The Effect of Superimposed Electrical Stimulation on Sitting Balance, Respiratory Functions, and Abdominal Muscle Thickness in Complete Spinal Cord Injury
Condition: Spinal Cord Injury Thoracic
MeSH terms: Spinal Cord Injuries; Wounds and Injuries
Study type: Interventional

Summary: 
      The primary aim of the current study was to investigate the effects of SiFES (superimposed
      functional electrical stimulation) on sitting balance in patients with complete Spinal Cord
      Injury (SCI) compared to exercise alone. Additionally, the study aims to investigate
      improvements in respiratory functions and changes in abdominal muscle thickness measured by
      ultrasonography (USG) following SiFES treatment.

      The fundamental questions that investigators want to answer are as follows:

        -  [question 1]: "Does abdominal SiFES therapy improve sitting balance in patients with
           complete SCI?"

        -  [question 2]: "Does abdominal SiFES therapy improve respiratory functions in patients
           with complete SCI?"
    

Detailed description: 
      Many patients with SCI are ambulatory with a wheelchair. Therefore, providing good sitting
      balance in these patients is a key factor for performing activities of daily living (ADL) and
      achieving functional independence. Paralysis of abdominal muscles in patients with SCI
      disrupts body balance. In these patients, problems with trunk balance can lead to frequent
      falls and poor rehabilitation outcomes. Also, abdominal muscles assist in forceful
      expiration. Loss of innervation to abdominal and intercostal muscles reduces their ability to
      excrete secretions and cough effectively. As a result, respiratory tract complications, such
      as pneumonia, atelectasis, and respiratory failure can arise. It should be noted that in
      individuals with SCI, respiratory tract complications are the primary cause of morbidity and
      mortality. Newly used SiFES is a method in which the biofeedback-enabled FES device detects
      muscle contractions, and this electromyography (EMG) signal triggers the muscle stimulant
      mode of the device. In this method, more stimuli are conveyed to the brain through afferent
      nerves, allowing for motor learning to potentially occur by reviving the region represented
      in the cortex. In the current study, the investigators planned due to the anticipation that
      the synchronized stimulation of SiFES with function will be effective in patients with SCI
      injuries who currently have weak contraction abilities. The investigators considering the key
      role of abdominal muscles in trunk stability, believed that the integrated effect of SiFES is
      of great importance to patients. In the current randomized controlled and prospective study,
      the investigators included thirty-four participants with thoracic complete SCI. The
      investigators divided the participants into two equal groups: one group received SiFES
      applied to the abdominal muscles, while the control group received therapeutic exercise (TE)
      only. The investigators administered the interventions three times a week for four weeks. The
      investigators conducted muscle thickness measurements of bilateral rectus abdominis (RA),
      obliques externus (OE), obliques internus (OI), and transversus abdominis (TA) muscles using
      ultrasonography for all participants before and after treatment. Additionally, the
      investigators applied the modified functional reach test (mFRT), trunk control test (TCT),
      and pulmonary function test (PFT) to assess the participants.
    

Intervention name(s): NeuroTrac MyoPlus Pro single-channel electromyography biofeedback electrotherapy devices; Isometric strengthening exercises
Intervention type(s): Device; Other
Intervention description(s): Neuromuscular electrical stimulation (NMES) is applied to intact second motor neurons and target muscles of patients with SCI and provides functional and therapeutic benefits in neurological rehabilitation. Functional electrical stimulation (FES) is a type of NMES that is used for electrical stimulation during exercises such as crunches. Newly used SiFES is a method in which the biofeedback-enabled FES device detects muscle contractions, and this electromyography (EMG) signal triggers the muscle stimulant mode of the device.; Isometric abdominal strengthening exercises are part of the standard rehabilitation program for individuals with spinal cord injuries.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Investigators included thirty-four participants with thoracic complete SCI in this randomized controlled and prospective study. Investigators divided the participants into two equal groups, where one group received the biofeedback triggered superimposed functional electrical stimulation (SiFES) applied to the abdominal muscles, and the control group received transcutaneous electrical stimulation (TE) only, applied three times a week for four weeks.
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: spinal cord injury; abdominal muscle; electrical stimulation; sitting balance