.2m; confidence interval [CI], 39.8-104.6m; BA group mean, 63.8m; Cl, -10.2 to 137.9m), as compared with after standard PT (AB group mean, 38.4m; Cl, 1.8-75.0m; BA group mean, 60.1m; Cl, 9.2-110.9m). A similar pattern was observed for overground walking speed. Conclusions: This pilot study indicated that PWB supported treadmill training with FES had a positive effect on overground gait parameters and could potentially accelerate gait training in subjects with incomplete SCI. A larger randomized trial is required to substantiate these findings.