Increases in muscular cross-sectional area (CSA) occur in quadriplegics after training, but the effects of neuromuscular electrical
stimulation (NMES) along with training are unknown. Thus, we addressed two questions: (1) Does NMES during treadmill gait
training increase the quadriceps CSA in complete quadriplegics?; and (2) Is treadmill gait training alone enough to observe
an increase in CSA? Fifteen quadriplegics were divided into gait (n = 8) and control (n = 7) groups. The gait group performed
training with NMES for 6 months twice a week for 20 minutes each time. After 6 months of traditional therapy, the control
group received the same gait training protocol but without NMES for an additional 6 months. Axial images of the thigh were
acquired at the beginning of the study, at 6 months (for both groups), and at 12 months for the control group to determine
the average quadriceps CSA. After 6 months, there was an increase of CSA in the gait group (from 49.8 ± 9.4 cm
2 to 57.3 ± 10.3 cm
2), but not in the control group (from 43.6 ± 7.6 cm
2 to 41.8 ± 8.4 cm
2). After another 6 months of gait without NMES in the control group, the CSA did not change (from 41.8 ± 8.4 cm
2 to 41.7 ± 7.9 cm
2). The increase in quadriceps CSA after gait training in patients with chronic complete quadriplegia appears associated with
NMES.
One or more of the authors (ACJ) has received funding from Grants 2005/53530-0, 2003/05856-9, and 1996/12198-2 from Fundação
de Amparo à Pesquisa do Estado de São Paulo.
Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations
were conducted in conformity with ethical principles of research, and that informed consent for participation in the study
was obtained.