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Arai S, Sasaki A, Tsugaya S, Nomura T, Milosevic M. Inhibition of tibialis anterior spinal reflex circuits using frequency-specific neuromuscular electrical stimulation. Artif Organs 2024; 48:891-901. [PMID: 38436108 DOI: 10.1111/aor.14737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/24/2024] [Accepted: 02/18/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Neuromuscular electrical stimulation (NMES) can generate muscle contractions and elicit excitability of neural circuits. However, the optimal stimulation frequency for effective neuromodulation remains unclear. METHODS Eleven able-bodied individuals participated in our study to examine the effects of: (1) low-frequency NMES at 25 Hz, (2) high-frequency NMES at 100 Hz; and (3) mixed-frequency NMES at 25 and 100 Hz switched every second. NMES was delivered to the right tibialis anterior (TA) muscle for 1 min in each condition. The order of interventions was pseudorandomized between participants with a washout of at least 15 min between conditions. Spinal reflexes were elicited using single-pulse transcutaneous spinal cord stimulation applied over the lumbar enlargement to evoke responses in multiple lower-limb muscles bilaterally and maximum motor responses (Mmax) were elicited in the TA muscle by stimulating the common peroneal nerve to assess fatigue at the baseline and immediately, 5, 10, and 15 min after each intervention. RESULTS Our results showed that spinal reflexes were significantly inhibited immediately after the mixed-frequency NMES, and for at least 15 min in follow-up. Low-frequency NMES inhibited spinal reflexes 5 min after the intervention, and also persisted for at least 10 min. These effects were present only in the stimulated TA muscle, while other contralateral and ipsilateral muscles were unaffected. Mmax responses were not affected by any intervention. CONCLUSIONS Our results indicate that even a short-duration (1 min) NMES intervention using low- and mixed-frequency NMES could inhibit spinal reflex excitability of the TA muscle without inducing fatigue.
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Affiliation(s)
- Suzufumi Arai
- Graduate School of Engineering Science, Department of Mechanical Science and Bioengineering, Osaka University, Toyonaka, Japan
| | - Atsushi Sasaki
- Graduate School of Engineering Science, Department of Mechanical Science and Bioengineering, Osaka University, Toyonaka, Japan
- The Miami Project to Cure Paralysis, University of Miami, Miami, Florida, USA
| | - Shota Tsugaya
- Graduate School of Engineering Science, Department of Mechanical Science and Bioengineering, Osaka University, Toyonaka, Japan
| | - Taishin Nomura
- Graduate School of Engineering Science, Department of Mechanical Science and Bioengineering, Osaka University, Toyonaka, Japan
- Global Center for Medical Engineering and Informatics, Osaka University, Suita, Japan
| | - Matija Milosevic
- Graduate School of Engineering Science, Department of Mechanical Science and Bioengineering, Osaka University, Toyonaka, Japan
- The Miami Project to Cure Paralysis, University of Miami, Miami, Florida, USA
- Department of Neurological Surgery, University of Miami, Miami, Florida, USA
- Department of Biomedical Engineering, University of Miami, Miami, Florida, USA
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Dewald HA, Yao J, Dewald JPA, Nader A, Kirsch RF. Peripheral nerve blocks of wrist and finger flexors can increase hand opening in chronic hemiparetic stroke. Front Neurol 2024; 15:1284780. [PMID: 38456150 PMCID: PMC10919218 DOI: 10.3389/fneur.2024.1284780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 02/01/2024] [Indexed: 03/09/2024] Open
Abstract
Introduction Hand opening is reduced by abnormal wrist and finger flexor activity in many individuals with stroke. This flexor activity also limits hand opening produced by functional electrical stimulation (FES) of finger and wrist extensor muscles. Recent advances in electrical nerve block technologies have the potential to mitigate this abnormal flexor behavior, but the actual impact of nerve block on hand opening in stroke has not yet been investigated. Methods In this study, we applied the local anesthetic ropivacaine to the median and ulnar nerve to induce a complete motor block in 9 individuals with stroke and observed the impact of this block on hand opening as measured by hand pentagonal area. Volitional hand opening and FES-driven hand opening were measured, both while the arm was fully supported on a haptic table (Unloaded) and while lifting against gravity (Loaded). Linear mixed effect regression (LMER) modeling was used to determine the effect of Block. Results The ropivacaine block allowed increased hand opening, both volitional and FES-driven, and for both unloaded and loaded conditions. Notably, only the FES-driven and Loaded condition's improvement in hand opening with the block was statistically significant. Hand opening in the FES and Loaded condition improved following nerve block by nearly 20%. Conclusion Our results suggest that many individuals with stroke would see improved hand-opening with wrist and finger flexor activity curtailed by nerve block, especially when FES is used to drive the typically paretic finger and wrist extensor muscles. Such a nerve block (potentially produced by aforementioned emerging electrical nerve block technologies) could thus significantly address prior observed shortcomings of FES interventions for individuals with stroke.
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Affiliation(s)
- Hendrik A. Dewald
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States
| | - Jun Yao
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, United States
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, United States
| | - Julius P. A. Dewald
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, United States
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, United States
| | - Antoun Nader
- Department of Anesthesiology, Northwestern University, Chicago, IL, United States
| | - Robert F. Kirsch
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States
- Cleveland FES Center, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, United States
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Gkesou A, Papavasileiou A, Karagiaridis S, Kannas T, Amiridis IG, Hatzitaki V, Patikas DA. Fatigability of the thenar muscles using electrical nerve stimulation with fixed stimuli count, while varying the frequency and duty cycle. J Electromyogr Kinesiol 2023; 73:102838. [PMID: 37976607 DOI: 10.1016/j.jelekin.2023.102838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/30/2023] [Accepted: 11/03/2023] [Indexed: 11/19/2023] Open
Abstract
Our aim was to compare three electrical stimulation protocols (P20, P30 and P40), with the same number of stimuli, but different stimulation frequencies (20, 30 and 40 Hz, respectively) and duty cycles [1.2:1.2 s (continuous), 0.8:1.2 s (intermittent) and 0.6:1.2 s (intermittent), respectively). Twitch force and the peak-to-peak M-wave amplitude of the thenar muscles were measured before, during and after each protocol at 1-40 Hz in random order. Twelve healthy adults (23-41 years old) were examined for each protocol in random order and in separate sessions. P20 elicited the highest mean force, and P40 the lowest decrease in percent force at the end of the protocol. Force evoked at 1 and 10 Hz decreased less after P40, compared with P20 and P30. The M-wave amplitude was significantly reduced throughout all protocols, with the largest decrease observed during P30. Although an increase in frequency typically induced earlier and greater decrement in force, this was compensated or even reversed by increasing the interval between each stimulation train, while keeping the number of pulses per stimulation cycle constant. The lesser decrease in M-wave amplitude during P40 compared with P20 indicates that longer between-train intervals may help maintaining the integrity of neuromuscular propagation.
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Affiliation(s)
- A Gkesou
- School of Physical Education and Sports Science at Serres, Aristotle University of Thessaloniki, Greece
| | - A Papavasileiou
- School of Physical Education and Sports Science at Serres, Aristotle University of Thessaloniki, Greece
| | - S Karagiaridis
- School of Physical Education and Sports Science at Serres, Aristotle University of Thessaloniki, Greece
| | - T Kannas
- School of Physical Education and Sports Science at Serres, Aristotle University of Thessaloniki, Greece
| | - I G Amiridis
- School of Physical Education and Sports Science at Serres, Aristotle University of Thessaloniki, Greece
| | - V Hatzitaki
- School of Physical Education and Sports Science, Aristotle University of Thessaloniki, Greece
| | - D A Patikas
- School of Physical Education and Sports Science at Serres, Aristotle University of Thessaloniki, Greece.
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Canny E, Vansteensel MJ, van der Salm SMA, Müller-Putz GR, Berezutskaya J. Boosting brain-computer interfaces with functional electrical stimulation: potential applications in people with locked-in syndrome. J Neuroeng Rehabil 2023; 20:157. [PMID: 37980536 PMCID: PMC10656959 DOI: 10.1186/s12984-023-01272-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/23/2023] [Indexed: 11/20/2023] Open
Abstract
Individuals with a locked-in state live with severe whole-body paralysis that limits their ability to communicate with family and loved ones. Recent advances in brain-computer interface (BCI) technology have presented a potential alternative for these people to communicate by detecting neural activity associated with attempted hand or speech movements and translating the decoded intended movements to a control signal for a computer. A technique that could potentially enrich the communication capacity of BCIs is functional electrical stimulation (FES) of paralyzed limbs and face to restore body and facial movements of paralyzed individuals, allowing to add body language and facial expression to communication BCI utterances. Here, we review the current state of the art of existing BCI and FES work in people with paralysis of body and face and propose that a combined BCI-FES approach, which has already proved successful in several applications in stroke and spinal cord injury, can provide a novel promising mode of communication for locked-in individuals.
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Affiliation(s)
- Evan Canny
- Department of Neurology and Neurosurgery, Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mariska J Vansteensel
- Department of Neurology and Neurosurgery, Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sandra M A van der Salm
- Department of Neurology and Neurosurgery, Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gernot R Müller-Putz
- Institute of Neural Engineering, Laboratory of Brain-Computer Interfaces, Graz University of Technology, Graz, Austria
| | - Julia Berezutskaya
- Department of Neurology and Neurosurgery, Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands.
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Vargas L, Musselman ED, Grill WM, Hu X. Asynchronous axonal firing patterns evoked via continuous subthreshold kilohertz stimulation. J Neural Eng 2023; 20:10.1088/1741-2552/acc20f. [PMID: 36881885 PMCID: PMC10433012 DOI: 10.1088/1741-2552/acc20f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 03/07/2023] [Indexed: 03/09/2023]
Abstract
Objective.Transcutaneous electrical stimulation of peripheral nerves is a common technique to assist or rehabilitate impaired muscle activation. However, conventional stimulation paradigms activate nerve fibers synchronously with action potentials time-locked with stimulation pulses. Such synchronous activation limits fine control of muscle force due to synchronized force twitches. Accordingly, we developed a subthreshold high-frequency stimulation waveform with the goal of activating axons asynchronously.Approach.We evaluated our waveform experimentally and through model simulations. During the experiment, we delivered continuous subthreshold pulses at frequencies of 16.67, 12.5, or 10 kHz transcutaneously to the median and ulnar nerves. We obtained high-density electromyographic (EMG) signals and fingertip forces to quantify the axonal activation patterns. We used a conventional 30 Hz stimulation waveform and the associated voluntary muscle activation for comparison. We modeled stimulation of biophysically realistic myelinated mammalian axons using a simplified volume conductor model to solve for extracellular electric potentials. We compared the firing properties under kHz and conventional 30 Hz stimulation.Main results.EMG activity evoked by kHz stimulation showed high entropy values similar to voluntary EMG activity, indicating asynchronous axon firing activity. In contrast, we observed low entropy values in EMG evoked by conventional 30 Hz stimulation. The muscle forces evoked by kHz stimulation also showed more stable force profiles across repeated trials compared with 30 Hz stimulation. Our simulation results provide direct evidence of asynchronous firing patterns across a population of axons in response to kHz frequency stimulation, while 30 Hz stimulation elicited synchronized time-locked responses across the population.Significance.We demonstrate that the continuous subthreshold high-frequency stimulation waveform can elicit asynchronous axon firing patterns, which can lead to finer control of muscle forces.
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Affiliation(s)
- Luis Vargas
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC, United States of America
| | - Eric D Musselman
- Department of Biomedical Engineering, Duke University, Durham, NC, United States of America
| | - Warren M Grill
- Department of Biomedical Engineering, Duke University, Durham, NC, United States of America
- Department of Electrical and Computer Engineering, Duke University, Durham, NC, United States of America
- Department of Neurobiology, Duke University, Durham, NC, United States of America
- Department of Neurosurgery, Duke University, Durham, NC, United States of America
| | - Xiaogang Hu
- Department of Mechanical Engineering, Pennsylvania State University, University Park, PA, United States of America
- Department of Kinesiology, Pennsylvania State University, University Park, PA, United States of America
- Department of Physical Medicine & Rehabilitation, Pennsylvania State Hershey College of Medicine, Hershey, PA, United States of America
- Huck Institutes of the Life Sciences, Pennsylvania State University, University Park, PA, United States of America
- Center for Neural Engineering, Pennsylvania State University, University Park, PA, United States of America
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Wide-pulse electrical stimulation of the quadriceps allows greater maximal evocable torque than conventional stimulation. Eur J Appl Physiol 2023; 123:1209-1214. [PMID: 36753001 DOI: 10.1007/s00421-023-05145-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/23/2023] [Indexed: 02/09/2023]
Abstract
PURPOSE The effectiveness of a neuromuscular electrical stimulation (NMES) program has been shown to be proportional to the maximal evocable torque (MET), which is potentially influenced by pulse characteristics such as duration and frequency. The aim of this study was to compare MET between conventional and wide-pulse NMES at two different frequencies. METHODS MET-expressed as a percentage of maximal voluntary contraction (MVC) torque-and maximal tolerable current intensity were quantified on 71 healthy subjects. The right quadriceps was stimulated with three NMES protocols using different pulse duration/frequency combinations: conventional NMES (0.2 ms/50 Hz; CONV), wide-pulse NMES at 50 Hz (1 ms/50 Hz; WP50) and wide-pulse NMES at 100 Hz (1 ms/100 Hz; WP100). The proportion of subjects reaching the maximal stimulator output (100 mA) before attaining maximal tolerable current intensity was also quantified. RESULTS The proportion of subjects attaining maximal stimulator output was higher for CONV than WP50 and WP100 (p < 0.001). In subjects who did not attain maximal stimulator output in any protocol, MET was higher for both WP50 and WP100 than for CONV (p < 0.001). Maximal tolerable current intensity was lower for both WP50 and WP100 than for CONV and was also lower for WP100 than for WP50 (p < 0.001). CONCLUSION When compared to conventional NMES, wide-pulse protocols resulted in greater MET and lower maximal tolerable current intensity. Overall, this may lead to better NMES training/rehabilitation effectiveness and less practical issues associated with maximal stimulator output limitations.
