Article

OBJECTIVE: To investigate whether combined trunk and gluteal neuromuscular
electrical stimulation (NMES) alters seated posture and improves pelvic tissue
health in persons with a spinal cord injury. DESIGN: Intervention study; case
series. SETTING : Research laboratory, medical center. PARTICIPANTS: Seven persons
with spinal cord injury recruited from a group of experienced implanted lower
extremity NMES system users. INTERVENTION : Combined trunk and gluteal NMES in the
sitting position. Five minutes of preintervention sitting was assessed, followed
by 5 minutes of NMES application, and then 5 minutes of postintervention. MAIN
OUTCOME MEASURES: Pelvic tissue health was evaluated by concurrently measuring
transcutaneous oxygen tension (TcPO2) bilaterally over the ischia and the seating
interface pressure (IP). TcPO2 data were binned into low (<10 mm Hg), medium
(10-30 mm Hg), and high (>30 mm Hg) ranges, and the percentage time that TcPO2
was in each range was calculated. Ischial and sacral regions of interest were
defined and the maximum region of interest and mean IP were determined, together
with the maximum IP gradient for the entire contact area. Initial seating
postures varied; 4 persons were initially sacral sitters. Tissue health responses
to NMES were reviewed for sacral and nonsacral sitters. RESULTS: For sacral
sitters, the sacral region IP and the maximum IP gradient tended to decrease
during NMES and increased again after the intervention. Mean ischial TcPO2
increased during NMES and remained elevated after the intervention, increasing
high TcPO2 percentage time for 50% of the sacral sitters both during and after
the intervention. Nonsacral sitters showed few changes in tissue health as the
result of the application of NMES. CONCLUSIONS: Trunk and gluteal stimulation
acutely corrects anterior/posterior IP distribution, improving regional tissue
health for sacral sitters. This correction requires constant application of NMES.
The potential for positive changes in tissue health would be maximized by regular
NMES use incorporating weight shifting.
CI - Copyright (c) 2013 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS