One year of home-based daily FES in complete ower motor neuron paraplegia: Recovery of etanic contractility drives the structural mprovements of denervated muscle

Helmut Kern, Ugo Carraro, Nicoletta Adami, Christian Hofer, Stefan Loefler, Michael Vogelauer, Winfried Mayr, Rudiger Rupp, Sandra Zampieri

Research output: Contribution to journalArticlepeer-review


Objective: Spinal cord injury (SCI) causes muscle atrophy, which is particularly severe, due to inability to perform tetanic contractions, when lower motor neurons (LMN) are involved. We performed a longitudinal study in 25 Europeans suffering from complete conus cauda syndrome from 0.7 to 8.7 years comparing functional and structural thigh muscle properties before and after 2 years of home-based daily training by functional electrical stimulation (FES).The mid-term results after 1 year and preliminary muscle biopsy observations at project end-point from a subset of subjects are here reported. Methods: Muscles were electrically stimulated at home by means of large surface electrodes and a customdesigned stimulator. The poor excitability of the LMN denervated muscles was first improved by twitchcontraction training. Then, tetanic contractions against progressively increased loading were elicited. Finally, standing-up exercises were daily performed. The bulk of thigh muscle was estimated by transverse computer tomography (CT) scan and force measurements. Needle biopsies of vastus lateralis were harvested before and after 2 years of FES. Results: The 1 year home-based daily FES training induced: (1) very similar increases in muscle excitability and contractility in right and left legs; (2) feasibility to elicit tetanic contractions by means of train-stimulation with about ten times improvement of muscle force; (3) increase in the 26% of muscle bulk, as shown by CT scan analyses, improving appearance of limbs and muscle cushioning; (4) myofiber size increase (z94%) in a small series of muscle biopsies obtained after 2 years of FES. None of the subjects that performed 1 year home-based daily FES training (20 persons) had worsened their functional class, while 20% (4/20) improved to functional class 4, that is, the ability to stand. Discussion: The European Union (EU) Project Rise shows that 'home-based daily FES training' is a safe and effective therapy that may maintain life-long physical exercise by active muscle contraction (FES is the only option for denervated muscle) as a procedure to recover the early-lost tetanic contractility of denervated muscle, and to counteract muscle atrophy in order to prevent clinical complications.

Original languageEnglish
Pages (from-to)5-12
Number of pages8
JournalNeurological Research
Issue number1
Publication statusPublished - Feb 2010


  • CT scan
  • Functional electrical stimulation
  • Home-based daily FES training
  • Human
  • Long-term denervation
  • Lower motor neuron lesion
  • Paraplegia
  • Spinal cord injury
  • Tetanic contraction

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology


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