Effects of Neuromuscular Electrical Stimulation for Quadriceps Muscle Thickness and Lower Extremity Motor Score in Individuals with Subacute Incomplete Cervical Spinal Cord Injury: A Randomized Controlled Trial

Overview

Journal Phys Ther Res

Date 2025 Jan 27

PMID 39866385

Authors

Yusuke Morooka

Yosuke Kunisawa

Yuya Okubo

Yasuyuki Takakura

Affiliations

Soon will be listed here.

Abstract

Objective: In this study, we aimed to determine the effects of 2-week neuromuscular electrical stimulation (NMES) on quadriceps muscle atrophy and lower extremity motor score in individuals with subacute incomplete cervical spinal cord injury (SCI).

Methods: This stratified randomized controlled trial, conducted in the advanced critical care center of a university hospital, comprised 49 individuals with American Spinal Injury Association (ASIA) impairment scale grade C and D incomplete cervical SCI. The participants were stratified based on the ASIA impairment scale grade and randomly assigned to the control (n = 25) or NMES (n = 24) group. The control group participants received only conventional rehabilitation; the NMES group participants received conventional rehabilitation plus NMES in the quadriceps muscles of both lower limbs. The primary endpoints were quadriceps muscle thickness and L3 ASIA lower extremity motor score (L3 motor score), measured at the study's initiation and after 2 weeks.

Results: The quadriceps muscle thickness changes on the stronger and weaker sides were -14.2% ± 11.3% and -15.1% ± 13.8%, respectively, in the NMES group and -25.7% ± 16.8% and -26.0% ± 13.3%, respectively, in the control group, indicating significantly lesser reduction on both sides in the NMES group ( <0.05). The L3 motor scores on the stronger and weaker sides were 0.8 ± 1.2 and 1.3 ± 1.4 (NMES group) and 0.4 ± 0.8 and 0.4 ± 0.8 (control group), respectively, indicating significant improvement only on the weaker side ( <0.05).

Conclusions: For subacute incomplete cervical SCI, 2 weeks of NMES reduces quadriceps muscle atrophy and improves the L3 motor score values on the weaker side compared with standard treatment.

References

Modlesky C, Bickel C, Slade J, Meyer R, Cureton K, Dudley G . Assessment of skeletal muscle mass in men with spinal cord injury using dual-energy X-ray absorptiometry and magnetic resonance imaging. J Appl Physiol (1985). 2003; 96(2):561-5. DOI: 10.1152/japplphysiol.00207.2003. View

Gruther W, Benesch T, Zorn C, Paternostro-Sluga T, Quittan M, Fialka-Moser V . Muscle wasting in intensive care patients: ultrasound observation of the M. quadriceps femoris muscle layer. J Rehabil Med. 2008; 40(3):185-9. DOI: 10.2340/16501977-0139. View

Moore C, Craven B, Thabane L, Laing A, Frank-Wilson A, Kontulainen S . Lower-extremity muscle atrophy and fat infiltration after chronic spinal cord injury. J Musculoskelet Neuronal Interact. 2015; 15(1):32-41. PMC: 5092153. View

Jaja B, Jiang F, Badhiwala J, Schar R, Kurpad S, Grossman R . Association of Pneumonia, Wound Infection, and Sepsis with Clinical Outcomes after Acute Traumatic Spinal Cord Injury. J Neurotrauma. 2019; 36(21):3044-3050. PMC: 6791472. DOI: 10.1089/neu.2018.6245. View

Arias-Fernandez P, Romero-Martin M, Gomez-Salgado J, Fernandez-Garcia D . Rehabilitation and early mobilization in the critical patient: systematic review. J Phys Ther Sci. 2018; 30(9):1193-1201. PMC: 6127491. DOI: 10.1589/jpts.30.1193. View

Lee B, Cripps R, Fitzharris M, Wing P . The global map for traumatic spinal cord injury epidemiology: update 2011, global incidence rate. Spinal Cord. 2013; 52(2):110-6. DOI: 10.1038/sc.2012.158. View

Miyakoshi N, Suda K, Kudo D, Sakai H, Nakagawa Y, Mikami Y . A nationwide survey on the incidence and characteristics of traumatic spinal cord injury in Japan in 2018. Spinal Cord. 2020; 59(6):626-634. DOI: 10.1038/s41393-020-00533-0. View

