5x4min 5d/week walking exercise 120ms ID / 400ms IP; 5s SD / 1s SP 40ms ID / 10ms IP; continues + switch 165x4min 5d/week stand up – sit down exercise stand up – stepping – sit down exercise 120ms ID / 400ms IP; 5s SD / 1s SP 40ms ID / 10ms IP; continues + switch 85x4min 5d/week 3-4x3min 5d/week + ankle weight 2x/week 120ms ID / 400ms IP; 5s SD / 1s SP 40ms ID / 10ms IP; 3s SD / 3s SP 6-8 5x3min 5d/week 120-150ms ID / 500ms IP; 4s SD / 2s SP 0-2 Training parameters Stimulation parameters Timeline (months)

Background. Spinal cord injury causes muscle wasting and loss of function, which are especially severe after complete and permanent damage to lower motor neurons. In a previous cross-sectional study, long-standing denervated muscles were rescued by home-based functional electrical stimulation (h-bFES) training. Objective. To confirm results by a 2-year longitudinal prospective study of 25 patients with complete conus/cauda equina lesions. Methods. Denervated leg muscles were stimulated by h-bFES using a custom-designed stimulator and large surface electrodes. Muscle mass, force, and structure were determined before and after 2 years of h-bFES using computed tomography, measurements of knee torque during stimulation, and muscle biopsies analyzed by histology and electron microscopy. Results. Twenty of 25 patients completed the 2-year h-bFES program, which resulted in ( a) a 35% cross-sectional increase in area of the quadriceps muscle from 28.2 ± 8.1 to 38.1 ± 12.7 cm 2 ( P < .001), a 75% increase in mean diameter of muscle fibers from 16.6 ± 14.3 to 29.1 ± 23.3 μm ( P < .001), and improvements of the ultrastructural organization of contractile material; and ( b) a 1187% increase in force output during electrical stimulation from 0.8 ± 1.3 to 10.3 ± 8.1 N m ( P < .001). The recovery of quadriceps force was sufficient to allow 25% of the subjects to perform FES-assisted stand-up exercises. Conclusions. Home-based FES of denervated muscle is an effective home therapy that results in rescue of muscle mass and tetanic contractility. Important immediate benefits for the patients are the improved cosmetic appearance of lower extremities and the enhanced cushioning effect for seating.

OBJECTIVES:To evaluate the beneficial effect of training in patients with patellofemoral pain syndrome (PFPS) and influence of additional electric muscle stimulation (EMS) of the knee extensor muscles.DESIGN:A randomized clinical trial.SETTING:Supervised physiotherapy (PT) training and home-based EMS.PARTICIPANTS:Patients (N=38; 14 men, 24 women) with bilateral PFPS.INTERVENTIONS:One group (PT) received supervised PT training for 12 weeks. The other received PT and EMS. The stimulation protocol was applied to the knee extensors for 20 minutes, 2 times daily, 5 times a week for 12 weeks at 40 Hz, with a pulse duration of .2 6ms, at 5 seconds on and 10 seconds off. Maximal tolerable stimulation intensity was up to 80 mA.MAIN OUTCOME MEASURES:Patellofemoral pain assessment with visual analog scale during activities of daily life, Kujala patellofemoral score, and isometric strength measurement before and after 12 weeks treatment as well as after 1 year.RESULTS:Thirty-six patients completed the 12-week follow-up. There was a statistically significant reduction of pain in both groups (PT group, P=.003; PT and EMS group, P<.001) and significant improvement of the Kujala score in both groups (PT group, P<.001; PT and EMS group, P<.001) after 12 weeks of treatment with improvement of function and reduction of pain at the 1-year follow-up. The difference between the 2 treatment groups was statistically not significant. We could not measure any significant change in isometric knee extensor strength in either group.CONCLUSIONS:A supervised PT program can reduce pain and improve function in patients with PFPS. We did not detect a significant additional effect of EMS with the protocol described previously.

Contrary to general believe, in one case of 18month cauda equina lesion four-month electrical stimulation of thigh muscles (impulse energy 1.92 Joule) increased stimulation frequency from 2 to 20 Hz, i. e., up to tetanic contractions. After 2 years of treatment, CT-cross sectional area of quadriceps improved 58.3% (right) and 44.4% (left) with increased muscle density. Mean myofiber size was 37.2 ± 24.8 µm (right) and 40.5 ± 24.9 µm (left). Improvement of stimulated knee torque, from zero to 12.0 Nm and 10.5 Nm, respectively, enabled to stand up trials. Surviving myofibers undergo re-growth (they show the chess board appearance of normal muscle), and dying myofibers continuously regenerate (up to 3% are embryonic myosin positive 3-year post-FES). Regeneration events are essential components of the FES rehabilitation protocol due to superior excitability of regenerated myofibers in comparison to long-term denervated, degenerated myofibers, which were almost not excitable before FES training.

High intensity stimulation is a feasible clinical method for preventing effects of early den-ervation, however in long-term denervation exponential currents could not elicit tetanic contractions of denervated-degenerated muscles (DDM) powerful enough to sustain motil-ity functions. In our earlier clinical work, we demonstrated that electrical stimulation with exponential current could slow down atrophy of the DDM in human. Here we show that a modulated long-term training program restore function up to supported standing. To elicit single muscle twitches of the DDM we use biphasic electric impulses with durations of 120-150 ms at the beginning of muscle training. Contractions of whole thigh muscles are elicited by using anatomically shaped large-size electrodes. In the progress of training , sustained contractions are achieved with the following parameters: pulse duration of 30-50 ms, frequency of 16-25 Hz, amplitudes of up to 250 mA. This stimulation protocol effectively improves the structural and metabolic characteristics of the denervated-degenerated human muscles. Following these procedures trophism and power of DDM improve even if denervation lasts up to 20 years. Effectiveness of electrical stimulation protocols of DDM is demonstrated by measuring contraction force. Measurements by CT-scans reveal high variation in the increase of thigh muscle cross-sectional area during the first years of functional electrical stimulation (FES). At present we are conducting a cooperative European research project with the goal to strengthen the scientific bases of this innovative rehabilitation procedure for people with permanent chronic denervation of skeletal muscles. Our working hypothesis is based on sound knowledge of regeneration capabilities of satellite cells in long-term denervated skeletal muscles and on the expected additional contribution of myoblast replication activated by the above-described FES training of degenerated-denervated muscles. All patients with complete conus cauda lesion are welcome to join the European partners in the effort to develop this new rehabilitation procedure. We are confident that the goal will be scored and the quality of life of this specific group of patients will improve during the four-year period of the EU research project " RISE ". Functional electrical stimulation (FES) is an effective clinical rehabilitation practice for upper motoneuron le-sions (peroneal FES of drop foot, Cleveland freehand system for tetraplegic hand, leg pacemaker for walking and cycling, etc.) [7, 9, 17]. On the other hand, in the patients with lower motoneuron lesions, like complete conus and cauda equina lesion, it is impossible to restore and maintain trophism and function of the permanent denervated muscles …