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Pechstein AE, Gollie JM, Keyser RE, Guccione AA. Walking Endurance and Oxygen Uptake On-Kinetics in Individuals With Parkinson Disease Following Overground Locomotor Training. J Neurol Phys Ther 2023; 47:99-111. [PMID: 36538418 DOI: 10.1097/npt.0000000000000423] [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: 12/24/2022]
Abstract
BACKGROUND AND PURPOSE Poor walking endurance in Parkinson disease (PD) may be attributable to both bioenergetic and biomechanical factors, but locomotor training methods addressing both these factors simultaneously are understudied. Our objective was to examine the effects of overground locomotor training (OLT) on walking endurance in individuals with mild-to-moderate PD, and to further explore potential cardiorespiratory contributions. METHODS A single-arm, longitudinal design was used to examine the effects of 24 biweekly sessions of OLT in people with mild-to-moderate PD (n = 12). Walking endurance was measured as total distance walked during a 10-minute walk test (10minWT). Oxygen uptake (V˙ o2 ) on-kinetic profiles were determined using a monoexponential function. Perceived fatigability was assessed following the 10minWT using a self-report scale. Magnitude of change in primary outcomes was assessed using Cohen's d and adjusted for sample size (Cohen's d(unbiased) ). RESULTS Participants executed 3036 (297) steps and maintained 65.5% (8%) age-predicted heart rate maximum in a typical session lasting 56.9 (2.5) minutes. Medium effects in total distance walked-885.9 (157.2) versus 969.5 (140.9); Cohen's d(unbiased) = 0.54-and phase II time constant of the V˙ o2 on-kinetic profile-33.7 (12.3) versus 25.9 (15.3); Cohen's d(unbiased) = 0.54-were observed alongside trivial effects for perceived fatigability-4.7 (1.4) versus 4.8 (1.5); Cohen's d(unbiased) = 0.11-following OLT. DISCUSSION AND CONCLUSIONS These preliminary findings may demonstrate the potential for moderate-intensity OLT to improve walking endurance and enhance cardiorespiratory adjustments to walking activity in adults with mild-to-moderate PD.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A407 ).
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Affiliation(s)
- Andrew E Pechstein
- Department of Rehabilitation Science, George Mason University, Fairfax, Virginia (A.E.P., J.M.G., R.E.K., A.A.G.); Department of Physical Therapy, University of Delaware, Newark (A.E.P.); and Research Service, Veterans Affairs Medical Center, Washington, District of Columbia (J.M.G.)
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2
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Li L. Gait & posture: Fatigue, fatigability, and muscle torque reduction. Gait Posture 2022; 95:234. [PMID: 32950359 DOI: 10.1016/j.gaitpost.2020.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/02/2020] [Accepted: 09/10/2020] [Indexed: 02/02/2023]
Affiliation(s)
- Li Li
- Georgia Southern University, Statesboro, GA 30460, United States.
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Gollie JM, Guccione AA, Keyser RE, Chin LMK, Panza GS, Herrick JE. Walking endurance, muscle oxygen extraction, and perceived fatigability after overground locomotor training in incomplete spinal cord injury: A pilot study. J Spinal Cord Med 2022; 45:381-389. [PMID: 32795157 PMCID: PMC9135420 DOI: 10.1080/10790268.2020.1798137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objective: The purpose of this study was to examine the effects of overground locomotor training (OLT) on walking endurance and gastrocnemius oxygen extraction in people with chronic cervical motor-incomplete spinal cord injury (SCI).Design: Prospective single-arm pre-post pilot study.Setting: Human Performance Research Laboratory.Participants: Adult men with traumatic chronic cervical SCI (n = 6; age = 30.8 ± 12.5).Intervention: Twenty-four sessions of structured OLT.Outcome measures: Walking endurance was determined during a constant work-rate time-to-exhaustion treadmill test. Normalized perceived fatigability was calculated by dividing subjective ratings of tiredness by walking time. Cardiorespiratory outcomes and muscle oxygen extraction were analyzed using breath-by-breath gas-exchange and near-infrared spectroscopy.Results: OLT resulted in large effects on walking endurance (1232 ± 446 s vs 1645 ± 255 s; d = 1.1; P = 0.045) and normalized perceived fatigability (5.3 ± 1.5 a.u. vs 3.6 ± 0.9 a.u.; d = 1.3; P = 0.033). Small-to-medium effects on absolute (2.8 ± 2.5 a.u. vs 4.2 ± 3.5 a.u.; d = 0.42; P = 0.035) and isotime (2.8 ± 2.5 a.u. vs 3.8 ± 3.0 a.u.; d = 0.33; P = 0.023) muscle oxygen extraction were also observed after OLT.Conclusion: These findings provide preliminary data supporting the potential for improved walking endurance, enhanced muscle O2 extraction, and reduced perceived fatigability in people with chronic cervical motor-incomplete SCI following the OLT program described in this study.