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Fernandes JA, Silva MLD, Trancho AC, Macedo JRDD, Martins HR, Silva PE. Assessment of neuromuscular electrical stimulation in critically ill patients: physical therapists’ knowledge and barriers to its use. FISIOTERAPIA E PESQUISA 2022. [DOI: 10.1590/1809-2950/21003529032022en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
ABSTRACT Transcutaneous neuromuscular electrical stimulation (NMES) is considered an important tool to prevent muscle mass and strength loss in patients admitted to intensive care units (ICU). This study aimed to evaluate physical therapists’ profile and knowledge of NMES and identify the main barriers to its use in ICUs. This observational cross-sectional study was conducted via a structured questionnaire created by the authors. It consisted of 12 objective questions to analyze physical therapists’ knowledge of NMES use in critically ill patients. Physical therapists were invited to participate in this study during an international symposium on NMES. In total, 56 physical therapists, with a mean age of 33.5±7.2 years and working an average of 9.7±7 years after graduation, completed the survey. Overall, 34 respondents worked in ICUs, of which only four (12%) reported regular NMES use in their ICUs. We found a low average of correct answers to our questionnaire (25%; 3/12). The main barriers reported to using NMES in ICUs were lack of knowledge (28; 50%) and equipment (24; 43%). The number of correct answers expert and non-expert physical therapists was not statistically significant (p=0.68). Thus, we observed participants’ poor knowledge of NMES use in critically ill patients. Respondents showed that NMES has been underused in their ICUs. Lack of knowledge and equipment seems to be the main barriers for the use of NMES in ICUs.
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Santiago-Pescador S, Fajardo-Blanco D, López-Ortiz S, Peñín-Grandes S, Méndez-Sánchez R, Lucia A, Martín-Hernández J, Santos-Lozano A. Acute effects of electrostimulation and blood flow restriction on muscle thickness and fatigue in the lower body. Eur J Sport Sci 2022:1-9. [PMID: 35965445 DOI: 10.1080/17461391.2022.2113145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AbstractNeuromuscular electrical stimulation (NMES) in combination with blood flow restriction (BFR) enhances muscle hypertrophy and force-generating capacity. The present study aimed to investigate the acute effects of BFR and NMES, both in isolation and in combination, on muscle thickness (MT) and fatigue in the lower body of 20 young healthy subjects. Different stimuli were applied for 25 min, defined by the combination of BFR with high- and low-frequency NMES, and also isolated BFR or NMES. Changes in MT were then evaluated by ultrasound of the rectus femoris (RF) and vastus lateralis (VL) muscles at the end of the session (POST) and 15 min later (POST 15'). Lower limb fatigue was evaluated indirectly by strength performance. Results showed that RF MT was higher under the combined protocol (BFR+NMES) or isolated BFR than under NMES - regardless of the frequency - both at POST (p ≤ 0.018) and POST 15' (p ≤ 0.016). No significant changes in MT were observed under isolated NMES or BFR at POST 15' when compared with basal values (p ≥ 0.067). No significant differences were observed for VL MT between conditions (p = 0.322) or for fatigue between conditions (p ≥ 0.258). Our results indicate that a combination of BFR and NMES acutely increases MT in sedentary subjects. Also, although not significantly, BFR conditions had a greater tendency to induce fatigue than isolated NMES.
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Affiliation(s)
| | - Daniel Fajardo-Blanco
- i+HeALTH, Department of Health Sciences, Miguel de Cervantes European University, Valladolid, Spain
| | - Susana López-Ortiz
- i+HeALTH, Department of Health Sciences, Miguel de Cervantes European University, Valladolid, Spain
| | - Saúl Peñín-Grandes
- i+HeALTH, Department of Health Sciences, Miguel de Cervantes European University, Valladolid, Spain
| | - Roberto Méndez-Sánchez
- Department of Physiotherapy, University of Salamanca, Campus Miguel de Unamuno, Salamanca, Spain
| | - Alejandro Lucia
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain.,Research Institute of the Hospital 12 de Octubre ("imas12", PaHerg group), Madrid, Spain
| | - Juan Martín-Hernández
- i+HeALTH, Department of Health Sciences, Miguel de Cervantes European University, Valladolid, Spain
| | - Alejandro Santos-Lozano
- i+HeALTH, Department of Health Sciences, Miguel de Cervantes European University, Valladolid, Spain.,Research Institute of the Hospital 12 de Octubre ("imas12", PaHerg group), Madrid, Spain
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Xu R, Zhao X, Wang Z, Zhang H, Meng L, Ming D. A Co-driven Functional Electrical Stimulation Control Strategy by Dynamic Surface Electromyography and Joint Angle. Front Neurosci 2022; 16:909602. [PMID: 35898409 PMCID: PMC9309284 DOI: 10.3389/fnins.2022.909602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/13/2022] [Indexed: 11/29/2022] Open
Abstract
Functional electrical stimulation (FES) is widely used in neurorehabilitation to improve patients’ motion ability. It has been verified to promote neural remodeling and relearning, during which FES has to produce an accurate movement to obtain a good efficacy. Therefore, many studies have focused on the relationship between FES parameters and the generated movements. However, most of the relationships have been established in static contractions, which leads to an unsatisfactory result when applied to dynamic conditions. Therefore, this study proposed a FES control strategy based on the surface electromyography (sEMG) and kinematic information during dynamic contractions. The pulse width (PW) of FES was determined by a direct transfer function (DTF) with sEMG features and joint angles as the input. The DTF was established by combing the polynomial transfer functions of sEMG and joint torque and the polynomial transfer functions of joint torque and FES. Moreover, the PW of two FES channels was set based on the muscle synergy ratio obtained through sEMG. A total of six healthy right-handed subjects were recruited in this experiment to verify the validity of the strategy. The PW of FES applied to the left arm was evaluated based on the sEMG of the right extensor carpi radialis (ECR) and the right wrist angle. The coefficient of determination (R2) and the normalized root mean square error (NRMSE) of FES-included and voluntary wrist angles and torques were used to verify the performance of the strategy. The result showed that this study achieved a high accuracy (R2 = 0.965 and NRMSE = 0.047) of joint angle and a good accuracy (R2 = 0.701 and NRMSE = 0.241) of joint torque reproduction during dynamic movements. Moreover, the DTF in real-time FES system also had a nice performance of joint angle fitting (R2 = 0.940 and NRMSE = 0.071) and joint torque fitting (R2 = 0.607 and NRMSE = 0.303). It is concluded that the proposed strategy is able to generate proper FES parameters based on sEMG and kinematic information for dynamic movement reproduction and can be used in a real-time FES system combined with bilateral movements for better rehabilitation.
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Affiliation(s)
- Rui Xu
- Laboratory of Motor Rehabilitation, Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
- College of Precision Instruments and Optoelectronics Engineering, Tianjin University, Tianjin, China
| | - Xinyu Zhao
- Laboratory of Motor Rehabilitation, Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
| | - Ziyao Wang
- Laboratory of Motor Rehabilitation, Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
| | - Hengyu Zhang
- Laboratory of Motor Rehabilitation, Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
| | - Lin Meng
- Laboratory of Motor Rehabilitation, Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
- *Correspondence: Lin Meng,
| | - Dong Ming
- Laboratory of Motor Rehabilitation, Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
- College of Precision Instruments and Optoelectronics Engineering, Tianjin University, Tianjin, China
- Dong Ming,
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Abitante TJ, Rutkove SB, Duda KR, Newman DJ. Effect of Athletic Training on Fatigue During Neuromuscular Electrical Stimulation. Front Sports Act Living 2022; 4:894395. [PMID: 35774382 PMCID: PMC9237484 DOI: 10.3389/fspor.2022.894395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/09/2022] [Indexed: 11/25/2022] Open
Abstract
The purpose of this study was to explore the effect an individual's exercise training type will have on muscle fatigability during repetitive contractions induced by Neuromuscular Electrical Stimulation (NMES). Thirty-four subjects comprising of competitive athletes and controls were recruited into three cohorts: Endurance (runners/cyclists) n = 13; nine male, four female; 27 ± 8 years old, Explosive (Lifters/Sprinters) n = 11; nine male, two female; 30 ± 7 years old, and controls n = 10, six male, four female, 26 ± 4 years old. Subjects were placed in a custom-made leg extension rig, and received NMES against a fixed resistance (NMES-FR), to the Vastus Medialis muscle resulting in isometric leg extensions, at a duty cycle of 1 s on/3 s rest, for 20 min. The force of the isometric contractions was recorded using a Hogan MicroFet2 dynamometer, and three separate fatigue metrics were calculated to compare the different cohorts, sports within each cohort, and gender within each cohort. For every fatigue metric, the endurance group fatigued significantly less than both the explosive and control cohorts, with no difference observed between the explosive and the controls. Within each cohort, no significant difference was observed in any fatigue metric between sport or gender, but these comparisons lacked power. The results show that only high capacity endurance activity will have any effect on reducing one's fatigability during repetitive NMES. The implications of this conclusion can aid in the development of NMES regimens for use in healthy populations, such as athletic training or astronaut musculoskeletal countermeasures, as well as clinical applications when fatigue is to be minimized.
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Affiliation(s)
- Thomas J. Abitante
- Harvard-MIT Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, United States
- The Charles Stark Draper Laboratory, Inc., Cambridge, MA, United States
- *Correspondence: Thomas J. Abitante
| | - Seward B. Rutkove
- Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - Kevin R. Duda
- The Charles Stark Draper Laboratory, Inc., Cambridge, MA, United States
| | - Dava J. Newman
- MIT Media Lab, Department of Aeronautics and Astronautics, Massachusetts Institute of Technology, Cambridge, MA, United States
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Baron MV, Silva PE, Koepp J, Urbanetto JDS, Santamaria AFM, Dos Santos MP, de Mello Pinto MV, Brandenburg C, Reinheimer IC, Carvalho S, Wagner MB, Miliou T, Poli-de-Figueiredo CE, Pinheiro da Costa BE. Efficacy and safety of neuromuscular electrical stimulation in the prevention of pressure injuries in critically ill patients: a randomized controlled trial. Ann Intensive Care 2022; 12:53. [PMID: 35695996 PMCID: PMC9188909 DOI: 10.1186/s13613-022-01029-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 06/05/2022] [Indexed: 11/30/2022] Open
Abstract
Background Pressure injuries (PIs), especially in the sacral region are frequent, costly, and increase morbidity and mortality of patients in an intensive care unit (ICU). These injuries can occur as a result of prolonged pressure and/or shear forces. Neuromuscular electrical stimulation (NMES) can increase muscle mass and improve local circulation, potentially reducing the incidence of PI. Methods We performed a randomized controlled trial to assess the efficacy and safety of NMES in preventing PI in critically ill patients. We included patients with a period of less than 48 h in the ICU, aged ≥ 18 years. Participants were randomly selected (1:1 ratio) to receive NMES and usual care (NMES group) or only usual care (control group—CG) until discharge, death, or onset of a PI. To assess the effectiveness of NMES, we calculated the relative risk (RR) and number needed to treat (NNT). We assessed the muscle thickness of the gluteus maximus by ultrasonography. To assess safety, we analyzed the effects of NMES on vital signs and checked for the presence of skin burns in the stimulated areas. Clinical outcomes were assessed by time on mechanical ventilation, ICU mortality rate, and length of stay in the ICU. Results We enrolled 149 participants, 76 in the NMES group. PIs were present in 26 (35.6%) patients in the CG and 4 (5.3%) in the NMES group (p ˂ 0.001). The NMES group had an RR = 0.15 (95% CI 0.05–0.40) to develop a PI, NNT = 3.3 (95% CI 2.3–5.9). Moreover, the NMES group presented a shorter length of stay in the ICU: Δ = − 1.8 ± 1.2 days, p = 0.04. There was no significant difference in gluteus maximus thickness between groups (CG: Δ = − 0.37 ± 1.2 cm vs. NMES group: Δ = 0 ± 0.98 cm, p = 0.33). NMES did not promote deleterious changes in vital signs and we did not detect skin burns. Conclusions NMES is an effective and safe therapy for the prevention of PI in critically ill patients and may reduce length of stay in the ICU. Trial registration RBR-8nt9m4. Registered prospectively on July 20th, 2018, https://ensaiosclinicos.gov.br/rg/RBR-8nt9m4
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Affiliation(s)
- Miriam Viviane Baron
- Pontifical Catholic University of Rio Grande do Sul, Rio Grande do Sul, Porto Alegre, Brazil. .,Instituto Interdisciplinar de Educação, Ciência e Saúde, Fortaleza, Ceará, Brazil.
| | - Paulo Eugênio Silva
- Secretaria de Estado de Saúde do Distrito Federal, Hospital de Base do Distrito Federal, Distrito Federal, Brasília, Brazil
| | - Janine Koepp
- University of Santa Cruz do Sul, Santa Cruz do Sul, Rio Grande do Sul, Brazil
| | | | | | | | | | - Cristine Brandenburg
- Faculdade de Educação, Ciências e Letras do Sertão Central, Quixadá, Ceará, Brazil.,Instituto Interdisciplinar de Educação, Ciência e Saúde, Fortaleza, Ceará, Brazil
| | | | - Sonia Carvalho
- Rigshospital, Inge Lehmannsvej, Copenhagen East, Denmark
| | - Mário Bernardes Wagner
- Pontifical Catholic University of Rio Grande do Sul, Rio Grande do Sul, Porto Alegre, Brazil
| | - Thomas Miliou
- State University of Campinas, Campinas, São Paulo, Brazil
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12
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Bekhet AH, Jahan AM, Bochkezanian V, Musselman KE, Elsareih AA, Gorgey AS. Effects of Electrical Stimulation Training on Body Composition Parameters After Spinal Cord Injury: A Systematic Review. Arch Phys Med Rehabil 2022; 103:1168-1178. [PMID: 34687676 DOI: 10.1016/j.apmr.2021.09.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 08/10/2021] [Accepted: 09/05/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine the effects of neuromuscular electrical stimulation (NMES) or functional electrical stimulation (FES), or both, training on different body composition parameters in individuals with spinal cord injury. DATA SOURCES Three independent reviewers searched PubMed, Web of Science, Scopus, Cochrane Central, and Virtual Health Library until March 2020. STUDY SELECTION Studies were included if they applied NMES/FES on the lower limb muscles after spinal cord injury, reported stimulation parameters (frequency, pulse duration, and amplitude of current), and body composition parameters, which included muscle cross-sectional area (CSA), fat-free mass, lean mass (LM), fat mass, visceral adipose tissue, and intramuscular fat. DATA SYNTHESIS A total of 46 studies were included in the final analysis with a total sample size of 414 subjects. NMES loading exercise and FES cycling exercise were commonly used for training. Increases in muscle CSA ranged from 5.7-75%, with an average of 26% (n=33). Fifteen studies reported changes (both increase and decrease) in LM or fat-free mas ranged from -4% to 35%, with an average of less than 5%. Changes in fat mass (n=10) were modest. The effect on ectopic adipose tissue is inconclusive, with 2 studies showing an average reduction in intramuscular fat by 9.9%. Stimulation parameters ranged from 200-1000 μs for pulse duration, 2-60 Hz for the frequency, and 10-200 mA in amplitude. Finally, increase in weekly training volumes after NMES loading exercise resulted in a remarkable increase in percentage changes in LM or muscle CSA. CONCLUSIONS NMES/FES is an effective rehabilitation strategy for muscle hypertrophy and increasing LM. Weekly training volumes are associated with muscle hypertrophy after NMES loading exercise. Furthermore, positive muscle adaptations occur despite the applied stimulation parameters. Finally, the included studies reported wide range of stimulation parameters without reporting rationale for such selection.
