An electric stimulation cycling protocol for gait in incomplete spinal cord injury

Objective: To determine the feasibility and impact of an outpatient, electric stimulation cycling (ESC) protocol on a patient with incomplete spinal cord injury (SCI). Design: Pre-post case study. Setting: Outpatient rehabilitation hospital. Participant: A 24-year old man with an incomplete SCI occurring 25 months before study entry at the T12-L1 level. Intervention: A 2-phase, 10-week ESC intervention occurring 3 days a week. Phase 1 provided 30-minute ESC sessions at increasing resistance with electric stimulation applied to the quadriceps and hamstrings; phase 2 required cycling independently (ie, without stimulation) at maximal effort for increasing lengths of time. Main Outcome Measures: Gait velocity, stride length, and step length, all collected during a 10-meter walking test, and the Walking Index of Spinal Cord Injury-II (WISCI-II). Results: During phase 1, the patient quickly increased workload, session duration, and distance; during phase 2, duration that the subject was able to cycle without stimulation increased markedly. After the entire intervention, the subject exhibited diminished edema, new ability to voluntarily step, new ability to voluntarily dorsiflex the ankle and voluntarily flex the toe, and new ability to perform valued activities, such as transfers. He also exhibited increased mean gait velocity (.33 m/s), left (.11m) and right (.07 m) stride length, left (.06m) and right (.05m) step length, and a 10-point WISCI-II increase. The subject was also able to discontinue use of several medications after intervention. Conclusions: SCI patients' endurance and gait deficits can possibly be effectively addressed on an outpatient basis and with minimal assistance by using this regimen.