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Kanona H, Saeed SR, Randhawa P, Kimber R, Rodger A, Khalil S, Andrews P. Evaluation of the Patient with Facial Palsy: A Multidisciplinary Approach. Facial Plast Surg 2024; 40:400-406. [PMID: 38301715 DOI: 10.1055/s-0044-1779046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
This article aims to provide an overview of the management of facial palsy within a multidisciplinary team setting and discusses considerations used to develop patient-specific management plans. The national landscape of facial function services is also discussed including suggestions on what may enable a more equitable and sustainable service for the future.
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Affiliation(s)
- Hala Kanona
- The Royal National ENT Hospital, University College London Hospitals, London, United Kingdom
| | - Shakeel R Saeed
- The Royal National ENT Hospital, University College London Hospitals, London, United Kingdom
- The Royal National ENT Hospital and National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, United Kingdom
| | - Premjit Randhawa
- The Royal National ENT Hospital, University College London Hospitals, London, United Kingdom
| | - Rebecca Kimber
- The Royal National ENT Hospital and National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, United Kingdom
| | - Anne Rodger
- The Royal National ENT Hospital and National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, United Kingdom
| | - Sherif Khalil
- The Royal National ENT Hospital, University College London Hospitals, London, United Kingdom
- The Royal National ENT Hospital and National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, United Kingdom
| | - Peter Andrews
- The Royal National ENT Hospital, University College London Hospitals, London, United Kingdom
- The Royal National ENT Hospital and National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, United Kingdom
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2
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Bazarek SF, Krenn MJ, Shah SB, Mandeville RM, Brown JM. Novel Technologies to Address the Lower Motor Neuron Injury and Augment Reconstruction in Spinal Cord Injury. Cells 2024; 13:1231. [PMID: 39056812 PMCID: PMC11274462 DOI: 10.3390/cells13141231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 07/11/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024] Open
Abstract
Lower motor neuron (LMN) damage results in denervation of the associated muscle targets and is a significant yet under-appreciated component of spinal cord injury (SCI). Denervated muscle undergoes a progressive degeneration and fibro-fatty infiltration that eventually renders the muscle non-viable unless reinnervated within a limited time window. The distal nerve deprived of axons also undergoes degeneration and fibrosis making it less receptive to axons. In this review, we describe the LMN injury associated with SCI and its clinical consequences. The process of degeneration of the muscle and nerve is broken down into the primary components of the neuromuscular circuit and reviewed, including the nerve and Schwann cells, the neuromuscular junction, and the muscle. Finally, we discuss three promising strategies to reverse denervation atrophy. These include providing surrogate axons from local sources; introducing stem cell-derived spinal motor neurons into the nerve to provide the missing axons; and finally, instituting a training program of high-energy electrical stimulation to directly rehabilitate these muscles. Successful interventions for denervation atrophy would significantly expand reconstructive options for cervical SCI and could be transformative for the predominantly LMN injuries of the conus medullaris and cauda equina.
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Affiliation(s)
- Stanley F. Bazarek
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA; (S.F.B.); (M.J.K.); (R.M.M.)
- Department of Neurological Surgery, University Hospitals-Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Matthias J. Krenn
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA; (S.F.B.); (M.J.K.); (R.M.M.)
- Department of Neurosurgery, University of Mississippi Medical Center, Jackson, MS 39216, USA
- Center for Neuroscience and Neurological Recovery, Methodist Rehabilitation Center, Jackson, MS 39216, USA
- Spinal Cord Injury Medicine and Research Services, VA Medical Center, Jackson, MS 39216, USA
| | - Sameer B. Shah
- Departments of Orthopedic Surgery and Bioengineering, University of California-San Diego, La Jolla, CA 92093, USA;
- Research Division, VA San Diego Medical Center, San Diego, CA 92161, USA
| | - Ross M. Mandeville
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA; (S.F.B.); (M.J.K.); (R.M.M.)
| | - Justin M. Brown
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA; (S.F.B.); (M.J.K.); (R.M.M.)
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Lysak A, Farnebo S, Geuna S, Dahlin LB. Muscle preservation in proximal nerve injuries: a current update. J Hand Surg Eur Vol 2024; 49:773-782. [PMID: 38819009 DOI: 10.1177/17531934231216646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Optimal recovery of muscle function after proximal nerve injuries remains a complex and challenging problem. After a nerve injury, alterations in the affected muscles lead to atrophy, and later degeneration and replacement by fat-fibrous tissues. At present, several different strategies for the preservation of skeletal muscle have been reported, including various sets of physical exercises, muscle massage, physical methods (e.g. electrical stimulation, magnetic field and laser stimulation, low-intensity pulsed ultrasound), medicines (e.g. nutrients, natural and chemical agents, anti-inflammatory and antioxidants, hormones, enzymes and enzyme inhibitors), regenerative medicine (e.g. growth factors, stem cells and microbiota) and surgical procedures (e.g. supercharge end-to-side neurotization). The present review will focus on methods that aimed to minimize the damage to muscles after denervation based on our present knowledge.
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Affiliation(s)
- Andrii Lysak
- Institute of Traumatology and Orthopedics of National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
| | - Simon Farnebo
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Hand Surgery, Plastic Surgery and Burns, Linköping University Hospital, Linköping, Sweden
| | - Stefano Geuna
- Department of Clinical and Biological Sciences; Neuroscience Institute Cavalieri Ottolenghi, University of Torino, Torino, Italy
| | - Lars B Dahlin
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Translational Medicine - Hand Surgery, Lund University, Malmö, Sweden
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
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4
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Walluks K, Praetorius JP, Arnold D, Figge MT. Impact of functional electrical stimulation on nerve-damaged muscles by quantifying fat infiltration using deep learning. Sci Rep 2024; 14:12158. [PMID: 38802457 PMCID: PMC11130129 DOI: 10.1038/s41598-024-62805-6] [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: 12/04/2023] [Accepted: 05/21/2024] [Indexed: 05/29/2024] Open
Abstract
Quantitative imaging in life sciences has evolved into a powerful approach combining advanced microscopy acquisition and automated analysis of image data. The focus of the present study is on the imaging-based evaluation of the posterior cricoarytenoid muscle (PCA) influenced by long-term functional electrical stimulation (FES), which may assist the inspiration of patients with bilateral vocal fold paresis. To this end, muscle cross-sections of the PCA of sheep were examined by quantitative image analysis. Previous investigations of the muscle fibers and the collagen amount have not revealed signs of atrophy and fibrosis due to FES by a laryngeal pacemaker. It was therefore hypothesized that regardless of the stimulation parameters the fat in the muscle cross-sections would not be significantly altered. We here extending our previous investigations using quantitative imaging of intramuscular fat in cross-sections. In order to perform this analysis both reliably and faster than a qualitative evaluation and time-consuming manual annotation, the selection of the automated method was of crucial importance. To this end, our recently established deep neural network IMFSegNet, which provides more accurate results compared to standard machine learning approaches, was applied to more than 300 H&E stained muscle cross-sections from 22 sheep. It was found that there were no significant differences in the amount of intramuscular fat between the PCA with and without long-term FES, nor were any significant differences found between the low and high duty cycle stimulated groups. This study on a human-like animal model not only confirms the hypothesis that FES with the selected parameters has no negative impact on the PCA, but also demonstrates that objective and automated deep learning-based quantitative imaging is a powerful tool for such a challenging analysis.
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Affiliation(s)
- Kassandra Walluks
- Applied Systems Biology, Leibniz Institute for Natural Product Research and Infection Biology, Hans Knöll Institute, Jena, Germany
- Faculty of Biological Sciences, Friedrich Schiller University Jena, Jena, Germany
- Institute of Zoology and Evolutionary Research, Faculty of Biological Sciences, Friedrich Schiller University Jena, Jena, Germany
| | - Jan-Philipp Praetorius
- Applied Systems Biology, Leibniz Institute for Natural Product Research and Infection Biology, Hans Knöll Institute, Jena, Germany
- Faculty of Biological Sciences, Friedrich Schiller University Jena, Jena, Germany
| | - Dirk Arnold
- Clinic and Polyclinic for Otorhinolaryngology, University Hospital Jena, Jena, Germany.
| | - Marc Thilo Figge
- Applied Systems Biology, Leibniz Institute for Natural Product Research and Infection Biology, Hans Knöll Institute, Jena, Germany.
- Institute of Microbiology, Faculty of Biological Sciences, Friedrich Schiller University Jena, Jena, Germany.
