The effect of Functional Electrical Stimulation-assisted posture-shifting in bone mineral density: case series-pilot study

STUDY DESIGN: A training intervention study using standing dynamic load-shifting Functional Electrical Stimulation (FES) in a group of individuals with complete spinal cord injury (SCI) T2 to T10. OBJECTIVES: Investigate the effect of FES-assisted dynamic load-shifting exercises on bone mineral density (BMD). SETTING: University Lab within the Biomedical Engineering METHODS: Twelve participants with ASIA A SCI were recruited for this study. Three participants completed side-to-side load-shifting FES-assisted exercises for 29 ± 5 weeks, 2× per week for 1 h, and FES knee extension exercises on alternate days 3× per week for 1 h. Volumetric Bone Mineral density (vBMD) at the distal femur and tibia were assessed using peripheral quantitative computed tomography (pQCT) before and after the intervention study. RESULTS: Participants with acute and subacute SCI showed an absolute increase of f trabecular vBMD (vBMD(TRAB)) in the proximal (mean of 26.9%) and distal tibia (mean of 22.35%). Loss of vBMD(TRAB) in the distal femur was observed. CONCLUSION: Improvements in vBMD(TRAB) in the distal tibia were found in acute and subacute SCI participants, and in the proximal tibia of acute participants, when subjected to anti-gravity FES-assisted load-bearing exercises for 29 ± 5 weeks. No vBMD improvement in distal femur or tibial shaft were observed in any of the participants as was expected. However, improvements of vBMD in the proximal and distal tibia were observed in two participants. This study provides evidence of an improvement of vBMD(TRAB), when combining high-intensity exercises with lower intensity exercises 5× per week for 1 h.