Demchak T, Linderman J, Mysiw W, Jackson R, Suun J, Devor S . Effects of functional electric stimulation cycle ergometry training on lower limb musculature in acute sci individuals. J Sports Sci Med. 2014; 4(3):263-71. PMC: 3887329. View

van Middendorp J, Hosman A, Donders A, Pouw M, Ditunno Jr J, Curt A . A clinical prediction rule for ambulation outcomes after traumatic spinal cord injury: a longitudinal cohort study. Lancet. 2011; 377(9770):1004-10. DOI: 10.1016/S0140-6736(10)62276-3. View

10.

Nussbaum E, Houghton P, Anthony J, Rennie S, Shay B, Hoens A . Neuromuscular Electrical Stimulation for Treatment of Muscle Impairment: Critical Review and Recommendations for Clinical Practice. Physiother Can. 2017; 69(5):1-76. PMC: 5683854. DOI: 10.3138/ptc.2015-88. View

11.

Gorgey A, Dudley G . Skeletal muscle atrophy and increased intramuscular fat after incomplete spinal cord injury. Spinal Cord. 2006; 45(4):304-9. DOI: 10.1038/sj.sc.3101968. View

12.

Elder C, Apple D, Bickel C, Meyer R, Dudley G . Intramuscular fat and glucose tolerance after spinal cord injury--a cross-sectional study. Spinal Cord. 2004; 42(12):711-6. DOI: 10.1038/sj.sc.3101652. View

13.

Arija-Blazquez A, Ceruelo-Abajo S, Diaz-Merino M, Godino-Duran J, Martinez-Dhier L, Martin J . Effects of electromyostimulation on muscle and bone in men with acute traumatic spinal cord injury: A randomized clinical trial. J Spinal Cord Med. 2013; 37(3):299-309. PMC: 4064579. DOI: 10.1179/2045772313Y.0000000142. View

14.

Nozoe M, Kanai M, Kubo H, Kitamura Y, Shimada S, Mase K . Changes in quadriceps muscle thickness in acute non-ambulatory stroke survivors. Top Stroke Rehabil. 2015; 23(1):8-14. DOI: 10.1179/1945511915Y.0000000002. View

15.

Thomaz S, Cipriano Jr G, Formiga M, Fachin-Martins E, Cipriano G, Martins W . Effect of electrical stimulation on muscle atrophy and spasticity in patients with spinal cord injury - a systematic review with meta-analysis. Spinal Cord. 2019; 57(4):258-266. DOI: 10.1038/s41393-019-0250-z. View

16.

Crameri R, Weston A, Rutkowski S, Middleton J, Davis G, Sutton J . Effects of electrical stimulation leg training during the acute phase of spinal cord injury: a pilot study. Eur J Appl Physiol. 2001; 83(4 -5):409-15. DOI: 10.1007/s004210000263. View

17.

Harvey L, Fornusek C, Bowden J, Pontifex N, Glinsky J, Middleton J . Electrical stimulation plus progressive resistance training for leg strength in spinal cord injury: a randomized controlled trial. Spinal Cord. 2010; 48(7):570-5. DOI: 10.1038/sc.2009.191. View

18.

Glinsky J, Harvey L, van Es P, Chee S, Gandevia S . The addition of electrical stimulation to progressive resistance training does not enhance the wrist strength of people with tetraplegia: a randomized controlled trial. Clin Rehabil. 2009; 23(8):696-704. DOI: 10.1177/0269215509104171. View

19.

Hosman A, Barbagallo G, Popescu E, Van de Meent H, Oner F, De Iure F . Neurological recovery after early versus delayed surgical decompression for acute traumatic spinal cord injury. Bone Joint J. 2023; 105-B(4):400-411. DOI: 10.1302/0301-620X.105B4.BJJ-2022-0947.R2. View

20.

Baldi J, Jackson R, Moraille R, Mysiw W . Muscle atrophy is prevented in patients with acute spinal cord injury using functional electrical stimulation. Spinal Cord. 1998; 36(7):463-9. DOI: 10.1038/sj.sc.3100679. View