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Affiliation(s)
| | - Alhadi M Jahan
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, Canada
| | - Vanesa Bochkezanian
- Department of Exercise and Health Sciences, School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD, Australia
| | - Kristin E Musselman
- KITE, Toronto Rehabilitation Institute-University Health Network, Toronto, Canada; Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada; Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Amr A Elsareih
- Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Ashraf S Gorgey
- Faculty of Physical Therapy, Cairo University, Giza, Egypt; Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire VAMC, 1201 Broad Rock Boulevard, Richmond, VA; Virginia Commonwealth University, Department of Physical Medicine & Rehabilitation, Richmond, VA.
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13
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Mercado-Gutierrez JA, Dominguez R, Hernandez-Popo I, Quinzaños-Fresnedo J, Vera-Hernandez A, Leija-Salas L, Gutierrez-Martinez J. A Flexible Pulse Generator Based on a Field Programmable Gate Array Architecture for Functional Electrical Stimulation. Front Neurosci 2022; 15:702781. [PMID: 35126033 PMCID: PMC8814338 DOI: 10.3389/fnins.2021.702781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 12/09/2021] [Indexed: 11/15/2022] Open
Abstract
Non-invasive Functional Electrical Stimulation (FES) is a technique applied for motor rehabilitation of patients with central nervous system injury. This technique requires programmable multichannel systems to configure the stimulation parameters (amplitude, frequency, and pulse width). Most FES systems are based on microcontrollers with fixed architecture; this limits the control of the parameters and the scaling to multiple channels. Although field programmable gate arrays (FPGA) have been used in FES systems as alternative to microcontrollers, most of them focus on signal acquisition, processing, or communication functions, or are for invasive stimulation. A few FES systems report using FPGAs for parameter configuration and pulse generation in non-invasive FES. However, generally they limit the value of the frequency or amplitude parameters to enable multichannel operation. This restricts free selection of parameters and implementation of modulation patterns, previously reported to delay FES-induced muscle fatigue. To overcome those limitations, this paper presents a proof-of-concept (technology readiness level three-TRL 3) regarding the technical feasibility and potential use of an FPGA-based pulse generator for non-invasive FES applications (PG-nFES). The main aims were: (1) the development of a flexible pulse generator for FES applications and (2) to perform a proof-of-concept of the system, comprising: electrical characterization of the stimulation parameters, and verification of its potential for upper limb FES applications. Biphasic stimulation pulses with high linearity (r2 > 0.9998) and repeatability (>0.81) were achieved by combining the PG-nFES with a current-controlled output stage. Average percentage error in the characterizations was under 3% for amplitude (1–48 mA) and pulse width (20–400 μs), and 0% for frequency (10–150 Hz). A six-channel version of the PG-nFES was implemented to demonstrate the scalability feature. The independence of parameters was tested with three patterns of co-modulation of two parameters. Moreover, two complete FES channels were implemented and the claimed features of the PG-nFES were verified by performing upper limb functional movements involving the hand and the arm. Finally, the system enabled implementation of a stimulation pattern with co-modulation of frequency and pulse width, applied successfully for efficient elbow during repetitions of a functional movement.
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Affiliation(s)
- Jorge A. Mercado-Gutierrez
- Departamento de Ingeniería Eléctrica, Sección Bioelectrónica, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, Mexico City, Mexico
- División de Investigación en Ingeniería Médica, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Ricardo Dominguez
- Departamento de Ingeniería Eléctrica, Universidad Autónoma Metropolitana — Iztapalapa, Mexico City, Mexico
| | - Ignacio Hernandez-Popo
- CONACYT — Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Jimena Quinzaños-Fresnedo
- División de Rehabilitación Neurológica, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Arturo Vera-Hernandez
- Departamento de Ingeniería Eléctrica, Sección Bioelectrónica, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, Mexico City, Mexico
| | - Lorenzo Leija-Salas
- Departamento de Ingeniería Eléctrica, Sección Bioelectrónica, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, Mexico City, Mexico
| | - Josefina Gutierrez-Martinez
- División de Investigación en Ingeniería Médica, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
- *Correspondence: Josefina Gutierrez-Martinez,
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14
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Petrie MA, Taylor EB, Suneja M, Shields RK. Genomic and Epigenomic Evaluation of Electrically Induced Exercise in People With Spinal Cord Injury: Application to Precision Rehabilitation. Phys Ther 2021; 102:6413907. [PMID: 34718779 PMCID: PMC8754383 DOI: 10.1093/ptj/pzab243] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/06/2021] [Accepted: 09/23/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Physical therapists develop patient-centered exercise prescriptions to help overcome the physical, emotional, psychosocial, and environmental stressors that undermine a person's health. Optimally prescribing muscle activity for people with disability, such as a spinal cord injury, is challenging because of their loss of volitional movement control and the deterioration of their underlying skeletal systems. This report summarizes spinal cord injury-specific factors that should be considered in patient-centered, precision prescription of muscle activity for people with spinal cord injury. This report also presents a muscle genomic and epigenomic analysis to examine the regulation of the proliferator-activated receptor γ coactivator 1α (PGC-1α) (oxidative) and myostatin (hypertrophy) signaling pathways in skeletal muscle during low-frequency (lower-force) electrically induced exercise versus higher-frequency (higher-force) electrically induced exercise under constant muscle recruitment (intensity). METHODS Seventeen people with spinal cord injury participated in 1 or more unilateral electrically induced exercise sessions using a lower-force (1-, 3-, or 5-Hz) or higher-force (20-Hz) protocol. Three hours after the exercise session, percutaneous muscle biopsies were performed on exercised and nonexercised muscles for genomic and epigenomic analysis. RESULTS We found that low-frequency (low-force) electrically induced exercise significantly increased the expression of PGC-1α and decreased the expression of myostatin, consistent with the expression changes observed with high-frequency (higher-force) electrically induced exercise. Further, we found that low-frequency (lower-force) electrically induced exercise significantly demethylated, or epigenetically promoted, the PGC-1α signaling pathway. A global epigenetic analysis showed that >70 pathways were regulated with low-frequency (lower-force) electrically induced exercise. CONCLUSION These novel results support the notion that low-frequency (low-force) electrically induced exercise may offer a more precise rehabilitation strategy for people with chronic paralysis and severe osteoporosis. Future clinical trials are warranted to explore whether low-frequency (lower-force) electrically induced exercise training affects the overall health of people with chronic spinal cord injury.
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Affiliation(s)
- Michael A Petrie
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
| | - Eric B Taylor
- Department of Biochemistry, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
| | - Manish Suneja
- Department of Internal Medicine, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
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15
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Hioki M, Kanehira N, Koike T, Saito A, Takahashi H, Shimaoka K, Sakakibara H, Oshida Y, Akima H. Effect of electromyostimulation on intramyocellular lipids of the vastus lateralis in older adults: a randomized controlled trial. BMC Musculoskelet Disord 2021; 22:569. [PMID: 34158031 PMCID: PMC8218407 DOI: 10.1186/s12891-021-04456-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 05/26/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Excessive intramyocellular lipid (IMCL) accumulation is a primary cause of skeletal muscle insulin resistance, especially in older adults, and interventions that reduce IMCL contents are important to improve insulin sensitivity. Electromyostimulation (EMS)-induced changes in IMCL content in older adults remain unknown. The purpose of this study was to clarify the effects of a single bout of EMS on the IMCL content of the vastus lateralis muscle in older adults. METHODS Twenty-two physically active, non-obese older men and women were randomly assigned to an EMS intervention group (69.0 ± 5.2 years, n = 12) or a control group (68.4 ± 3.5 years, n = 10). EMS was applied to the vastus lateralis (7 s on and 7 s off) for 30 min; control participants sat quietly for 30 min. IMCL content within the vastus lateralis was quantified with 1H-magnetic resonance spectroscopy (n = 7 per group). Fasting plasma glucose and insulin values were determined from blood samples collected before and after the EMS intervention. RESULTS EMS induced a significant reduction in plasma glucose (93.1 ± 9.6 to 89.5 ± 9.1 mg/dL, p < 0.01), but not IMCL content (15.7 ± 15.7 to 15.8 ± 13.1 mmol/kg wet weight, p = 0.49) or insulin (5.4 ± 2.4 to 4.7 ± 2.7 μIU/mL, p = 0.18). In the control group, no changes in IMCL content in the vastus lateralis was observed after prolonged quiet sitting. CONCLUSION EMS intervention for 30 min induces changes in plasma glucose, but no changes in IMCL content in older adults. TRIAL REGISTRATION University hospital Medical Information Network (UMIN) Center ID: UMIN000020126 . Retrospectively registered on December 222,015. https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000023242.
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Affiliation(s)
- Maya Hioki
- Graduate School of Medicine, Nagoya University, 65 Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan.
| | - Nana Kanehira
- Department of Health and Nutrition, Tokaigakuen University, 2-901 Nakahira, Tenpaku, Nagoya, Aichi, 468-8514, Japan
| | - Teruhiko Koike
- Research Center of Health, Physical Fitness & Sports, Nagoya University, 1 Furo, Chikusa-ku, Nagoya, Aichi, 464-8601, Japan
| | - Akira Saito
- Center for Health and Sports Science, Kyushu Sangyo University, 2-3-1 Matsukadai, Higashi-ku, Fukuoka, Fukuoka, 813-8503, Japan
| | - Hideyuki Takahashi
- Japan Institute of Sports Sciences, 3-15-1 Nishigaoka, Kita-ku, Tokyo, 115-0056, Japan
| | - Kiyoshi Shimaoka
- Department of Human Wellness, Tokaigakuen University, 21-233 Nishinohora, Ukigai, Miyoshi, Aichi, 470-0207, Japan
| | - Hisataka Sakakibara
- Ichinomiya Kenshin College of Nursing, 5-4-1 Jouganndoori, Ichinomiya, Aichi, 491-0063, Japan
| | - Yoshiharu Oshida
- Research Center of Health, Physical Fitness & Sports, Nagoya University, 1 Furo, Chikusa-ku, Nagoya, Aichi, 464-8601, Japan
| | - Hiroshi Akima
- Research Center of Health, Physical Fitness & Sports, Nagoya University, 1 Furo, Chikusa-ku, Nagoya, Aichi, 464-8601, Japan
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16
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van der Scheer JW, Goosey-Tolfrey VL, Valentino SE, Davis GM, Ho CH. Functional electrical stimulation cycling exercise after spinal cord injury: a systematic review of health and fitness-related outcomes. J Neuroeng Rehabil 2021; 18:99. [PMID: 34118958 PMCID: PMC8196442 DOI: 10.1186/s12984-021-00882-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 05/19/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES The objective of this review was to summarize and appraise evidence on functional electrical stimulation (FES) cycling exercise after spinal cord injury (SCI), in order to inform the development of evidence-based clinical practice guidelines. METHODS PubMed, the Cochrane Central Register of Controlled Trials, EMBASE, SPORTDiscus, and CINAHL were searched up to April 2021 to identify FES cycling exercise intervention studies including adults with SCI. In order to capture the widest array of evidence available, any outcome measure employed in such studies was considered eligible. Two independent reviewers conducted study eligibility screening, data extraction, and quality appraisal using Cochranes' Risk of Bias or Downs and Black tools. Each study was designated as a Level 1, 2, 3 or 4 study, dependent on study design and quality appraisal scores. The certainty of the evidence for each outcome was assessed using GRADE ratings ('High', 'Moderate', 'Low', or 'Very low'). RESULTS Ninety-two studies met the eligibility criteria, comprising 999 adults with SCI representing all age, sex, time since injury, lesion level and lesion completeness strata. For muscle health (e.g., muscle mass, fiber type composition), significant improvements were found in 3 out of 4 Level 1-2 studies, and 27 out of 32 Level 3-4 studies (GRADE rating: 'High'). Although lacking Level 1-2 studies, significant improvements were also found in nearly all of 35 Level 3-4 studies on power output and aerobic fitness (e.g., peak power and oxygen uptake during an FES cycling test) (GRADE ratings: 'Low'). CONCLUSION Current evidence indicates that FES cycling exercise improves lower-body muscle health of adults with SCI, and may increase power output and aerobic fitness. The evidence summarized and appraised in this review can inform the development of the first international, evidence-based clinical practice guidelines for the use of FES cycling exercise in clinical and community settings of adults with SCI. Registration review protocol: CRD42018108940 (PROSPERO).