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5
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Walluks K, Hoffmann B, Svensson CM, Förster G, Müller AH, Jarvis J, Perkins J, Figge MT, Arnold D. Long-term stimulation by implanted pacemaker enables non-atrophic treatment of bilateral vocal fold paresis in a human-like animal model. Sci Rep 2024; 14:10440. [PMID: 38714750 PMCID: PMC11076618 DOI: 10.1038/s41598-024-60875-0] [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: 12/01/2023] [Accepted: 04/29/2024] [Indexed: 05/10/2024] Open
Abstract
A wide variety of treatments have been developed to improve respiratory function and quality of life in patients with bilateral vocal fold paresis (BVFP). One experimental method is the electrical activation of the posterior cricoarytenoid (PCA) muscle with a laryngeal pacemaker (LP) to open the vocal folds. We used an ovine (sheep) model of unilateral VFP to study the long-term effects of functional electrical stimulation on the PCA muscles. The left recurrent laryngeal nerve was cryo-damaged in all animals and an LP was implanted except for the controls. After a reinnervation phase of six months, animals were pooled into groups that received either no treatment, implantation of an LP only, or implantation of an LP and six months of stimulation with different duty cycles. Automated image analysis of fluorescently stained PCA cross-sections was performed to assess relevant muscle characteristics. We observed a fast-to-slow fibre type shift in response to nerve damage and stimulation, but no complete conversion to a slow-twitch-muscle. Fibre size, proportion of hybrid fibres, and intramuscular collagen content were not substantially altered by the stimulation. These results demonstrate that 30 Hz burst stimulation with duty cycles of 40% and 70% did not induce PCA atrophy or fibrosis. Thus, long-term stimulation with an LP is a promising approach for treating BVFP in humans without compromising muscle conditions.
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Affiliation(s)
- Kassandra Walluks
- Applied Systems Biology, Leibniz Institute for Natural Product Research and Infection Biology-Hans Knöll Institute, Jena, Germany
- Faculty of Biological Sciences, Friedrich Schiller University Jena, Jena, Germany
- Institute of Zoology and Evolutionary Research, Faculty of Biological Sciences, Friedrich Schiller University Jena, Jena, Germany
| | - Bianca Hoffmann
- Applied Systems Biology, Leibniz Institute for Natural Product Research and Infection Biology-Hans Knöll Institute, Jena, Germany
| | - Carl-Magnus Svensson
- Applied Systems Biology, Leibniz Institute for Natural Product Research and Infection Biology-Hans Knöll Institute, Jena, Germany
| | - Gerhard Förster
- Clinic for Otorhinolaryngology/Plastic Surgery, Wald-Klinikum Gera, Gera, Germany
| | - Andreas H Müller
- Clinic for Otorhinolaryngology/Plastic Surgery, Wald-Klinikum Gera, Gera, Germany
| | - Jonathan Jarvis
- Faculty of Science, Sport and Exercise Sciences, John Moores University, Liverpool, UK
| | | | - Marc Thilo Figge
- Applied Systems Biology, Leibniz Institute for Natural Product Research and Infection Biology-Hans Knöll Institute, Jena, Germany.
- Institute of Microbiology, Faculty of Biological Sciences, Friedrich Schiller University Jena, Jena, Germany.
| | - Dirk Arnold
- Clinic and Polyclinic for Otorhinolaryngology, University Hospital Jena, Jena, Germany.
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Praetorius JP, Walluks K, Svensson CM, Arnold D, Figge MT. IMFSegNet: Cost-effective and objective quantification of intramuscular fat in histological sections by deep learning. Comput Struct Biotechnol J 2023; 21:3696-3704. [PMID: 37560127 PMCID: PMC10407270 DOI: 10.1016/j.csbj.2023.07.031] [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: 04/14/2023] [Revised: 07/21/2023] [Accepted: 07/22/2023] [Indexed: 08/11/2023] Open
Abstract
The assessment of muscle condition is of great importance in various research areas. In particular, evaluating the degree of intramuscular fat (IMF) in tissue sections is a challenging task, which today is still mostly performed qualitatively or quantitatively by a highly subjective and error-prone manual analysis. We here realize the mission to make automated IMF analysis possible that (i) minimizes subjectivity, (ii) provides accurate and quantitative results quickly, and (iii) is cost-effective using standard hematoxylin and eosin (H&E) stained tissue sections. To address all these needs in a deep learning approach, we utilized the convolutional encoder-decoder network SegNet to train the specialized network IMFSegNet allowing to accurately quantify the spatial distribution of IMF in histological sections. Our fully automated analysis was validated on 17 H&E-stained muscle sections from individual sheep and compared to various state-of-the-art approaches. Not only does IMFSegNet outperform all other approaches, but this neural network also provides fully automated and highly accurate results utilizing the most cost-effective procedures of sample preparation and imaging. Furthermore, we shed light on the opacity of black-box approaches such as neural networks by applying an explainable artificial intelligence technique to clarify that the success of IMFSegNet actually lies in identifying the hard-to-detect IMF structures. Embedded in our open-source visual programming language JIPipe that does not require programming skills, it can be expected that IMFSegNet advances muscle condition assessment in basic research across multiple areas as well as in research fields focusing on translational clinical applications.
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Affiliation(s)
- Jan-Philipp Praetorius
- Applied Systems Biology, Leibniz institute for natural Product Research and infection Biology – Hans Knöll institute (HKI), Jena, Germany
- Faculty of Biological Sciences, Friedrich Schiller University Jena, Jena, Germany
| | - Kassandra Walluks
- Applied Systems Biology, Leibniz institute for natural Product Research and infection Biology – Hans Knöll institute (HKI), Jena, Germany
- Faculty of Biological Sciences, Friedrich Schiller University Jena, Jena, Germany
- Institute of Zoology and Evolutionary Research, Faculty of Biological Sciences, Friedrich Schiller University Jena, Jena, Germany
| | - Carl-Magnus Svensson
- Applied Systems Biology, Leibniz institute for natural Product Research and infection Biology – Hans Knöll institute (HKI), Jena, Germany
| | - Dirk Arnold
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany
- Facial-Nerve-Center Jena, Jena University Hospital, Jena, Germany
| | - Marc Thilo Figge
- Applied Systems Biology, Leibniz institute for natural Product Research and infection Biology – Hans Knöll institute (HKI), Jena, Germany
- Institute of Microbiology, Faculty of Biological Sciences, Friedrich Schiller University Jena, Jena, Germany
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7
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Electrical stimulation alters muscle morphological properties in denervated upper limb muscles. EBioMedicine 2021; 74:103737. [PMID: 34896792 PMCID: PMC8671101 DOI: 10.1016/j.ebiom.2021.103737] [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] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 11/22/2022] Open
Abstract
Background Damage to lower motor neuron causes denervation and degeneration of the muscles affected. Experimental and clinical studies of muscle denervation in lower extremities demonstrated that direct electrical stimulation (ES) of muscle can prevent denervation atrophy and restore contractility. The aim of this study was to identify possible myogenic effect of ES on denervated forearm and hand muscles in persons with spinal cord injury (SCI) and tetraplegia. Methods This prospective interventional study with repeated measurement design included 22 patients aged 48·6 (± 15·7), 0·25 (0·1/46) years after spinal cord lesion, AIS A-D. In each patient, two electrophysiologically-confirmed denervated muscles in the hand and forearm were analyzed – one extrinsic (Extensor Carpi Ulnaris - ECU) and one intrinsic (1st Dorsal Interosseus - IOD1). Muscles were stimulated for 33 min, five times per week over a 12-weeks period. Using ultrasonography (USG), muscle thickness (MT) and pennation angle (PA) of these muscles were determined at start and end of the stimulation period. Findings MT of IOD1 increased from 6·3 mm (± 3·2 mm) to 9·2 mm (± 2·4 mm) (p = 0·004) and the PA from 5·5° (± 3·0°) to 11° (± 2·2°) (p = 0·001). The corresponding values for the ECU were 5·5 mm (± 2·5 mm) to 7·0 mm (± 2·2 mm) (p = 0·039) and 5·5° (± 3·4°) to 9·4° (± 3·8°) (p = 0·005), respectively. The correlation of MT between baseline and completion was r = 0·58 (p = 0·037) for the ECU and r = 0·63 (p = 0·008) for the IOD1. Interpretation 12 weeks of direct muscle stimulation increases the MT and PA of the denervated intrinsic and extrinsic hand muscles studied. Funding Swiss Paraplegic Centre, Switzerland
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MiniVStimA: A miniaturized easy to use implantable electrical stimulator for small laboratory animals. PLoS One 2020; 15:e0241638. [PMID: 33125415 PMCID: PMC7598460 DOI: 10.1371/journal.pone.0241638] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/16/2020] [Indexed: 01/17/2023] Open
Abstract
According to PubMed, roughly 10% of the annually added publications are describing findings from the small animal model (mice and rats), including investigations in the field of muscle physiology and training. A subset of this research requires neural stimulation with flexible adjustments of stimulation parameters, highlighting the need for reliable implantable electrical stimulators, small enough (~1 cm3), that even mice can tolerate them without impairing their movement. The MiniVStimA is a battery-powered implant for nerve stimulation with an outer diameter of 15 mm and an encapsulated volume of 1.2 cm3 in its smallest variation. It can be pre-programmed according to the experimental protocol and controlled after implantation with a magnet. It delivers constant current charge-balanced monophasic rectangular pulses up to 2 mA and 1 ms phase width (1 kΩ load). The circuitry is optimized for small volume and energy efficiency. Due to the variation of the internal oscillator (31 kHz ± 10%), calibration measures must be implemented during the manufacturing process, which can reduce the deviation of the frequency related parameters down to ± 1%. The expected lifetime of the smaller (larger) version is 100 (480) days for stimulation with 7 Hz all day and 10 (48) days for stimulation with 100 Hz. Devices with complex stimulation patterns for nerve stimulation have been successfully used in two in-vivo studies, lasting up to nine weeks. The implant worked fully self-contained while the animal stayed in its familiar environment. External components are not required during the entire time.
