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Updated: Jun 16, 2026
Paradigms of Lower Extremity Electrical Stimulation Training After Spinal Cord Injury
Published on: February 1, 2018
Functional Electrical Stimulation Combined With Reactive Balance Training for Individuals With Incomplete Spinal Cord
Matthew G Heffernan1,2, Katherine Chan2, Jonguk Lee2,3
1Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, ON, Canada.
Introduction:
Individuals with motor incomplete spinal cord injury (iSCI) have difficulty eliciting reactive steps when balance is lost, increasing fall risk. Functional electrical stimulation (FES) applied to the common fibular nerve elicits a flexor withdrawal response, potentially assisting reactive stepping. Combining reactive balance training with FES (Reactive Balance Training [RBT] + FES) may enhance reactive balance control. This study compared the efficacy of RBT + FES to RBT alone in individuals with chronic, motor iSCI.
Methods:
Twenty-two individuals (63.9 ± 14.8 years; 3.8 ± 2.8 years post-injury) were randomly assigned to RBT + FES or RBT alone. They completed 18 1-hour training sessions over 6 weeks. Outcome measures were assessed pre-, immediately post- and 6 months post-intervention, and included the behavioural response of the Lean-and-Release test (single-step, 2-step, ≥3-step, or fall) and clinical measures of balance, balance confidence, fall concern, lower limb strength, and proprioception of the ankle. A 2-way mixed analysis of variance assessed group differences over time. Fall incidence was monitored via an online survey for 6 months following training.
Results:
Significant improvements over time were observed for single-step and fall responses during the Lean-and-Release test, and on all clinical outcomes (P ≤ .01) with the exception of ankle proprioception. No significant group or group × time interactions were found, suggesting similar improvements between groups. There were no significant between-group differences in fall tracking data.
Discussion:
Both RBT + FES and RBT alone led to significant improvements in reactive stepping ability, balance control, balance confidence, fall concern, and lower limb strength. However, the FES protocol applied in this study did not provide additional benefit.