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Affiliation(s)
- Jan W van der Scheer
- Peter Harrison Centre for Disability Sport, School for Sport, Exercise and Health Sciences, Loughborough University, Epinal Way, Loughborough, LE11 3TU, UK
- The Healthcare Improvement Studies (THIS) Institute, Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt Building, Cambridge, CB2 OAH, UK
| | - Victoria L Goosey-Tolfrey
- Peter Harrison Centre for Disability Sport, School for Sport, Exercise and Health Sciences, Loughborough University, Epinal Way, Loughborough, LE11 3TU, UK
| | - Sydney E Valentino
- Department of Kinesiology, McMaster University, Room IWC EG115, 1280 Main St. W., Hamilton, ON, L8S 4K1, Canada
| | - Glen M Davis
- Discipline of Exercise and Sport Sciences, Faculty of Medicine and Health, Sydney School of Health Sciences, University of Sydney, Sydney, NSW, 2006, Australia
| | - Chester H Ho
- Division of Physical Medicine & Rehabilitation, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, T6G 2R3, Canada.
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17
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Recommendations to Increase Neuromuscular Electrical Stimulation Training Intensity During Quadriceps Treatments for Orthopedic Knee Conditions. Clin J Sport Med 2021; 31:330-334. [PMID: 30817324 DOI: 10.1097/jsm.0000000000000737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 01/21/2019] [Indexed: 02/02/2023]
Abstract
Neuromuscular electrical stimulation (NMES) is often used by clinicians as a therapeutic adjunct to improve quadriceps strength deficits following orthopedic knee conditions. The efficacy of NMES treatments is primarily dependent on the NMES training intensity, which is a direct result of NMES-induced torque production. The importance of NMES training intensity is well known, yet adequate NMES training intensities are often difficult to achieve due to a variety of limitations associated with NMES (eg, fatigue and patient discomfort). This article provides recommendations that a clinician can use to increase NMES training intensity when strengthening the quadriceps with NMES for orthopedic knee conditions. These recommendations should allow forceful contractions that can be sustained over a treatment with multiple repetitions without the rapid decline in force that is typically seen when NMES is used.
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18
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Birkbeck MG, Blamire AM, Whittaker RG, Sayer AA, Dodds RM. The role of novel motor unit magnetic resonance imaging to investigate motor unit activity in ageing skeletal muscle. J Cachexia Sarcopenia Muscle 2021; 12:17-29. [PMID: 33354940 PMCID: PMC7890268 DOI: 10.1002/jcsm.12655] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/27/2020] [Accepted: 11/05/2020] [Indexed: 12/14/2022] Open
Abstract
Sarcopenia is a progressive and generalized disease, more common in older adults, which manifests as a loss of muscle strength and mass. The pathophysiology of sarcopenia is still poorly understood with many mechanisms suggested. Age associated changes to the neuromuscular architecture, including motor units and their constituent muscle fibres, represent one such mechanism. Electromyography can be used to distinguish between different myopathies and produce counts of motor units. Evidence from electromyography studies suggests that with age, there is a loss of motor units, increases to the sizes of remaining units, and changes to their activity patterns. However, electromyography is invasive, can be uncomfortable, does not reveal the exact spatial position of motor units within muscle and is difficult to perform in deep muscles. We present a novel diffusion-weighted magnetic resonance imaging technique called 'motor unit magnetic resonance imaging (MUMRI)'. MUMRI aims to improve our understanding of the changes to the neuromuscular system associated with ageing, sarcopenia and other neuromuscular diseases. To date, we have demonstrated that MUMRI can be used to detect statistically significant differences in fasciculation rate of motor units between (n = 4) patients with amyotrophic lateral sclerosis (mean age ± SD: 53 ± 15) and a group of (n = 4) healthy controls (38 ± 7). Patients had significantly higher rates of fasciculation compared with healthy controls (mean = 99.1/min, range = 25.7-161.0 in patients vs. 7.7/min, range = 4.3-9.7 in controls; P < 0.05. MUMRI has detected differences in size, shape, and distribution of single human motor units between (n = 5) young healthy volunteers (29 ± 2.2) and (n = 5) healthy older volunteers (65.6 ± 14.8). The maximum size of motor unit territories in the older group was 12.4 ± 3.3 mm and 9.7 ± 2.7 mm in the young group; P < 0.05. MUMRI is an entirely non-invasive tool, which can be used to detect physiological and pathological changes to motor units in neuromuscular diseases. MUMRI also has the potential to be used as an intermediate outcome measure in sarcopenia trials.
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Affiliation(s)
- Matthew G Birkbeck
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.,NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Northern Medical Physics and Clinical Engineering, Freeman Hospital, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Andrew M Blamire
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Roger G Whittaker
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Avan Aihie Sayer
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.,NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Richard M Dodds
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.,NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
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19
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Rabello R, Fröhlich M, Maffiuletti NA, Vaz MA. Influence of Pulse Waveform and Frequency on Evoked Torque, Stimulation Efficiency, and Discomfort in Healthy Subjects. Am J Phys Med Rehabil 2021; 100:161-167. [PMID: 32701636 DOI: 10.1097/phm.0000000000001541] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of the study was to determine the influence of neuromuscular electrical stimulation pulse waveform and frequency on evoked torque, stimulation efficiency, and discomfort at two neuromuscular electrical stimulation levels. DESIGN This is a repeated measures study. The quadriceps muscle of 24 healthy men was stimulated at submaximal (neuromuscular electrical stimulationsub) and maximal (neuromuscular electrical stimulationmax) levels using two pulse waveforms (symmetrical, asymmetrical) and three pulse frequencies (60, 80, 100 Hz). Repeated measures analysis of variance and effect sizes were used to verify the effect of pulse waveform and pulse frequency on stimulation efficiency (evoked torque/current intensity) and discomfort and to assess the magnitude of the differences, respectively. RESULTS Stimulation efficiency was higher for symmetrical (neuromuscular electrical stimulationsub = 0.88 ± 0.21 Nm/mA; neuromuscular electrical stimulationmax = 1.27 ± 0.46 Nm/mA) compared with asymmetrical (neuromuscular electrical stimulationsub = 0.77 ± 0.21 Nm/mA; neuromuscular electrical stimulationmax = 1.02 ± 0.34 Nm/mA; P ≤ 0.001; effect size = 0.56-0.66) but did not significantly differ between frequencies (P = 0.17). At both neuromuscular electrical stimulation levels, there were no statistically significant differences in discomfort between pulse waveforms or frequencies. CONCLUSIONS The higher stimulation efficiency of symmetrical pulses suggests that this waveform would be preferred to asymmetrical pulses in clinical practice. Stimulation frequencies between 60 and 100 Hz can be used interchangeably because of similar efficiency and discomfort.
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Affiliation(s)
- Rodrigo Rabello
- From the Laboratório de Pesquisa do Exercício, Escola de Educação Física, Fisioterapia e Dança, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brasil (RR, MF, MAV); Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy (RR); and Human Performance Laboratory, Schulthess Clinic, Zurich, Switzerland (NAM)
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20
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Insausti-Delgado A, López-Larraz E, Omedes J, Ramos-Murguialday A. Intensity and Dose of Neuromuscular Electrical Stimulation Influence Sensorimotor Cortical Excitability. Front Neurosci 2021; 14:593360. [PMID: 33519355 PMCID: PMC7845652 DOI: 10.3389/fnins.2020.593360] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 11/30/2020] [Indexed: 12/13/2022] Open
Abstract
Neuromuscular electrical stimulation (NMES) of the nervous system has been extensively used in neurorehabilitation due to its capacity to engage the muscle fibers, improving muscle tone, and the neural pathways, sending afferent volleys toward the brain. Although different neuroimaging tools suggested the capability of NMES to regulate the excitability of sensorimotor cortex and corticospinal circuits, how the intensity and dose of NMES can neuromodulate the brain oscillatory activity measured with electroencephalography (EEG) is still unknown to date. We quantified the effect of NMES parameters on brain oscillatory activity of 12 healthy participants who underwent stimulation of wrist extensors during rest. Three different NMES intensities were included, two below and one above the individual motor threshold, fixing the stimulation frequency to 35 Hz and the pulse width to 300 μs. Firstly, we efficiently removed stimulation artifacts from the EEG recordings. Secondly, we analyzed the effect of amplitude and dose on the sensorimotor oscillatory activity. On the one hand, we observed a significant NMES intensity-dependent modulation of brain activity, demonstrating the direct effect of afferent receptor recruitment. On the other hand, we described a significant NMES intensity-dependent dose-effect on sensorimotor activity modulation over time, with below-motor-threshold intensities causing cortical inhibition and above-motor-threshold intensities causing cortical facilitation. Our results highlight the relevance of intensity and dose of NMES, and show that these parameters can influence the recruitment of the sensorimotor pathways from the muscle to the brain, which should be carefully considered for the design of novel neuromodulation interventions based on NMES.
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Affiliation(s)
- Ainhoa Insausti-Delgado
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
- International Max Planck Research School (IMPRS) for Cognitive and Systems Neuroscience, Tübingen, Germany
- IKERBASQUE, Basque Foundation for Science, Bilbao, Spain
| | - Eduardo López-Larraz
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
- Bitbrain, Zaragoza, Spain
| | - Jason Omedes
- Instituto de Investigación en Ingeniería de Aragón (I3A), Zaragoza, Spain
- Departamento de Informática e Ingeniería de Sistemas (DIIS), University of Zaragoza, Zaragoza, Spain
| | - Ander Ramos-Murguialday
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
- Neurotechnology Laboratory, TECNALIA, Basque Research and Technology Alliance (BRTA), Donostia-San Sebastián, Spain
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21
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Conley CEW, Mattacola CG, Jochimsen KN, Dressler EV, Lattermann C, Howard JS. A Comparison of Neuromuscular Electrical Stimulation Parameters for Postoperative Quadriceps Strength in Patients After Knee Surgery: A Systematic Review. Sports Health 2021; 13:116-127. [PMID: 33428557 DOI: 10.1177/1941738120964817] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
CONTEXT Postoperative quadriceps strength weakness after knee surgery is a persistent issue patients and health care providers encounter. OBJECTIVE To investigate the effect of neuromuscular electrical stimulation (NMES) parameters on quadriceps strength after knee surgery. DATA SOURCES CINAHL, MEDLINE, SPORTDiscus, and PubMed were systematically searched in December 2018. STUDY SELECTION Studies were excluded if they did not assess quadriceps strength or if they failed to report the NMES parameters or quadriceps strength values. Additionally, studies that applied NMES to numerous muscle groups or simultaneously with other modalities/treatments were excluded. Study quality was assessed with the Physiotherapy Evidence Database (PEDro) scale for randomized controlled trials. STUDY DESIGN Systematic review. LEVEL OF EVIDENCE Level 1. DATA EXTRACTION Treatment parameters for each NMES treatment was extracted for comparison. Quadriceps strength means and standard deviations were extracted and utilized to calculate Hedge g effect sizes with 95% CIs. RESULTS Eight RCTs were included with an average Physiotherapy Evidence Database scale score of 5 ± 2. Hedge g effect sizes ranged from small (-0.37; 95% CI, -1.00 to 0.25) to large (1.13; 95% CI, 0.49 to 1.77). Based on the Strength of Recommendation Taxonomy Quality of Evidence table, the majority of the studies included were low quality RCTs categorized as level 2: limited quality patient-oriented evidence. CONCLUSION Because of inconsistent evidence among studies, grade B evidence exists to support the use of NMES to aid in the recovery of quadriceps strength after knee surgery. Based on the parameters utilized by studies demonstrating optimal treatment effects, it is recommended to implement NMES treatment during the first 2 postoperative weeks at a frequency of ≥50 Hz, at maximum tolerable intensity, with a biphasic current, with large electrodes and a duty cycle ratio of 1:2 to 1:3 (2- to 3-second ramp).
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Affiliation(s)
- Caitlin E W Conley
- Department of Orthopaedic Surgery and Sports Medicine, College of Medicine, University of Kentucky, Lexington, Kentucky
| | - Carl G Mattacola
- College of Health and Human Sciences, The University of North Carolina Greensboro, Greensboro, North Carolina
| | - Kate N Jochimsen
- Division of Athletic Training, School of Medicine, West Virginia University, Morgantown, West Virginia
| | - Emily V Dressler
- Department of Biostatistics and Data Science, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Christian Lattermann
- Department of Orthopedic Surgery, Center for Cartilage Repair and Sports Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jennifer S Howard
- Department of Health and Exercise Science, Beaver College of Health Sciences, Appalachian State University, Boone, North Carolina
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Ainsley EN, Barss TS, Collins DF. Contraction fatigability during interleaved neuromuscular electrical stimulation of the ankle dorsiflexors does not depend on contraction amplitude. Appl Physiol Nutr Metab 2020; 45:948-956. [DOI: 10.1139/apnm-2019-0851] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Interleaved neuromuscular electrical stimulation (iNMES) involves alternating stimulus pulses between the tibialis anterior muscle and common peroneal nerve. The current investigation aimed to characterize the relationship between contraction amplitude, motor unit (MU) “overlap”, and contraction fatigability during iNMES. It was hypothesized that as iNMES generates progressively larger contractions, more MUs would be recruited from both sites (i.e., more MU overlap), resulting in more fatigability for larger than smaller contractions. Fourteen participants completed 3 sessions. Fatigability was assessed as the decline in torque over 180 contractions (0.3 s “on”, 0.7 s “off”) when iNMES was delivered to produce initial contractions of ∼5%, 15%, or 30% of a maximal voluntary contraction. Although MU overlap increased significantly with contraction amplitude, the relative (percent) decline in torque was not different between the contraction amplitudes and torque declined on average by 23%. Contraction fatigability was not significantly correlated with either MU overlap or initial contraction amplitude. In conclusion, iNMES can produce fatigue-resistant contractions across a functionally-meaningful range of contraction amplitudes for rehabilitation. Novelty Interleaved neuromuscular electrical stimulation progressively recruits MUs as contraction amplitude increases. However, the relative amount of fatigability of recruited MUs was not different as contraction amplitude increased. This suggests iNMES can be used effectively to produce fatigue-resistant and functionally meaningful contractions.
