Stimulation of shank muscles during functional electrical stimulation cycling increases ankle excursion in individuals with spinal cord injury

Fornusek C, Davis GM, Baek I. Stimulation of shank muscles during functional electrical stimulation cycling increases ankle excursion in individuals with spinal cord injury. Objective To investigate the effect of shank muscle stimulation on ankle joint excursion during passive and functional electrical stimulation (FES) leg cycling. Design Within-subject comparisons. Setting Laboratory setting. Participants Well-trained FES cyclists (N=7) with chronic spinal cord injuries. Interventions Two experimental sessions were performed on an isokinetic FES cycle ergometer with a pedal boot that allowed the ankle to plantarflex and dorsiflex during cycling. During the first session, the optimal stimulation timings to induce plantarflexion and dorsiflexion were investigated by systematically altering the stimulation angles of the shank muscles (tibialis anterior [TA] and triceps surae [TS]). During the second session, TA and TS stimulation was included with standard FES cycling (quadriceps, hamstrings, and gluteals) for 6 subjects. Main Outcome Measures Ankle, knee, and hip movements were analyzed using 2-dimensional video. Results The ankle excursions during passive cycling were 19°±6°. TA and TS stimulation increased ankle joint excursion up to 33°±10° and 27°±7°, respectively. Compared with passive cycling, ankle joint excursion was not significantly increased during standard FES cycling (24°±7°). TA and TS stimulation significantly increased the ankle excursion when applied during standard FES cycling (41°±4°). Conclusions Freeing the ankle joint to rotate during FES cycling was found to be safe. The combination of shank muscle stimulation and repetitive ankle joint movement may be beneficial for improving ankle flexibility and leg conditioning. Further research is required to test and design ankle supports that might maximize the benefits of shank muscle activation.