The process and outcomes of implementing a Functional Electrical Stimulation leg cycle ergometry (FES-LCE) program in an acute rehabilitation setting following spinal cord injury

BACKGROUND: Evidence suggests Functional Electrical Stimulation leg cycle ergometry (FES-LCE) is beneficial for people living with chronic spinal cord injury (SCI). However, approaches to implement FES-LCE during acute rehabilitation are not established. OBJECTIVE: Describe the process of developing and implementing a FES-LCE program for SCI patients within acute rehabilitation. METHODS: Implementing an FES-LCE program required developing patient inclusion/exclusion criteria, training protocols for staff, patient, and family/caregivers, and procedures for scheduling patients with devices. RESULTS: Our FES-LCE program experienced a 263.6% increase in utilization from 2016 (354 FES-LCE sessions) to 2017 (1,404 sessions) including 390.3% increased weekend use (31 sessions to 152 sessions). From 2016 to 2018, our evening community fitness program participation significantly increased after incorporating FES-LCE as an exercise option. Implementation barriers included patient concerns (e.g., injury level, family/caregiver support), clinician considerations (e.g., staffing, scheduling), and institutional issues (e.g., internet connectivity). CONCLUSIONS: FES-LCE can be successfully implemented within inpatient rehabilitation among patients with SCI, yet hinges upon ease of access for clinicians and patients. Our program allowed SCI patients to achieve use following dosing parameters without interfering in the 3-hours of activity-based therapies potential benefits. Future research should examine short- and long-term effects of FES-LCE use on patient outcomes.