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McAvoy M, Doloff JC, Khan OF, Rosen J, Langer R, Anderson DG. Vascularized Muscle Flap to Reduce Wound Breakdown During Flexible Electrode-Mediated Functional Electrical Stimulation After Peripheral Nerve Injury. Front Neurol 2020; 11:644. [PMID: 32793094 PMCID: PMC7385241 DOI: 10.3389/fneur.2020.00644] [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: 04/08/2020] [Accepted: 05/29/2020] [Indexed: 11/15/2022] Open
Abstract
The success of devices delivering functional electrical stimulation (FES) has been hindered by complications related to implants including skin breakdown and subsequent wound dehiscence. Our hypothesis was that a vascularized muscle flap along the dorsal surface of an epimysial electrode would prevent skin breakdown during FES therapy to treat atrophy of the gastrocnemius muscle during peripheral nerve injury. Resection of a tibial nerve segment with subsequent electrode implantation on the dorsal surfaces of the gastrocnemius muscle was performed on ten Lewis rats. In five rats, the biceps femoris (BF) muscle was dissected and placed along the dorsal surface of the electrode (Flap group). The other five animals did not undergo flap placement (No Flap group). All animals were treated with daily FES therapy for 2 weeks and degree of immune response and skin breakdown were evaluated. The postoperative course of one animal in the No Flap group was complicated by complete wound dehiscence requiring euthanasia of the animal on postoperative day 4. The remaining 4 No Flap animals showed evidence of ulceration at the implant by postoperative day 7. The 5 animals in the Flap group did not have ulcerative lesions. Excised tissue at postoperative day 14 examined by histology and in vivo Imaging System (IVIS) showed decreased implant-induced inflammation in the Flap group. Expression of specific markers for local foreign body response were also decreased in the Flap group.
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Affiliation(s)
- Malia McAvoy
- Harvard-MIT Division of Health Sciences and Technology, Harvard Medical School, Massachusetts Institute of Technology, Boston, MA, United States
| | - Joshua C Doloff
- Department of Biomedical Engineering, Translational Tissue Engineering Center, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Department of Materials Science and Engineering, Institute of NanoBioTechnology, Johns Hopkins University, Baltimore, MD, United States
| | - Omar F Khan
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada.,Department of Immunology, University of Toronto, Toronto, ON, Canada
| | - Joseph Rosen
- Dartmouth-Hitchcock Medical Center, Geisel School of Medicine, Lebanon, NH, United States
| | - Robert Langer
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, United States.,Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States.,Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, United States.,Department of Biomedical and Materials Science Engineering, Translational Tissue Engineering Center, Wilmer Eye Institute and the Institute for NanoBioTechnology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Daniel G Anderson
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, United States.,Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States.,Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, United States.,Department of Biomedical and Materials Science Engineering, Translational Tissue Engineering Center, Wilmer Eye Institute and the Institute for NanoBioTechnology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Piccinini G, Cuccagna C, Caliandro P, Coraci D, Germanotta M, Pecchioli C, Padua L. Efficacy of electrical stimulation of denervated muscle: A multicenter, double-blind, randomized clinical trial. Muscle Nerve 2020; 61:773-778. [PMID: 32249950 DOI: 10.1002/mus.26880] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 03/25/2020] [Accepted: 03/27/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND This was a multicenter, double-blind, randomized clinical trial to investigate the efficacy of electrical stimulation of denervated muscle (ESDM) on recovery of patients with peripheral nerve injuries. METHODS We enrolled 38 patients with traumatic peripheral nerve injuries with axonal damage and clinical impairment of two muscles, who were randomly treated with real or sham electrical stimulation (ES). Clinical and neurophysiological examinations were performed before treatment, at the end of treatment, and 3 mo posttreatment, by the same physician who was blinded to the ES allocation. RESULTS All patients improved but there was no significant beneficial effect of ESDM compared with sham treatment. CONCLUSIONS This study failed to demonstrate the efficacy of ESDM for peripheral nerve injuries. However, given the large number of variables related to ES and the heterogeneity in disease etiologies and clinical manifestations, future studies on homogeneous populations using different stimulation protocols may be useful.
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Affiliation(s)
- Giulia Piccinini
- Fondazione Policlinico Universitario A, Gemelli IRCCS, Rome, Italy
| | | | - Pietro Caliandro
- Fondazione Policlinico Universitario A, Gemelli IRCCS, Rome, Italy
| | - Daniele Coraci
- Fondazione Policlinico Universitario A, Gemelli IRCCS, Rome, Italy
| | | | | | - Luca Padua
- Fondazione Policlinico Universitario A, Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
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Chandrasekaran S, Davis J, Bersch I, Goldberg G, Gorgey AS. Electrical stimulation and denervated muscles after spinal cord injury. Neural Regen Res 2020; 15:1397-1407. [PMID: 31997798 PMCID: PMC7059583 DOI: 10.4103/1673-5374.274326] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Spinal cord injury (SCI) population with injury below T10 or injury to the cauda equina region is characterized by denervated muscles, extensive muscle atrophy, infiltration of intramuscular fat and formation of fibrous tissue. These morphological changes may put individuals with SCI at higher risk for developing other diseases such as various cardiovascular diseases, diabetes, obesity and osteoporosis. Currently, there is no available rehabilitation intervention to rescue the muscles or restore muscle size in SCI individuals with lower motor neuron denervation. We, hereby, performed a review of the available evidence that supports the use of electrical stimulation in restoration of denervated muscle following SCI. Long pulse width stimulation (LPWS) technique is an upcoming method of stimulating denervated muscles. Our primary objective is to explore the best stimulation paradigms (stimulation parameters, stimulation technique and stimulation wave) to achieve restoration of the denervated muscle. Stimulation parameters, such as the pulse duration, need to be 100–1000 times longer than in innervated muscles to achieve desirable excitability and contraction. The use of electrical stimulation in animal and human models induces muscle hypertrophy. Findings in animal models indicate that electrical stimulation, with a combination of exercise and pharmacological interventions, have proven to be effective in improving various aspects like relative muscle weight, muscle cross sectional area, number of myelinated regenerated fibers, and restoring some level of muscle function. Human studies have shown similar outcomes, identifying the use of LPWS as an effective strategy in increasing muscle cross sectional area, the size of muscle fibers, and improving muscle function. Therefore, displaying promise is an effective future stimulation intervention. In summary, LPWS is a novel stimulation technique for denervated muscles in humans with SCI. Successful studies on LPWS of denervated muscles will help in translating this stimulation technique to the clinical level as a rehabilitation intervention after SCI.
