FES-assisted Gait Training for Incomplete Spinal Cord Injury

Background: Spinal cord injury (SCI) disrupts neural communication, resulting in impaired walking ability due to muscle weakness, altered reflex modulation, and reduced voluntary muscle activation below the lesion level. Functional electrical stimulation (FES) applied during gait training has been shown to enhance muscle activation and improve gait performance. However, it remains unclear whether gait training with automated multi-channel FES provides additional benefits beyond conventional treadmill gait training in individuals with chronic incomplete SCI (iSCI). Objectives: (1) To determine whether gait training combined with FES leads to greater improvements in overground walking speed compared to improvements observed during the preceding period of conventional gait training alone. (2) To evaluate retention of walking improvements following the FES intervention. (3) To explore whether changes in gait performance are associated with changes in muscle coordination and muscle strength. Methods: This study is a prospective single-group, repeated-measures study with two sequential intervention phases: 10 weeks of conventional treadmill gait training followed by 10 weeks of gait training with FES. Individuals with chronic iSCI (≥12 months post-injury; AIS C or D; neurological level C2-T12) will participate in a 23-week program. Assessments will be performed at baseline (T0), after conventional training (T1), after FES gait training (T2), and at 10-weeks post intervention (T3). The primary outcome is the 10-Meter Walk Test (10MWT) walking speed (m/s). The primary analysis compares the change in 10MWT performance during the FES-assisted phase (T2-T1) with the change during the conventional phase (T1-T0). Secondary outcomes include spatiotemporal gait parameters, Walking Index for Spinal Cord Injury II, Hoffer classification, treadmill gait performance, muscle activity, and isometric leg muscle strength.