Background: The combination of body weight-supported gait training with functional electrical stimulation (FES) may provide the optimal stimulus for improving overground walking after spinal cord injury (SCI). This potential benefit is likely due to the combination of specificity with the maximization of muscle contractions. Objectives: To investigate the effects of 12 weeks of FES-ambulation on overground walking and health-related quality of life (HRQOL) in individuals with SCI. Methods: Six individuals (60.5 ± 13.2 years) with SCI (C4-L3; AIS D; 9.3 ± 12.0 years post injury), completed a thrice-weekly, 12-week FES-ambulation training program. Locomotor function was assessed via the Walking Index for Spinal Cord Injury II (WISCI II), the 6-minute walk test (6MWT), the 10-meter walk test (10MWT), and the body-weight support required during training. HRQOL was assessed via the Short Form-36, the Perceived Stress Scale, and the Center of Epidemiological Studies for Depression scale. Results: Participants showed significant improvements in the 6MWT (223.6 ± 141.5 m to 297.3 ± 164.5 m; P = .03), the required body weight support (55.3% ± 12.6% to 14.7% ± 23.2%; P = .03), and a nonsignificant trend toward an increase in walking speed during the 10MWT (0.69 ± 0.4 m/s to 0.9 ± 0.5 m/s; P = .08) following the training program. Four participants showed improvements on the WISCI II (1-4 points). Participants also showed a decrease in the Short Form-36 pain score (6.5 ± 1.2 to 5.0 ± 1.7; P = .04) and an increase in the overall mental health score (47.8 ± 12.6 to 54.2 ± 6.7; P = .04). Conclusion: FES-ambulation was associated with enhanced overground walking in individuals with AIS D SCI, reduced pain, and improved mental health.

Anderson K. Targeting recovery: Priorities of the spinal cord-injured population. J Neurotrauma. 2004;21:1371–1383.
,
Targeting recovery: Priorities of the spinal cord-injured population
,
J Neurotrauma.
, vol.
21
(pg.
1371
-
1383
)
Dittuno PL, Patrick M, Stineman M, Ditunno F. Who wants to walk? Preferences for recovery after SCI: A longitudinal and cross-sectional study. Spinal Cord. 2008;46:500–506.
,
Who wants to walk? Preferences for recovery after SCI: A longitudinal and cross-sectional study
,
Spinal Cord.
, vol.
46
(pg.
500
-
506
)
Field-Fote EC, Roach KE. Influence of a locomotor training approach on walking speed and distance in people with chronic spinal cord injury: A randomized clinical trial. J Am Phys Ther Assoc. 2011;91:48–60.
,
Influence of a locomotor training approach on walking speed and distance in people with chronic spinal cord injury: A randomized clinical trial
,
J Am Phys Ther Assoc.
, vol.
91
(pg.
48
-
60
)
Hicks AL, Adams MM, Ginis KM, Philips SM, McCartney N. Long-term body-weight-supported treadmill training and subsequent follow up in persons with chronic SCI: Effects on functional walking ability and measures of subjective well-being. Spinal Cord. 2005;43:291–298.
,
Long-term body-weight-supported treadmill training and subsequent follow up in persons with chronic SCI: Effects on functional walking ability and measures of subjective well-being
,
Spinal Cord.
, vol.
43
(pg.
291
-
298
)
Protas EJ, Holmes A, Qureshy H, Johnson A, Lee D, Sherwood A. Supported treadmill ambulation training after spinal cord injury: A pilot study. Arch Phys Med Rehabil. 2001;82:825–831.
,
Supported treadmill ambulation training after spinal cord injury: A pilot study
,
Arch Phys Med Rehabil.
, vol.
82
(pg.
825
-
831
)
Yang JF, Norton J, Nevett-Ducherer J, Roy FD, Gross DP, Gorassini MA. Volitional muscle strength in the legs predicts changes in walking speed following locomotor training in people with chronic spinal cord injury. Phys Ther. 2011;91:931–943.