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Affiliation(s)
| | - John Davis
- Spinal Cord Injury and Disorders, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
| | - Ines Bersch
- Swiss Paraplegic Centre, Nottwil, Switzerland; Institute of Clinical Sciences, Department of Orthopedics at the University of Gothenburg, Gothenburg, Sweden
| | - Gary Goldberg
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University; Electrodiagnostic Center, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
| | - Ashraf S Gorgey
- Spinal Cord Injury and Disorders, Hunter Holmes McGuire VA Medical Center; Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
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Hruby LA, Gstoettner C, Sturma A, Salminger S, Mayer JA, Aszmann OC. Bionic Upper Limb Reconstruction: A Valuable Alternative in Global Brachial Plexus Avulsion Injuries-A Case Series. J Clin Med 2019; 9:jcm9010023. [PMID: 31861941 PMCID: PMC7019829 DOI: 10.3390/jcm9010023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 12/17/2019] [Accepted: 12/18/2019] [Indexed: 12/15/2022] Open
Abstract
Global brachial plexopathies including multiple nerve root avulsions may result in complete upper limb paralysis despite surgical treatment. Bionic reconstruction, which includes the elective amputation of the functionless hand and its replacement with a mechatronic device, has been described for the transradial level. Here, we present for the first time that patients with global brachial plexus avulsion injuries and lack of biological shoulder and elbow function benefit from above-elbow amputation and prosthetic rehabilitation. Between 2012 and 2017, forty-five patients with global brachial plexus injuries approached our centre, of which nineteen (42.2%) were treated with bionic reconstruction. While fourteen patients were amputated at the transradial level, the entire upper limb was replaced with a prosthetic arm in a total of five patients. Global upper extremity function before and after bionic arm substitution was assessed using two objective hand function tests, the action research arm test (ARAT), and the Southampton hand assessment procedure (SHAP). Other outcome measures included the DASH questionnaire, VAS to assess deafferentation pain and the SF-36 health survey to evaluate changes in quality of life. Using a hybrid prosthetic arm mean ARAT scores improved from 0.6 ± 1.3 to 11.0 ± 6.7 (p = 0.042) and mean SHAP scores increased from 4.0 ± 3.7 to 13.8 ± 9.2 (p = 0.058). After prosthetic arm replacement mean DASH scores improved from 52.5 ± 9.4 to 31.2 ± 9.8 (p = 0.003). Deafferentation pain decreased from mean VAS 8.5 ± 1.0 to 6.7 ± 2.1 (p = 0.055), while the physical and mental component summary scale as part of the SF-36 health survey improved from 32.9 ± 6.4 to 40.4 ± 9.4 (p = 0.058) and 43.6 ± 8.9 to 57.3 ± 5.5 (p = 0.021), respectively. Bionic reconstruction can restore simple but robust arm and hand function in longstanding brachial plexus patients with lack of treatment alternatives.
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Affiliation(s)
- Laura A Hruby
- Department of Orthopaedics and Trauma Surgery, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
- Clinical Laboratory for Bionic Extremity Reconstruction, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Clemens Gstoettner
- Clinical Laboratory for Bionic Extremity Reconstruction, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Agnes Sturma
- Clinical Laboratory for Bionic Extremity Reconstruction, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
- Department of Bioengineering, Imperial College London, London SW7 2AZ, UK
| | - Stefan Salminger
- Clinical Laboratory for Bionic Extremity Reconstruction, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Johannes A Mayer
- Clinical Laboratory for Bionic Extremity Reconstruction, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, Schnarrenbergstraße 95, 72076 Tübingen, Germany
| | - Oskar C Aszmann
- Clinical Laboratory for Bionic Extremity Reconstruction, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
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Preparation of carboxylic graphene oxide‐composited polypyrrole conduits and their effect on sciatic nerve repair under electrical stimulation. J Biomed Mater Res A 2019; 107:2784-2795. [DOI: 10.1002/jbm.a.36781] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 08/02/2019] [Accepted: 08/07/2019] [Indexed: 12/11/2022]
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Rink S, Bendella H, Akkin SM, Manthou M, Grosheva M, Angelov DN. Experimental Studies on Facial Nerve Regeneration. Anat Rec (Hoboken) 2019; 302:1287-1303. [DOI: 10.1002/ar.24123] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 10/09/2018] [Accepted: 11/02/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Svenja Rink
- Department of Prosthetic Dentistry, School of Dental and Oral MedicineUniversity of Cologne Cologne Germany
| | - Habib Bendella
- Department of NeurosurgeryUniversity of Witten/Herdecke, Cologne Merheim Medical Center (CMMC) Cologne Germany
| | - Salih Murat Akkin
- Department of Anatomy, School of MedicineSANKO University Gaziantep Turkey
| | - Marilena Manthou
- Department of Histology and EmbryologyAristotle University Thessaloniki Thessaloniki Greece
| | - Maria Grosheva
- Department of Oto‐Rhino‐LaryngologyUniversity of Cologne Cologne Germany
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Cercone M, Jarvis JC, Ducharme NG, Perkins J, Piercy RJ, Willand MP, Mitchell LM, Sledziona M, Soderholm L, Cheetham J. Functional electrical stimulation following nerve injury in a large animal model. Muscle Nerve 2019; 59:717-725. [PMID: 30815883 DOI: 10.1002/mus.26460] [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] [Received: 07/27/2018] [Revised: 02/12/2019] [Accepted: 02/25/2019] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Controversy exists over the effects of functional electrical stimulation (FES) on reinnervation. We hypothesized that intramuscular FES would not delay reinnervation after recurrent laryngeal nerve (RLn) axonotmesis. METHODS RLn cryo-injury and electrode implantation in ipsilateral posterior cricoarytenoid muscle (PCA) were performed in horses. PCA was stimulated for 20 weeks in eight animals; seven served as controls. Reinnervation was monitored through muscle response to hypercapnia, electrical stimulation and exercise. Ultimately, muscle fiber type proportions and minimum fiber diameters, and RLn axon number and degree of myelination were determined. RESULTS Laryngeal function returned to normal in both groups within 22 weeks. FES improved muscle strength and geometry, and induced increased type I:II fiber proportion (p = 0.038) in the stimulated PCA. FES showed no deleterious effects on reinnervation. DISCUSSION Intramuscular electrical stimulation did not delay PCA reinnervation after axonotmesis. FES can represent a supportive treatment to promote laryngeal functional recovery after RLn injury. Muscle Nerve 59:717-725, 2019.
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Affiliation(s)
- Marta Cercone
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | | | - Norm G Ducharme
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | - Justin Perkins
- Comparative Neuromuscular Diseases Laboratory, Department of Clinical Sciences and Services, Royal Veterinary College, London, UK
| | - Richard J Piercy
- Comparative Neuromuscular Diseases Laboratory, Department of Clinical Sciences and Services, Royal Veterinary College, London, UK
| | | | - Lisa M Mitchell
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | - Michael Sledziona
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | - Leo Soderholm
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | - Jonathan Cheetham
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
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Heaton JT, Kobler JB, Otten DM, Hillman RE, Zeitels SM. Development of a Closed-Loop Stimulator for Laryngeal Reanimation: Part 2. Device Testing in the Canine Model of Laryngeal Paralysis. Ann Otol Rhinol Laryngol 2019; 128:53S-70S. [PMID: 30843434 DOI: 10.1177/0003489418820545] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE: Laryngeal paralysis of central or peripheral origin can potentially be treated using functional electrical stimulation (FES) of laryngeal muscles. Experiments in canines (dogs) were performed using implant prototypes capable of closed-loop FES to refine engineering designs and specifications, test surgical approaches for implantation, and better understand the in vivo effects of laryngeal muscle stimulation on short- and long-term glottic function. STUDY DESIGN: Prospective, laboratory. METHODS: We designed and tested a series of microprocessor-based implantable devices that can stimulate glottic opening or closing based on input from physiological control signals (real-time processing of electromyographic [EMG] signals). After acute device testing experiments, 2 dogs were implanted for 8 and 24 months, with periodic testing of closed-loop laryngeal muscle stimulation triggered from EMG signals. In total, 5 dogs were tested for the effects of laryngeal muscle stimulation on vocal fold (VF) posturing in larynges with nerve supplies that were intact (7 VFs), synkinetically reinnervated (2 VFs), or chronically denervated (1 VF). In 3 cases, the stimulation was combined with airflow-driven phonation to study the consequent modulation of phonatory parameters. RESULTS: Initial device prototypes used inductive coupling for power and communication, while later iterations used battery power and infrared light communication (detailed descriptions are provided in the Part 1 companion paper). Two animals were successfully implanted with the inductively powered units, which operated until removed at 8 months in 1 animal or for more than 16 months in the second animal. Surgically, the encapsulated implants were well tolerated, and procedures for placing, attaching, and connecting the devices were developed. To simulate EMG control signals in anesthetized animals, we created 2 types of nerve/muscle signal sources. In one approach, a neck muscle had a cuff electrode placed on its motor nerve that was connected to transdermal electrical connection ports for periodic testing. In the second approach, the recurrent laryngeal nerve on one side of the larynx was stimulated to generate a VF EMG signal, which was then used to trigger FES of the paralyzed contralateral side (eg, restoring VF movement symmetry). Implant testing identified effective stimulation parameters and closed-loop stimulation artifact rejection techniques for FES of both healthy and paralyzed VFs. Stimulation levels effective for VF adduction did not cause signs of discomfort during awake testing. CONCLUSION: Our inductive and battery-powered prototypes performed effectively during in vivo testing, and the 2 units that were implanted for long-term evaluation held up well. As a proof of concept, we demonstrated that elicited neck strap muscle or laryngeal EMG potentials could be used as a control signal for closed-loop stimulation of laryngeal adduction and vocal pitch modulation, depending on electrode positioning, and that VFs were stimulable in the presence of synkinetic reinnervation or chronic denervation.