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Affiliation(s)
- Jared M. Gollie
- Research Services, Veterans Affairs Medical Center, Washington, District of Columbi, USA
- Department of Health, Human Function, and Rehabilitation Sciences, The George Washington University, Washington, District of Columbi, USA
- Rehabilitation Science Department, George Mason University, Fairfax, Virginia, USA
| | - Andrew A. Guccione
- Rehabilitation Science Department, George Mason University, Fairfax, Virginia, USA
| | - Randall E. Keyser
- Rehabilitation Science Department, George Mason University, Fairfax, Virginia, USA
- Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Lisa M. K. Chin
- Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Gino S. Panza
- Department of Physiology, Wayne State University, Detroit, Michigan, USA
- Research Services, John D. Dingell Veterans Affairs Medical Center, Detroit, Michigan, USA
| | - Jeffrey E. Herrick
- Department of Exercise Physiology, University of Lynchburg, Lynchburg, Virginia, USA
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4
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Hutchinson MJ, Goosey-Tolfrey VL. Rethinking aerobic exercise intensity prescription in adults with spinal cord injury: time to end the use of "moderate to vigorous" intensity? Spinal Cord 2022; 60:484-490. [PMID: 34880442 PMCID: PMC9209328 DOI: 10.1038/s41393-021-00733-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/19/2021] [Accepted: 11/23/2021] [Indexed: 11/13/2022]
Abstract
STUDY DESIGN Cohort study. OBJECTIVES To investigate and critique different methods for aerobic exercise intensity prescription in adults with spinal cord injury (SCI). SETTING University laboratory in Loughborough, UK. METHODS Trained athletes were split into those with paraplegia (PARA; n = 47), tetraplegia (TETRA; n = 20) or alternate health condition (NON-SCI; n = 67). Participants completed a submaximal step test with 3 min stages, followed by graded exercise test to exhaustion. Handcycling, arm crank ergometry or wheelchair propulsion were performed depending on the sport of the participant. Oxygen uptake (V̇O2), heart rate (HR), blood lactate concentration ([BLa]) and ratings of perceived exertion (RPE) on Borg's RPE scale were measured throughout. Lactate thresholds were identified according to log-V̇O2 plotted against log-[BLa] (LT1) and 1.5 mmol L-1 greater than LT1 (LT2). These were used to demarcate moderate (<LT1), heavy (>LT1, < LT2) and severe (>LT2) exercise intensity domains. RESULTS Associations between percentage of peak V̇O2 (%V̇O2peak) and HR (%HRpeak) with RPE differed between PARA and TETRA. At LT1 and LT2, %V̇O2peak and %HRpeak were significantly greater in TETRA compared to PARA and NON-SCI (P < 0.05). The variation in %V̇O2peak and %HRpeak at lactate thresholds resulted in large variability in the domain distribution at fixed %V̇O2peak and %HRpeak. CONCLUSIONS Fixed %V̇O2peak and %HRpeak should not be used for aerobic exercise intensity prescription in adults with SCI as the method does not lead to uniform exercise intensity domain distribution.
