A TASK ORIENTED APPROACH BY MEANS OF A TRANSCUTANEOUS NEUROPROSTHESIS: A 7 YEAR CLINICAL EXPERIENCE FOR EXERCISE,
STANDING AND WALKING ON SCI SUBJECTS

H.A. Cerrel-Bazo¹., A. Rizzetto¹., E. Corà¹., R. Bogoni¹., A. Bolner¹., S.W.Brown²

Centro di Neuroriabilitazione e Ricerca di Villa Margherita, Arcugnano, Vicenza, Italy¹

Metropolitan State Hospital, Norwalk California, USA²

Aims of the Study: Train spinal cord individuals to perform a task by means of FES and analyse metabolic and physiological responses, energy efficiency and performance of SCI standing and walking by means of a transcutaneous FES system (TFES).

Methods: 60 motor complete SCI are able to stand and walk following a computer-controlled FES exercise program (CCE) and a gait training program (GTP) by TFES. Under standard conditions the above mention variables were recorded while standing (Tilt-Table and by TFES) for 30 min and walking (on a treadmill) for 6 min (at 5,10,15,18,20 m/min speed) and for 45 minutes (at self preferred maximum speed [SPMS]). All data were entered into a Statview SE+ for computer. ANOVA was used to assess energy cost between groups (the TFES group was compare to a control group [able body and ARGO SCI users]).

Results: CCE-GTP and ability to stand-walk independently with TFES average 5-6 months. Base on standing and walking endurance TFES walkers were classified: Good walkers: Speed (m/min) 14, walking distance (m) 580 m, walking time (min) 42, standing time (min) 30. Moderate walkers: Speed (m/min) 10, walking distance (m) 160 m, walking time (min) 12.5, standing time (min) 23. Poor walkers: Speed (m/min) 8, walking distance (m) 42 m, walking time (min) 3, standing time (min) 3. The TFES group showed higher statiscally significance (p<.001) values for most variables analysed when compare to the control group. Oxygen cost increase one time fold from sitting to TFES-standing and 3 to 4 times fold when TFES-walking. At SPMS 45 min walking post-hoc analysis showed a higher metabolic efficiency for the able body group compare to the TFES and ARGO group. During standing-walking metabolic and physiological responses were significantly higher for the TFES group. Statiscally significant differences were reported for lactic acid, O2-Pulse, ventilation and catecholamines, higher for the TFES group.The TFES mean total sweat rate was higher and statistical significant compare to the able body group.

Discussions: Well selected and trained SCI can perform a task oriented approach by means of TFES. Functional achievment was not the goal. Treadmill-Walking at a costant speed is metabolic demanding. Good TFES walkers adapt their cardiovascular and polmonary responses to the physical effort. Good standing-walking performances appear to be correlated to a higher metabolic efficiency, daily changes of the SCI system need to be study to better address the problem of efficient continuative performance. TFES standing and walking is a good active physical therapy on well selected SCI subjects.