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Affiliation(s)
- James T Heaton
- 1 Department of Surgery, Harvard Medical School, Boston, MA, USA
- 2 Division of Laryngeal Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - James B Kobler
- 1 Department of Surgery, Harvard Medical School, Boston, MA, USA
- 2 Division of Laryngeal Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - David M Otten
- 3 Laboratory for Electromagnetic and Electronic Systems, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Robert E Hillman
- 1 Department of Surgery, Harvard Medical School, Boston, MA, USA
- 2 Division of Laryngeal Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Steven M Zeitels
- 1 Department of Surgery, Harvard Medical School, Boston, MA, USA
- 2 Division of Laryngeal Surgery, Massachusetts General Hospital, Boston, MA, USA
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Gojda J, Waldauf P, Hrušková N, Blahutová B, Krajčová A, Urban T, Tůma P, Řasová K, Duška F. Lactate production without hypoxia in skeletal muscle during electrical cycling: Crossover study of femoral venous-arterial differences in healthy volunteers. PLoS One 2019; 14:e0200228. [PMID: 30822305 PMCID: PMC6396965 DOI: 10.1371/journal.pone.0200228] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 02/11/2019] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Aim of the study was to compare metabolic response of leg skeletal muscle during functional electrical stimulation-driven unloaded cycling (FES) to that seen during volitional supine cycling. METHODS Fourteen healthy volunteers were exposed in random order to supine cycling, either volitional (10-25-50 W, 10 min) or FES assisted (unloaded, 10 min) in a crossover design. Whole body and leg muscle metabolism were assessed by indirect calorimetry with concomitant repeated measurements of femoral venous-arterial differences of blood gases, glucose, lactate and amino acids. RESULTS Unloaded FES cycling, but not volitional exercise, led to a significant increase in across-leg lactate production (from -1.1±2.1 to 5.5±7.4 mmol/min, p<0.001) and mild elevation of arterial lactate (from 1.8±0.7 to 2.5±0.8 mM). This occurred without widening of across-leg veno-arterial (VA) O2 and CO2 gaps. Femoral SvO2 difference was directly proportional to VA difference of lactate (R2 = 0.60, p = 0.002). Across-leg glucose uptake did not change with either type of exercise. Systemic oxygen consumption increased with FES cycling to similarly to 25W volitional exercise (138±29% resp. 124±23% of baseline). There was a net uptake of branched-chain amino acids and net release of Alanine from skeletal muscle, which were unaltered by either type of exercise. CONCLUSIONS Unloaded FES cycling, but not volitional exercise causes significant lactate production without hypoxia in skeletal muscle. This phenomenon can be significant in vulnerable patients' groups.
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Affiliation(s)
- Jan Gojda
- Department of Anaesthesia and Intensive Care Medicine, Kralovske Vinohrady University Hospital and The Third Faculty of Medicine, Charles University, Prague, Czech Republic
- 2 Department of Internal Medicine, Kralovske Vinohrady University Hospital and The Third Faculty of Medicine, Charles University, Prague, Czech Republic
- * E-mail:
| | - Petr Waldauf
- Department of Anaesthesia and Intensive Care Medicine, Kralovske Vinohrady University Hospital and The Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Natália Hrušková
- Department of Rehabilitation, Kralovske Vinohrady University Hospital and The Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Barbora Blahutová
- Department of Rehabilitation, Kralovske Vinohrady University Hospital and The Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Adéla Krajčová
- Department of Anaesthesia and Intensive Care Medicine, Kralovske Vinohrady University Hospital and The Third Faculty of Medicine, Charles University, Prague, Czech Republic
- 2 Department of Internal Medicine, Kralovske Vinohrady University Hospital and The Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Tomáš Urban
- Department of Anaesthesia and Intensive Care Medicine, Kralovske Vinohrady University Hospital and The Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Petr Tůma
- Department of Hygiene, The Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Kamila Řasová
- Department of Rehabilitation, Kralovske Vinohrady University Hospital and The Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - František Duška
- Department of Anaesthesia and Intensive Care Medicine, Kralovske Vinohrady University Hospital and The Third Faculty of Medicine, Charles University, Prague, Czech Republic
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Taylor MJ, Fornusek C, Ruys AJ. The duty cycle in Functional Electrical Stimulation research. Part II: Duty cycle multiplicity and domain reporting. Eur J Transl Myol 2018; 28:7733. [PMID: 30662696 PMCID: PMC6317134 DOI: 10.4081/ejtm.2018.7733] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 09/21/2018] [Indexed: 12/17/2022] Open
Abstract
In part I of this review, we introduced the duty cycle as a fundamental parameter in controlling the effect of electrical stimulation pulse trains on muscle structural and functional properties with special emphasis on fatigue. Following on from a survey of the literature, we discuss here the relative ability of intermittent and continuous stimulation to fatigue muscle. In addition, pertinent literature is explored on a more deeper level, highlighting contentions regarding the duty cycle across studies. In response to literature inconsistencies, we propose frameworks upon which the duty cycle parameter may be specified. We present the idea of domain reporting for the duty cycle, and illustrate with practical examples. In addition we dig further into the literature and present a set of notations that have been used by different researchers to report the duty cycle. We also propose the idea of the duty cycle multiple, which together with domain reporting, will help researchers understand more precisely duty cycles of electrical stimulation. As a case study, we also show how the duty cycle has been looked at by researchers in the context of pressure sore attenuation in patients. Together with part I, it is hoped that the frameworks suggested provide a complete picture of how duty cycle has been discussed across the literature, and gives researchers a more trans-theoretical basis upon which they may report the duty cycle in their studies. This may also lead to a more precise specification of electrical stimulation protocols used in patients.
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Affiliation(s)
- Matthew J. Taylor
- Faculty of Engineering and IT, University of Sydney, Camperdown, Australia
- Charles Perkins Centre, University of Sydney, Camperdown, Australia
| | - Ché Fornusek
- Faculty of Medicine and Health, University of Sydney, Lidcombe, Australia
| | - Andrew J. Ruys
- Faculty of Engineering and IT, University of Sydney, Camperdown, Australia
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Cheetham J, Perkins JD, Jarvis JC, Cercone M, Maw M, Hermanson JW, Mitchell LM, Piercy RJ, Ducharme NG. Effects of Functional Electrical Stimulation on Denervated Laryngeal Muscle in a Large Animal Model. Artif Organs 2015; 39:876-85. [DOI: 10.1111/aor.12624] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Jon Cheetham
- Department of Clinical Sciences; College of Veterinary Medicine; Cornell University; Ithaca NY USA
| | - Justin D. Perkins
- Comparative Neuromuscular Disease Laboratory; Royal Veterinary College; London
| | | | - Marta Cercone
- Department of Clinical Sciences; College of Veterinary Medicine; Cornell University; Ithaca NY USA
| | | | - John W. Hermanson
- Department of Biomedical Sciences; College of Veterinary Medicine; Cornell University; Ithaca NY USA
| | - Lisa M. Mitchell
- Department of Clinical Sciences; College of Veterinary Medicine; Cornell University; Ithaca NY USA
| | - Richard J. Piercy
- Comparative Neuromuscular Disease Laboratory; Royal Veterinary College; London
| | - Norm G. Ducharme
- Department of Clinical Sciences; College of Veterinary Medicine; Cornell University; Ithaca NY USA
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20
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Khodabukus A, Baehr LM, Bodine SC, Baar K. Role of contraction duration in inducing fast-to-slow contractile and metabolic protein and functional changes in engineered muscle. J Cell Physiol 2015; 230:2489-97. [PMID: 25857846 DOI: 10.1002/jcp.24985] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 03/04/2015] [Indexed: 12/26/2022]
Abstract
The role of factors such as frequency, contraction duration and active time in the adaptation to chronic low-frequency electrical stimulation (CLFS) is widely disputed. In this study we explore the ability of contraction duration (0.6, 6, 60, and 600 sec) to induce a fast-to-slow shift in engineered muscle while using a stimulation frequency of 10 Hz and keeping active time constant at 60%. We found that all contraction durations induced similar slowing of time-to-peak tension. Despite similar increases in total myosin heavy (MHC) levels with stimulation, increasing contraction duration resulted in progressive decreases in total fast myosin. With contraction durations of 60 and 600 sec, MHC IIx levels decreased and MHC IIa levels increased. All contraction durations resulted in fast-to-slow shifts in TnT and TnC but increased both fast and slow TnI levels. Half-relaxation slowed to a greater extent with contraction durations of 60 and 600 sec despite similar changes in the calcium sequestering proteins calsequestrin and parvalbumin and the calcium uptake protein SERCA. All CLFS groups resulted in greater fatigue resistance than control. Similar increases in GLUT4, mitochondrial enzymes (SDH and ATPsynthase), the fatty acid transporter CPT-1, and the metabolic regulators PGC-1α and MEF2 were found with all contraction durations. However, the mitochondrial enzymes cytochrome C and citrate synthase were increased to greater levels with contraction durations of 60 and 600 sec. These results demonstrate that contraction duration plays a pivotal role in dictating the level of CLFS-induced contractile and metabolic adaptations in tissue-engineered skeletal muscle.
