Pressure changes under the ischial tuberosities during gluteal neuromuscular stimulation in spinal cord injury: a comparison of sacral nerve root stimulation with surface functional electrical stimulation

Liu, Liang Q. ORCID: https://orcid.org/0000-0002-6358-1637 and Ferguson-Pell, Martin W. (2015) Pressure changes under the ischial tuberosities during gluteal neuromuscular stimulation in spinal cord injury: a comparison of sacral nerve root stimulation with surface functional electrical stimulation. Archives of Physical Medicine and Rehabilitation, 96 (4) . pp. 620-626. ISSN 0003-9993 [Article] (doi:10.1016/j.apmr.2014.10.008)

Abstract

Objective: To compare the magnitude of interface pressure changes during gluteal maximus contraction by stimulating sacral nerve roots with surface electrical stimulations in spinal cord injuries (SCI).
Design: Pilot interventional study.
Settings: Spinal injury research laboratory, Royal National Orthopaedic Hospital.
Participants: Adults with supra-sacral complete SCI.
Interventions: Sacral nerve root stimulation (SNRS) via a functional magnetic stimulator (FMS) or a sacral anterior root stimulator (SARS) implant; surface functional electrical stimulation (FES).
Outcome Measures: Interface pressure under ischial tuberosity (IT) defined as peak pressure, gradient at peak pressure and average pressure.
Results: With optimal FMS, an average of 29% reduction of IT peak pressure was achieved during FMS (mean ± SD, 160.1mmHg ± 24.3at rest vs. 114.7mmHg ± -18.0 during FMS, t(5)=6.3, p=0.002); an average 30% reduction of peak pressure during stimulation via a SARS implant (143.2mmHg± 31.7at rest vs. 98.5mmHg± 21.5during SARS, t(5)=4.4, p=0.007) and an average 22% decrease of IT peak pressure during FES stimulation (153.7mmHg ± 34.8at rest vs.120.5mmHg ± 26.1 during FES, t(5)=5.3, p=0.003) obtained. In 4 participants who completed both FMS and FES studies, the percentage of peak pressure reduction with FMS was slightly greater than FES (mean difference, 7.8%; 95% CI, 1.6% to 14.0%, P= 0.04).
Conclusion: Sacral nerve root stimulation or surface FES can induce sufficient gluteus maximus contraction and significantly reduced ischial pressure. SNRS via a SARS implant maybe more convenient, efficient for frequently activating gluteus maximus.
Key words: electrical stimulation, gluteal, pressure ulcer, sacral nerve roots, spinal cord injury

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