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Affiliation(s)
- Emily N. Ainsley
- Human Neurophysiology Laboratory, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, AB T6G 2H9, Canada
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB T6G 2E1, Canada
| | - Trevor S. Barss
- Human Neurophysiology Laboratory, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, AB T6G 2H9, Canada
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB T6G 2E1, Canada
| | - David F. Collins
- Human Neurophysiology Laboratory, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, AB T6G 2H9, Canada
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB T6G 2E1, Canada
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23
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Wernbom M, Aagaard P. Muscle fibre activation and fatigue with low-load blood flow restricted resistance exercise-An integrative physiology review. Acta Physiol (Oxf) 2020; 228:e13302. [PMID: 31108025 DOI: 10.1111/apha.13302] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 05/12/2019] [Accepted: 05/17/2019] [Indexed: 12/13/2022]
Abstract
Blood flow-restricted resistance exercise (BFRRE) has been shown to induce increases in muscle size and strength, and continues to generate interest from both clinical and basic research points of view. The low loads employed, typically 20%-50% of the one repetition maximum, make BFRRE an attractive training modality for individuals who may not tolerate high musculoskeletal forces (eg, selected clinical patient groups such as frail old adults and patients recovering from sports injury) and/or for highly trained athletes who have reached a plateau in muscle mass and strength. It has been proposed that achieving a high degree of muscle fibre recruitment is important for inducing muscle hypertrophy with BFRRE, and the available evidence suggest that fatiguing low-load exercise during ischemic conditions can recruit both slow (type I) and fast (type II) muscle fibres. Nevertheless, closer scrutiny reveals that type II fibre activation in BFRRE has to date largely been inferred using indirect methods such as electromyography and magnetic resonance spectroscopy, while only rarely addressed using more direct methods such as measurements of glycogen stores and phosphocreatine levels in muscle fibres. Hence, considerable uncertainity exists about the specific pattern of muscle fibre activation during BFRRE. Therefore, the purpose of this narrative review was (1) to summarize the evidence on muscle fibre recruitment during BFRRE as revealed by various methods employed for determining muscle fibre usage during exercise, and (2) to discuss reported findings in light of the specific advantages and limitations associated with these methods.
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Affiliation(s)
- Mathias Wernbom
- Center for Health and Performance, Department of Food and Nutrition and Sport Science University of Gothenburg Gothenburg Sweden
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Per Aagaard
- Department of Sports Sciences and Clinical Biomechanics, SDU Muscle Research Cluster (SMRC) University of Southern Denmark Odense M Denmark
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24
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Yoshikawa M, Morifuji T, Matsumoto T, Maeshige N, Tanaka M, Fujino H. Effects of combined treatment with blood flow restriction and low-current electrical stimulation on muscle hypertrophy in rats. J Appl Physiol (1985) 2019; 127:1288-1296. [PMID: 31556832 DOI: 10.1152/japplphysiol.00070.2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This study aimed to clarify the effects of a combined treatment comprising blood flow restriction and low-current electrical stimulation on skeletal muscle hypertrophy in rats. Male Wistar rats were divided into control (Cont), blood flow restriction (Bfr), electrical stimulation (Es), or Bfr with Es (Bfr + Es) groups. Pressure cuffs (80 mmHg) were placed around the thighs of Bfr and Bfr + Es rats. Low-current Es was applied to calf muscles in the Es and Bfr + Es rats. In experiment 1, a 1-day treatment regimen (5-min stimulation, followed by 5-min rest) was delivered four times to study the acute effects. In experiment 2, the same treatment regimen was delivered three times/wk for 8 wk. Body weight, muscle mass, changes in maximal isometric contraction, fiber cross-sectional area of the soleus muscle, expression of phosphorylated and total-ERK1/2, phosphorylated-rpS6 Ser235/236, phosphorylated and total Akt, and phosphorylated-rpS6 Ser240/244 were measured. Bfr and Es treatment alone failed to induce muscle hypertrophy and increase the expression of phosphorylated rpS6 Ser240/244. Combined Bfr + Es upregulated muscle mass, increased the fiber cross-sectional area, and increased phosphorylated rpS6 Ser240/244 expression and phosphorylated rpS6 Ser235/236 expression compared with controls. Combined treatment with Bfr and low-current Es can induce muscle hypertrophy via activation of two protein synthesis signaling pathways. This treatment should be introduced for older patients with sarcopenia and others with muscle weakness.NEW & NOTEWORTHY We investigated the acute and chronic effect of low-current electrical stimulation with blood flow restriction on skeletal muscle hypertrophy and the mechanisms controlling the hypertrophic response. Low-current electrical stimulation could not induce skeletal muscle hypertrophy, but a combination treatment did. Blood lactate and growth hormone levels were increased in the early response. Moreover, activation of ERK1/2 and mTOR pathways were observed in both the acute and chronic response, which contribute to muscle hypertrophy.
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Affiliation(s)
- Madoka Yoshikawa
- Department of Rehabilitation Science, Kobe University Graduate School of Health Science, Kobe, Japan
| | - Takeshi Morifuji
- Department of Rehabilitation Science, Kobe University Graduate School of Health Science, Kobe, Japan.,Department of Rehabilitation Science, Osaka Kawasaki Rehabilitation University, Kaizuka, Japan
| | - Tomohiro Matsumoto
- Department of Rehabilitation Science, Kobe University Graduate School of Health Science, Kobe, Japan
| | - Noriaki Maeshige
- Department of Rehabilitation Science, Kobe University Graduate School of Health Science, Kobe, Japan
| | - Minoru Tanaka
- Department of Rehabilitation Science, Kobe University Graduate School of Health Science, Kobe, Japan.,Department of Rehabilitation Science, Osaka Health Science University, Osaka, Japan
| | - Hidemi Fujino
- Department of Rehabilitation Science, Kobe University Graduate School of Health Science, Kobe, Japan
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25
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Lein DH, Eidson C, Hammond K, Yuen HK, Bickel CS. The impact of varying interphase interval on neuromuscular electrical stimulation-induced quadriceps femoris muscle performance and perceived discomfort. Physiother Theory Pract 2019; 37:1117-1125. [DOI: 10.1080/09593985.2019.1685032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Donald H Lein
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Chris Eidson
- Department of Occupational Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kelley Hammond
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Occupational Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Hon K. Yuen
- Department of Occupational Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
| | - C. Scott Bickel
- Department of Physical Therapy, Samford University, School of Health Professions, Birmingham, AL, USA
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26
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Wiest MJ, Bergquist AJ, Heffernan MG, Popovic M, Masani K. Fatigue and Discomfort During Spatially Distributed Sequential Stimulation of Tibialis Anterior. IEEE Trans Neural Syst Rehabil Eng 2019; 27:1566-1573. [PMID: 31265401 DOI: 10.1109/tnsre.2019.2923117] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Neuromuscular electrical stimulation is conventionally applied through a single pair of electrodes over the muscle belly, denominated single electrode stimulation (SES). SES is limited by discomfort and incomplete motor-unit recruitment, restricting electrically-evoked torque and promoting premature fatigue-induced torque-decline. Sequential stimulation involving rotation of pulses between multiple pairs of electrodes has been proposed as an alternative, denominated spatially distributed sequential stimulation (SDSS). The present aim was to compare discomfort, maximal-tolerated torque, and fatigue-related outcomes between SES and SDSS of tibialis anterior. Ten healthy participants completed two experimental sessions. The self-reported discomfort at sub-maximal torque, the maximal-tolerated torque, fatigue-induced torque-decline during, and doublet-twitch torque at 10- and 100-Hz before and after, 300 intermittent (0.6-s-ON-0.6-s-OFF) isokinetic contractions were compared between SES and SDSS. SDSS stimulation improved fatigue-related outcomes, whereas increased discomfort and reduced maximal-tolerated torque. SDSS holds promise for reducing fatigue. However, limited torque production and associated discomfort may limit its utility for rehabilitation/training.
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27
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Jiang SL, Wang Z, Yi W, He F, Qi H, Ming D. Current Change Rate Influences Sensorimotor Cortical Excitability During Neuromuscular Electrical Stimulation. Front Hum Neurosci 2019; 13:152. [PMID: 31156411 PMCID: PMC6529745 DOI: 10.3389/fnhum.2019.00152] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 04/23/2019] [Indexed: 11/23/2022] Open
Abstract
Neuromuscular electrical stimulation (NMES) is frequently used in rehabilitation therapy to improve motor recovery. To optimize the stimulatory effect of NMES, the parameters of NMES, including stimulation mode, location, current intensity, and duration, among others have been investigated; however, these studies mainly focused on the effects of changing parameters in the current plateau stage of the NMES cycle, while the impacts on other stages, such as the current rising stage, have yet to be investigated. In this article, we studied the electroencephalograph (EEG) effects during NMES, with different rates of current change in the rising stage, and stable current intensity in the plateau stage. EEG signals (64-channel) were collected from 28 healthy subjects, who were administered with high, medium, or low current change rate (CCR) NMES through a right-hand wrist extensor. Time-frequency analysis and brain source analysis, using the LORETA method, were used to investigate neural activity in sensorimotor cortical areas. The strengths of cortical activity induced by different CCR conditions were compared. NMES with a high CCR activated the sensorimotor cortex, despite the NMES current intensity in the plateau stage lower than the motor threshold. Reduction of the Alpha 2 band (10–13 Hz) event related spectral power (ERSP) during NMES stimulation was significantly enhanced by increasing CCR (p < 0.05). LORETA-based source analysis demonstrated that, in addition to typical sensory areas, such as primary somatosensory cortex (S1), sensorimotor areas including primary motor cortex (M1), premotor cortex (PMC), and somatosensory association cortex (SAC) were all activated by within threshold NMES. Furthermore, compared with the low CCR condition, cortical activity was significantly enhanced in the S1, M1, and PMC areas under high CCR conditions. This study shows CCR in the NMES rising stage can affect EEG responses in the sensorimotor cortex and suggests that CCR is an important parameter applicable to the optimization of NMES treatment.
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Affiliation(s)
- Sheng-Long Jiang
- Biomedical Engineering Department, School of Precision Instrument & Opto-Electronics Engineering, Tianjin University, Tianjin, China
| | - Zhongpeng Wang
- Biomedical Engineering Department, School of Precision Instrument & Opto-Electronics Engineering, Tianjin University, Tianjin, China
| | - Weibo Yi
- Beijing Machine and Equipment Institute, Beijing, China
| | - Feng He
- Biomedical Engineering Department, School of Precision Instrument & Opto-Electronics Engineering, Tianjin University, Tianjin, China
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
| | - Hongzhi Qi
- Biomedical Engineering Department, School of Precision Instrument & Opto-Electronics Engineering, Tianjin University, Tianjin, China
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
- *Correspondence: Hongzhi Qi Dong Ming
| | - Dong Ming
- Biomedical Engineering Department, School of Precision Instrument & Opto-Electronics Engineering, Tianjin University, Tianjin, China
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
- *Correspondence: Hongzhi Qi Dong Ming
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28
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Pano-Rodriguez A, Beltran-Garrido JV, Hernández-González V, Reverter-Masia J. Effects of whole-body ELECTROMYOSTIMULATION on health and performance: a systematic review. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 19:87. [PMID: 31014310 PMCID: PMC6480820 DOI: 10.1186/s12906-019-2485-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 03/14/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Whole-body electrical myostimulation (WB-EMS) is a relatively recent training methodology that has been extraordinarily used in recent years. However, there is a lack of consensus on the effectiveness of WB-EMS in the situations in which its use has been largely popularized. The objective of this systematic review was to determine the effects produced by WB-EMS. METHODS A search of PubMed, Web of Science, Scopus and Cochrane was performed to identify all the studies that have applied electrical stimulation in lower and upper limbs simultaneously and that have clearly presented their protocols for the training and application of the stimulation. The last search was performed on September 9, 2018. Studies written in English or German were included. RESULTS A total of 21 articles met the inclusion criteria and were analyzed following the guidelines of the Cochrane Guide for Systematic Reviews. Nineteen studies analyzed the chronic effects of WB-EMS, and 2 analyzed acute effects with a total of 505 subjects (310 men and 195 women). In total, 35% were moderately trained, and 65% were sedentary subjects. Different dependent variables were studied, such as anthropometric parameters, strength parameters, energy expenditure, psychophysiological parameters and blood parameters. There is a lack of randomized controlled studies, and the studies included exhibit a moderate to high level of risk of bias. CONCLUSIONS Given the limited number of available studies on WB-EMS, the scarce amount of scientific evidence found does not allow definitive conclusions about its effects; therefore, future studies about WB-EMS are necessary.
