Context: Functional electric stimulation (FES) cycling is a commonly used therapeutic exercise modality after spinal cord injury (SCI); however, additional precautions must be taken in certain situations. The purpose of this study was to develop and apply a safety monitoring protocol for autonomic dysreflexia (AD) during FES cycling and to determine if an interval-FES cycling program can be safe and beneficial to an individual with cervical SCI, a history of AD, and a non-dependent cardiac pacemaker.

The participant was a 36-year-old male with C6 AIS-C SCI sustained 9 years earlier, intermittent AD, and implanted cardiac pacemaker. Ten sessions of interval-FES cycling were performed twice weekly for 5 weeks. Rating of perceived exertion (RPE), blood pressure (BP), oxygen saturation (O2sat), and heart rate (HR) were monitored before, after, and every 5 min during cycling. ECG and cardiac pacemaker were evaluated by a cardiologist after ending the program.

Findings: The participant reported self-limited chills 27 times over 10 sessions (19 “light”, 3 “moderate”, 5 “sharp”). Chills coincided with BP increases 59% of the time and their magnitudes moderately correlated (r = 0.32). The ECG was determined to be normal and the pacemaker fully functional at the end of the study, while blood glucose decreased (111–105 mg/dl), HbA1c levels increased (5.5–5.9%), and resting BP decreased (118/84–108/66 mmHg).

Conclusion/Clinical Relevance: A person with cervical SCI, symptomatic AD, and a non-dependent pacemaker can safely participate and benefit from the interval-FES cycling program provided adequate monitoring of symptoms and vital signs.

背景：功能性电刺激 (FES) 骑自行车是脊髓损伤 (SCI) 后常用的治疗性运动方式；但是，在某些情况下必须采取额外的预防措施。本研究的目的是制定和应用 FES 骑行期间自主神经反射异常 (AD) 的安全监测方案，并确定间隔 FES 骑行计划对患有颈椎 SCI、AD 病史的个体是否安全和有益，和非依赖性心脏起搏器。

参与者是一名 36 岁的男性，患有 9 年前的 C6 AIS-C SCI、间歇性 AD 和植入心脏起搏器。每周两次，为期 5 周，共进行 10 次间隔 FES 循环。在骑自行车之前、之后和每 5 分钟监测感知劳累 (RPE)、血压 (BP)、氧饱和度 (O2sat) 和心率 (HR) 的评级。心电图和心脏起搏器在项目结束后由心脏病专家进行评估。

结果：参与者报告了 10 次自限性寒战 27 次（19 次“轻度”，3 次“中度”，5 次“剧烈”）。在 59% 的时间里，寒战与血压升高同时发生，并且它们的幅度适度相关 ( r  = 0.32)。在研究结束时，ECG 被确定为正常，起搏器完全正常工作，同时血糖降低 (111-105 mg/dl)，HbA1c 水平升高 (5.5-5.9%)，静息血压降低 (118/84 –108/66 毫米汞柱）。

结论/临床相关性：患有颈椎 SCI、有症状的 AD 和非依赖起搏器的人可以安全地参与并受益于间隔 FES 循环计划，提供对症状和生命体征的充分监测。