Supporting front crawl swimming in paraplegics using electrical stimulation: a feasibility study.

Area of Science:

• Neurology
• Rehabilitation Medicine
• Sports Science

Background:

• Spinal cord injury (SCI) severely limits physical activity due to motor function loss, impaired thermoregulation, and fatigue.
• Hydrotherapy and swim training offer benefits like weight relief, spasticity reduction, and improved fitness for SCI individuals.
• Traditional exercise is challenging post-SCI, necessitating innovative therapeutic approaches.

Purpose of the Study:

• To assess the feasibility and effects of a novel hybrid exercise modality combining functional electrical stimulation (FES) and transcutaneous spinal cord stimulation (tSCS) with swimming for individuals with SCI.
• To evaluate the impact of FES and tSCS on swimming performance, spasticity, and biomechanics in paraplegic swimmers.
• To explore the potential of stimulation-assisted swimming as a safe and effective rehabilitation strategy.

Main Methods:

• Two individuals with complete SCI (ASIA A, Th5/6 lesion) participated in a 10-week swim training program incorporating FES of knee extensors and tSCS.
• tSCS was applied to stimulate afferent fibers (L2-S2) for spasticity reduction and trunk muscle recruitment.
• Swimming performance (lap times) and biomechanics (knee/hip extension, trunk roll) were measured using IMUs under various stimulation conditions (no stimulation, tSCS, FES, FES+tSCS).

Main Results:

• Swim training with stimulation support significantly reduced lap times for both subjects (FES: 8.7-15.4% decrease; FES+tSCS: 19.3-20.9% decrease).
• tSCS significantly reduced lower extremity spasticity for up to 4 hours post-swimming.
• FES and FES+tSCS improved knee extension, while FES+tSCS also enhanced hip extension in one subject; trunk roll angles remained similar across conditions.

Conclusions:

• Stimulation-assisted swimming is a safe, feasible, and promising hybrid exercise for SCI rehabilitation, enhancing swimming speed and reducing spasticity.
• The combination of FES and tSCS with hydrotherapy presents a potential therapeutic avenue for individuals with SCI, stroke, and multiple sclerosis.
• Further research is warranted to explore FES and tSCS benefits in water for gait and balance in various neurological conditions.