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Affiliation(s)
- Alvaro Pano-Rodriguez
- Research Group Human Movement, University of Lleida, Av. de l’Estudi Generaln.4 E-25001Lleida, Lleida, Spain
| | | | - Vicenç Hernández-González
- Research Group Human Movement, University of Lleida, Av. de l’Estudi Generaln.4 E-25001Lleida, Lleida, Spain
| | - Joaquim Reverter-Masia
- Research Group Human Movement, University of Lleida, Av. de l’Estudi Generaln.4 E-25001Lleida, Lleida, Spain
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29
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Shapiro M, Gottlieb U, Springer S. Optimizing neuromuscular electrical stimulation for hand opening. Somatosens Mot Res 2019; 36:63-68. [DOI: 10.1080/08990220.2019.1587401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Maxim Shapiro
- Physical Therapy Department, Faculty of Health Sciences, Ariel University, Ariel, Israel
| | - Uri Gottlieb
- Physical Therapy Department, Faculty of Health Sciences, Ariel University, Ariel, Israel
- Israel Defense Force Medical Corps, Zerifin, Israel
| | - Shmuel Springer
- Physical Therapy Department, Faculty of Health Sciences, Ariel University, Ariel, Israel
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Guzmán-González B, Llanos P, Calatayud J, Maffiuletti NA, Cruz-Montecinos C. Effect of neuromuscular electrical stimulation frequency on postprandial glycemia, current-related discomfort, and muscle soreness. A crossover study. Appl Physiol Nutr Metab 2019; 44:834-839. [PMID: 30620614 DOI: 10.1139/apnm-2018-0801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Consensus is lacking regarding optimal neuromuscular electrical stimulation (NMES) parameters for postprandial glycemic control. Therefore, the aim of this study was to determine the NMES frequency inducing the greatest hypoglycemic effect in healthy individuals. The secondary aim was to compare current-related discomfort and muscle soreness between different frequencies. We conducted an experimental clinical study with a randomized crossover design. Sixteen healthy and sedentary participants received NMES for 20 min at 5, 10, or 50 Hz (pulse duration: 400 μs, on-off ratio: 4:12 s) following a standardized meal. Glycemia, discomfort, and muscle soreness during and after NMES were compared between conditions. Five-hertz NMES generated a significant hypoglycemic effect, contrary to 10 Hz and 50 Hz. Ten-hertz and 50-Hz NMES resulted respectively in lower current-related discomfort and greater muscle soreness compared with the other frequencies. Women reported higher discomfort than men. These findings contribute towards the possibility of more efficient long-term NMES treatments in terms of glycemic response and patient tolerance.
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Affiliation(s)
- Benjamín Guzmán-González
- a Laboratory of Clinical Biomechanics, Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago 8380453, Chile
| | - Pablo Llanos
- b Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago 8380453, Chile
| | - Joaquín Calatayud
- c Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia 46010, Spain; National Research Centre for the Working Environment, Copenhagen 2100, Denmark
| | | | - Carlos Cruz-Montecinos
- e Laboratory of Clinical Biomechanics, Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago 8380453, Chile.,f Laboratory of Biomechanics and Kinesiology, San José Hospital, Santiago 8380419, Chile
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31
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Laubacher M, Aksoez EA, Brust AK, Baumberger M, Riener R, Binder-Macleod S, Hunt KJ. Stimulation of paralysed quadriceps muscles with sequentially and spatially distributed electrodes during dynamic knee extension. J Neuroeng Rehabil 2019; 16:5. [PMID: 30616683 PMCID: PMC6322281 DOI: 10.1186/s12984-018-0471-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 12/05/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND During functional electrical stimulation (FES) tasks with able-bodied (AB) participants, spatially distributed sequential stimulation (SDSS) has demonstrated substantial improvements in power output and fatigue properties compared to conventional single electrode stimulation (SES). The aim of this study was to compare the properties of SDSS and SES in participants with spinal cord injury (SCI) in a dynamic isokinetic knee extension task simulating knee movement during recumbent cycling. METHOD Using a case-series design, m. vastus lateralis and medialis of four participants with motor and sensory complete SCI (AIS A) were stimulated for 6 min on both legs with both electrode setups. With SES, target muscles were stimulated by a pair of electrodes. In SDSS, the distal electrodes were replaced by four small electrodes giving the same overall stimulation frequency and having the same total surface area. Torque was measured during knee extension by a dynamometer at an angular velocity of 110 deg/s. Mean power of the left and right sides (PmeanL,R) was calculated from all stimulated extensions for initial, final and all extensions. Fatigue is presented as an index value with respect to initial power from 1 to 0, whereby 1 means no fatigue. RESULTS SDSS showed higher PmeanL,R values for all four participants for all extensions (increases of 132% in participant P1, 100% in P2, 36% in P3 and 18% in P4 compared to SES) and for the initial phase (increases of 84%, 59%, 66%, and 16%, respectively). Fatigue resistance was better with SDSS for P1, P2 and P4 but worse for P3 (0.47 vs 0.35, 0.63 vs 0.49, 0.90 vs 0.82 and 0.59 vs 0.77, respectively). CONCLUSION Consistently higher PmeanL,R was observed for all four participants for initial and overall contractions using SDSS. This supports findings from previous studies with AB participants. Fatigue properties were better in three of the four participants. The lower fatigue resistance with SDSS in one participant may be explained by a very low muscle activation level in this case. Further investigation in a larger cohort is warranted.
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Affiliation(s)
- Marco Laubacher
- Department of Physical Therapy, University of Delaware, Newark, United States of America.
| | - Efe A Aksoez
- Department of Physical Therapy, University of Delaware, Newark, United States of America
| | - Anne K Brust
- Department of Physical Therapy, University of Delaware, Newark, United States of America
| | - Michael Baumberger
- Institute for Rehabilitation and Performance Technology, Division of Mechanical Engineering, Department of Engineering and Information Technology, Bern University of Applied Sciences, Pestalozzistrasse 20, Burgdorf, 3400, Switzerland.,Sensory Motor Systems Lab, Department of Health Sciences and Technology, ETH Zurich, Zurich, 8000, Switzerland
| | - Robert Riener
- Institute for Rehabilitation and Performance Technology, Division of Mechanical Engineering, Department of Engineering and Information Technology, Bern University of Applied Sciences, Pestalozzistrasse 20, Burgdorf, 3400, Switzerland.,Sensory Motor Systems Lab, Department of Health Sciences and Technology, ETH Zurich, Zurich, 8000, Switzerland
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Mettler JA, Magee DM, Doucet BM. Low-frequency electrical stimulation with variable intensity preserves torque. J Electromyogr Kinesiol 2018; 42:49-56. [DOI: 10.1016/j.jelekin.2018.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 05/22/2018] [Accepted: 06/14/2018] [Indexed: 01/05/2023] Open
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Efficiency of Neuromuscular Electrical Stimulation and Transcutaneous Nerve Stimulation on Hemiplegic Shoulder Pain: A Randomized Controlled Trial. Arch Phys Med Rehabil 2018; 99:1730-1739. [DOI: 10.1016/j.apmr.2018.04.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Revised: 01/09/2018] [Accepted: 04/18/2018] [Indexed: 11/20/2022]
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Hamilton LD, Mani D, Almuklass AM, Davis LA, Vieira T, Botter A, Enoka RM. Electrical nerve stimulation modulates motor unit activity in contralateral biceps brachii during steady isometric contractions. J Neurophysiol 2018; 120:2603-2613. [PMID: 30156959 DOI: 10.1152/jn.00235.2018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The purpose of our study was to compare the influence of five types of electrical nerve stimulation delivered through electrodes placed over the right biceps brachii on motor unit activity in the left biceps brachii during an ongoing steady isometric contraction. The electrical stimulation protocols comprised different combinations of pulse duration (0.2 and 1.0 ms), stimulus frequency (50 and 90 Hz), and stimulus current (greater or less than motor threshold). The electrical nerve stimulation protocols were applied over the muscle of the right elbow flexors of 13 participants (26 ± 3 yr) while they performed voluntary contractions with the left elbow flexors to match a target force set at 10% of maximum. All five types of electrical nerve stimulation increased the absolute amplitude of the electromyographic (EMG) signal recorded from the left biceps brachii with high-density electrodes. Moreover, one stimulation condition (1 ms, 90 Hz) had a consistent influence on the centroid location of the EMG amplitude distribution and the average force exerted by the left elbow flexors. Another stimulation condition (0.2 ms, 90 Hz) reduced the coefficient of variation for force during the voluntary contraction, and both low-frequency conditions (50 Hz) increased the duration of the mean interspike interval of motor unit action potentials after the stimulation had ended. The findings indicate that the contralateral effects of electrical nerve stimulation on the motor neuron pool innervating the homologous muscle can be influenced by both stimulus pulse duration and stimulus frequency. NEW & NOTEWORTHY Different types of electrical nerve stimulation delivered through electrodes placed over the right biceps brachii modulated the ongoing motor unit activity in the left biceps brachii. Although the effects varied with stimulus pulse duration, frequency, and current, all five types of electrical nerve stimulation increased the amplitude of the electromyographic activity in the left biceps brachii. Moreover, most of the effects in the left arm occurred after the electrical nerve stimulation of the right arm had been terminated.
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Affiliation(s)
- Landon D Hamilton
- Department of Integrative Physiology, University of Colorado , Boulder, Colorado
| | - Diba Mani
- Department of Integrative Physiology, University of Colorado , Boulder, Colorado
| | - Awad M Almuklass
- Department of Integrative Physiology, University of Colorado , Boulder, Colorado.,College of Medicine, King Saud bin Abdulaziz University for Health Sciences , Riyadh , Saudi Arabia
| | - Leah A Davis
- Department of Integrative Physiology, University of Colorado , Boulder, Colorado
| | - Taian Vieira
- LISiN, Department of Electronics and Telecommunications, Politecnico di Torino, Torino , Italy
| | - Alberto Botter
- LISiN, Department of Electronics and Telecommunications, Politecnico di Torino, Torino , Italy
| | - Roger M Enoka
- Department of Integrative Physiology, University of Colorado , Boulder, Colorado
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Rongsawad K, Ratanapinunchai J. Effects of Very High Stimulation Frequency and Wide-Pulse Duration on Stimulated Force and Fatigue of Quadriceps in Healthy Participants. Ann Rehabil Med 2018; 42:250-259. [PMID: 29765878 PMCID: PMC5940601 DOI: 10.5535/arm.2018.42.2.250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 08/02/2017] [Indexed: 11/13/2022] Open
Abstract
Objective To determine the effect of very high stimulation frequency (150 and 200 Hz) with wide pulse duration versus 50 Hz with wide pulse duration on stimulated force and fatigue of quadriceps femoris in healthy participants. Methods Thirty-four healthy participants underwent fatigue test using three stimulation frequency conditions (50, 150, and 200 Hz) with pulse duration of 0.9 ms. Normalized force values at the end of each fatigue protocol and curve fitting patterns were compared among stimulated frequencies. Results Very high stimulation frequency (150 and 200 Hz) conditions showed a trend of having more decline in normalized stimulated force during fatigue test compared to a low stimulation frequency at 50 Hz. However, the difference was not statistically significant. Responder group showed the same slope of a linear fitting pattern, implying the same pattern of muscle fatigue among three stimulation frequency conditions (−3.32 in 50 Hz, −2.88 in 150 Hz, and −3.14 in 200 Hz, respectively). Conclusion There were high inter-subject variations in the response to different frequency stimulation conditions. However, very high stimulation frequency generated the same fatigue pattern as the low stimulation frequency in the responder group. Further research is needed to explore the mechanism involved.
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Affiliation(s)
- Kitima Rongsawad
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Jonjin Ratanapinunchai
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
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Maffiuletti NA, Gondin J, Place N, Stevens-Lapsley J, Vivodtzev I, Minetto MA. Clinical Use of Neuromuscular Electrical Stimulation for Neuromuscular Rehabilitation: What Are We Overlooking? Arch Phys Med Rehabil 2017; 99:806-812. [PMID: 29233625 DOI: 10.1016/j.apmr.2017.10.028] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 10/18/2017] [Accepted: 10/31/2017] [Indexed: 12/19/2022]
Abstract
The clinical success of neuromuscular electrical stimulation (NMES) for neuromuscular rehabilitation is greatly compromised by the poor consideration of different physiological and methodological issues that are not always obvious to the clinicians. Therefore, the aim of this narrative review is to reexamine some of these fundamental aspects of NMES using a tripartite model perspective. First, we contend that NMES does not actually bypass the central nervous system but results in a multitude of neurally mediated responses that contribute substantially to force generation and may engender neural adaptations. Second, we argue that too much emphasis is generally placed on externally controllable stimulation parameters while the major determinant of NMES effectiveness is the intrinsically determined muscle tension generated by the current (ie, evoked force). Third, we believe that a more systematic approach to NMES therapy is required in the clinic and this implies a better identification of the patient-specific impairment and of the potential "responders" to NMES therapy. On the basis of these considerations, we suggest that the crucial steps to ensure the clinical effectiveness of NMES treatment should consist of (1) identifying the neuromuscular impairment with clinical assessment and (2) implementing algorithm-based NMES therapy while (3) properly dosing the treatment with tension-controlled NMES and eventually amplifying its neural effects.
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Affiliation(s)
| | - Julien Gondin
- NeuroMyoGene Institute, University Claude Bernard Lyon 1, INSERM U1217, CNRS UMR 5310, Villeurbanne, France
| | - Nicolas Place
- Institute of Sport Sciences, Faculty of Biology Medicine, University of Lausanne, Lausanne, Switzerland
| | - Jennifer Stevens-Lapsley
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO; Geriatric Research Education and Clinical Center, VA Eastern Colorado Healthcare System, Denver, CO
| | - Isabelle Vivodtzev
- INSERM U1042, HP2 Laboratory (Hypoxia: Pathophysiology), University Grenoble Alps, Grenoble, France
| | - Marco A Minetto
- Division of Physical Medicine and Rehabilitation, Department of Surgical Sciences, University of Turin, Turin, Italy
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Giroux C, Roduit B, Rodriguez-Falces J, Duchateau J, Maffiuletti NA, Place N. Short vs. long pulses for testing knee extensor neuromuscular properties: does it matter? Eur J Appl Physiol 2017; 118:361-369. [PMID: 29218407 DOI: 10.1007/s00421-017-3778-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 11/29/2017] [Indexed: 01/13/2023]
Abstract
PURPOSE The present study aimed at comparing knee extensor neuromuscular properties determined with transcutaneous electrical stimulation using two pulse durations before and after a standardized fatigue protocol. METHODS In the first sub-study, 19 healthy participants (ten women and nine men; 28 ± 5 years) took part to two separate testing sessions involving the characterization of voluntary activation (twitch interpolation technique), muscle contractility (evoked forces by single and paired stimuli), and neuromuscular propagation (M-wave amplitude from vastus lateralis and vastus medialis muscles) obtained at supramaximal intensity with a pulse duration of either 0.2 or 1 ms. The procedures were identical in the second sub-study (N = 11), except that neuromuscular properties were also evaluated after a standardized fatiguing exercise. Electrical stimulation was delivered through large surface electrodes positioned over the quadriceps muscle and a visual analog scale was used to evaluate the discomfort to paired stimuli evoked at rest. RESULTS There was no difference between pulse durations in the estimates of voluntary activation, neuromuscular propagation, and muscle contractility both in the non-fatigued and fatigued states. The discomfort associated with supramaximal paired electrical stimuli was also comparable between the two pulse durations. CONCLUSIONS It appears that 0.2- and 1-ms-long pulses provide a comparable evaluation of knee extensor neuromuscular properties.
