Lower Extremity Functional Electrical Stimulation Cycling Promotes Physical & Neurological Recovery In Chronic Spinal Cord Injury

A new study by Kennedy Krieger Institute’s International Center for Spinal Cord Injury (Epub ahead of print) finds that long-term lower extremity functional electrical stimulation (FES) cycling, as part of a rehabilitation regimen, is associated with substantial improvements in individuals with chronic spinal cord injury (SCI). Improvements include neurological and functional gains, as well as enhanced physical health demonstrated by decreased fat, increased muscle mass and improved lipid profile. Prior to this study’s publication in the Journal of Spinal Cord Medicine, the benefits of activity-based restorative therapy (ABRT) programs, such as FES cycling, were largely anecdotal despite publicity in conjunction with the recovery of actor and activist Christopher Reeve.

In FES, small electrical pulses are applied to paralyzed muscles to stimulate movement. In the case of FES cycling, FES pulses prompt the legs of an individual with SCI to “cycle” on an adapted stationary recumbent bicycle. The repetitive activity offers cardiovascular exercise similar to that which an able-bodied individual achieves through walking, but this new research shows that the results go far beyond basic health benefits.

“Exercise has not been commonly advocated for individuals with paralysis because of the assumption that it is of little benefit and it is challenging to exercise limbs that an individual cannot voluntarily move,” said John W. McDonald, M.D., Ph.D., senior study author and director of the International Center for Spinal Cord Injury at the Kennedy Krieger Institute. “However, we found that FES cycling is a practical form of exercise that provides substantial benefits, including improved physical integrity, enhanced neurological and functional performance, increased muscle size and strength, reduced muscle spasticity and improved quality of life.”

Biking Restores Brain Connectivity in Parkinson’s

PROBLEM: It’s commonly known that Parkinson’s Disease is a chronic, progressive, disease of central nervous system that affects motor ability — its recognizable early stages are characterized by shakiness and difficulty walking. No cure exists, which is why back in 2003, the best Dr. Jay Alberts of the Cleveland Clinic Lerner Research Institute rode a tandem bicycle across Iowa with a Parkinson’s patient (to raise awareness). Unexpectedly, the patient showed improvements in her condition after the trip. In what now much be common lore at the Institute, Alberts attempted to explain the inexplicable by noticing that his own pace was faster than that of his partner, who was forced, by the cruel mechanics of tandem cycling, to pedal faster in order to keep up.

METHODOLOGY: Alberts and his colleagues used functional connectivity MRI to study the brains of 26 patients with Parkinson’s Disease before and after they engaged in an 8-week exercise program and then, as a follow-up, one month later. Three times a week, the patients worked out on stationary bicycles. The experimental group used a modified bike that, using an algorithm in the place of a super in-shape doctor, would measure their rate of exertion and use it as a basis to push them harder than they would otherwise choose.

RESULTS: What the researchers referred to as “forced rate activity,” others might feel is more accurately labeled “torture.” But when they calculated the brain activation of the patients forced to pedal past their comfort level, they found lasting increases in connectivity between two areas of the brain responsible for motor ability: the primary motor cortex and the posterior region of the thalamus.

CONCLUSION: Forced-rate bicycle exercise appears to be an effective therapy for Parkinson’s disease. 

IMPLICATION: The treatment delivered dramatic results, and has the distinction of being inexpensive and accessible. Alberts contends that even those without access to their own algorithm for forced-rate activity may be able to see improvement by using an at-home stationary bike. The next step is to evaluate the possible effects of other forms of exercise, like swimming. 

The full study was presented at the annual meeting of the Radiological Society of North America.