,
Volitional muscle strength in the legs predicts changes in walking speed following locomotor training in people with chronic spinal cord injury
, vol.
91
(pg.
931
-
943
)
Dobkin B, Barbeau H, Deforge D, Ditunno J, Elashoff R. The evolution of walking-related outcomes over the first 12 weeks of rehabilitation for incomplete traumatic spinal cord injury: The multicenter randomized spinal cord injury locomotor trial. Neurorehabil Neural Repair. 2007;21:25–35.
,
The evolution of walking-related outcomes over the first 12 weeks of rehabilitation for incomplete traumatic spinal cord injury: The multicenter randomized spinal cord injury locomotor trial
,
Neurorehabil Neural Repair.
, vol.
21
(pg.
25
-
35
)
Effing TW, Meeteren NL, Asbeck FW, Prevo AJ. Body weight-supported treadmill training in chronic incomplete spinal cord injury: A pilot study evaluating functional health status and quality of life. Spinal Cord. 2006;44:287–296.
,
Body weight-supported treadmill training in chronic incomplete spinal cord injury: A pilot study evaluating functional health status and quality of life
,
Spinal Cord.
, vol.
44
(pg.
287
-
296
)
Martin Ginis K, Latimer AE. The effects of single bouts of body-weight supported treadmill training on the feeling states of people with spinal cord injury. Spinal Cord. 2007;45:112–115.
,
The effects of single bouts of body-weight supported treadmill training on the feeling states of people with spinal cord injury
,
Spinal Cord.
, vol.
45
(pg.
112
-
115
)
Huang HJ, Ferris DP. Neural coupling between upper and lower limbs during recumbent stepping. J Appl Physiol. 2004;97:1299–1308.
,
Neural coupling between upper and lower limbs during recumbent stepping
,
J Appl Physiol.
, vol.
97
(pg.
1299
-
1308
)
Hornby GT, Cmapbell DD, Zemon DH, Kahn JH. Clinical and quantitative evaluation of robotic-assisted treadmill walking to retrain ambulation after spinal cord injury. Top Spinal Cord Inj Rehabil. 2005;11:1–12.
,
Clinical and quantitative evaluation of robotic-assisted treadmill walking to retrain ambulation after spinal cord injury
,
Top Spinal Cord Inj Rehabil.
, vol.
11
(pg.
1
-
12
)
Baldi JC, Jackson RD, Moraille R, Mysiw WJ. Muscle atrophy is prevented in patients with acute spinal cord injury using function electrical stimulation. Spinal Cord. 1998;36:463–469.
,
Muscle atrophy is prevented in patients with acute spinal cord injury using function electrical stimulation
,
Spinal Cord.
, vol.
36
(pg.
463
-
469
)
Faghri PD, Glaser RM, Figoni SF. Functional electrical stimulation leg cycle ergometer exercise: Training effects on cardiorespiratory responses of spinal cord injured subjects at rest and during submaximal exercise. Arch Phys Med Rehabil. 1992;73:1085–1093.
,
Functional electrical stimulation leg cycle ergometer exercise: Training effects on cardiorespiratory responses of spinal cord injured subjects at rest and during submaximal exercise
,
Arch Phys Med Rehabil.
, vol.
73
(pg.
1085
-
1093
)
Mohr T, Andersen JL, Sorensen FB, et al. Long term adaptation to electrically induced cycling training in severe spinal cord injured individuals. Spinal Cord. 1997;35:1–16.
,
Long term adaptation to electrically induced cycling training in severe spinal cord injured individuals
,
Spinal Cord.
, vol.
35
(pg.
1
-
16
)
Ditunno PL, Dittuno JF Jr. Walking Index for Spinal Cord Injury (WISCI II): Scale revision. Spinal Cord. 2001;39:654–656.
,
Walking Index for Spinal Cord Injury (WISCI II): Scale revision
,
Spinal Cord.
, vol.
39
(pg.