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Affiliation(s)
- Alastair Khodabukus
- Division of Neurobiology, Physiology and Behavior, University of California Davis, Davis, California
| | - Leslie M Baehr
- Division of Neurobiology, Physiology and Behavior, University of California Davis, Davis, California
| | - Sue C Bodine
- Division of Neurobiology, Physiology and Behavior, University of California Davis, Davis, California
| | - Keith Baar
- Division of Neurobiology, Physiology and Behavior, University of California Davis, Davis, California
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21
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Sensory nerve cross-anastomosis and electrical muscle stimulation synergistically enhance functional recovery of chronically denervated muscle. Plast Reconstr Surg 2015; 134:736e-745e. [PMID: 25347648 DOI: 10.1097/prs.0000000000000599] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Long-term muscle denervation leads to severe and irreversible atrophy coupled with loss of force and motor function. These factors contribute to poor functional recovery following delayed reinnervation. The authors' previous work demonstrated that temporarily suturing a sensory nerve to the distal motor stump (called sensory protection) significantly reduces muscle atrophy and improves function following reinnervation. The authors have also shown that 1 month of electrical stimulation of denervated muscle significantly improves function and reduces atrophy. In this study, the authors tested whether a combination of sensory protection and electrical stimulation would enhance functional recovery more than either treatment alone. METHODS Rat gastrocnemius muscles were denervated by cutting the tibial nerve. The peroneal nerve was then sutured to the distal tibial stump following 3 months of treatment (i.e., electrical stimulation, sensory protection, or both). Three months after peroneal repair, functional and histologic measurements were taken. RESULTS All treatment groups had significantly higher muscle weight (p<0.05) and twitch force (p<0.001) compared with the untreated group (denervated), but fiber type composition did not differ between groups. Importantly, muscle weight and force were significantly greater in the combined treatment group (p<0.05) compared with stimulation or sensory protection alone. The combined treatment also produced motor unit counts significantly greater than sensory protection alone (p<0.05). CONCLUSIONS The combination treatment synergistically reduces atrophy and improves reinnervation and functional measures following delayed nerve repair, suggesting that these approaches work through different mechanisms. The authors' research supports the clinical use of both modalities together following peripheral nerve injury.
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Carraro U, Edmunds KJ, Gargiulo P. 3D False Color Computed Tomography for Diagnosis and Follow-Up of Permanent Denervated Human Muscles Submitted to Home-Based Functional Electrical Stimulation. Eur J Transl Myol 2015; 25:5133. [PMID: 26913154 PMCID: PMC4749015 DOI: 10.4081/ejtm.2015.5133] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 03/17/2015] [Indexed: 12/24/2022] Open
Abstract
This report outlines the use of a customized false-color 3D computed tomography (CT) protocol for the imaging of the rectus femoris of spinal cord injury (SCI) patients suffering from complete and permanent denervation, as characterized by complete Conus and Cauda Equina syndrome. This muscle imaging method elicits the progression of the syndrome from initial atrophy to eventual degeneration, as well as the extent to which patients' quadriceps could be recovered during four years of home-based functional electrical stimulation (h-b FES). Patients were pre-selected from several European hospitals and functionally tested by, and enrolled in the EU Commission Shared Cost Project RISE (Contract n. QLG5-CT-2001-02191) at the Department of Physical Medicine, Wilhelminenspital, Vienna, Austria. Denervated muscles were electrically stimulated using a custom-designed stimulator, large surface electrodes, and customized progressive stimulation settings. Spiral CT images and specialized computational tools were used to isolate the rectus femoris muscle and produce 3D and 2D reconstructions of the denervated muscles. The cross sections of the muscles were determined by 2D Color CT, while muscle volumes were reconstructed by 3D Color CT. Shape, volume, and density changes were measured over the entirety of each rectus femoris muscle. Changes in tissue composition within the muscle were visualized by associating different colors to specified Hounsfield unit (HU) values for fat, (yellow: [-200; -10]), loose connective tissue or atrophic muscle, (cyan: [-9; 40]), and normal muscle, fascia and tendons included, (red: [41; 200]). The results from this analysis are presented as the average HU values within the rectus femoris muscle reconstruction, as well as the percentage of these tissues with respect to the total muscle volume. Results from this study demonstrate that h-b FES induces a compliance-dependent recovery of muscle volume and size of muscle fibers, as evidenced by the gain and loss in muscle mass. These results highlight the particular utility of this modality in the quantitative longitudinal assessment of the responses of skeletal muscle to long-term denervation and h-b FES recovery.
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Affiliation(s)
- Ugo Carraro
- IRRCS Fondazione Ospedale San Camillo, Venezia, Italy
| | - Kyle J. Edmunds
- Institute for Biomedical and Neural Engineering, Reykjavik University
- Landspítali, Reykjavík, Iceland
| | - Paolo Gargiulo
- Institute for Biomedical and Neural Engineering, Reykjavik University
- Landspítali, Reykjavík, Iceland
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23
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Khodabukus A, Baar K. Streptomycin Decreases the Functional Shift to a Slow Phenotype Induced by Electrical Stimulation in Engineered Muscle. Tissue Eng Part A 2015; 21:1003-12. [DOI: 10.1089/ten.tea.2014.0462] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alastair Khodabukus
- Division of Neurobiology, Physiology and Behavior, University of California Davis, Davis, California
| | - Keith Baar
- Division of Neurobiology, Physiology and Behavior, University of California Davis, Davis, California
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Willand MP, Chiang CD, Zhang JJ, Kemp SWP, Borschel GH, Gordon T. Daily Electrical Muscle Stimulation Enhances Functional Recovery Following Nerve Transection and Repair in Rats. Neurorehabil Neural Repair 2014; 29:690-700. [DOI: 10.1177/1545968314562117] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background. Incomplete recovery following surgical reconstruction of damaged peripheral nerves is common. Electrical muscle stimulation (EMS) to improve functional outcomes has not been effective in previous studies. Objective. To evaluate the efficacy of a new, clinically translatable EMS paradigm over a 3-month period following nerve transection and immediate repair. Methods. Rats were divided into 6 groups based on treatment (EMS or no treatment) and duration (1, 2, or 3 months). A tibial nerve transection injury was immediately repaired with 2 epineurial sutures. The right gastrocnemius muscle in all rats was implanted with intramuscular electrodes. In the EMS group, the muscle was electrically stimulated with 600 contractions per day, 5 days a week. Terminal measurements were made after 1, 2, or 3 months. Rats in the 3-month group were assessed weekly using skilled and overground locomotion tests. Neuromuscular junction reinnervation patterns were also examined. Results. Muscles that received daily EMS had significantly greater numbers of reinnervated motor units with smaller average motor unit sizes. The majority of muscle endplates were reinnervated by a single axon arising from a nerve trunk with significantly fewer numbers of terminal sprouts in the EMS group, the numbers being small. Muscle mass and force were unchanged but EMS improved behavioral outcomes. Conclusions. Our results demonstrated that EMS using a moderate stimulation paradigm immediately following nerve transection and repair enhances electrophysiological and behavioral recovery.
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Affiliation(s)
| | | | | | | | | | - Tessa Gordon
- The Hospital for Sick Children, Toronto, Ontario, Canada
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Liu X, Li D, Jiang D, Fang Y. Acetylcholine secretion by motor neuron-like cells from umbilical cord mesenchymal stem cells. Neural Regen Res 2014; 8:2086-92. [PMID: 25206517 PMCID: PMC4146069 DOI: 10.3969/j.issn.1673-5374.2013.22.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 07/25/2013] [Indexed: 11/29/2022] Open
Abstract
Umbilical cord mesenchymal stem cells were isolated by a double enzyme digestion method. The third passage of umbilical cord mesenchymal stem cells was induced with heparin and/or basic fibroblast growth factor. Results confirmed that cell morphology did not change after induction with basic fibroblast growth factor alone. However, neuronal morphology was visible, and microtubule-associated protein-2 expression and acetylcholine levels increased following induction with heparin alone or heparin combined with basic fibroblast growth factor. Hb9 and choline acetyltransferase expression was high following inductive with heparin combined with basic fibroblast growth factor. Results indicate that the inductive effect of basic fibroblast growth factor alone was not obvious. Heparin combined with basic fibroblast growth factor noticeably promoted the differentiation of umbilical cord mesenchymal stem cells into motor neuron-like cells. Simultaneously, umbilical cord mesenchymal stem cells could secrete acetylcholine.
