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J Spinal Cord Med. 2017 Nov;40(6):748-758. doi: 10.1080/10790268.2017.1368961. Epub 2017 Sep 20.

Evaluating the efficacy of functional electrical stimulation therapy assisted walking after chronic motor incomplete spinal cord injury: effects on bone biomarkers and bone strength.

Author information

1
a Toronto Rehabilitation Institute - UHN , Toronto , ON , Canada.
2
b Department of Medcine , University of Toronto , Toronto , ON , Canada.
3
c University of Waterloo , Waterloo , ON , Canada.
4
d Sunnybrook Research Institute - Sunnybrook Health Sciences Centre , Toronto , ON , Canada.
5
e Institute of Biomaterials and Biomedical Engineering BBME, University of Toronto , Toronto , ON , Canada.

Abstract

OBJECTIVES:

To determine the efficacy of functional electrical stimulation therapy assisted walking (FES-T) compared to a conventional aerobic and resistance training (CONV) with respect to bone biomarkers and lower extremity bone strength outcomes among adults with chronic motor incomplete spinal cord injury (SCI).

DESIGN:

Parallel group randomized controlled trial ( www.clinicaltrials.gov - NCT0020196819). Site: Tertiary academic rehabilitation centre in Canada.

METHODS:

Adults with chronic (≥18 months) motor incomplete SCI (C2-T12 AIS C-D) were consented and randomized to FES-T or CONV training for 45 minutes thrice-weekly for 4 months. Osteocalcin (OC), β-cross laps (CTX) and sclerostin were assessed at baseline, and 4 months. Similarly, total hip, distal femur and proximal tibia region bone mineral density (BMD) via DXA (4500A, Hologic Inc. Waltham, MA, USA) and tibia bone quality via pQCT (Stratec XCT-2000, Mezintecknik, Pforzheim, Germany) were assessed at baseline, 4, and 12 months. Between group differences were analyzed using repeated measures general linear models.

RESULTS:

Thirty-four participants (17 FES-T, 17 CONV) consented and were randomized, 27 participants completed the 4-month intervention and 12-month outcome assessments. Participants in the FES-T arm had a decrease in CTX and a significant increase in OC at intervention completion (P<0.05). Significant biomarker changes were not observed in the CONV group. No within or between group differences from baseline were observed in sclerostin or bone strength.

CONCLUSIONS:

Four months of FES-T improved bone turnover (increase in OC and decrease in CTX) but not bone strength among individuals with chronic SCI. Future, long term FES-T may augment lower extremity bone strength.

KEYWORDS:

Bone density; C-Telopepetide; Functional electrical stimulation; Osteocalcin; Sclerostin; Spinal cord injury

PMID:
28929919
PMCID:
PMC5778938
[Available on 2018-11-01]
DOI:
10.1080/10790268.2017.1368961
[Indexed for MEDLINE]

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