4. Recruitment of Antagonist Muscle Pairs (RAMP) using electrical stimulation to maximise bone stimulation in paralysed limbs of people with SCI: RAMP ES

Research Team.  PI: Dr Sylvie Coupaud, Dr Alex Ireland, Dr Mariel Purcell
Locations:  Queen Elizabeth National Spinal Injuries Unit and University of Strathclyde, Glasgow

Duration/Dates/Cost:  36 (+ 6) months / June 2018 – December 2021                                  Total project costs:  £108,238


Abstract of research:   Spinal cord injury (SCI) results in extreme disuse in the paralysed limbs, starting with rapid muscle atrophy, and followed by disuse osteoporosis, with an associated high risk of fractures. Electrically-Stimulated (ES) exercise has been shown to reverse muscle atrophy, but effective ES technologies for maintaining bone health in SCI are lacking. This is likely due to an inability to replicate the high peak muscle forces produced during daily activities in uninjured individuals. Our proposed approach of applying ES synergistically for the Recruitment of Antagonist Muscle Pairs (RAMP) has the potential to produce high forces required from key muscle groups, whilst minimising joint torques. The study will apply surface ES to thigh and calf muscle pairs to improve exercise efficacy for bone and reduce discomfort, time and equipment required. Imaging and dynamometry outcome measures will be used to quantify muscle outputs and changes in bone health attributed to RAMP ES Intervention.

The expected outcome to benefit the Spinal Cord Injury Community: The importance of reducing fracture risk by maintaining bone health after SCI, and the limited options currently available to treat osteoporosis after SCI are currently inadequately addressed or explained to the community. Patient and Public Involvement (PPI) in this project will be via Spinal Injuries Scotland (SIS), who have provided a statement of support.  The Spinal Injuries Association will be contacted for further reach, to the rest of the UK. SIS publications and focused events will be used to: (1) explain issues of osteoporosis and fractures in chronic SCI; (2) advertise the proposed research on the development of RAMP-ES aimed at treating bone loss after SCI; (3) collect views on the technology and protocols; and (4) provide feedback to the community on the RAMP-ES evaluation and findings. With regards patient education, a specific issue will be highlighted to the SCI community, concerning the variability of rates of bone loss in the sub-acute phases of SCI. We will emphasise that some patients with complete SCI already reach low bone mineral density values (close to fracture thresholds) by the end of the first year.  The data from our longitudinal and patient-specific prediction studies suggest that young male patients are most likely to be “fast” bone losers, and this could put them at increased risk of lower-limb fractures even before the accepted 3-7 year steady-state phase of chronic SCI. 10 Attitudes to exercise need to be addressed to ensure user engagement and compliance therefore, to address aspects of user-friendliness, intended end-users of RAMP-ES will be consulted in the design of the technology and protocols for this study.