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Affiliation(s)
- Michael J. Hutchinson
- grid.6571.50000 0004 1936 8542Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Victoria L. Goosey-Tolfrey
- grid.6571.50000 0004 1936 8542Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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5
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Panza GS, Sutor T, Gee CM, Graco M, McCully KK, Chiodo A, Badr MS, Nash MS. Is Sleep Disordered Breathing Confounding Rehabilitation Outcomes in Spinal Cord Injury Research? Arch Phys Med Rehabil 2021; 103:1034-1045. [PMID: 34537222 DOI: 10.1016/j.apmr.2021.08.015] [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: 08/15/2021] [Accepted: 08/24/2021] [Indexed: 11/02/2022]
Abstract
The purpose of this article is to highlight the importance of considering sleep-disordered breathing (SDB) as a potential confounder to rehabilitation research interventions in spinal cord injury (SCI). SDB is highly prevalent in SCI, with increased prevalence in individuals with higher and more severe lesions, and the criterion standard treatment with continuous positive airway pressure remains problematic. Despite its high prevalence, SDB is often untested and untreated in individuals with SCI. In individuals without SCI, SDB is known to negatively affect physical function and many of the physiological systems that negatively affect physical rehabilitation in SCI. Thus, owing to the high prevalence, under testing, low treatment adherence, and known negative effect on the physical function, it is contended that underdiagnosed SDB in SCI may be confounding physical rehabilitation research studies in individuals with SCI. Studies investigating the effect of treating SDB and its effect on physical rehabilitation in SCI were unable to be located. Thus, studies investigating the likely integrated relationship among physical rehabilitation, SDB, and proper treatment of SDB in SCI are needed. Owing to rapid growth in both sleep medicine and physical rehabilitation intervention research in SCI, the authors contend it is the appropriate time to begin the conversations and collaborations between these fields. We discuss a general overview of SDB and physical training modalities, as well as how SDB could be affecting these studies.
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Affiliation(s)
- Gino S Panza
- John D. Dingell Veterans Affairs Medical Center, Detroit, MI; Department of Physiology, Wayne State University School of Medicine, Detroit, MI.
| | - Tommy Sutor
- Research Service, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA
| | - Cameron M Gee
- International Collaboration on Repair Discoveries, Vancouver, BC, Canada
| | - Marnie Graco
- Institute for Breathing and Sleep, Austin Health; and School of Physiotherapy, University of Melbourne, Melbourne, Australia
| | | | - Anthony Chiodo
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
| | - M Safwan Badr
- John D. Dingell Veterans Affairs Medical Center, Detroit, MI; Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI
| | - Mark S Nash
- Department of Neurological Surgery, Physical Medicine & Rehabiliation, and Physical Therapy, Miami, FL; The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL
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6
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Wooten LC, Neville BT, Keyser RE. Measures of excess [Formula: see text]CO 2 and recovery [Formula: see text]CO 2 as indices of performance fatigability during exercise: a pilot study. Pilot Feasibility Stud 2021; 7:131. [PMID: 34162443 PMCID: PMC8220798 DOI: 10.1186/s40814-021-00840-0] [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: 10/19/2020] [Accepted: 04/16/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The severity of performance fatigability and the capacity to recover from activity are profoundly influenced by skeletal muscle energetics, specifically the ability to buffer fatigue-inducing ions produced from anaerobic metabolism. Mechanisms responsible for buffering these ions result in the production of excess carbon dioxide (CO2) that can be measured as expired CO2 ([Formula: see text]CO2) during cardiopulmonary exercise testing (CPET). The primary objective of this study was to assess the feasibility of select assessment procedures for use in planning and carrying out interventional studies, which are larger interventional studies investigating the relationships between CO2 expiration, measured during and after both CPET and submaximal exercise testing, and performance fatigability. METHODS Cross-sectional, pilot study design. Seven healthy subjects (30.7±5.1 years; 5 females) completed a peak CPET and constant work-rate test (CWRT) on separate days, each followed by a 10-min recovery then 10-min walk test. Oxygen