Bone mineral density can be kept in spinal cord injured subjects under long term neuromuscular electrical stimulation

Abstract

Background: Neuromuscular electrical stimulation is a rehabilitation method currently used among patients with spinal cord injury, but its results are not well defined yet. The objective of this study is to analyze the contribution of rehabilitation with Neuro-Muscular Electrical Stimulation (NMES) assessing Bone Mineral Density (BMD), quality of life aspects and demographic characteristics, after 10 years under treatment. Methods and findings: Retrospective longitudinal study between 2008 and 2020, at Spinal Cord Injury Outpatient Clinic, University Hospital, with 24 participants with spinal cord injury in rehabilitation with NMES. Identification questionnaire, Functional Independence Measure (FIM) and bone density exam were used for, respectively, demographic analysis, quality of life and BMD. Data from 2008 were catalogued as Pi and current data as Pa. Student’s T-test was used for statistical evaluation, being significantly relevant when p<0.05. Mean age was 45.3 years old, with 22 male individuals; 14 are paraplegic and 10 are tetraplegic; 13 individuals presented injury by traffic accident, 2 by fall from height, 4 by dive, 4 by firearm injury and 1 by tumor; 11 individuals with cervical-level injury and 13 thoracic-level injury, all with complete disability. FIM average Pi=80.2 and average Pa=84 (p=0.36); BMD of vertebrae L1-L4 average Pi=-0.02 and average Pa=-0.17 (p=0.50); BMD of femoral neck average Pi=-2.1 and average Pa=-1.9 (p=0.12); outcomes: 2 osteopenia and 1 osteoporosis for L1-L4; 18 osteopenia and 4 osteoporosis for femoral neck. Limitations of this study include the small sample of individuals and their difficulty to maintain 10-years follow-up treatment. Conclusion: Demographic characteristics were compatible to literature, except for the age. FIM score and BMD remained similar to the beginning of treatment with NMES, concluding that there was stabilization of these parameters during treatment.