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J Neurophysiol (January 11, 2006). doi:10.1152/jn.01181.2005
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Submitted on November 8, 2005
Accepted on January 7, 2006

Musculoskeletal Plasticity after Acute Spinal Cord Injury: Effects of Long-Term Neuromuscular Electrical Stimulation Training

Richard K. Shields1* and Shauna Dudley-Javoroski1

1 Graduate Program in Physical Therapy and Rehabilitation Science, The University of Iowa, Iowa City, IA, USA

* To whom correspondence should be addressed. E-mail: richard-shields{at}uiowa.edu.

Maintaining the physiologic integrity of paralyzed limbs may be critical for those with spinal cord injury (SCI) to be viable candidates for a future cure. No long term intervention has been tested to attempt to prevent the severe musculoskeletal deterioration that occurs after SCI. The purposes of this study were to determine whether a long term neuromuscular electrical stimulation training program can preserve the physiological properties of the plantar flexor muscles (peak torque, fatigue index, torque-time integral and contractile speed) as well as influence distal tibia trabecular bone mineral density (BMD). Subjects began unilateral plantar flexion electrical stimulation training within 6 weeks after SCI while the untrained leg served as a control. Mean compliance for the 2 year training program was 83%. Mean estimated compressive loads delivered to the tibia were ~1 to 1.5 times body weight. The training protocol yielded significant trained versus untrained limb differences for torque (+24%), torque-time integral (+27%), fatigue index (+50%), torque rise time (+45%), and between-twitch fusion (+15%). These between-limb differences were even greater when measured at the end of a repetitive stimulation protocol (125 contractions). Peripheral quantitative computed tomography revealed 31% higher distal tibia trabecular BMD in trained limbs than in untrained limbs. The intervention used in this study was sufficient to limit many of the deleterious muscular and skeletal adaptations that normally occur after SCI. Importantly, this method of load delivery was feasible and may serve the basis for an intervention to preserve the musculoskeletal properties of individuals with SCI.




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