consumption ([Formula: see text]O2) and [Formula: see text]CO2 on- and off-kinetics (transition constant and oxidative response index), excess-[Formula: see text]CO2, and performance fatigability severity scores (PFSS) were measured. Data were analyzed using regression analyses. RESULTS All subjects that met the inclusion/exclusion criteria and consented to participate in the study completed all exercise testing sessions with no adverse events. All testing procedures were carried out successfully and outcome measures were obtained, as intended, without adverse events. Excess-[Formula: see text]CO2 accounted for 61% of the variability in performance fatigability as measured by [Formula: see text]O2 on-kinetic ORI (ml/s) (R2=0.614; y = 8.474x - 4.379, 95% CI [0.748, 16.200]) and 62% of the variability as measured by PFSS (R2=0.619; y = - 0.096x + 1.267, 95% CI [-0.183, -0.009]). During CPET, [Formula: see text]CO2 -off ORI accounted for 70% (R2=0.695; y = 1.390x - 11.984, 95% CI [0.331, 2.449]) and [Formula: see text]CO2 -off Kt for 73% of the variability in performance fatigability measured by [Formula: see text]O2 on-kinetic ORI (ml/s) (R2=0.730; y = 1.818x - 13.639, 95% CI [0.548, 3.087]). CONCLUSION The findings of this study suggest that utilizing [Formula: see text]CO2 measures may be a viable and useful addition or alternative to [Formula: see text]O2 measures, warranting further study. While the current protocol appeared to be satisfactory, for obtaining select cardiopulmonary and performance fatigability measures as intended, modifications to the current protocol to consider in subsequent, larger studies may include use of an alternate mode or measure to enable control of work rate constancy during performance fatigability testing following initial CPET.
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Affiliation(s)
- Liana C. Wooten
- Department of Health, Human Function, and Rehabilitation Science, George Washington University, Washington, DC USA
- Department of Rehabilitation Science, College of Health and Human Services, George Mason University, Fairfax, VA USA
| | - Brian T. Neville
- Department of Rehabilitation Science, College of Health and Human Services, George Mason University, Fairfax, VA USA
| | - Randall E. Keyser
- Department of Rehabilitation Science, College of Health and Human Services, George Mason University, Fairfax, VA USA
- Rehabilitation Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD USA
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Gonnelli F, Rejc E, Giovanelli N, Floreani M, Porcelli S, Harkema S, Willhite A, Stills S, Richardson T, Lazzer S. Effects of NMES pulse width and intensity on muscle mechanical output and oxygen extraction in able-bodied and paraplegic individuals. Eur J Appl Physiol 2021; 121:1653-1664. [PMID: 33656575 DOI: 10.1007/s00421-021-04647-y] [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: 09/17/2020] [Accepted: 02/15/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE Neuromuscular Electrical Stimulation (NMES) is commonly used in neuromuscular rehabilitation protocols, and its parameters selection substantially affects the characteristics of muscle activation. Here, we investigated the effects of short pulse width (200 µs) and higher intensity (short-high) NMES or long pulse width (1000 µs) and lower intensity (long-low) NMES on muscle mechanical output and fractional oxygen extraction. Muscle contractions were elicited with 100 Hz stimulation frequency, and the initial torque output was matched by adjusting stimulation intensity. METHODS Fourteen able-bodied and six spinal cord-injured (SCI) individuals participated in the study. The NMES protocol (75 isometric contractions, 1-s on-3-s off) targeting the knee extensors was performed with long-low or short-high NMES applied over the midline between anterior superior iliac spine and patella protrusion in two different days. Muscle work was estimated by torque-time integral, contractile properties by rate of torque development and half-relaxation time, and vastus lateralis fractional oxygen extraction was assessed by Near-Infrared Spectroscopy (NIRS). RESULTS Torque-time integral elicited by the two NMES paradigms was similar throughout the stimulation protocol, with differences ranging between 1.4% (p = 0.877; able-bodied, mid-part of the protocol) and 9.9% (p = 0.147; SCI, mid-part of the protocol). Contractile properties were also comparable in the two NMES paradigms. However, long-low NMES resulted in higher fractional oxygen extraction in able-bodied (+ 36%; p = 0.006). CONCLUSION Long-low and short-high NMES recruited quadriceps femoris motor units that demonstrated similar contractile and fatigability properties. However, long-low NMES conceivably resulted in the preferential recruitment of vastus lateralis muscle fibers as detected by NIRS.