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Affiliation(s)
- Caroline Giroux
- Laboratory ‛Bioingenierie, Tissus et Neuroplasticité' (EA 7377), Université Paris-Est Créteil, Créteil, France.,Laboratory Sport, Expertise and Performance (EA 7370), Research Department, French Institute of Sport (INSEP), Paris, France
| | - Boris Roduit
- Institut des Sciences du Sport de l'Université de Lausanne, Quartier UNIL-Centre, Bâtiment Synathlon, 1015, Lausanne, Switzerland
| | - Javier Rodriguez-Falces
- Department of Electrical and Electronical Engineering, Public University of Navarra, Pamplona, Spain
| | - Jacques Duchateau
- Laboratory of Applied Biology and Neurophysiology, ULB Neuroscience Institute, Université Libre de Bruxelles (ULB), Bruxelles, Belgium
| | | | - Nicolas Place
- Institut des Sciences du Sport de l'Université de Lausanne, Quartier UNIL-Centre, Bâtiment Synathlon, 1015, Lausanne, Switzerland.
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Vromans M, Faghri P. Electrical Stimulation Frequency and Skeletal Muscle Characteristics: Effects on Force and Fatigue. Eur J Transl Myol 2017; 27:6816. [PMID: 29299218 PMCID: PMC5745385 DOI: 10.4081/ejtm.2017.6816] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 10/14/2017] [Accepted: 10/14/2017] [Indexed: 12/02/2022] Open
Abstract
This investigation aimed to determine the force and muscle surface electromyography (EMG) responses to different frequencies of electrical stimulation (ES) in two groups of muscles with different size and fiber composition (fast- and slow-twitch fiber proportions) during a fatigue-inducing protocol. Progression towards fatigue was evaluated in the abductor pollicis brevis (APB) and vastus lateralis (VL) when activated by ES at three frequencies (10, 35, and 50Hz). Ten healthy adults (mean age: 23.2 ± 3.0 years) were recruited; participants signed an IRB approved consent form prior to participation. Protocols were developed to 1) identify initial ES current intensity required to generate the 25% maximal voluntary contraction (MVC) at each ES frequency and 2) evaluate changes in force and EMG activity during ES-induced contraction at each frequency while progressing towards fatigue. For both muscles, stimulation at 10Hz required higher current intensity of ES to generate the initial force. There was a significant decline in force in response to ES-induced fatigue for all frequencies and for both muscles (p<0.05). However, the EMG response was not consistent between muscles. During the progression towards fatigue, the APB displayed an initial drop in force followed by an increase in EMG activity and the VL displayed a decrease in EMG activity for all frequencies. Overall, it appeared that there were some significant interactions between muscle size and fiber composition during progression towards fatigue for different ES frequencies. It could be postulated that muscle characteristics (size and fiber composition) should be considered when evaluating progression towards fatigue as EMG and force responses are not consistent between muscles.
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Affiliation(s)
- Maria Vromans
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT, USA
| | - Pouran Faghri
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT, USA.,Department of Allied Health Sciences, Storrs, CT, USA
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Vromans M, Faghri PD. Functional electrical stimulation-induced muscular fatigue: Effect of fiber composition and stimulation frequency on rate of fatigue development. J Electromyogr Kinesiol 2017; 38:67-72. [PMID: 29169055 DOI: 10.1016/j.jelekin.2017.11.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 11/07/2017] [Accepted: 11/09/2017] [Indexed: 01/23/2023] Open
Abstract
This investigation evaluated the progression towards fatigue in two muscles of differing fast- and slow-twitch fiber proportions (abductor pollicis brevis (APB) and vastus lateralis (VL)) when activated by functional electrical stimulation (FES) at three frequencies (10, 35, and 50 Hz). Fatigue was defined as a 50% drop from the initial FES-induced force of 25% maximal voluntary contraction (MVC). Ten healthy adults (mean age: 23.2 ± 3.0 years) were recruited; participants signed an IRB approved consent form prior to participation. Protocols were developed to evaluate the effects of muscle size, fiber type and FES frequency on total time to fatigue. Results indicated that the predominantly fast-twitch VL fatigued more quickly than the slow-twitch APB at the higher frequencies (p < 0.05), but did not significantly differ with stimulation at 10 Hz. Overall, muscle size and FES frequencies showed some significant interactions when generating a defined force and during fatigue development. Furthermore, it appears that to reduce fatigue, FES treatments should not extend past ∼14-16 min for large and small muscle groups, respectively, when the muscle group's optimal stimulation frequency is applied.
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Affiliation(s)
- Maria Vromans
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT, USA
| | - Pouran D Faghri
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT, USA; Department of Allied Health Sciences, Storrs, CT, USA.
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Laubacher M, Aksöz AE, Riener R, Binder-Macleod S, Hunt KJ. Power output and fatigue properties using spatially distributed sequential stimulation in a dynamic knee extension task. Eur J Appl Physiol 2017; 117:1787-1798. [PMID: 28674921 PMCID: PMC5556133 DOI: 10.1007/s00421-017-3675-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 06/28/2017] [Indexed: 11/06/2022]
Abstract
PURPOSE The low power output and fatigue resistance during functional electrical stimulation (FES) limits its use for functional applications. The aim of this study was to compare the power output and fatigue properties of spatially distributed sequential stimulation (SDSS) against conventional single electrode stimulation (SES) in an isokinetic knee extension task simulating knee movement during recumbent cycling. METHODS M. vastus lateralis and m. vastus medialis of eight able-bodied subjects were stimulated for 6 min on both legs with both setups. In the SES setup, target muscles were each stimulated by a pair of electrodes. In SDSS, four small electrodes replaced the SES active electrodes, but reference electrodes were the same. Torque was measured during knee extension movement by a dynamometer at an angular velocity of 110°/s. Mean power (P mean) was calculated from stimulated extensions for the first 10 extensions, the final 20 extensions and overall. Fatigue is presented as an index, calculated as the decrease with respect to initial power. RESULTS P mean was significantly higher for SDSS than for SES in the final phase (9.9 ± 4.0 vs. 7.4 ± 4.3 W, p = 0.035) and overall (11.5 ± 4.0 vs. 9.2 ± 4.5 W, p = 0.037). With SDSS, the reduction in P mean was significantly smaller compared to SES (from 14.9 to 9.9 vs. 14.6 to 7.4 W, p = 0.024). The absolute mean pulse width was substantially lower with SDSS (62.5 vs. 90.0 µs). CONCLUSION Although less stimulation was applied, SDSS showed a significantly higher mean power output than SES. SDSS also had improved fatigue resistance when compared to conventional stimulation. The SDSS approach may provide substantial performance benefits for cyclical FES applications.
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Affiliation(s)
- Marco Laubacher
- Division of Mechanical Engineering, Department of Engineering and Information Technology, Institute for Rehabilitation and Performance Technology, Bern University of Applied Sciences, 3400, Burgdorf, Switzerland.
- Sensory Motor Systems Laboratory, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.
| | - Anil Efe Aksöz
- Division of Mechanical Engineering, Department of Engineering and Information Technology, Institute for Rehabilitation and Performance Technology, Bern University of Applied Sciences, 3400, Burgdorf, Switzerland
- Sensory Motor Systems Laboratory, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Robert Riener
- Sensory Motor Systems Laboratory, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | | | - Kenneth J Hunt
- Division of Mechanical Engineering, Department of Engineering and Information Technology, Institute for Rehabilitation and Performance Technology, Bern University of Applied Sciences, 3400, Burgdorf, Switzerland
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Kilohertz and Low-Frequency Electrical Stimulation With the Same Pulse Duration Have Similar Efficiency for Inducing Isometric Knee Extension Torque and Discomfort. Am J Phys Med Rehabil 2017; 96:388-394. [PMID: 27680427 DOI: 10.1097/phm.0000000000000631] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To test the hypotheses that, as compared with pulsed current with the same pulse duration, kilohertz frequency alternating current would not differ in terms of evoked-torque production and perceived discomfort, and as a result, it would show the same current efficiency. DESIGN A repeated-measures design with 4 stimuli presented in random order was used to test 25 women: (1) 500-microsecond pulse duration, (2) 250-microsecond pulse duration, (3) 500-microsecond pulse duration and low carrier frequency (1 kHz), (4) 250-microsecond pulse duration and high carrier frequency (4 kHz). Isometric peak torque of quadriceps muscle was measured using an isokinetic dynamometer. Discomfort was measured using a visual analog scale. RESULTS Currents with long pulse durations induced approximately 21% higher evoked torque than short pulse durations. In addition, currents with 500 microseconds delivered greater amounts of charge than stimulation patterns using 250-microsecond pulse durations (P < 0.05). All currents presented similar discomfort. There was no difference on stimulation efficiency with the same pulse duration. CONCLUSIONS Both kilohertz frequency alternating current and pulsed current, with the same pulse duration, have similar efficiency for inducing isometric knee extension torque and discomfort. However, neuromuscular electrical stimulation (NMES) with longer pulse duration induces higher NMES-evoked torque, regardless of the carrier frequency. Pulse duration is an important variable that should receive more attention for an optimal application of NMES in clinical settings.
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Springer S, Shapiro M. Effects of amplitude and phase-duration modification on electrically induced contraction force and discomfort. Technol Health Care 2017; 25:625-634. [DOI: 10.3233/thc-160733] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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GROSPRÊTRE SIDNEY, GUEUGNEAU NICOLAS, MARTIN ALAIN, LEPERS ROMUALD. Central Contribution to Electrically Induced Fatigue depends on Stimulation Frequency. Med Sci Sports Exerc 2017; 49:1530-1540. [DOI: 10.1249/mss.0000000000001270] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
Determining volitional activation (VA) can provide insights on the cause of muscle weakness in orthopedic and neurological populations. Two electrical stimulation techniques are traditionally used to quantify VA: interpolation (IT) and superimposition (CAR). IT allows for a more accurate VA estimation, however it requires individuals to be stimulated twice, compared to once for CAR, and thus increases stimulation associated discomfort. To date, there is no agreement on what is the best practical technique for calculating quadriceps VA. This paper aims to address this problem by determining what reference force (i.e., using either peak force or force at the time of stimulation) and type of stimulation (train of pulses (burst), doublet, and twitch) is the best technique to use. Our findings showed that the IT with the force at the time of stimulation as a reference should be used to determine VA and that when a burst was used, the VA ratio computations were more accurate. Additionally, using a twitch with a 2ms pulse duration produced reliable VA calculations and may be an acceptable alternative for pain-sensitive subjects. Accurate assessment of VA deficits can help clinicians design rehabilitation programs that are based on subject-specific strength impairments and are more effective.
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Bergquist AJ, Wiest MJ, Okuma Y, Collins DF. Interleaved neuromuscular electrical stimulation after spinal cord injury. Muscle Nerve 2017; 56:989-993. [PMID: 28245521 DOI: 10.1002/mus.25634] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2017] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Neuromuscular electrical stimulation (NMES) over a muscle belly (mNMES) recruits superficial motor units (MUs) preferentially, whereas NMES over a nerve trunk (nNMES) recruits MUs evenly throughout the muscle. We performed tests to determine whether "interleaving" pulses between the mNMES and nNMES sites (iNMES) reduces the fatigability of contractions for people experiencing paralysis because of chronic spinal cord injury. METHODS Plantar flexion torque and soleus electromyography (M-waves) were recorded from 8 participants. A fatigue protocol (75 contractions; 2 s on/2 s off for 5 min) was delivered by iNMES. The results were compared with previously published data collected with mNMES and nNMES in the same 8 participants. RESULTS Torque declined ∼40% more during mNMES than during nNMES or iNMES. M-waves declined during mNMES but not during nNMES or iNMES. DISCUSSION To reduce fatigability of electrically evoked contractions of paralyzed plantar flexors, iNMES is equivalent to nNMES, and both are superior to mNMES. Muscle Nerve 56: 989-993, 2017.
