Abstract
Objective
To compare the magnitude of interface pressure changes during gluteal maximus contraction
by stimulating sacral nerve roots with surface electrical stimulations in patients
with spinal cord injuries (SCIs).
Design
Pilot interventional study.
Setting
Spinal injury research laboratory.
Participants
Adults (N=18) with suprasacral complete SCI.
Interventions
Sacral nerve root stimulation (SNRS) via a functional magnetic stimulator (FMS) or
a sacral anterior root stimulator (SARS) implant; and surface functional electrical
stimulation (FES).
Main Outcome Measures
Interface pressure under the ischial tuberosity (IT) defined as peak pressure, gradient
at peak pressure, and average pressure.
Results
With optimal FMS, a 29% average reduction of IT peak pressure was achieved during
FMS (mean ± SD: 160.1±24.3mmHg at rest vs 114.7±18.0mmHg during FMS, t5=6.3, P=.002). A 30% average reduction of peak pressure during stimulation via an SARS implant
(143.2±31.7mmHg at rest vs 98.5±21.5mmHg during SARS, t5=4.4, P=.007) and a 22% average decrease of IT peak pressure during FES stimulation (153.7±34.8mmHg
at rest vs 120.5±26.1mmHg during FES, t5=5.3, P=.003) were obtained. In 4 participants who completed both the FMS and FES studies,
the percentage of peak pressure reduction with FMS was slightly greater than with
FES (mean difference, 7.8%; 95% confidence interval, 1.6%–14.0; P=.04).
Conclusions
SNRS or surface FES can induce sufficient gluteus maximus contraction and significantly
reduce ischial pressure. SNRS via an SARS implant may be more convenient and efficient
for frequently activating the gluteus maximus.
Keywords
List of abbreviations:
FES (functional electrical stimulation), FMS (functional magnetic stimulation), IT (ischial tuberosity), PrU (pressure ulcer), SARS (sacral anterior root stimulator), SCI (spinal cord injury), SNRS (sacral nerve root stimulation)To read this article in full you will need to make a payment
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References
- Prevention and treatment of PUs: clinical practice guideline.NPUAP, Washington (DC)2009: 169
- Pelvic movement and interface pressure distribution during manual wheelchair propulsion.Arch Phys Med Rehabil. 2003; 84: 1466-1472
- Major risk factors for PUs in the spinal cord disabled: a literature review.Spinal Cord. 1996; 34: 255-263
- An exploration of the occurrence of PUs in a British spinal injuries unit.J Clin Nurs. 2002; 11: 470-478
- Wheelchair posture and pressure sores.Charles C. Thomas, Springfield1984
- Skin sores after spinal cord injury: relationship to life adjustment.Spinal Cord. 1998; 36: 51-56
- The epidemiology of secondary conditions following spinal cord injury.Top Spinal Cord Inj Rehabil. 2004; 10: 15-29
- The cost of PUs in the United Kingdom.J Wound Care. 2012; 21 (264, 266): 261-262
- A systematic review of risk factors for the development and recurrence of PUs in people with spinal cord injuries.Spinal Cord. 2013; 51: 522-527
- Pressure sore prevention for the wheelchair-bound spinal injury patient.Paraplegia. 1980; 18: 42-51
- A systematic review of therapeutic interventions for pressure ulcers after spinal cord injury.Arch Phys Med Rehabil. 2009; 90: 213-231
- Effects of intermittent electrical stimulation on superficial pressure, tissue oxygenation, and discomfort levels for the prevention of deep tissue injury.Ann Biomed Eng. 2011; 39: 649-663
- Electrical muscle stimulation for pressure variation at the seating interface.J Rehabil Res Dev. 1989; 26: 1-8
- Pressure changes under the ischial tuberosities of seated individuals during sacral nerve root stimulation.J Rehabil Res Dev. 2006; 43: 209-218
- Intermittent electrical stimulation redistributes pressure and promotes tissue oxygenation in loaded muscles of individuals with spinal cord injury.J Appl Physiol (1985). 2011; 110: 246-255
- The effect of surface electric stimulation of the gluteal muscles on the interface pressure in seated people with spinal cord injury.Arch Phys Med Rehabil. 2008; 89: 1724-1732
- Effects of regular use of neuromuscular electrical stimulation on tissue health.J Rehabil Res Dev. 2003; 40: 469-475
- The effects of combined trunk and gluteal neuromuscular electrical stimulation on posture and tissue health in spinal cord injury.PM R. 2013; 5: 688-696
- Effects of electrical stimulation-induced gluteal versus gluteal and hamstring muscles activation on sitting pressure distribution in persons with a spinal cord injury.Spinal Cord. 2012; 50: 590-594
- Assessment of mechanical conditions in subdermal tissues during sitting: a combined experimental-MRI and finite element approach.J Biomech. 2007; 40: 1443-1454
Article info
Publication history
Published online: October 31, 2014
Footnotes
Supported by the Royal National Orthopaedic Hospital, Stanmore, United Kingdom (grant no. 03/010); and by the ASPIRE Stanmore, United Kingdom, for providing equipment enabling us to run this project.
Disclosures: none.
Identification
Copyright
© 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
