Functional electrical exercise: a comprehensive approach for physical conditioning of the spinal cord injured patient

The purpose of the present study was to define a comprehensive approach to the rehabilitation of the paralyzed individual. Consequently, we have examined the cardiopulmonary effects of active physical therapy (APT) (as measured by blood pressure [BP], heart rate [HR], equivalent ventilatory rate [ VE], oxygen consumption rate [VO2], blood lactate [LA], and selected blood gases [pO2, pCO2 and pH]), and the skeletal effects of APT (bone density changes). The equipment utilized in this study were an isokinetic leg trainer, an exercise bicycle ergometer, and a single axis vibration platform. The procedures involved standard exercise protocols followed by the eight SCI subjects (four paraplegics and four quadriplegics) utilizing the above equipment, an evaluation of the cardiopulmonary response to the leg trainer and bicycle ergometer, and a computed tomography study of bone density changes in response to lower leg vibration. The following conclusions were reached: 1) APT results in an increase in cardiovascular stability; over a four-week period mean resting BP increased by an average 29 mmHg in four quadriplegic subjects, while mean exercising BP was reduced by an average 10 mmHg. 2) BP and HR responses to exercise are variable as a function of the level of the injury and type of location of exercise. 3) VO2 correctly showed level of the exercise and LA showed the stress; however, ventilation was variable with hyperventilation in some subjects. 4) Arterial pO2, pCO2, pH are variable during exercise; with complete quadriplegics typical pO2 at rest was 82 mmHg, showing venous admixture as with Pickwickian syndrome with CO2 retention and low arterial pO2 during exercise. 5) APT results in an increase in bone mineral density through impact loading of the paralyzed extremity.