Clinical experience with functional electrical stimulation-assisted gait with parastep in spinal cord-injured patients

Study Design. Clinical evaluation of the Parastep method, a six-channel tra nscutaneous functional electrical stimulation device, in spinal cord-injure d patients. Objectives. To investigate the motor performances of this new technique reg arding energy expenditure and to evaluate its advantages acid limitations, especially in social activities involving ambulation. Methods. This study was conducted in 15 thoracic spine-injured patients. Th e lesion was complete except in two patients. The gait ability and the func tional use were judged clinically. Energy cost was evaluated from heart rat e, peak oxygen uptake, and lactatemia. Results. Thirteen patients completed the training (mean: 20 sessions) and a chieved independent ambulation with a walker. The mean walking distance, wi thout rest, was 52.8 +/- 69 m, and the mean speed was 0.15 +/- 0.14 m/sec. One patient with incomplete lesion, who had been nonambulatory for 8 months aft er the injury, became able to walk without functional electrical stimu lation after five sessions. The follow-up was 40 +/- 11 months. Five patien ts pursued using functional electrical stimulation-assisted gait as a means of physical exercise but not for ambulation in social activities. The pati ents experienced marked psychological benefits, with positive changes in th eir way of life. In three subjects, a comparison of physiologic responses t o exercise between a progressive arm ergometer test and a walking test with the Parastep (Sigmedics, Inc., North field, IL) at a speed of 0.1 m/sec wa s performed, showing that the heart rate, the peak oxygen uptake, and lacta temia during gait were close to those obtained the end of the maximal test on the ergometer. Conclusions. In spite of its ease of operation and good cosmetic acceptance , the Parastep approach has very limited applications for mobility in daily life, because of its modest performance associated with high metabolic cos t and cardiovascular strain. However, it can be proposed as a resource to k eep physical and psychological fitness in patients with spinal cord injury.