On the effect of functional electrical stimulation upon spasticity and gait in the individual with incomplete spinal cord injury.

Functional electrical stimulation (FES) has been used for many years as a method of improving walking ability in individuals with neurological damage. In spite of this, its use in mainstream physiotherapy practice continues to be limited. One of the possible reasons for this may be the persistent belief that FES somehow increases spasticity in this subject group. This study had two main aims: to investigate the effects of FES upon spasticity, and upon the walking abilities in the individual with incomplete spinal cord injury (ISCI).Review of the literature relating to FES, spasticity and gait resulted in the following conclusions. FES has not been shown to increase spasticity; in fact it is far more likely to decrease it via the activation of spinal inhibitory neuronal mechanisms. FES has been found to have an overall beneficial affect on gait parameters. Although it is perceived as a substantially disabling impairment, spasticity is a hugely complex phenomenon that has proven difficult to measure. Conclusions as to the effects of spasticity upon gait need to be made with care. Due to this final point consideration was also given to the theoretical links between spasticity and gait. As the measurement of spasticity was shown to be substantially problematic, a review of the psychometric properties of the measures chosen to answer the research questions was undertaken.Given the stated aims of the project, two research questions were asked: 1. What changes in spasticity does an individual who receives FES as a treatment experience? 2. What changes in gait does an individual who receives FES as a treatment experience? The chosen methodology was that of a single subject experimental design. Ten subjects with incomplete spinal cord injury were recruited to the study; eight completed the programme. FES systems were applied cutaneously to improve the walking abilities of all subjects. The Modified Ashworth Scale (MAS) and isokinetic dynamometric analysis of lower limb resistance to movement were used as measures of spasticity. The Rancho Los Amigos Observational Gait Analysis System (OGA) was chosen to analyse walking ability. TELER Gait Indicators were developed, also to analyse gait, due to the perceived issues with the Rancho Los Amigos system. The results of this study show that spasticity, when measured by the MAS, did not increase in 7 out of 8 subjects. When considered as a group, the subjects demonstrated substantial improvement in their walking abilities. When considered individually the degree of improvement varied substantially. The overall conclusion is that FES can be a useful treatment option for the subject with ISCI. However, careful assessment and application is needed to optimise benefit for the individual. This study also adds to the literature regarding FES, spasticity and gait in its use of a methodology that allows the clinician to consider potential benefits to the individual subject.