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Affiliation(s)
- Xueyuan Liu
- Department of Anatomy, Liaoning Medical University, Jinzhou 121001, Liaoning Province, China
| | - Dehua Li
- Department of Anatomy, Liaoning Medical University, Jinzhou 121001, Liaoning Province, China
| | - Dong Jiang
- Department of Anatomy, Liaoning Medical University, Jinzhou 121001, Liaoning Province, China
| | - Yan Fang
- Department of Anatomy, Liaoning Medical University, Jinzhou 121001, Liaoning Province, China
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Willand MP, Holmes M, Bain JR, Fahnestock M, De Bruin H. Electrical muscle stimulation after immediate nerve repair reduces muscle atrophy without affecting reinnervation. Muscle Nerve 2013; 48:219-25. [PMID: 23637030 DOI: 10.1002/mus.23726] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2012] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Electrical stimulation of denervated muscle has been shown to minimize atrophy and fibrosis and increase force in animal and human models. However, electrical stimulation after nerve repair is controversial due to questions of efficacy. METHODS Using a rat model, we investigated the efficacy of short-term electrical muscle stimulation for increasing reinnervation and preventing muscle atrophy. After tibial nerve transection and immediate repair with the fibular nerve, 1 month of electrical stimulation was applied 5 days/week for 1 hour to the gastrocnemius muscle via implanted electrodes. RESULTS After 2 months of further recovery without stimulation, muscle weights, twitch forces, and type I fiber areas were significantly greater in stimulated animals than in repaired controls without stimulation. Motor unit size and numbers were not different between the 2 groups. CONCLUSIONS Short-term electrical muscle stimulation after nerve repair significantly reduces muscle atrophy and does not affect motor reinnervation.
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Affiliation(s)
- Michael P Willand
- School of Biomedical Engineering, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
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Lin S, Xu L, Hu S, Zhang C, Wang Y, Xu J. Optimal time-point for neural stem cell transplantation to delay denervated skeletal muscle atrophy. Muscle Nerve 2012; 47:194-201. [PMID: 23042154 DOI: 10.1002/mus.23447] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2012] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Transplantation of neural stem cells (NSCs) is a promising treatment to delay denervated skeletal muscle atrophy; however, the optimal time-point between peripheral nerve injury and NSC transplantation needs to be determined. METHODS Improvement in rat gastrocnemius muscle function was evaluated after NSCs were transplanted into sectioned distal tibial nerves. We also assessed survival and differentiation. ANOVA was used to compare the mean value of the number of neuron-like cells, cross-sectional area amelioration, the amount of activated fibers, and latency and amplitude of the gastrocnemius compound muscle action potential. RESULTS The group in which the NSCs were transplanted 1 week after tibial nerve transection had the largest number of neuron-like cells, maximum cross-sectional area amelioration, and maximum amount of activated gastrocnemius fibers compared with all other groups (P < 0.01). CONCLUSIONS The optimal time-point for NSC transplantation for delaying denervated skeletal muscle atrophy is 1 week after severing the nerve.
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Affiliation(s)
- Sen Lin
- Department of Orthopaedics, Shanghai Sixth People's Hospital and School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Willand MP, Holmes M, Bain JR, Fahnestock M, de Bruin H. Determining the effects of electrical stimulation on functional recovery of denervated rat gastrocnemius muscle using motor unit number estimation. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2012; 2011:1977-80. [PMID: 22254721 DOI: 10.1109/iembs.2011.6090557] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The use of electrical muscle stimulation to treat denervated muscle prior to delayed reinnervation has been widely debated. There is evidence showing both positive and negative results following different protocols of electrical stimulation. In this study we investigated the role electrical stimulation has on muscle reinnervation following immediate and delayed nerve repair using motor unit estimation techniques. Rat gastrocnemius muscle was denervated and repaired using the peroneal nerve either immediately or following three-months with and without electrical stimulation. Motor unit counts, average motor unit sizes, and maximum compound action potentials were measured three-months following peroneal nerve repair. Motor unit counts in animals that were denervated and stimulated were significantly higher than those that were denervated and not stimulated. Both average motor unit sizes and maximum compound action potentials showed no significant differences between denervated and denervated-stimulated animals. These results provide evidence that electrical stimulation prior to delayed nerve repair increases muscle receptivity to regenerating axons and may be a worthwhile treatment for peripheral nerve injuries.
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Affiliation(s)
- Michael P Willand
- School of Biomedical Engineering, McMaster University, Hamilton, ON L8S 4K1, Canada.
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29
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Cheetham J, Regner A, Jarvis JC, Priest D, Sanders I, Soderholm LV, Mitchell LM, Ducharme NG. Functional electrical stimulation of intrinsic laryngeal muscles under varying loads in exercising horses. PLoS One 2011; 6:e24258. [PMID: 21904620 PMCID: PMC3164194 DOI: 10.1371/journal.pone.0024258] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Accepted: 08/07/2011] [Indexed: 11/22/2022] Open
Abstract
Bilateral vocal fold paralysis (BVCP) is a life threatening condition and appears to be a good candidate for therapy using functional electrical stimulation (FES). Developing a working FES system has been technically difficult due to the inaccessible location and small size of the sole arytenoid abductor, the posterior cricoarytenoid (PCA) muscle. A naturally-occurring disease in horses shares many functional and etiological features with BVCP. In this study, the feasibility of FES for equine vocal fold paralysis was explored by testing arytenoid abduction evoked by electrical stimulation of the PCA muscle. Rheobase and chronaxie were determined for innervated PCA muscle. We then tested the hypothesis that direct muscle stimulation can maintain airway patency during strenuous exercise in horses with induced transient conduction block of the laryngeal motor nerve. Six adult horses were instrumented with a single bipolar intra-muscular electrode in the left PCA muscle. Rheobase and chronaxie were within the normal range for innervated muscle at 0.55±0.38 v and 0.38±0.19 ms respectively. Intramuscular stimulation of the PCA muscle significantly improved arytenoid abduction at all levels of exercise intensity and there was no significant difference between the level of abduction achieved with stimulation and control values under moderate loads. The equine larynx may provide a useful model for the study of bilateral fold paralysis.
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Affiliation(s)
- Jon Cheetham
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, United States of America.
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Skouras E, Ozsoy U, Sarikcioglu L, Angelov DN. Intrinsic and therapeutic factors determining the recovery of motor function after peripheral nerve transection. Ann Anat 2011; 193:286-303. [PMID: 21458252 DOI: 10.1016/j.aanat.2011.02.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Revised: 02/03/2011] [Accepted: 02/04/2011] [Indexed: 01/01/2023]
Abstract
Insufficient recovery after peripheral nerve injury has been attributed to (i) poor pathfinding of regrowing axons, (ii) excessive collateral axonal branching at the lesion site and (iii) polyneuronal innervation of the neuromuscular junctions (NMJ). The facial nerve transection model has been used initially to measure restoration of function after varying therapies and to examine the mechanisms underlying their effects. Since it is very difficult to control the navigation of several thousand axons, efforts concentrated on collateral branching and NMJ-polyinnervation. Treatment with antibodies against trophic factors to combat branching improved the precision of reinnervation, but had no positive effects on functional recovery. This suggested that polyneuronal reinnervation--rather than collateral branching--may be the critical limiting factor. The former could be reduced by pharmacological agents known to perturb microtubule assembly and was followed by recovery of function. Because muscle polyinnervation is activity-dependent and can be manipulated, attempts to design a clinically feasible therapy were performed by electrical stimulation or by soft tissue massage. Electrical stimulation applied to the transected facial nerve or to paralysed facial muscles did not improve vibrissal motor performance and failed to diminish polyinnervation. In contrast, gentle stroking of the paralysed muscles (vibrissal, orbicularis oculi, tongue musculature) resulted in full recovery of function. This manual stimulation was also effective after hypoglossal-facial nerve suture and after interpositional nerve grafting, but not after surgical reconstruction of the median nerve. All these findings raise hopes that clinically feasible and effective therapies could be soon designed and tested.
