Premium
Intensive Electrical Stimulation Attenuates Femoral Bone Loss in Acute Spinal Cord Injury
Author(s) -
Groah Suzanne L.,
Lichy Alison M.,
Libin Alexander V.,
Ljungberg Inger
Publication year - 2010
Publication title -
pmandr
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.617
H-Index - 66
eISSN - 1934-1563
pISSN - 1934-1482
DOI - 10.1016/j.pmrj.2010.08.003
Subject(s) - medicine , spinal cord injury , bone mineral , femur , creatinine , urology , anesthesia , surgery , spinal cord , osteoporosis , psychiatry
Objective To determine whether intensive electrical stimulation (ES) can reduce femoral bone mineral density (BMD) loss in acute spinal cord injury (SCI). Design Randomized controlled trial. Setting Inpatient rehabilitation hospital. Participants Twenty‐six subjects with C4 to T12 American Spinal Injury Association Impairment Scale A or B SCI less than 12 weeks postinjury. Methods The control group received usual rehabilitative care and the intervention group received usual care plus 1 hour of ES over the quadriceps 5 days per week for 6 weeks. Main Outcome Measurements Outcome measurements were collected at baseline, postintervention (interim), and 3 months postinjury (follow‐up), and included dual energy x‐ray absorptiometry, serum osteocalcin (OC), and urinary N‐telopeptide (NTx). Results In the control group, there was increasing BMD loss with distance from the spine (lumbar −1.88%, hip −12.25%, distal femur −15.15%, proximal tibia −17.40%). This trend was attenuated over the distal femur in the ES group (lumbar −1.29%, hip −14.45%, distal femur −7.40%, proximal tibia −12.31%). NTx increased over the 3 assessments in controls ([mean ± standard deviation] 115.00 ± 34.10, 154.86 ± 70.41, and 171.33 ± 75.8 nmol/mmol creatinine) compared with the ES group (160.56 ± 140.06, 216.71 ± 128.40, and 154.67 ± 69.12 nmol/mmol creatinine)—all of which were elevated compared with the reference range, and the differences between the 2 groups were not significant. Osteocalcin levels markedly decreased in the control group (12.90 ± 7.30, 24.00 ± 4.29, and 6.40 ± 7.28 μg/L) to subnormal levels, and remained stable and in the normal range in the ES group (13.80 ± 7.64, 11.86 ± 6.77, and 14.80 ± 12.91 μg/L), although differences between the groups were not significant. Conclusions Lower extremity BMD loss increases with distance from the spine. An intensive lower extremity ES program may attenuate BMD loss locally after acute motor complete SCI, although it is unknown whether these benefits are maintained in the long term.