Walking after incomplete spinal cord injury with an implanted neuromuscular electrical stimulation system and a hinged knee replacement: a single-subject study

Spinal Cord Series and Cases, 2020 · DOI: https://doi.org/10.1038/s41394-020-00336-8 · Published: August 31, 2020

Spinal Cord Injury Neurology Orthopedics

Simple Explanation

This study looks at a person with an incomplete spinal cord injury (iSCI) who used electrical stimulation (NMES) to help her walk. Over time, she developed knee pain and needed knee replacement surgery. The study measured how well she walked with and without the NMES and before and after her knee replacement. The goal was to see how both treatments affected her walking ability and pain. The results showed that the knee replacement helped reduce her pain, and the NMES continued to help her walk longer distances. The combination of both treatments allowed her to return to a better level of walking ability.

Study Duration

Not specified

Participants

Single 56-year-old female with C6 AIS C SCI

Evidence Level

Level IV: Single-subject repeated measures study

Key Findings

1
Knee replacement reduced pain and limited knee hyperextension, allowing the participant to walk without consciously flexing her knees.
2
NMES improved walking endurance, leg motions, and toe clearance, especially during fatigue.
3
The combined approach restored walking ability to levels achieved before significant knee pain developed.

Research Summary

This single-subject study investigated the combined effects of neuromuscular electrical stimulation (NMES) and total knee arthroplasty (TKA) on walking ability in an individual with incomplete spinal cord injury (iSCI). The participant experienced improved walking speed, toe clearance, and reduced pain after undergoing both interventions. NMES primarily enhanced endurance and leg motion, while TKA reduced pain and limited knee hyperextension. The study suggests that integrating various solutions, like NMES and TKA, can be a valuable approach in treating individuals with complex biomechanical and neuromuscular deficits after iSCI.

Practical Implications

Combined Interventions

Integrating NMES and TKA can be a beneficial approach for individuals with iSCI and complex biomechanical deficits.

Individualized Treatment

Treatment plans should consider the potential benefits of combining interventions to address both pain and motor deficits.

Surgical Considerations

When considering joint replacement in individuals with implanted NMES systems, communication between surgical and research teams is crucial to ensure the integrity of the NMES system.

Study Limitations

1
Single-subject study limits generalizability.
2
Lack of 6MWT and maximum walk tests prior to TKA after knee pain worsened.
3
Two non-functional electrodes may have underrepresented the potential impact of NMES assistance.

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