02:21pm Tuesday 12 December 2017

First-of-its-kind study shows benefits of electrical stimulation therapy for people paralyzed by spinal cord injury

By Carolyn Lovas

A new treatment approach which uses tiny bursts of electricity to reawaken paralyzed muscles “significantly” reduced disability and improved grasping in people with incomplete spinal cord injuries, beyond the effects of standard therapy, newly published research shows.

In a study published online in the journal Neurorehabilitation and Neural Repair, Toronto researchers report that functional electrical stimulation (FES) therapy worked better than conventional occupational therapy alone to increase patients’ ability to pick up and hold objects. FES therapy uses low-intensity electrical pulses generated by a pocket-sized electric stimulator.

“This study proves that by stimulating peripheral nerves and muscles, you can actually ‘retrain’ the brain,” said the study’s lead author, Professor Milos Popovic of the Institute for Biomaterials and Biomedical Engineering, a Senior Scientist at Toronto Rehab and head of the hospital’s Neural Engineering and Therapeutics Team. “A few years ago, we did not believe this was possible.”

Study participants who received the stimulation therapy also saw big improvements in their
independence and ability to perform everyday activities such as dressing and eating, said Popovic. “This has real implications for people’s quality of life and independence, and for their
caregivers.”

Unlike permanent FES systems, the one designed by Popovic and colleagues is for short-term treatment. The therapist uses the stimulator to make muscles move in a patient’s limb. The idea is that after many repetitions, the nervous system can ‘relearn’ the motion and eventually activate the muscles on its own, without the device.

The randomized trial, the first of its kind, involved 24 rehabilitation inpatients who could not grasp objects or perform many activities of daily living. All received conventional occupational therapy five days per week for eight weeks. However, one group (nine people) also received an hour of FES therapy daily, while another group (12 people) had an additional hour of conventional occupational therapy only. (Three patients did not complete the trial.)

Comparisons between the functional abilities of the two groups showed that stimulation therapy “significantly reduced disability and improved voluntary grasping beyond the effects of considerable conventional upper extremity therapy in individuals with tetraplegia,” the authors wrote.

Popovic noted that patients who received only occupational therapy saw a “gentle improvement” in their grasping ability, but the level of improvement achieved with FES therapy was at least three times greater using the Spinal Cord Independence Measure, which evaluates degree of disability in patients with spinal cord injury.

Based on their findings, the study’s authors recommend that stimulation therapy should be part of the therapeutic process for people with incomplete spinal cord injuries whose hand function is impaired. Popovic’s team has almost completed a prototype of their stimulator, but need inancial support to take it forward. Popovic thinks the device could be available to hospitals within a year of being funded.

One limitation of the study is that the research team could not get all participants to take part in a six-month follow-up assessment. However, six individuals who received FES therapy were assessed six months after the study. All had better hand function after six months than on the day they were discharged from the study.

Other authors of the newly published study are Naaz Kapadia, and Drs. Vera Zivanovic and Julio
Furlan of Toronto Rehab, and Drs. Cathy Craven and Colleen McGillivray of U of T’s Department of Medicine.


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