Training with electrical stimulation: effects on stability and quality of life in individuals with spinal cord injury
Main Article Content
DOI:
https://doi.org/10.17979/sportis.2025.11.4.11873Abstract
This study is based on the importance of optimizing quality of life in individuals with spinal cord injury (SCI), given that such injuries comprehensively affect the physical, psychological, and social dimensions of an individual. The present study has two primary objectives: (1) to evaluate whether a strength training program incorporating neuromuscular electrical stimulation (NMES) applied to muscles capable of voluntary contraction enhances core stability in individuals with SCI, and (2) to compare differences in quality of life and core stability between an experimental group and a control group. Thirty participants with SCI were randomly assigned to two groups: experimental (n = 15) and control (n = 15). Quality of life was assessed using the GENCAT questionnaire, and core stability was measured with the modified Functional Reach Test (mFRT). The intervention consisted of a local NMES protocol administered over 12 weeks, with three 20-minute sessions per week. A paired Student’s t-test was used to analyze pre- and post-intervention outcomes. The results demonstrated significant improvements in core stability and several dimensions of quality of life in the experimental group. These findings suggest that NMES is a safe and effective method for enhancing core stability and quality of life in individuals with SCI, serving as a valuable complement to rehabilitation.
Keywords:
Article Details
References
Abou, L., & Rice, L. A. (2024). The associations of functional independence and quality of life with sitting balance and wheelchair skills among wheelchair users with spinal cord injury. Journal of Spinal Cord Medicine, 47(3), 361–368. https://doi.org/10.1080/10790268.2022.2057721
Akkurt, H., Karapolat, H. U., Kirazli, Y., & Kose, T. (2017). The effects of upper extremity aerobic exercise in patients with spinal cord injury: A randomized controlled study. European Journal of Physical and Rehabilitation Medicine, 53(2), 219–227. https://doi.org/10.23736/S1973-9087.16.03804-1
Alonso, S., & Rodríguez, J. (2024). Immersive virtual reality: Impact on quality of life in individuals with physical disabilities. Journal of Strength and Conditioning Research, 38(10), e626–e637. https://doi.org/10.1519/JSC.0000000000004910
Arsh, A., Darain, H., Ullah, I., & Shakil-Ur-Rehman, S. (2021). Diagnostic tests to assess balance in patients with spinal cord injury: A systematic review of their validity and reliability. Asian Biomedicine, 15(3), 111–118. https://doi.org/10.2478/abm-2021-0014
Carpes, F. P., Reinehr, F. B., & Mota, C. B. (2008). Effects of a program for trunk strength and stability on pain, low back and pelvis kinematics, and body balance: A pilot study. Journal of Bodywork and Movement Therapies, 12(1), 22–30. https://doi.org/10.1016/j.jbmt.2007.05.001
Chen, W. Y., Jang, Y., Wang, J. D., Huang, W. N., Chang, C. C., Mao, H. F., & Wang, Y. H. (2011). Wheelchair-related accidents: relationship with wheelchair-using behavior in active community wheelchair users. Archives of Physical Medicine and Rehabilitation, 92(6), 892–898. https://doi.org/10.1016/j.apmr.2011.01.008
Divyalasya, T. V., Kumar, A. K., Sahana Bhat, N. R., Lakhan, R., & Agrawal, A. (2021). Quality of Life after Surviving a Spinal Cord Injury: An Observational Study in South India. Neurology India, 69(4), 861–866. https://doi.org/10.4103/0028-3886.323887
Dolbow, D. R., Gorgey, A. S., Johnston, T. E., & Bersch, I. (2023). Electrical Stimulation Exercise for People with Spinal Cord Injury: A Healthcare Provider Perspective. Journal of Clinical Medicine, 12(9), 3150. https://doi.org/10.3390/jcm12093150
