Postural bipedance in paraplegics under neuromuscular electrical stimulation: Is it possible to improve it based on sagittal spinal alignment?

Abstract

Study design: Experimental trial based on the analytical study of radiographic standards of the sagittal spinal alignment in paraplegics in upright position under surface neuromuscular electrical stimulation (NMES). Objectives: To evaluate changes in radiographic standards of the sagittal spinal alignment of paraplegics under three different models of NMES used to optimize the global bipedal posture. Setting: The University Hospital Ambulatory (UNICAMP), Campinas, SP, Brazil. Methods: Ten paraplegic patients were selected. Each patient underwent three different models of NMES. The influence that each NMES model exerted over the sagittal balance of the spine was evaluated by lateral panoramic X-rays. Wilcoxon's test was used to compare the modifications observed in each NMES model in the group studied. Results: Using the femoral quadriceps muscles' NMES as the starting point, the inclusion of the gluteus maximus' NMES generated an increase of the lumbar lordosis and a decrease of the spinal tilt angle. These alterations resulted in partial improvement of the anterior sagittal imbalance. NMES of the paralyzed paravertebral lumbar muscles resulted in a more expressive increase on the lumbar lordosis, with no significant change on the spinal tilt. On the latter model, however, an improvement of 20% was observed in the global sagittal imbalance due to a posterior translation of the spine as pointed out by the decrease in the C7-HA horizontal distance. Conclusions: The proposed NMES models were able to partially amend the anterior sagittal imbalance of the paraplegic patients in bipedal posture. © 2012 International Spinal Cord Society All rights reserved.