Effects of Functional Electrical Stimulation-cycling Plus Progressive Resistance Training on Muscle Strength After Incomplete Spinal Cord Injury: A Randomized Controlled Trial

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A spinal cord injury (SCI) is a chronic health condition in which the individual loses certain functions, no longer being able to exercise them in the same way as before the injury (Vall, Mauricio, Costa, Pereira, & Friesen, 2011). SCI can induce prolonged inactivity and subsequent secondary complications such as muscle atrophy, pressure ulcers, and demineralization of the lower limb bones (Yoshida et al., 2013). Patients who survive with SCI often left with considerable residual disability that require longterm care for hospitalization, rehablitation and home care services (Wyndaele & Wyndaele, 2006). In United states, the incidence of SCI is approximately 40 cases per million population per year. The average age at time of injury is 31.7 years, with teenagers and young adults having the greatest risk (Livecchi, 2011). However, in Malaysia among all survivors of SCI about 50% of the patients experienced severe SCI (ASIA A or B), mainly involving patients in the age group 16 to 45 and experiencing traumatic SCI (Ibrahim et al., 2013). Musculoskeletal atrophy is a serious complication of SCI which contributes to the development of secondary impairements in spinal cord injured individuals. Although better medical care of persons with SCI has helped to progressively improve their health and life expectancy over the last six decades, gains in mobility and self-care skills have remained relatively stagnant because further improvements in these areas are dependent on advancements in basic science that may lead to reversal of the neurological loss (Ragnarsson, 2008). Thus, it is well accepted among healthcare professionals and now diplomats worldwide that regular physical activity is a cornerstone of physical and psychologic well-being. Since the 1960s, FES-induced muscle contractions have been widely used as a rehabilitation therapy or an exercise regimen for the paralyzed lower limbs of people with SCI. With FES, paralyzed legs can be artificially evoked to produce otherwise unattainable dynamic movements, such as cycling, rowing, knee extension, standing, and stepping (Davis, Hamzaid, & Fornusek, 2008). On the basis of this observation, FES cycle ergometers have been designed and extensively tested and prescribed for persons with SCI based on established clinical benefits. It can be performed either as static muscle contractions and dynamic knee extension (Hettinga & Andrews, 2008). FES-LCE did improve muscular strength and endurance, increase exercise Performance, and improve cardiovarcular response (Thrasher, Ward, & Fisher, 2013 ; Davis et al, 2008). However, the persistance of the result from the exercise training still unknown. Therefore, in this study the objective is to investigate the effects of FES-cycling ergometer plus progression resistance exercise on muscle strength and cardiovascular response among incomplete SCI patient.

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