[Therapeutic and functional electrical stimulation for paraplegics].

The first objective of this study was to compare the cross-sectional areas of muscles and muscle force before and after 6 months of therapeutic electrical stimulation (TES) by using computed tomography (CT), Cybex II, a strain-gauge, and manual muscle test (MMT) in 5 complete paraplegics. The stimulation parameters were a frequency of 20 Hz, a pulse width of 0.2 ms, and an output voltage of -15V. The cross-sectional areas of muscle, the CT numbers, and both the muscle torque and the muscle force increased after TES, but the initial muscle force need to have been greater than a poor-minus level on MMT in order to achieve practical benefits from TES. Therefore TES should be started as early as possible after the onset of paraplegia in order to maintain and improve muscle quality. The second objective of this study was to re-chart the electrical stimulation used for reconstructing the standing-up motion in paraplegics. Twelve healthy subjects were monitored during two different kinds of standing-up motion: 1) standing-up while the arms remained crossed in front of the chest, and 2) hands-assisted standing-up using parallel bars. The electromyogram, joint angle, and the vertical component of the floor reaction force were synchronized with time, and investigated. The main muscles for standing-up are the quadriceps, the tibialis anterior, and the paraspinal muscles. Comparing 1) and 2), the hands-assisted standing-up was performed with less muscle activity except for the rectus femoris and the iliopsoas muscle, and with less maximum vertical floor reaction force. A T6 paraplegic patient could stand-up smoothly from a wheel-chair using the parallel bars after electrical stimulation based on data from the hands-assisted standing-up study on healthy subjects. In comparison with healthy subjects, the knee joints initially flexed before extending, and the ankle joints were more dorsiflexed in the paraplegic patient. The maximum vertical floor reaction force was also less.