Dolbow, D. R., Bersch, I., Gorgey, A. S., & Davis, G. M. (2024). The Clinical Management of Electrical Stimulation Therapies in the Rehabilitation of Individuals with Spinal Cord Injuries. Journal of Clinical Medicine, 13(10), 2995. https://doi.org/10.3390/jcm13102995
Duan, R., Qu, M., Yuan, Y., Lin, M., Liu, T., Huang, W., Gao, J., Zhang, M., & Yu, X. (2021). Clinical Benefit of Rehabilitation Training in Spinal Cord Injury: A Systematic Review and Meta-Analysis. Spine, 46(6), E398–E410. https://doi.org/10.1097/BRS.0000000000003789
Hartkopp, A., Brùnnum-Hansen, H., Seidenschnur, A.-M., & Biering-Sùrensen, F. (1997). Survival and cause of death after traumatic spinal cord injury A long-term epidemiological survey from Denmark. https://doi.org/10.1038/sj.sc.3100556
Ilha, J., Abou, L., Romanini, F., Dall Pai, A. C., & Mochizuki, L. (2020). Postural control and the influence of the extent of thigh support on dynamic sitting balance among individuals with thoracic spinal cord injury. Clinical Biomechanics (Bristol, Avon), 73, 108–114. https://doi.org/10.1016/j.clinbiomech.2020.01.012
Karamian, B. A., Siegel, N., Nourie, B., Serruya, M. D., Heary, R. F., Harrop, J. S., & Vaccaro, A. R. (2022). The role of electrical stimulation for rehabilitation and regeneration after spinal cord injury. Journal of Orthopaedics and Traumatology, 23(1), 2. https://doi.org/10.1186/s10195-021-00623-6
Kljajic, D., et al. (2016). The impact of sports activities on quality of life of persons with a spinal cord injury. Zdravstveno Varstvo, 55(2), 94–101. https://doi.org/10.1515/sjph-2016-0014
Lynch, S. M., Leahy, P., & Barker, S. P. (1998). Reliability of measurements obtained with a modified functional reach test in subjects with spinal cord injury. Physical Therapy, 78(2), 128–133. https://doi.org/10.1093/ptj/78.2.128
Nair, M. S., Kulkarni, V. N., & Shyam, A. K. (2022). Combined Effect of Virtual Reality Training (VRT) and Conventional Therapy on Sitting Balance in Patients with Spinal Cord Injury (SCI): Randomized Control Trial. Neurology India, 70(8), S245–S250. https://doi.org/10.4103/0028-3886.360934
Norman, G. R., Sloan, J. A., & Wyrwich, K. W. (2003). Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation. Medical Care, 41(5), 582–592. https://doi.org/10.1097/01.MLR.0000062554.74615.4C
Norrbrink, C., Sörling, K., Hultling, C., von Kieseritzky, F., & Wahman, K. (2021). "Challenges and facilitators-navigating in the landscape of spinal cord injury neuropathic pain"-a qualitative study on the use of prescribed drugs. Spinal Cord, 59(2), 215–224. https://doi.org/10.1038/s41393-020-00553-w
Pelletier, C. (2023). Exercise prescription for persons with spinal cord injury: A review of physiological considerations and evidence-based guidelines. Applied Physiology, Nutrition, and Metabolism, 48(12), 882–895. https://doi.org/10.1139/apnm-2023-0227
Sato, H., MSc, Miyata, K., PhD, Yoshikawa, K., PhD, Chiba, S., RPT, & Mizukami, M., PhD (2025). Responsiveness and minimal clinically important differences of the Trunk Assessment Scale for Spinal Cord injury (TASS). Journal of Spinal Cord Medicine. https://doi.org/10.1080/10790268.2022.2087138
Seáñez, I., & Capogrosso, M. (2021). Motor improvements enabled by spinal cord stimulation combined with physical training after spinal cord injury: Review of experimental evidence. Bioelectronic Medicine, 7(1), 1–16. https://doi.org/10.1186/s42234-021-00077-5
Singh, A., Tetreault, L., Kalsi-Ryan, S., Nouri, A., & Fehlings, M. G. (2014). Global prevalence and incidence of traumatic spinal cord injury. Clinical Epidemiology, 6, 309–331. https://doi.org/10.2147/CLEP.S68889
Sliwinski, M. M., Akselrad, G., Alla, V., Buan, V., & Kaemmerlen, E. (2020). Community exercise programming and its potential influence on quality of life and functional reach for individuals with spinal cord injury. Journal of Spinal Cord Medicine, 43(3), 358–363. https://doi.org/10.1080/10790268.2018.1543104
