Baldi J C, Jackson R D, Moraille R, Mysiw W J
Department of Physical Medicine and Rehabilitation, Ohio State University, Columbus 43210, USA.
Spinal Cord. 1998 Jul;36(7):463-9. doi: 10.1038/sj.sc.3100679.
Severe muscle atrophy occurs rapidly following traumatic spinal cord injury (SCI). Previous research shows that neuromuscular or 'functional' electrical stimulation (FES), particularly FES-cycle ergometry (FES-CE) can cause muscle hypertrophy in individuals with chronic SCI (> 1 year post-injury). However, the modest degree of hypertrophy in these already atrophied muscles has lessened earlier hopes that FES therapy would reduce secondary impairments of SCI. It is not known whether FES treatments are effective when used to prevent, rather than reverse, muscle atrophy in individuals with acute SCI. This study explored whether unloaded isometric FES contractions (FES-IC) or FES-CE decreased subsequent muscle atrophy in individual with acute SCI (< 3 months post-injury). Twenty-six subjects, 14-15 weeks post-traumatic SCI, were assigned to control, FES-IC, or FES-CE against progessively increasing resistance. Subjects were involved in the study for 3 or 6 months. Total body lean body mass (TB-LBM), lower limb lean body mass (LL-LBM), and gluteal lean body mass (G-LBM) were determined before the study, and at 3 and 6 months using dual energy X-ray absorptiometry (DEXA). Controls lost an average of 6.1%, 10.1%, 12.4%, after 3 months and 9.5%, 21.4%, 26.8% after 6 months in TB-LBM, LL-LBM and G-LBM respectively. Subjects in the FES-IC group consistently lost less lean body mass than controls, however, only 6 month G-LBM loss was significantly attenuated in this group relative to the controls. In the FES-CE group, LL-LBM and G-LBM loss were prevented at both 3 and 6 months, and TB-LBM loss was prevented at 6 months. In addition, FES-CE significantly increased G-LBM and LL-LBM after 6 months of training relative to pre-training levels. Within the control group, there was no significant relationship between LL-LBM loss (3 and 6 months) and the number of days between injury and baseline measurement. In summary, this study shows that FES-CE, but not FES-IC, training prevents muscle atrophy in acute SCI after 3 months of training, and causes significant hypertrophy after 6 months. The magnitude of differences in regionalized LBM between controls and FES-CE subject raises hopes that such treatment may indeed be beneficial in preventing secondary impairments of SCI if employed before extensive post-injury atrophy occurs.
创伤性脊髓损伤（SCI）后会迅速出现严重的肌肉萎缩。先前的研究表明，神经肌肉或“功能性”电刺激（FES），尤其是FES-周期测力计训练（FES-CE），可使慢性SCI患者（受伤后>1年）的肌肉肥大。然而，这些已经萎缩的肌肉中肥大程度适中，削弱了人们早期认为FES疗法会减少SCI继发性损伤的希望。尚不清楚FES治疗用于预防急性SCI患者的肌肉萎缩而非逆转肌肉萎缩时是否有效。本研究探讨了无负荷等长FES收缩（FES-IC）或FES-CE是否能减少急性SCI患者（受伤后<3个月）随后的肌肉萎缩。26名创伤性SCI后14 - 15周的受试者被分配到对照组、FES-IC组或进行逐渐增加阻力的FES-CE组。受试者参与研究3或6个月。在研究前、3个月和6个月时，使用双能X线吸收法（DEXA）测定全身瘦体重（TB-LBM）、下肢瘦体重（LL-LBM）和臀肌瘦体重（G-LBM）。对照组在3个月后TB-LBM、LL-LBM和G-LBM平均分别减少了6.1%、10.1%、12.4%，6个月后分别减少了9.5%、21.4%、26.8%。FES-IC组的受试者始终比对照组损失的瘦体重少，然而，该组中只有6个月时G-LBM的损失相对于对照组有显著减轻。在FES-CE组中，3个月和6个月时LL-LBM和G-LBM的损失均得到预防，6个月时TB-LBM的损失得到预防。此外，相对于训练前水平，FES-CE在训练6个月后显著增加了G-LBM和LL-LBM。在对照组中，LL-LBM的损失（3个月和6个月时）与受伤至基线测量之间的天数没有显著关系。总之，本研究表明，FES-CE训练而非FES-IC训练可在训练3个月后预防急性SCI患者的肌肉萎缩，并在6个月后导致显著的肌肉肥大。对照组与FES-CE组受试者之间区域化瘦体重的差异程度让人希望，如果在受伤后广泛萎缩发生之前采用这种治疗方法，可能确实有助于预防SCI的继发性损伤。
