Investigation Of Osteometabolic And Cardio-respiratory Changes Occurring After Gait Training Under Neuromuscular Electric Stimulation In Quadriplegic Patients [investigação Das Alterações Osteo- Metabólicas E Cardio-respiratórias Ocorridas Após O Treinamento De Marcha Sob Estimulação Elétrica Neuromuscular Em Pacientes Tetraplégicos]

This study was aimed to evaluate the effects of gait training with neuromuscular electric stimulation (NMES) on skeletal and cardio-respiratory systems of full quadriplegic patients (C4-C8). Aerobic power (VO2), carbon dioxide production (VCO2), minute ventilation (VE), heart rate (HR), blood pressure (BP), energy consumption, bone markers analysis (osteocalcin, bone alkaline phosphatase, pyridinoline, and deoxypyridinoline) and bone densitometry (DEXA) of the femoral neck and total femur were performed at baseline and six months later. Eleven patients walked on ergometric wake, with NMES and discharge of 60 - 70% of body weight, during six months, twice a week, 20 minutes daily. Ten patients did not perform the gait. Within the gait group, 81.8% showed significant increases of formation markers, of which 72.7% also presented with reduced bone resorption. Within the control group, 20% showed increased bone formation. DEXA results were, in general, opposite to those of bone markers. Cardio-respiratory tests showed a significant increase for VO2 l/min (36%), VCO2 (42.97%), VE (30.48%), SBP mmHg (4.8%) and energy consumption kcal/min (37.68%). In the control group, only VO2 l/min showed a significant increase (26.29%). Gait training with NMES was more efficient in increasing bone formation rates and aerobic power in quadriplegic patients.143141147Whiteneck, G.G., Charlifue, S.W., Frankel, H.L., Fraser, M.H., Gardner, B.P., Gerhart, K.A., Krishnan, K.R., Short, D.J., Mortality, morbidity, and psychosocial outcomes of persons spinal cord injured more than 20 years ago (1992) Paraplegia, 30, pp. 617-630De Barros Filho, T.E., De Oliveira, R.P., Tsanaclis, A.M., De Barros, E.M., Cristante, A.F., Palma, R.M., An experimental model for the transplantation of fetal central nervous system cells to the injured spinal cord in rats (2002) Rev Hosp Clin Fac Med São Paulo, 57, pp. 256-264Garland, D.E., Stewart, C.A., Adkins, R.H., Hu, S.S., Rosen, C., Liotta, F.J., Weinstein, D.A., Osteoporosis after spinal cord injury (1992) J Orthop Res, 10, pp. 371-378Mohr, T., Podenphant, J., Biering-Sorensen, F., Galbo, H., Thamsborg, G., Kjær, M., Increased bone mineral density after prolonged electrically induced cycle training of paralyzed limbs in spinal cord injured man (1997) Calcif Tissue Int, 61, pp. 22-25Figoni, S.F., Exercise responses and quadriplegia (1993) Med Sci Sports Exerc, 25, pp. 433-441Faghri, P.D., Glaser, R.M., Figoni, S.F., Functional electrical stimulation leg cycle ergometer exercise: Training effects on cardiorespiratory responses of spinal cord injured subjects at rest and during submaximal exercise (1992) Arch Phys Med Rehabil, 73, pp. 1085-1093Hannon, R., Blumsohn, A., Naylor, K., Eastell, R., Response of biochemical markers of bone turnover to hormone replacement therapy: Impact of biological variability (1998) J Bone Miner Res, 13, pp. 1124-1133Lekamwasam, S., Lenora, R.S., Effect of leg rotation on hip bone mineral density measurements (2003) J Clin Densitom, 6, pp. 331-336Bloomfield, S.A., Mysiw, W.J., Jackson, R.D., Bone mass and endocrine adaptations to training in spinal cord injured individuals (1996) Bone, 19, pp. 61-68Dawson-Hughes, B., Pharmacologic treatment of postmenopausal osteoporosis (1999) An Official Publication of the American Society for Bone and Mineral Research. Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism. 4th Ed., pp. 283-288. , MJ Favus, editor. Philadelphia: Lippincott-Raven PublishersGoss, F.L., Mcdermott, A., Robertson, R.J., Changes in peak oxygen uptake following computerized functional electrical stimulation in the spinal cord injured (1992) Res Q Exerc Sport, 63, pp. 76-79Mohr, T., Andersen, J.L., Biering-Sorensen, F., Galbo, H., Bangsbo, J., Wagner, A., Kjær, M., Long-term adaptation to electrically induced cycle training in severe spinal cord injured individuals (1997) Spinal Cord, 35, pp. 1-16Dela, F., Mohr, T., Jensen, C.M.R., Haahr, H.L., Secher, N.H., Biering-Sorensen, F., Kjær, Cardiovascular control during exercise: Insights from spinal cord-injured humans (2003) Circulation, 107, pp. 2127-2133Janssen, T.W.J., Dallmeijer, A.J., Veeger, D., Van Der Woude, L.H.V., Normative values and determinants of physical capacity in individuals with spinal cord injury (2002) J Rehabil Res Dev, 39, pp. 29-39Blair, S.N., Kolh, H.W., Pattenbarger, R.S., Clark Jr., D.G., Cooper, K.H., Gibbons, L.W., Physical fitness and all causes of mortality: A prospective study of healthy men and women (1989) J Amer Med Assoc, 262, pp. 2395-240