Implanted functional electrical stimulation: an alternative for standing and walking in pediatric spinal cord injury

Study design: Post intervention, repeated measures design, comparing two interventions. Setting: Orthopedic pediatric hospital specializing in spinal cord injury. Methods: Nine subjects, ages 7-20 years, received an eight-channel implanted lower extremity functional electrical stimulation (FES) system for standing and walking. Electrodes were placed to stimulate hip and knee extension, and hip abduction and adduction. Standing and walking were achieved through constant stimulation to the implanted muscles, allowing a swing through gait pattern with an assistive device. After training with FES and long leg braces (LLB), subjects were tested in eight upright mobility activities, which were scored based upon completion time and level of independence. Results: Seven subjects completed data collection. These subjects completed four activities faster (P<0.02) and five activities more independently (P<0.025) with FES as compared to LLB. Transitions between sitting and standing, which were scored in isolation for two mobility activities, were achieved faster and with more independence with FES. In addition, subjects reported preferring FES for the majority of activities. No activity required more time or more assistance to complete with FES as compared to LLB. Conclusion: The implanted FES system provided these subjects with enhanced functional abilities over traditional LLB and decreased the need for physical assistance by a caregiver, suggesting that it is a realistic alternative for upright mobility in a pediatric population with spinal cord injury. Sponsorship: This study was funded by Shriners Hospitals for Children, Grant #8530. Spinal Cord (2003) 41, 144-152. doi:10.1038/sj.sc.3101392.