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Affiliation(s)
- Federica Gonnelli
- Department of Medicine, University of Udine, Udine, Italy.,School of Sport Sciences, University of Udine, Udine, Italy.,Kentucky Spinal Cord Injury Research Center, University of Louisville, 220 Abraham Flexner Way, Louisville, KY, 40202, USA
| | - Enrico Rejc
- Kentucky Spinal Cord Injury Research Center, University of Louisville, 220 Abraham Flexner Way, Louisville, KY, 40202, USA. .,Department of Neurosurgery, University of Louisville, Louisville, KY, USA.
| | - Nicola Giovanelli
- Department of Medicine, University of Udine, Udine, Italy.,School of Sport Sciences, University of Udine, Udine, Italy
| | - Mirco Floreani
- Department of Medicine, University of Udine, Udine, Italy.,School of Sport Sciences, University of Udine, Udine, Italy
| | - Simone Porcelli
- Department of Molecular Medicine, University of Pavia, Pavia, Italy.,Institute of Biomedical Technologies, National Research Council, Segrate, Italy
| | - Susan Harkema
- Kentucky Spinal Cord Injury Research Center, University of Louisville, 220 Abraham Flexner Way, Louisville, KY, 40202, USA.,Department of Neurosurgery, University of Louisville, Louisville, KY, USA.,Department of Bioengineering, University of Louisville, Louisville, KY, USA
| | - Andrea Willhite
- Kentucky Spinal Cord Injury Research Center, University of Louisville, 220 Abraham Flexner Way, Louisville, KY, 40202, USA
| | - Sean Stills
- Kentucky Spinal Cord Injury Research Center, University of Louisville, 220 Abraham Flexner Way, Louisville, KY, 40202, USA
| | - Tine Richardson
- Kentucky Spinal Cord Injury Research Center, University of Louisville, 220 Abraham Flexner Way, Louisville, KY, 40202, USA
| | - Stefano Lazzer
- Department of Medicine, University of Udine, Udine, Italy.,School of Sport Sciences, University of Udine, Udine, Italy
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Murray D, Chin LMK, Cowan RE, Groah SL, Keyser RE. Recovery Off-Kinetics Following Exhaustive Upper Body Exercise in Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2021; 26:304-313. [PMID: 33536736 DOI: 10.46292/sci19-00060] [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: 11/19/2022]
Abstract
Background People with spinal cord injury (SCI) present with impaired autonomic control when the lesion is above T6. This could lead to delayed cardiorespiratory recovery following vigorous physical activity. Objectives To characterize and compare gas exchange off-kinetics following exhaustive exercise in individuals with SCI and an apparently healthy control group. Methods Participants were 19 individuals with SCI who presented with the inability to voluntarily lift their legs against gravity (age, 44.6 ± 14.2 years; AIS A, n = 5; AIS B, n = 7; AIS C, n = 7; paraplegia, n = 14; tetraplegia, n = 5) and 10 healthy comparisons (COM; age, 30.5 ± 5.3 years). All participants performed an arm ergometer cardiopulmonary exercise test (aCPET) to volitional exhaustion followed by a 10-minute passive recovery. O2 uptake (V̇o2 ) and CO2 output (V̇co2 ) off-kinetics was examined using a mono-exponential model in which tau off (τoff ) and mean response time (MRT) were determined. The off-kinetics transition constant (Ktoff ) was calculated as ΔV̇o2 /MRT. Student t tests were used to compare SCI versus COM group means. Results COM had a significantly higher relative peak V̇o2 compared to SCI (1.70 ± 0.55 L/min vs 1.19 ± 0.51 L/min, p = .019). No difference was observed for τoff between the groups, however Ktoff for both V̇o2 and V̇co2 was significantly lower in the SCI compared to the COM group. Conclusion A reduced Ktoff during recovery may suggest inefficiencies in replenishing muscle ATP stores and lactate clearance in these participants with SCI. These findings may contribute to the observed lower cardiorespiratory fitness and greater fatigability typically reported in individuals with SCI.
