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Paradigms of Lower Extremity Electrical Stimulation Training After Spinal Cord Injury
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Effectiveness of Functional Electrical Stimulation Assisted Locomotor Training on walking Outcomes Following

Janelle Unger1,2, Joshua C Wiener1, Prachi Patel3

  • 1School of Physical Therapy, Faculty of Health Sciences, Western University, London, ON, Canada.

Neurorehabilitation and Neural Repair
|December 9, 2025
PubMed
Summary

Functional electrical stimulation-assisted locomotor training (FALT) did not significantly improve walking speed or endurance in individuals with incomplete spinal cord injury (iSCI). Further research needs standardized protocols for FES parameters and training dosage.

Keywords:
electric stimulationgaitspinal cord injuriessystematic reviewwalk test

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Area of Science:

  • Neuroscience
  • Rehabilitation Medicine
  • Biomedical Engineering

Background:

  • Functional electrical stimulation (FES) is explored to augment locomotor training for spinal cord injury (SCI).
  • Motor incomplete SCI (iSCI) presents challenges in walking recovery.
  • The efficacy of FES-assisted locomotor training (FALT) requires systematic evaluation.

Purpose of the Study:

  • To systematically review the therapeutic effectiveness of FES-assisted locomotor training (FALT).
  • To assess FALT's impact on walking speed and endurance in individuals with iSCI.
  • To synthesize evidence from interventional studies on FALT for iSCI.

Main Methods:

  • Systematic literature search across MEDLINE, EMBASE, and CINAHL databases.
  • Inclusion of interventional studies assessing FALT's effects on walking speed/endurance in iSCI.
  • Narrative synthesis of study characteristics and findings, with risk of bias assessment (Cochrane RoB2, ROBINS-I).
  • Random effects meta-analyses conducted for pooled effect sizes.

Main Results:

  • Thirteen studies (4 RCTs, 9 pre-post) were included; risk of bias varied.
  • Meta-analyses of 3 RCTs showed small, non-significant effects of treadmill-based FALT on walking speed (Hedge's g: -0.01) and endurance (Hedge's g: 0.20).
  • No significant improvements in walking speed or endurance were observed compared to control conditions.

Conclusions:

  • Current evidence does not support FALT as superior to other locomotor training methods for improving walking in iSCI.
  • Further research necessitates standardized reporting of training dose and FES parameters for FALT interventions in SCI.
  • High-quality, standardized trials are needed to clarify FALT's potential benefits for SCI rehabilitation.