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Affiliation(s)
- Emmanouil Skouras
- Department of Orthopedics and Traumatology, University of Cologne, Joseph-Stelzmann-Strasse 9, Cologne, Germany
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31
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Parizotto NA. Is electrical stimulation a consolidated treatment for denervated muscles and functional recovery after nerve injuries? Muscle Nerve 2011; 43:299-300. [PMID: 21254103 DOI: 10.1002/mus.21833] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Salmons S. Is stimulation of denervated muscle contraindicated when there is potential for reinnervation? Muscle Nerve 2011; 43:300. [PMID: 21254104 DOI: 10.1002/mus.21834] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Revised: 06/17/2010] [Accepted: 07/09/2010] [Indexed: 12/30/2022]
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Willand MP, Lopez JP, de Bruin H, Fahnestock M, Holmes M, Bain JR. A New System and Paradigm for Chronic Stimulation of Denervated Rat Muscle. J Med Biol Eng 2011; 31:87-92. [PMID: 22973186 DOI: 10.5405/jmbe.828] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Traditionally, animal studies employing electrical stimulation for conditioning denervated muscle rely on 24-hour-based stimulation paradigms, most employing implantable stimulators. While these stimulators provide the necessary current to cause muscular contraction, they have problems with battery life, programmability, and long-term robustness. Continuous 24-hour stimulation, while shown to be effective in animals, is not easily translatable to a clinical setting. It is also difficult to evaluate animal comfort and muscular contraction throughout a 24-hour period. We have developed a system and stimulation paradigm that can stimulate up to five animals at one time for one hour per day. The constant current stimulator is a USB-powered device that can, under computer control, output trains of pulses with selectable shapes, widths, durations and repetition rates. It is an external device with no implantable parts in the animal except for the stimulating electrodes. We tested the system on two groups of rats with denervated gastrocnemius muscles. One group was stimulated using a one-hour-per-day, 5-days-per-week stimulation paradigm for one month, while the other group had electrodes implanted but received no stimulation. Muscle weight and twitch force were significantly larger in the stimulated group than the non-stimulated group. Presently, we are using the stimulator to investigate electrical stimulation coupled with other therapeutic interventions that can minimize functional deficits after peripheral nerve injuries.
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Affiliation(s)
- Michael P Willand
- School of Biomedical Engineering, McMaster University, Hamilton, Ontario L8S4L8, Canada
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Runge MB, Dadsetan M, Baltrusaitis J, Knight AM, Ruesink T, Lazcano EA, Lu L, Windebank AJ, Yaszemski MJ. The development of electrically conductive polycaprolactone fumarate-polypyrrole composite materials for nerve regeneration. Biomaterials 2010; 31:5916-26. [PMID: 20483452 DOI: 10.1016/j.biomaterials.2010.04.012] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2010] [Accepted: 04/05/2010] [Indexed: 01/19/2023]
Abstract
Electrically conductive polymer composites composed of polycaprolactone fumarate and polypyrrole (PCLF-PPy) have been developed for nerve regeneration applications. Here we report the synthesis and characterization of PCLF-PPy and in vitro studies showing PCLF-PPy materials support both PC12 cell and dorsal root ganglia (DRG) neurite extension. PCLF-PPy composite materials were synthesized by polymerizing pyrrole in preformed PCLF scaffolds (M(n) 7,000 or 18,000 g mol(-1)) resulting in interpenetrating networks of PCLF-PPy. Chemical compositions and thermal properties were characterized by ATR-FTIR, XPS, DSC, and TGA. PCLF-PPy materials were synthesized with five different anions (naphthalene-2-sulfonic acid sodium salt (NSA), dodecylbenzenesulfonic acid sodium salt (DBSA), dioctyl sulfosuccinate sodium salt (DOSS), potassium iodide (I), and lysine) to investigate effects on electrical conductivity and to optimize chemical composition for cellular compatibility. PCLF-PPy materials have variable electrical conductivity up to 6 mS cm(-1) with bulk compositions ranging from 5 to 13.5 percent polypyrrole. AFM and SEM characterization show microstructures with a root mean squared (RMS) roughness of 1195 nm and nanostructures with RMS roughness of 8 nm. In vitro studies using PC12 cells and DRG show PCLF-PPy materials synthesized with NSA or DBSA support cell attachment, proliferation, neurite extension, and are promising materials for future studies involving electrical stimulation.
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Affiliation(s)
- M Brett Runge
- Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester MN 55905, USA
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Kern H, Carraro U, Adami N, Biral D, Hofer C, Forstner C, Mödlin M, Vogelauer M, Pond A, Boncompagni S, Paolini C, Mayr W, Protasi F, Zampieri S. Home-based functional electrical stimulation rescues permanently denervated muscles in paraplegic patients with complete lower motor neuron lesion. Neurorehabil Neural Repair 2010; 24:709-21. [PMID: 20460493 DOI: 10.1177/1545968310366129] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Spinal cord injury causes muscle wasting and loss of function, which are especially severe after complete and permanent damage to lower motor neurons. In a previous cross-sectional study, long-standing denervated muscles were rescued by home-based functional electrical stimulation (h-bFES) training. OBJECTIVE To confirm results by a 2-year longitudinal prospective study of 25 patients with complete conus/cauda equina lesions. METHODS Denervated leg muscles were stimulated by h-bFES using a custom-designed stimulator and large surface electrodes. Muscle mass, force, and structure were determined before and after 2 years of h-bFES using computed tomography, measurements of knee torque during stimulation, and muscle biopsies analyzed by histology and electron microscopy. RESULTS Twenty of 25 patients completed the 2-year h-bFES program, which resulted in (a) a 35% cross-sectional increase in area of the quadriceps muscle from 28.2 ± 8.1 to 38.1 ± 12.7 cm(2) (P < .001), a 75% increase in mean diameter of muscle fibers from 16.6 ± 14.3 to 29.1 ± 23.3 μm (P < .001), and improvements of the ultrastructural organization of contractile material; and (b) a 1187% increase in force output during electrical stimulation from 0.8 ± 1.3 to 10.3 ± 8.1 N m (P < .001). The recovery of quadriceps force was sufficient to allow 25% of the subjects to perform FES-assisted stand-up exercises. CONCLUSIONS Home-based FES of denervated muscle is an effective home therapy that results in rescue of muscle mass and tetanic contractility. Important immediate benefits for the patients are the improved cosmetic appearance of lower extremities and the enhanced cushioning effect for seating.
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Affiliation(s)
- Helmut Kern
- Ludwig Boltzmann Institute of Electrostimulation and Physical Rehabilitation, Vienna, Austria
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Russo TL, Peviani SM, Durigan JLQ, Gigo-Benato D, Delfino GB, Salvini TF. Stretching and electrical stimulation reduce the accumulation of MyoD, myostatin and atrogin-1 in denervated rat skeletal muscle. J Muscle Res Cell Motil 2010; 31:45-57. [DOI: 10.1007/s10974-010-9203-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2009] [Accepted: 02/05/2010] [Indexed: 12/22/2022]
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Electrical stimulation of paralyzed vibrissal muscles reduces endplate reinnervation and does not promote motor recovery after facial nerve repair in rats. Ann Anat 2009; 191:356-70. [PMID: 19481914 DOI: 10.1016/j.aanat.2009.03.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2009] [Revised: 03/24/2009] [Accepted: 03/24/2009] [Indexed: 01/26/2023]
Abstract
The outcome of peripheral nerve injuries requiring surgical repair is poor. Recent work has suggested that electrical stimulation (ES) of denervated muscles could be beneficial. Here we tested whether ES has a positive influence on functional recovery after injury and surgical repair of the facial nerve. Outcomes at 2 months were compared to animals receiving sham stimulation (SS). Starting on the first day after end-to-end suture (facial-facial anastomosis), electrical stimulation (square 0.1 ms pulses at 5 Hz at an ex tempore established threshold amplitude of between 3.0 and 5.0V) was delivered to the vibrissal muscles for 5 min a day, 3 times a week. Restoration of vibrissal motor performance following ES or SS was evaluated using the video-based motion analysis and correlated with the degree of collateral axonal branching at the lesion site, the number of motor endplates in the target musculature and the quality of their reinnervation, i.e. the degree of mono- versus poly-innervation. Neither protocol reduced collateral branching. ES did not improve functional outcome, but rather reduced the number of innervated motor endplates to approximately one-fifth of normal values and failed to reduce the proportion of poly-innervated motor endplates. We conclude that ES is not beneficial for recovery of whisker function after facial nerve repair in rats.
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Salmons S, Jarvis JC. Functional Electrical Stimulation of Denervated Muscles: An Experimental Evaluation. Artif Organs 2008; 32:597-603. [PMID: 18782128 DOI: 10.1111/j.1525-1594.2008.00608.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Stanley Salmons
- Muscle Research Group, Department of Human Anatomy & Cell Biology, University of Liverpool, Liverpool, UK.
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