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Affiliation(s)
- Donal Murray
- Department of Kinesiology, Western Illinois University, Macomb, Illinois.,Department of Rehabilitation Science, George Mason University, Fairfax, Virginia
| | - Lisa M K Chin
- Rehabilitation Medicine Department, National Institutes of Health Clinical Center, Bethesda, Maryland
| | - Rachel E Cowan
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Randall E Keyser
- Department of Rehabilitation Science, George Mason University, Fairfax, Virginia
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9
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Pechstein AE, Gollie JM, Guccione AA. Fatigability and Cardiorespiratory Impairments in Parkinson's Disease: Potential Non-Motor Barriers to Activity Performance. J Funct Morphol Kinesiol 2020; 5:E78. [PMID: 33467293 PMCID: PMC7739335 DOI: 10.3390/jfmk5040078] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/27/2020] [Accepted: 10/29/2020] [Indexed: 01/18/2023] Open
Abstract
Parkinson's disease (PD) is the second most common neurodegenerative condition after Alzheimer's disease, affecting an estimated 160 per 100,000 people 65 years of age or older. Fatigue is a debilitating non-motor symptom frequently reported in PD, often manifesting prior to disease diagnosis, persisting over time, and negatively affecting quality of life. Fatigability, on the other hand, is distinct from fatigue and describes the magnitude or rate of change over time in the performance of activity (i.e., performance fatigability) and sensations regulating the integrity of the performer (i.e., perceived fatigability). While fatigability has been relatively understudied in PD as compared to fatigue, it has been hypothesized that the presence of elevated levels of fatigability in PD results from the interactions of homeostatic, psychological, and central factors. Evidence from exercise studies supports the premise that greater disturbances in metabolic homeostasis may underly elevated levels of fatigability in people with PD when engaging in physical activity. Cardiorespiratory impairments constraining oxygen delivery and utilization may contribute to the metabolic alterations and excessive fatigability experienced in individuals with PD. Cardiorespiratory fitness is often reduced in people with PD, likely due to the combined effects of biological aging and impairments specific to the disease. Decreases in oxygen delivery (e.g., reduced cardiac output and impaired blood pressure responses) and oxygen utilization (e.g., reduced skeletal muscle oxidative capacity) compromise skeletal muscle respiration, forcing increased reliance on anaerobic metabolism. Thus, the assessment of fatigability in people with PD may provide valuable information regarding the functional status of people with PD not obtained with measures of fatigue. Moreover, interventions that target cardiorespiratory fitness may improve fatigability, movement performance, and health outcomes in this patient population.
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Affiliation(s)
- Andrew E. Pechstein
- Department of Rehabilitation Science, George Mason University, Fairfax, VA 22030, USA; (A.E.P.); (A.A.G.)
| | - Jared M. Gollie
- Department of Rehabilitation Science, George Mason University, Fairfax, VA 22030, USA; (A.E.P.); (A.A.G.)
- Research Services, Veterans Affairs Medical Center, Washington, DC 20422, USA
- Department of Health, Human Function, and Rehabilitation Sciences, The George Washington University, Washington, DC 20006, USA
| | - Andrew A. Guccione
- Department of Rehabilitation Science, George Mason University, Fairfax, VA 22030, USA; (A.E.P.); (A.A.G.)