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Affiliation(s)
- Austin J Bergquist
- Rehabilitation Engineering Laboratory, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Matheus J Wiest
- Human Neurophysiology Laboratory, Faculty of Physical Education and Recreation, E-488 Van Vliet Centre, University of Alberta, Edmonton, Alberta, Canada, T6G 2H9
| | - Yoshino Okuma
- Human Neurophysiology Laboratory, Faculty of Physical Education and Recreation, E-488 Van Vliet Centre, University of Alberta, Edmonton, Alberta, Canada, T6G 2H9
| | - David F Collins
- Human Neurophysiology Laboratory, Faculty of Physical Education and Recreation, E-488 Van Vliet Centre, University of Alberta, Edmonton, Alberta, Canada, T6G 2H9
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Dideriksen J, Leerskov K, Czyzewska M, Rasmussen R. Relation Between the Frequency of Short-Pulse Electrical Stimulation of Afferent Nerve Fibers and Evoked Muscle Force. IEEE Trans Biomed Eng 2017; 64:2737-2745. [PMID: 28237919 DOI: 10.1109/tbme.2017.2671853] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Objective: Functional electrical stimulation (FES) is conventionally performed by the stimulation of motor axons causing the muscle fibers innervated by these axons to contract. An alternative strategy that may evoke contractions with more natural motor unit behavior is to stimulate afferent fibers (primarily type Ia) to excite the motor neurons at the spinal level. The aim of the study was to investigate the range of forces that can be evoked in this way and the degree to which the torque can be controlled. Methods: We stimulated the tibial nerve of ten healthy participants at amplitudes at which the highest H-reflex with minimal M-wave was present. The evoked plantar flexion torque was recorded following short stimulation pulses (0.4 ms) with frequencies ranging from 20 to 200 Hz. Results: Across all subjects, the median highest evocable torque was 38.3% (quartiles: 16.9-51.0) of the maximum voluntary contraction torque (MVC). The average torque variability (standard deviation) was 1.7 +/- 0.7% MVC. For most subjects, the relation between stimulation frequency and evoked torque was well characterized by sigmoidal curves (median root mean square error: 6.4% MVC). The plateau of this sigmoid curve (indicating the range of frequencies over which torque amplitude could be modulated) was reached at 56.0 (quartiles: 29.4-81.9) Hz. Conclusion: Using the proposed method for FES, substantial evoked torques that could be controlled by stimulation frequency were achieved. Significance: Stimulation of afferent fibers could be a useful and fatigue-resistant strategy for several applications of FES.Objective: Functional electrical stimulation (FES) is conventionally performed by the stimulation of motor axons causing the muscle fibers innervated by these axons to contract. An alternative strategy that may evoke contractions with more natural motor unit behavior is to stimulate afferent fibers (primarily type Ia) to excite the motor neurons at the spinal level. The aim of the study was to investigate the range of forces that can be evoked in this way and the degree to which the torque can be controlled. Methods: We stimulated the tibial nerve of ten healthy participants at amplitudes at which the highest H-reflex with minimal M-wave was present. The evoked plantar flexion torque was recorded following short stimulation pulses (0.4 ms) with frequencies ranging from 20 to 200 Hz. Results: Across all subjects, the median highest evocable torque was 38.3% (quartiles: 16.9-51.0) of the maximum voluntary contraction torque (MVC). The average torque variability (standard deviation) was 1.7 +/- 0.7% MVC. For most subjects, the relation between stimulation frequency and evoked torque was well characterized by sigmoidal curves (median root mean square error: 6.4% MVC). The plateau of this sigmoid curve (indicating the range of frequencies over which torque amplitude could be modulated) was reached at 56.0 (quartiles: 29.4-81.9) Hz. Conclusion: Using the proposed method for FES, substantial evoked torques that could be controlled by stimulation frequency were achieved. Significance: Stimulation of afferent fibers could be a useful and fatigue-resistant strategy for several applications of FES.
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Affiliation(s)
- Jakob Dideriksen
- Sensory-Motor Interaction, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Kasper Leerskov
- Sensory-Motor Interaction, Department of Health Science and TechnologyAalborg University
| | - Magdalena Czyzewska
- Sensory-Motor Interaction, Department of Health Science and TechnologyAalborg University
| | - Rune Rasmussen
- Sensory-Motor Interaction, Department of Health Science and TechnologyAalborg University
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Wiest MJ, Bergquist AJ, Schimidt HL, Jones KE, Collins DF. Interleaved neuromuscular electrical stimulation: Motor unit recruitment overlap. Muscle Nerve 2017; 55:490-499. [PMID: 27422814 DOI: 10.1002/mus.25249] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 07/05/2016] [Accepted: 07/13/2016] [Indexed: 11/12/2022]
Abstract
INTRODUCTION In this study, we quantified the "overlap" between motor units recruited by single pulses of neuromuscular electrical stimulation (NMES) delivered over the tibialis anterior muscle (mNMES) and the common peroneal nerve (nNMES). We then quantified the torque produced when pulses were alternated between the mNMES and nNMES sites at 40 Hz ("interleaved" NMES; iNMES). METHODS Overlap was assessed by comparing torque produced by twitches evoked by mNMES, nNMES, and both delivered together, over a range of stimulus intensities. Trains of iNMES were delivered at the intensity that produced the lowest overlap. RESULTS Overlap was lowest (5%) when twitches evoked by both mNMES and nNMES produced 10% peak twitch torque. iNMES delivered at this intensity generated 25% of maximal voluntary dorsiflexion torque (11 Nm). DISCUSSION Low intensity iNMES leads to low overlap and produces torque that is functionally relevant to evoke dorsiflexion during walking. Muscle Nerve 55: 490-499, 2017.
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Affiliation(s)
- Matheus J Wiest
- Laboratory of Neurophysiology, Faculty of Physical Education and Recreation, 4-218 Van Vliet Complex, University of Alberta, Edmonton, Canada, T6G 2H9
| | - Austin J Bergquist
- Rehabilitation Engineering Laboratory, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Helen L Schimidt
- Laboratory of Neurophysiology, Faculty of Physical Education and Recreation, 4-218 Van Vliet Complex, University of Alberta, Edmonton, Canada, T6G 2H9.,Applied Neuromechanics Research Group, Neuromechanics Laboratory, Universidade Federal do Pampa, Uruguaiana, Brazil
| | - Kelvin E Jones
- Laboratory of Neurophysiology, Faculty of Physical Education and Recreation, 4-218 Van Vliet Complex, University of Alberta, Edmonton, Canada, T6G 2H9
| | - David F Collins
- Laboratory of Neurophysiology, Faculty of Physical Education and Recreation, 4-218 Van Vliet Complex, University of Alberta, Edmonton, Canada, T6G 2H9
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Brüggemann AK, Mello CL, Dal Pont T, Hizume Kunzler D, Martins DF, Bobinski F, Pereira Yamaguti W, Paulin E. Effects of Neuromuscular Electrical Stimulation During Hemodialysis on Peripheral Muscle Strength and Exercise Capacity: A Randomized Clinical Trial. Arch Phys Med Rehabil 2017; 98:822-831.e1. [PMID: 28093194 DOI: 10.1016/j.apmr.2016.12.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 12/13/2016] [Accepted: 12/15/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate the effects of neuromuscular electrical stimulation of high and low frequency and intensity, performed during hemodialysis, on physical function and inflammation markers in patients with chronic kidney disease (CKD). DESIGN Randomized clinical trial. SETTING Hemodialysis clinic. PARTICIPANTS Patients with CKD (N=51) were randomized into blocks of 4 using opaque sealed envelopes. They were divided into a group of high frequency and intensity neuromuscular electrical stimulation and a group of low frequency and intensity neuromuscular electrical stimulation. INTERVENTIONS The high frequency and intensity neuromuscular electrical stimulation group was submitted to neuromuscular electrical stimulation at a frequency of 50Hz and a medium intensity of 72.90mA, and the low frequency and intensity neuromuscular electrical stimulation group used a frequency of 5Hz and a medium intensity of 13.85mA, 3 times per week for 1 hour, during 12 sessions. MAIN OUTCOME MEASURES Peripheral muscle strength, exercise capacity, levels of muscle trophism marker (insulin growth factor 1) and levels of proinflammatory (tumor necrosis factor α) and anti-inflammatory (interleukin 10) cytokines. RESULTS The high frequency and intensity neuromuscular electrical stimulation group showed a significant increase in right peripheral muscle strength (155.35±65.32Nm initial vs 161.60±68.73Nm final; P=.01) and left peripheral muscle strength (156.60±66.51Nm initial vs 164.10±69.76Nm final; P=.02) after the training, which did not occur in the low frequency and intensity neuromuscular electrical stimulation group for both right muscle strength (109.40±32.08Nm initial vs 112.65±38.44Nm final; P=.50) and left muscle strength (113.65±37.79Nm initial vs 116.15±43.01Nm final; P=.61). The 6-minute walk test distance (6MWTD) increased in both groups: high frequency and intensity neuromuscular electrical stimulation group (435.55±95.81m initial vs 457.25±90.64m final; P=.02) and low frequency and intensity neuromuscular electrical stimulation group (403.80±90.56m initial vs 428.90±87.42m final; P=.007). The groups did not differ in peripheral muscle strength and 6MWTD after the training protocol. In the high frequency and intensity neuromuscular electrical stimulation group, a correlation was observed between the initial and final values of 6MWTD and muscle strength. In the low frequency and intensity neuromuscular electrical stimulation group, correlations occurred only between the 6MWTD and the initial muscle strength. Only the low frequency and intensity neuromuscular electrical stimulation group increased levels of insulin growth factor 1 (252.38±156.35pg/mL initial vs 336.97±207.34pg/mL final; P=.03), and only the high frequency and intensity neuromuscular electrical stimulation group reduced levels of interleukin 10 (7.26±1.81pg/mL vs 6.32±1.54pg/mL; P=.03). The groups showed no differences in tumor necrosis factor α levels. CONCLUSIONS Patients with CKD on hemodialysis improve exercise capacity after peripheral neuromuscular electrical stimulation of high and low frequency and intensity. However, the benefits on muscle and inflammatory outcomes seem to be specific for the adopted electrical stimulation strategy.
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Affiliation(s)
| | | | - Tarcila Dal Pont
- Santa Catarina State University - UDESC, Florianopolis, SC, Brazil
| | - Deborah Hizume Kunzler
- Santa Catarina State University - UDESC, Florianopolis, SC, Brazil; University of São Paulo, São Paulo, SP, Brazil
| | - Daniel Fernandes Martins
- Federal University of Santa Catarina, Florianopolis, SC, Brazil; University of Southern Santa Catarina - UNISUL, Florianopolis, SC, Brazil
| | - Franciane Bobinski
- Santa Catarina State University - UDESC, Florianopolis, SC, Brazil; Federal University of Santa Catarina, Florianopolis, SC, Brazil
| | | | - Elaine Paulin
- Santa Catarina State University - UDESC, Florianopolis, SC, Brazil; University of São Paulo, São Paulo, SP, Brazil.
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Lou JWH, Bergquist AJ, Aldayel A, Czitron J, Collins DF. Interleaved neuromuscular electrical stimulation reduces muscle fatigue. Muscle Nerve 2016; 55:179-189. [PMID: 27313001 DOI: 10.1002/mus.25224] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 06/06/2016] [Accepted: 06/15/2016] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Neuromuscular electrical stimulation (NMES) can be delivered over a muscle belly (mNMES) or nerve trunk (nNMES). Both methods generate contractions that fatigue rapidly due, in part, to non-physiologically high motor unit (MU) discharge frequencies. In this study we introduce interleaved NMES (iNMES), whereby stimulus pulses are alternated between mNMES and nNMES. iNMES was developed to recruit different MU populations with every other stimulus pulse, with a goal of reducing discharge frequencies and muscle fatigue. METHODS Torque and electromyography were recorded during fatigue protocols (12 min, 240 contractions) delivered using mNMES, nNMES, and iNMES. RESULTS Torque declined significantly 3 min into iNMES and 1 min into both mNMES and nNMES. Torque decreased by 39% during iNMES and by 67% and 58% during mNMES and nNMES, respectively. CONCLUSIONS iNMES resulted in less muscle fatigue than mNMES and nNMES. Delivering NMES in ways that reduce MU discharge frequencies holds promise for reducing muscle fatigue during NMES-based rehabilitation. Muscle Nerve, 2016 Muscle Nerve 55: 179-189, 2017.
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Affiliation(s)
- Jenny W H Lou
- Human Neurophysiology Laboratory, Faculty of Physical Education and Recreation, University of Alberta, E-488 Van Vliet Centre, Edmonton, Alberta, T6G 2H9, Canada
| | - Austin J Bergquist
- Rehabilitation Engineering Laboratory, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Abdulaziz Aldayel
- Department of Exercise Physiology, College of Sport Science and Physical Activity, King Saud University, Riyadh, Saudi Arabia
| | - Jennifer Czitron
- Human Neurophysiology Laboratory, Faculty of Physical Education and Recreation, University of Alberta, E-488 Van Vliet Centre, Edmonton, Alberta, T6G 2H9, Canada
| | - David F Collins
- Human Neurophysiology Laboratory, Faculty of Physical Education and Recreation, University of Alberta, E-488 Van Vliet Centre, Edmonton, Alberta, T6G 2H9, Canada
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50
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Glaviano NR, Saliba S. Can the Use of Neuromuscular Electrical Stimulation Be Improved to Optimize Quadriceps Strengthening? Sports Health 2016; 8:79-85. [PMID: 26582349 PMCID: PMC4702160 DOI: 10.1177/1941738115618174] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
CONTEXT Neuromuscular electrical stimulation (NMES) is a common modality used to retrain muscles and improve muscular strength after injury or surgery, particularly for the quadriceps muscle. There are parameter adjustments that can be made to maximize the effectiveness of NMES. While NMES is often used in clinical practice, there are some limitations that clinicians should be aware of, including patient discomfort, muscle fatigue, and muscle damage. EVIDENCE ACQUISITION PubMed was searched through August 2014 and all articles cross-referenced. STUDY DESIGN Clinical review. LEVEL OF EVIDENCE Level 3. RESULTS Clinicians can optimize torque production and decrease discomfort by altering parameter selection (pulse duration, pulse frequency, duty cycle, and amplitude). Pulse duration of 400 to 600 μs and a pulse frequency of 30 to 50 Hz appear to be the most effective parameters to optimize torque output while minimizing discomfort, muscle fatigue, or muscle damage. Optimal electrode placement, conditioning programs, and stimulus pattern modulation during long-term NMES use may improve results. CONCLUSION Torque production can be enhanced while decreasing patient discomfort and minimizing fatigue.
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Affiliation(s)
- Neal R. Glaviano
- Department of Kinesiology, Exercise and Sport Injury Laboratory, University of Virginia, Charlottesville, Virginia
- Neal R. Glaviano, MEd, ATC, Exercise and Sport Injury Laboratory, University of Virginia, Memorial Gymnasium, PO Box 400407, Charlottesville, VA 22904 ()
| | - Susan Saliba
- Curry School of Education, Department of Kinesiology, University of Virginia, Charlottesville, Virginia
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