Attenuation of autonomic dysreﬂexia during functional electrical stimulation cycling by neuromuscular electrical stimulation training: case reports

Spinal Cord Series and Cases, 2020 · DOI: https://doi.org/10.1038/s41394-020-0262-0 · Published: February 15, 2020

Simple Explanation

Spinal cord injury (SCI) can disrupt motor, sensory, and autonomic nervous systems, leading to health issues. Functional electrical stimulation (FES) cycling is a way to exercise after SCI, but it can trigger autonomic dysreﬂexia (AD), a dangerous rise in blood pressure. This study explores whether neuromuscular electrical stimulation (NMES) resistance training before FES cycling can lessen AD. Two participants with C6 SCI underwent either NMES training or passive motion exercises before starting FES cycling. The results suggest that NMES training may reduce the increase in blood pressure during FES cycling, potentially making FES exercise safer for individuals with SCI at risk of AD. This 'priming' of the nervous system may help to attenuate the autonomic nervous system response.

Study Duration

24 weeks

Participants

Two participants with motor-complete C6 SCI

Evidence Level

Level 4: Case Reports

Key Findings

1
Participant A, who received NMES-resistance training before FES cycling, had a smaller difference between their exercise and resting blood pressure compared to participant B, who received passive movement before FES cycling.
2
The difference in blood pressure during FES cycling decreased at a faster rate for participant A compared to participant B, suggesting a potential benefit of NMES-RT in attenuating the AD response.
3
NMES training may desensitize skin nociceptors or modulate autonomic activity through parasympathetic stimulation, helping to regulate the sympathetic nervous system's response to noxious stimuli during FES cycling.

Research Summary

This study investigated the impact of neuromuscular electrical stimulation (NMES) resistance training on autonomic dysreflexia (AD) during functional electrical stimulation (FES) cycling in two participants with C6 spinal cord injury (SCI). The results suggest that NMES-RT may attenuate the development of AD during FES-LEC, as evidenced by smaller increases in blood pressure during exercise in the participant who underwent NMES-RT prior to FES-LEC. The study highlights the potential of NMES-RT as a non-pharmacological intervention to manage AD and enable safer participation in FES-based exercise for individuals with SCI, although larger trials are needed to confirm these findings.

Practical Implications

Clinical Practice

NMES-RT may be considered as a preparatory intervention before initiating FES-LEC in individuals with SCI at risk of AD.

Rehabilitation Programs

Integrating NMES-RT into rehabilitation programs may improve the safety and efficacy of FES-based exercise for cardiovascular health.

Future Research

Larger, randomized controlled trials are needed to confirm the findings and explore the underlying mechanisms of NMES-RT in attenuating AD.

Study Limitations

1
Small sample size limits the generalizability of the findings.
2
The exploratory nature of the study calls for caution in interpreting the results.
3
Lack of specific guidelines to document remaining autonomic function after SCI.

Your Feedback

Was this summary helpful?

Back to Spinal Cord Injury