(note: be patient with me here. It took some time to figure out what this presentation was about, but I got there.)

Carrie Shogren

Neuromuscular Electrical Stimulation and Optimizing Functional Recovery

Okay, dang — got caught up in some conversations during the break and came back 4 minutes into this talk. Total fail, sorry!

Jumping in: FES is the traditional electrical stimulation that most everybody already knows about. It’s what makes those bikes work. FES works by sending a little jolt of electricity directly to a muscle.

Activity-Based Therapy is the term used to describe anything that returns function AS A RESULT of an activity.

Neuromuscular Electrical Stimulation (NMES) is different from FES … it’s not epistim and not FES, but a sort of enhanced FES. It has all the same kinds of goals that FES has for patients, plus raising excitability of the nervous system and activation below the level of the lesion. Available commercially right  now, and I’ll find the company info later and put it in here. SAGE Tablet from Restorative Therapies.

They’ve been doing studies on people with Lower Motor Neuron injuries = below T12. The stimulation parameters are different, plus they stimulate multiple muscles all at the same time.  At Courage Kenny they do task-specific stimulation … the stimulation effect lasts for a while, even after the machine is turned off.

There will be a new system called Xcite, which just got approved in Canada and is pending in the USA. A lot of what they’re doing has come from the Harkema lab in Louisville .. it’s not feasible to have everybody implanted, and this NMES is the next best thing. It’s an intervention based on learning in the epidural trials and the locomotor training studies. A sort of intermediate step.

Dave Collins, Central Contributions to Contractions Evoked is the paper this is based on, if any of you care to read the data yourselves.

She’s showing graphic data that shows residual excitability after device is turned off. They’re activating the interneurons, which in turn activate the motor neurons … and another graph showing how they get multiple muscles to be activated together.

First time I’ve heard of this, so chime in if I’m misunderstanding, please. I think it’s a sort of backward epistim concept — like the stimulation of a muscle group delivers an epistim-like experience to the cord itself.

Huh. Waiting for her to show some data on how this has worked in practice to get people doing things like grasping, standing, and so on.

Spinal networks are sophisticated, they’re influenced by sensory input, they can learn specific tasks, they’re integrated in a very complex way, they’re what execute details of movement …

Principles for NMS  optimize sensory cues, maximize weight bearing on the legs, optimize the kinematics, and maximize recovery strategies

Yay, outcomes … been at it for the last two years. So far, they’ve done

  • 2 or 3 x a week intensive fitness program
  • Worked on chronic injuries
  • NMES outcomes so far:
  • increased sensation of full bladder
  • Less AD
  • Decreased time with bowel cares
  • Improved temperature sensation
  • Improved arm and leg function
  • Improved trunk stability

Some patients did just NMES, some did NMES together with locomotor training

Showing a patient who needed 3 trainers to get to standing, one each at trunk, pelvis, and knees, and got to where he just needed someone to stabilize his pelvis to get up. Asia A, T11

Another slide full of tiny data points, but the main idea is that over time all the patients improved in their upper extremity tasks.