Perspectives of individuals with chronic spinal cord injury following novel balance training involving functional electrical stimulation with visual feedback: a qualitative exploratory study

David J Houston, Janelle Unger, Jae W Lee, Kei Masani, Kristin E Musselman, David J Houston, Janelle Unger, Jae W Lee, Kei Masani, Kristin E Musselman

Abstract

Background: Individuals with an incomplete spinal cord injury (iSCI) are highly susceptible to falls during periods of walking or standing. We recently reported the findings of a novel intervention combining functional electrical stimulation with visual feedback balance training (FES + VFBT) on standing balance abilities among five individuals with motor iSCI. However, the previous publication did not report the perceived impact of the intervention on the participants' lives. In this report, the experiences of these five individuals with incomplete spinal cord injury (iSCI) who had recently completed the four-week balance training program are described.

Methods: Five individuals with a motor iSCI took part in this study. Each individual was at least 12 months post-injury, capable of unassisted standing for 60 s and had a Berg Balance Scale Score < 46. Participants completed twelve sessions of a novel balance intervention combining closed-loop functional electrical stimulation with visual feedback balance training (FES + VFBT). Participants received visual feedback regarding their centre of pressure position as they completed balance-training exercises while FES was applied to the ankle plantarflexors and dorsiflexors bilaterally. Semi-structured interviews were conducted after completion of the balance training intervention and eight-weeks post-training to understand participant's experiences. Categories and themes were derived from the transcripts using conventional content analysis.

Results: Three themes were identified from the collected transcripts: (1) Perceived benefits across International Classification of Functioning, Disability and Health levels; (2) Change in perceived fall risk and confidence; (3) Motivation to keep going.

Conclusions: Participation in the FES + VFBT program resulted in perceived benefits that led to meaningful improvements in activities of daily living. Following completion of the training, individuals felt they still had the capacity to improve. Individuals felt they had increased their balance confidence, while a few participants also reported a decrease in their risk of falling. The inclusion of qualitative inquiry allows for the evaluation of the meaningfulness of an intervention and its perceived impact on the lives of the participants.

Trial registration: NCT04262414 (retrospectively registered February 10, 2020).

Keywords: Balance training; Functional electrical stimulation; Neurorehabilitation; Spinal cord injury; Visual feedback.

Conflict of interest statement

The authors declare that they have no competing interests.

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