Functional Electrical Stimulation For Walking In Paraplegia: 17-Year Follow-Up Of 2 Cases
Abstract
OBJECTIVE: To assess the safety and effectiveness of long-term use of functional electrical stimulation (FES) for exercise, standing, and walking in individuals with paraplegia, using percutaneous intramuscular wire electrodes. DESIGN: Case study with more than 17 years of follow-up. SETTING: Institutional rehabilitation practice. STUDY PARTICIPANTS: Two long-term (17 years) volunteer participants with paraplegia who were able to stand and walk using FES. INTERVENTION: Chronically indwelling percutaneous intramuscular wire electrodes connected to a portable microprocessor-controlled stimulator were used to exercise muscles while controlling trunk, hips, knees, and ankles and develop activation patterns to produce standing and walking. MAIN OUTCOME MEASURES: Clinical complications, electrode performance and survival probability, and functional performance. RESULTS: The most noted clinical complications included localized inflammation at the electrode site and superficial infection that responded well to topical and oral antibiotic treatment. The change from coil-wire electrodes, with a survival of 35% after 1 year, to double-helix electrodes improved electrode survival to 80% at 1 year and 48% at 5 years. Maintenance of the multichannel percutaneous FES walking system required replacement of an average of 2 electrodes every 6 months. Participants were able to use their system for independent exercise and standing and for walking with standby assistance. CONCLUSION: Although the FES system was devised as a temporary means of achieving functional activation until permanent means could be achieved, it was found to be effective and relatively safe for more than 17 years. Two long-time users of the system had no adverse effects to their skeletal system. The most common problems were daily care of electrodes at exit sites, frequent irritation of the skin around electrodes, and replacement of failed electrodes. The percutaneous system has the potential for short-term rehabilitation in individuals with incomplete paraplegia or stroke.
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The authors of the 17-year follow-up concluded that the system complies with short-term rehabilitation.
“leading to frequent electrode replacement, for which the authors conclude that the system complies with short term rehabilitation.”
From Interfaces with the peripheral nervous system for the control of a neuroprosthetic limb: a review (2020) · cites this paper as [33]
In a 17-year follow-up of two paraplegic patients with thoracic spine injury, patients using a system incorporating percutaneous muscle electrodes were able to climb stairs, walk for 20 minutes, and stand for 18 to 20 minutes per session.
“They were able to climb stairs, walk for 20 minutes, and stand for 18 to 20 minutes per session.”
From Interfaces with the peripheral nervous system for the control of a neuroprosthetic limb: a review (2020) · cites this paper as [33]
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Self-citation
- Authors
- Agarwal, S., Kobetic, R., Nandurkar, S., & Marsolais, E. B.
- Affiliations
- University Hospitals of Cleveland (US)
- Louis Stokes Cleveland VA Medical Center (US)
- Corresponding author
- Kobetic, Rudi
- Venue
- The Journal of Spinal Cord Medicine
- Publisher
- Informa UK Limited
- Published
- 2003-03
- Volume
- 26
- Issue
- 1
- Pages
- 86-91
- ISSN
- 1079-0268 (ISSN-L)
- 2045-7723
- OpenAlex
- W23271243
- Cited by
- 49
- References
- 19
- Citations by year
- 2025: 1 · 2024: 1 · 2023: 3 · 2022: 1 · 2020: 3 · 2019: 2 · 2018: 3 · 2016: 1 · 2015: 3 · 2014: 3 · 2013: 2 · 2012: 4
- FWCI
- 1.97
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Spinal Cord Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pathology and Forensic Medicine › Spinal Cord Injury Research
- Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
- Physical Sciences › Engineering › Biomedical Engineering › Prosthetics and Rehabilitation Robotics
- Keywords
- functional electrical stimulation, paraplegia, long-term follow-up, standing, physical activity, incomplete paraplegia, stroke rehabilitation
- MeSH terms
- Electrodes, Implanted, Electric Stimulation Therapy, Follow-Up Studies, Humans, Male, Middle Aged, Paraplegia, Posture, Spinal Cord Injuries, Time Factors, Exercise, Walking, Outcome Assessment, Health Care, Muscle, Skeletal
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