A study by the Kennedy Krieger Institute in the US found substantial improvements in individuals with spinal cord injury who used functional electrical stimulation (FES) cycling as part of a rehabilitation regime. The study showed improvements to neurological and some functional gains, as well as enhanced physical health demonstrated by decreased fat and increased muscle mass.

What is FES cycling?

FES is the application of electrical impulses to paralysed muscles causing a series of contractions and relaxations creating a functional movement. The electrical impulses are applied to the muscles via electrodes on the skin above the muscles.

In FES cycling a number of electrodes are placed over particular muscles on the legs. These muscles are stimulated sequentially in a pattern that enables the legs to turn cycle pedals. This is done on an adapted stationary recumbent bike.

The benefits of FES exercise

John W. McDonald, senior study author and director of the International Centre for Spinal Cord Injury at the Kennedy Kreiger Institute said “Exercise has not been commonly advocated for individuals with paralysis because of the assumption that it is of little benefit and it is challenging to exercise limbs that an individual cannot voluntarily move.” Kennedy found that FES cycling was a practical form of exercise that provides substantial benefits, including improved physical integrity, enhanced neurological and some functional performance, including increased muscle size and strength, reduced muscle spasticity and improved quality of life.

There were a total of 45 participants in the study who all had all been paralysed for at least 16 months. Of the 45 participants, 25 were assigned to the FES cycling program and the remaining 20 received no active physical therapy. They were matched by age, gender, injury level/severity and duration of injury.

Clinically important gains in neurological function were observed in the FES group; response in pinprick sensation was observed in 56 percent of the FES group compared with 25 percent of the control group, while 14 of the 25 FES subjects showed response in light touch scores compared to six of the 20 controls.

Results also showed that FES cycling enhanced muscle strength without increasing spasticity, a common side effect of paralysis that varies from mild muscle stiffness to severe, uncontrollable leg movements. The FES group was found to be on fewer anti-spasticity medications with lower doses than the control group, suggesting that the lower level of spasticity observed in the FES group was not due medication differences between the participants.

The repetitive activity offers cardiovascular exercise similar to that which an able-bodied individual achieves through walking, but this new research shows that the results go far beyond basic health benefits.

FES cycling was also associated with improvements in quality of life and correlated with overall improved health. FES and control groups showed no significant difference in total thigh volume. However, total thigh fat, measured by MRI, was 44.2 percent less in the FES group than in the controls. According to Dr. McDonald, this is a key finding because intramuscular fat is associated with glucose intolerance, a complication affecting nearly two-thirds of individuals with SCI.

The results of this study support the hypothesis that activity-based rehabilitative strategies can play an important role in promoting physical integrity, even when implemented years after an injury.

The actor Christopher Reeve was a keen activist of activity based rehabilitation and regularly used FES cycling as part of his rehabilitative programme. Prior to 1999 when he started activity based rehabilitation, he frequently required hospitalisation, he had a total of 9 life-threatening complications and required almost 600 days of antibiotic treatment. After 1999, he was rarely hospitalised, had only one serious medical complication, and needed only 60 days of antibiotic treatment.

Most organisations supporting those with spinal cord injuries welcome this American study which begins to demonstrate the benefits of FES for someone who is paralysed. The study is a positive step forward; however FES is not a cure for paralysis as it is not repairing the damaged spinal cord.  It should be noted that the benefit only provides for limited function in the lower limbs, and only if the regime is maintained indefinitely.

Individuals still have to learn how to cope with their injuries both emotionally and physically and require specialist support to do this. FES does however have many other benefits, which can however help individuals maintain quality of life after their spinal cord injury in combination with rehabilitation in a specialist spinal cord injury centre.

Organisations such as SIA are skilled in supporting those newly injured and should be contacted for information and support at the first available opportunity.