Electrical stimulation in spinal cord injuries

marco · 10-14-2001, 09:42 AM

Dr. Young,

My name is Marco, I'm 32 years old and since 1998 I have a spinal cord injury (C3 incomplete, C4, C5, C6 complete, Th6, Th7 complete) due to a diving accident.

Since 2000 I have a Brindley implanted.

Is it possible to use electrical stimulation for the following purposes?

Muscle trophic in upper and lower limbs (for example by using the principle of reciprocal reflex inhibition).
A better vascularisation in the lower limbs.
A decrease in tension of the upper limbs (for example using the same principle as being used to create an increase in muscle trophic)
Decrease in contractures (for example by using a stimulation that releases endorphins)
The main question is: is it possible to activate muscle cells that haven't been activated for several years (three years) by using electrical stimulation?

Yours sincerely,

Marco de Jong

SCI-Nurse · 10-14-2001, 09:53 PM

Marco, the SCI-Nurse with the most experience in FES will be covering this board starting Monday (tomorrow). I will defer this question to her.

(KLD)

Wise Young · 10-15-2001, 03:50 PM

Marco,

You have a double injury?

The answer to your questions are all yes's in my opinion but some are not yet available. Several companies are now developing multichannel stimulator controllers that will be able to mediate as many as 24 channels at a time, enough to control a Brindley type device, a Freehand type device, as well as bowel and spinal cord stimulation for neuropathic pain.

Many stimulation methods make use of reflex activation. Muscular activity should increase blood flow in the limbs. I am not sure that there is currently a stimulation method for reducing muscle tone in the upper limbs but muscle stimulation itself may reduce spasticity to some extent for a while after the stimulation. I have not heard of any stimulation method that releases endorphins (it seems that this may be better implemented through some kind of drug release pump rather than stimulating your nervous system sufficiently to produce endorphin release).

Regarding stimulating muscles that have not bee activated for several years, it depends on the muscles and why they have not been activated for several years. In general, if the motoneurons are intact and you have some spasticity, it should have tone and atrophy should be reversible. There is some controversy whether atrophy due to motoneuron loss can be reversed by electrical stimulation.

I would be glad to hear of any other opinion on the subject.

Wise.

SCI-Nurse · 10-15-2001, 06:15 PM

Marco - The electrical stimulation with which I have several years of experience involved Computerized Functional Electrical Stimulation delivered to the large muscles of the legs and the gluteal muscles, using a cycle ergometer (stationary bicycle). This technology is used for injuries from T10 and higher, in which the motor neurons are intact.

There was a year-long study done in Copenhagen, and published in 1997, using CFES in SCI persons. Participants in the study had been injured from 3 to 20 years. The majority of the participants were successful in the ergometry program, experiencing many benefits of this technology. The benefits included reversal of muscle atrophy, return to normal muscle fiber distribution demonstrated on muscle biopsy (subjects had muscle biopsies pre-therapy and after one year of participation), increased circulation benefits to lower extremeties and improved cardiovascular performance.

Amongst my own patients, I did start a C6/7 quad patient, who was 11 years post-injury, on CFES. She was successful and realized many important benefits from the program. crf

mattblan · 10-31-2001, 05:47 PM

I am T-10. Do you have any FES links i could look at. Also, do you know of any hopspitals in Sacramento with an FES system? Asking Kaiser gets me nowhere (they don't even have a scale i can use)

10-14-2001, 09:42 AM	#1
marco Junior Member Join Date: Oct 2001 Posts: 1	Electrical stimulation in spinal cord injuries Dr. Young, My name is Marco, I'm 32 years old and since 1998 I have a spinal cord injury (C3 incomplete, C4, C5, C6 complete, Th6, Th7 complete) due to a diving accident. Since 2000 I have a Brindley implanted. Is it possible to use electrical stimulation for the following purposes? Muscle trophic in upper and lower limbs (for example by using the principle of reciprocal reflex inhibition). A better vascularisation in the lower limbs. A decrease in tension of the upper limbs (for example using the same principle as being used to create an increase in muscle trophic) Decrease in contractures (for example by using a stimulation that releases endorphins) The main question is: is it possible to activate muscle cells that haven't been activated for several years (three years) by using electrical stimulation? Yours sincerely, Marco de Jong

10-15-2001, 06:15 PM	#4
SCI-Nurse Moderator Join Date: Jul 2001 Location: USA Posts: 41,349	electrical stimulation in SCI Marco - The electrical stimulation with which I have several years of experience involved Computerized Functional Electrical Stimulation delivered to the large muscles of the legs and the gluteal muscles, using a cycle ergometer (stationary bicycle). This technology is used for injuries from T10 and higher, in which the motor neurons are intact. There was a year-long study done in Copenhagen, and published in 1997, using CFES in SCI persons. Participants in the study had been injured from 3 to 20 years. The majority of the participants were successful in the ergometry program, experiencing many benefits of this technology. The benefits included reversal of muscle atrophy, return to normal muscle fiber distribution demonstrated on muscle biopsy (subjects had muscle biopsies pre-therapy and after one year of participation), increased circulation benefits to lower extremeties and improved cardiovascular performance. Amongst my own patients, I did start a C6/7 quad patient, who was 11 years post-injury, on CFES. She was successful and realized many important benefits from the program. crf

10-31-2001, 05:47 PM	#5
mattblan Senior Member Join Date: Oct 2001 Location: N. California Posts: 1,148	more FES info please I am T-10. Do you have any FES links i could look at. Also, do you know of any hopspitals in Sacramento with an FES system? Asking Kaiser gets me nowhere (they don't even have a scale i can use)

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10-14-2001, 09:53 PM	#2
SCI-Nurse Moderator Join Date: Jul 2001 Location: USA Posts: 41,349	Marco, the SCI-Nurse with the most experience in FES will be covering this board starting Monday (tomorrow). I will defer this question to her. (KLD)

10-15-2001, 03:50 PM	#3
Wise Young Administrator Join Date: Jul 2001 Location: New Brunswick, NJ, USA Posts: 37,975	Marco, You have a double injury? The answer to your questions are all yes's in my opinion but some are not yet available. Several companies are now developing multichannel stimulator controllers that will be able to mediate as many as 24 channels at a time, enough to control a Brindley type device, a Freehand type device, as well as bowel and spinal cord stimulation for neuropathic pain. Many stimulation methods make use of reflex activation. Muscular activity should increase blood flow in the limbs. I am not sure that there is currently a stimulation method for reducing muscle tone in the upper limbs but muscle stimulation itself may reduce spasticity to some extent for a while after the stimulation. I have not heard of any stimulation method that releases endorphins (it seems that this may be better implemented through some kind of drug release pump rather than stimulating your nervous system sufficiently to produce endorphin release). Regarding stimulating muscles that have not bee activated for several years, it depends on the muscles and why they have not been activated for several years. In general, if the motoneurons are intact and you have some spasticity, it should have tone and atrophy should be reversible. There is some controversy whether atrophy due to motoneuron loss can be reversed by electrical stimulation. I would be glad to hear of any other opinion on the subject. Wise.