Sweet, S. N., Martin Ginis, K. A., & Tomasone, J. R. (2013). Investigating intermediary variables in the physical activity and quality of life relationship in persons with spinal cord injury. Health Psychology, 32(8), 877–885. https://doi.org/10.1037/a0032383
Triolo, R. J., Bailey, S. N., Miller, M. E., Lombardo, L. M., & Audu, M. L. (2013). Effects of stimulating hip and trunk muscles on seated stability, posture, and reach after spinal cord injury. Archives of Physical Medicine and Rehabilitation, 94(9), 1766–1775. https://doi.org/10.1016/j.apmr.2013.02.023
Tsang, W. W., Gao, K. L., Chan, K. M., Purves, S., Macfarlane, D. J., & Fong, S. S. (2015). Sitting Tai Chi improves balance control and muscle strength in persons with spinal cord injuries: A pilot study. Evidence-Based Complementary and Alternative Medicine, 2015, 523852. https://doi.org/10.1155/2015/523852
Tulsky, D. S., Kisala, P. A., Victorson, D., Tate, D. G., Heinemann, A. W., Charlifue, S., Kirshblum, S. C., Fyffe, D., Gershon, R., Spungen, A. M., Bombardier, C. H., Dyson-Hudson, T. A., Amtmann, D., Kalpakjian, C. Z., Choi, S. W., Jette, A. M., Forchheimer, M., & Cella, D. (2015). Overview of the Spinal Cord Injury - Quality of Life (SCI-QOL) measurement system. Journal of Spinal Cord Medicine, 38(3), 257–269. https://doi.org/10.1179/2045772315Y.0000000023
van den Berg-Emons, R. J., Bussmann, J. B., & Stam, H. J. (2010). Accelerometry-based activity spectrum in persons with chronic physical conditions. Archives of Physical Medicine and Rehabilitation, 91(12), 1856–1861. https://doi.org/10.1016/j.apmr.2010.08.018
Verdugo, M. Á., et al. (2010). Development of an objective instrument to assess quality of life in social services: Reliability and validity in Spain [GENCAT Quality of Life Scale]. International Journal of Clinical and Health Psychology, 10(1), 105–123.
Walia, S., Kumar, P., & Kataria, C. (2021). Efficacy of electrical stimulation-augmented virtual reality training in improving balance in individuals with incomplete spinal cord injury: Study protocol. Asian Spine Journal, 15(6), 865–873. https://doi.org/10.31616/asj.2020.0047
Wang, S. J., Xu, D. Q., & Li, J. X. (2017). Effects of regular Tai Chi practice and jogging on neuromuscular reaction during lateral postural control in older people. Research in Sports Medicine, 25(1), 111–117. https://doi.org/10.1080/15438627.2016.1258649
Wiklund, I. (2004). Assessment of patient-reported outcomes in clinical trials: The example of health-related quality of life. Fundamental & Clinical Pharmacology, 18(3), 351–363. https://doi.org/10.1111/j.1472-8206.2004.00234.x
Wilbanks, S. R., Rogers, R., Pool, S., & Bickel, C. S. (2016). Effects of FES-assisted rowing on aerobic fitness and shoulder pain in manual wheelchair users. Journal of Spinal Cord Medicine, 39(6), 645–654. https://doi.org/10.1179/2045772315Y.0000000052
Wu, X., Liu, J., Tanadini, L. G., Lammertse, D. P., Blight, A. R., Kramer, J. L., Scivoletto, G., Jones, L., Kirshblum, S., Abel, R., Fawcett, J., Field-Fote, E., Guest, J., Levinson, B., Maier, D., Tansey, K., Weidner, N., Tetzlaff, W. G., Hothorn, T., Curt, A., … Steeves, J. D. (2015). Challenges for defining minimal clinically important difference (MCID) after spinal cord injury. Spinal Cord, 53(2), 84–91. https://doi.org/10.1038/sc.2014.232
Zupo, R., Poggi, B., Caggiano, N., Varrone, G., Castellana, F., Natoli, S., Sardone, R., Nardone, A., & Pavese, C. (2025). Methods of diagnosis and rehabilitation of dysphagia in patients with spinal cord injury: a systematic review. European journal of physical and rehabilitation medicine, 61(1), 41–51. https://doi.org/10.23736/S1973-9087.24.08614-3
