Increasing Muscle Mass in Spinal Cord Injured Persons With a Functional Electrical Stimulation Exercise Program.

Increasing Muscle Mass in Spinal Cord Injured Persons With a Functional Electrical Stimulation Exercise Program Scremin AME, Kurta L, Gentili A, et al (Department of Physical Medicine and Rehabilitation and Research Department, West Los Angeles Veterans Affairs Medical Center; Departments of Medicine and Psychology, University of California at Los Angeles School of Medicine, Los Angeles, Calif; Albuquerque Veterans Affairs Medical Center, Albuquerue, NM), Arch Phys Med Rehabil. 1999;80:1531-1536.

Functional electrical stimulation (FES) has applications in the prevention of secondary conditions and, in some cases, the restoration of function in people with spinal cord injury. The purpose of this study was to determine the effect of FES-induced lower-limb cycling on the amount and distribution of muscle mass in the thigh and leg.

Thirteen men with complete spinal cord injury, satisfactory lower-limb range of motion, and lower-limb spasticity agreed to participate in this study. After a thorough pre-experimental medical workup, the subjects were assigned to a 3-phase FES protocol. Phase I consisted of 30-minute sessions of progressive, weighted exercise of the quadriceps femoris muscle. Once subjects could lift 3 to 5 pounds, they progressed to phase II. In phase II, the lower limbs of the subjects were sequentially stimulated using FES to produce a cycling motion on an ergometer. Once the subjects could pedal for 30 minutes, they were progressed to phase III. Phase III consisted of 2 sessions. The first session was comprised of progressively loaded, 30-minute sessions of lower-limb ergometry. The second session included upper-limb ergometry. Prior to the start of the study and then twice again during phase III, a computerized tomography scan of the thigh and leg was performed. From these images, changes in muscle mass and adipose tissue mass were determined.

An increase in muscle mass was found in the thigh and leg after the resistive exercise training. The percentage increase in cross-sectional area of specific muscles was: rectus femoris, 31%; sartorius, 22%; adductor magnus-hamstrings, 26%; vastus lateralis, 39%; and vastus medialis-intermedius, 31%. The amount of adipose tissue, however, was unchanged. As a result, the relationship Of skeletal muscle to adipose tissue increased. The level of increase in skeletal muscle mass (22%-39%) was consistent with the findings of able-bodied people who perform resistive exercise. According to the authors, continuous training by the subjects maintained the gains for greater than 1 year.

Robert Sandstrom, PT, PhD Creighton University Omaha, Neb