Functional electrical stimulation (FES): muscle histochemical analysis.

Functional electrical stimulation (FES) has been used in Brazil since 1989 to obtain functional improvement in paraplegic patients' orthostasis and locomotion. The aim of this paper is to evaluate the histochemical changes observed in the quadriceps femoris muscle following the use of FES. We studied four patients with traumatic spinal cord lesions at T4-10 level, Frankel A, all within 12-24 months postlesion. They were all submitted to FES using the following criteria: square-wave, 20-30 Hz frequency, pulses of 0.003 seconds, time of stimulation 5 seconds, resting interval 10 seconds. The stimulation was applied during 90 consecutive days, 30 minutes each time, twice daily. The interval between the stimulations was 6 hours. Quadriceps muscle biopsies were performed before and after the use of FES. We used ATPase technique for the histochemical analysis, where three different dying patterns can be observed for the three types of muscular fibres (I, IIa and IIb). The two samples from each patient were analysed measuring the fibres' diameters and their index of atrophy, and counting the total number of each type of fibre in each sample. The mean total number of fibres in each sample was 256 +/- 12.3. The results showed that the sizes of the three types of fibres were not modified with the use of FES; the number of type IIa fibres increased in a significant fashion, after using of FES.

Evaluation of the physical fitness by the Bruno Balke protocol in sedentary and wheelchair trained paraplegic patients.

The Bruno Balke test is one of the methods available to measure the oxygen intake in wheelchair users. The equation of the test is:intake O2 = 33+ (speed average-133) x 0.17 ml/kg x min. (-1). The average speed represents the acceleration and may be used to measure the level of physical fitness. In order to verify the efficiency of this kind of evaluation, we selected ten male, sedentary paraplegic patients, level D5-D12 in an ordinary rehabilitation program and ten paraplegic athletes. All of them were submitted to the Bruno Balke test. The results demonstrated that the average speed, the covered distance and the oxygen intake were significantly greater in athletes than in sedentary individuals.

[Functional electrical stimulation in the reciprocal locomotion of paraplegic patients]. / Estimulação elétrica funcional na locomoção recíproca do paciente paraplégico por trauma raquimedular.

The functional electrical stimulations is employed for standing-up posture and reciprocal locomotion in paraplegic patients. Five male paraplegic patients, level D5-D12 mean age 32.4 years, were treated with functional electrical stimulation, during two months. The quadriceps and fibular nerves were stimulated for 30 minutes, twice a day. After the training period, two patients were able to remain in the stand-up position and walk in parallel bars; one of them was able to use a walker. In other patients the technique was without effect for standing and walking. This method is not the solution for locomotion of paraplegics and more research is needed for the improvement of the results of functional electrical stimulation.

Clinical fundaments for rehabilitation treatment in spinal cord injury.

Spinal cord injury leads to a severe disabling syndrome, which most often affects the young. The major etiologic factor in spinal cord injuries is trauma. Patients' rehabilitation is started in the acute phase, soon after the trauma occurs, mainly through preventive care against the formation of pressure sores, deformities of the palsy segments, proper vesical and bowel emptying and care with vasomotor alterations. The rehabilitation process continues at a specialized rehabilitation center, searching the best functional performance of each patient, according to the type and level of the spinal cord injury. This work shows fundaments for the rehabilitation treatment.

[Femoral fracture in patients with spinal cord injury]. / Fratura de fêmur em pacientes portadores de lesão medular.

Femoral fractures during the physical therapy in two patients with spinal cord injury and consequent osteoporosis in the paralyzed limbs are reported. The fractures were caused by a minor trauma and the spasticity was considered to be an additional factor in the accident. During the physical therapy the patients were seated with hip abduction and flexion of the knee. It is important that the patients participate in a program of physiotherapy. This, however, should be performed under strict control.