Bum S Lee*, Hyung I Shin, Sung M Kim, Byung S Kim
National Rehabilitation Hospital, Seoul, Korea
Introduction
The
Spinal Cord Injury (SCI) unit of our hospital has 50 beds, and most of patients
are subacute patients from acute care hospital.
The objective
of this study was to evaluate the outcome and usefulness of 8 weeks standing
and walking training with FES
to the hospitalized patients with spinal cord injury.
Methods
From
January 2000 to December 2002, 714 patients were admitted to SCI unit of our
hospital. Patients with C7 to L1 level lesions (ASIA impairment scale A, B or C) were
referred to FES for evaluation (n=273). After the
first FES evaluation, 93 patients were not entered into the FES training
program due to painful sensations (19 patients) or no muscle contraction
response to FES (74 patients). So 180 patients were entered into
the 8 weeks FES walking training
program (6 sessions per week and 20 minutes per session).
The
median age of the 180 patients was 32 years old (16 – 77), and the median time
since injury was 9 months (2 – 295). 111
patients were ASIA-A, 33 were ASIA-B and 36 were ASIA-C.
The FES training was done with a
6-channel system (Parastep®) and the 6-channel
stimulation sites were bilateral Gluteus maximus, Quadriceps and Tibialis
anterior muscles. The 8-week training program consisted of 6 sessions per week
at 20 minutes per session. Muscle strengthening session were 3 times per week,
and walking session were 3 times per week. The FES walking program started with
quadriceps muscle strengthening exercise in the sitting position, and then
progressed to standing and walking training.
Results
During
the training program, 23 patients (12.8%) dropped out. The reasons for drop out
were increased spasticity, pain and poor general condition. 77 patients (42.8%)
could stand with FES
after 8 weeks training. The average standing time was 10.6 ± 9.3
minutes, and maximal standing time was 50 minutes.
32
patients (17.8%) could walk after 8 weeks of FES training. The average walking
distance was 25.8 ± 28.6m and the maximal walking distance was 100m.
The only significant factor to predicting standing and walking was age.
The 32
walking patients were 4.5% of all admitted patients (714) in SCI unit of our
hospital for 3 years.
None of
the 180 patients bought the FES system at discharge, mainly because of the
cost (too expensive) and the fact that it could only be used for short
distances.
Discussion
In
comparison to previous studies, the result of our study shows a lower walking
rate and shorter walking distances. This result may be explained with two
reasons. First, we did not select the patients with good condition only. Almost
all of the C7 to L1 patients were referred to the training program, unless they
refused the FES therapy. Second, due to staffing
issues at our hospital, patients had only 3 walking sessions per week, and the
other 3 sessions were replaced with the muscle strengthening training.
But the
walking rate of 4.5% of all admitted SCI patients was similar with the result
of Kralj’s study. Kralj's
study, in his 9 years experience, showed that 5% of the 500 admitted patients
could walk with FES.
The result of our study may thus represent the SCI population more closely than
other studies.
At
discharge, none of the 180 patients bought the FES device. The reasons they did not
purchase Parastep® were the cost (too expensive) and the walking distances were too
short.
In conclusion,
42.8% of the patients with spinal cord injury could stand and 17.8% could walk after
8 weeks FES training. The only significant
factor to predicting standing and walking was age. Unfortunately, practical use
of FES for walking after discharge was
limited by the cost of the device and short walking distance.
References
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