654
-
656
)
Ware JE, Sherbourne CD. The MOS 36-item Short Form Health Survey (SF-36). Conceptual framework and item selection. Med Care. 1992;30:473–483.
,
The MOS 36-item Short Form Health Survey (SF-36). Conceptual framework and item selection
,
Med Care.
, vol.
30
(pg.
473
-
483
)
Tate DG, Kalpakjian CZ, Forchheimer MB. Quality of life issues in individuals with spinal cord injury. Arch Phys Med Rehabil. 2002;83:18–25.
,
Quality of life issues in individuals with spinal cord injury
,
Arch Phys Med Rehabil.
, vol.
83
(pg.
18
-
25
)
Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Social Behav. 1983;24:385–396.
,
A global measure of perceived stress
,
J Health Social Behav.
, vol.
24
(pg.
385
-
396
)
Radloff LS. The CES-D scale: A self-report depression scale for research in the general population. Appl Psychol Measure. 1977;1:385–401
,
The CES-D scale: A self-report depression scale for research in the general population
,
Appl Psychol Measure.
, vol.
1
(pg.
385
-
401
)
Wirz M, Zemon DH, Rupp R, et al. Effectiveness of automated locomotor training in patients with chronic incomplete spinal cord injury: A multicenter trial. Arch Phys Med Rehabil. 2005;86:672–680.
,
Effectiveness of automated locomotor training in patients with chronic incomplete spinal cord injury: A multicenter trial
,
Arch Phys Med Rehabil.
, vol.
86
(pg.
672
-
680
)
Thrasher TA, Flett HM, Popovic MR. Gait training regimen for incomplete spinal cord injury using functional electrical stimulation. Spinal Cord. 2006;44:357–361.
,
Gait training regimen for incomplete spinal cord injury using functional electrical stimulation
,
Spinal Cord.
, vol.
44
(pg.
357
-
361
)
Field-Fote EC. Combined use of body weight support, functional electric stimulation, and treadmill training to improve walking ability in individuals with chronic incomplete spinal cord injury. Arch Phys Med Rehabil. 2001;82:818–824.
,
Combined use of body weight support, functional electric stimulation, and treadmill training to improve walking ability in individuals with chronic incomplete spinal cord injury
,
Arch Phys Med Rehabil.
, vol.
82
(pg.
818
-
824
)
Basso DM. Invited commentary on “Influence of a locomotor training approach on walking speed and distance in people with chronic spinal cord injury: A randomized clinical trial.” Phys Ther. 2011;91:60–62.
,
Invited commentary on “Influence of a locomotor training approach on walking speed and distance in people with chronic spinal cord injury: A randomized clinical trial.”
,
Phys Ther.
, vol.
91
(pg.
60
-
62
)
Ditor DS, Latimer AE, Martin Ginis KA, Arbour KP, McCartney N, Hicks AL. Maintenance of exercise participation in individuals with spinal cord injury: Effects on quality of life, stress and pain. Spinal Cord. 2003;41:446–450.
,
Maintenance of exercise participation in individuals with spinal cord injury: Effects on quality of life, stress and pain
,
Spinal Cord.
, vol.
41
(pg.
446
-
450
)
Hicks AL, Ginis KM, Ditor DS, et al. Long-term exercise training in people with spinal cord injury: Effects on strength, arm ergometry performance and psychological well-being. Spinal Cord. 2003;41:34–43.
,
Long-term exercise training in people with spinal cord injury: Effects on strength, arm ergometry performance and psychological well-being
,
Spinal Cord.
, vol.
41
(pg.
34
-
43
)
Latimer AE, Martin Ginis K, Hicks AL, McCartney N. An examination of the mechanisms of exercise-induced change in psychological well-being among people with spinal cord injury. J Rehabil Res Dev. 2004;41:643–652.
,
An examination of the mechanisms of exercise-induced change in psychological well-being among people with spinal cord injury
,
J Rehabil Res Dev.
, vol.
41
(pg.
643
-
652
)
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