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10
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Ghatas MP, Holman ME, Gorgey AS. Methodological considerations for near-infrared spectroscopy to assess mitochondrial capacity after spinal cord injury. J Spinal Cord Med 2020; 43:623-632. [PMID: 31233377 PMCID: PMC7534271 DOI: 10.1080/10790268.2019.1631585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Background: Skeletal muscle mitochondrial activity is reduced by ∼ 50-60% after SCI, resulting in impaired energy expenditure, glucose utilization and insulin sensitivity. Near infra-red spectroscopy (NIRS) is a non-invasive tool that can be used to assess mitochondrial capacity. Objectives: (1) Highlight methodological limitations impacting data acquisition and analysis such as subcutaneous adipose tissue (SAT) thickness, movement artifacts, inadequate muscle stimulation, light interference, and ischemic discomfort. (2) Provide technical considerations to improve data acquisition and analysis. This may serve as guidance to other researchers and clinicians using NIRS. Study Design: cross-sectional observational design. Settings: Clinical research medical center. Participants: Sixteen men with 1 > year post motor complete SCI. Methods: NIRS signals were obtained from right vastus lateralis muscle utilizing a portable system. Signals were fit to a mono-exponential curve. Outcome Measures: Rate constant and r2 values for the fit curve, indirectly measures mitochondrial capacity. Results: Only four participants produced data with accepted rate constants of 0.002-0.013 s-1 and r2 of 0.71-0.87. Applications of studentized residuals ≥2.5 resulted in sparing data from another four participants with rate constants of 0.010-0.018 s-1and r2 values ranging from 0.86-0.99. Conclusions: Several limitations may challenge the use of NIRS to assess mitochondrial capacity after SCI. Acknowledging these limitations and applying additional data processing techniques may overcome the discussed limitations and facilitate data sparing.
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Affiliation(s)
- Mina P. Ghatas
- Spinal Cord Injury and Disorders, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia, USA
| | - Matthew E. Holman
- Spinal Cord Injury and Disorders, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia, USA,Department of Physical Therapy, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Ashraf S. Gorgey
- Spinal Cord Injury and Disorders, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia, USA,Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, USA,Correspondence to: Ashraf S. Gorgey, Spinal Cord Injury & Disorders Service, Hunter Holmes McGuire VA Medical Center, 1201 Broad Rock Blvd, Richmond, VA23249, USA. ;
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11
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Dorneles JR, Neto FR, Gonçalves CW, Costa RRG, Carregaro RL. Does prolonged walking cause greater muscle fatigability in individuals with incomplete spinal cord injury compared with matched-controls? Gait Posture 2020; 78:65-71. [PMID: 32268249 DOI: 10.1016/j.gaitpost.2020.03.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 03/17/2020] [Accepted: 03/22/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Individuals with incomplete spinal cord injury (iSCI) might show muscle fatigability during walking, primarily over long distances. The cause can be related to the motor impairment and walking compensations identified in this population. However, evidence on the occurrence of muscle fatigability after prolonged walking in individuals with iSCI is conflicting. RESEARCH QUESTION Does prolonged walking cause higher muscle fatigability in individuals with iSCI compared with matched-controls? METHODS We adopted a repeated measures design, in which maximal voluntary isometric contractions were performed before and after a walking test to induce the fatigability, in 24 individuals with iSCI and 24 matched-controls. Body weight-normalized peak torque (PT/BW), rate of force development (RFD), root mean square (RMS) and neuromuscular efficiency were used to assess the muscle fatigability. A mixed model ANOVA (2 × 2) was used for between-group and within-group comparisons. The significance was set in 5%. RESULTS Individuals with iSCI showed a greater decline in the PT/BW and RMS after the walking test. However, the RFD presented a greater decrease in the control group. SIGNIFICANCE Our results showed that prolonged walking caused higher muscle fatigability in individuals with iSCI compared to healthy individuals. Therefore, muscle fatigability should be considered during the rehabilitation planning and in activities of daily living of individuals with iSCI. Moreover, the identification of muscle fatigability in individuals with iSCI might be useful to prevent high levels of physical exertion and, possibly, the risk of fall.
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Affiliation(s)
- Jefferson Rodrigues Dorneles
- Master Program in Rehabilitation Sciences, Universidade De Brasília (UnB), Campus UnB Ceilândia, Brasília, Brazil; Spinal Cord Injury Department, Sarah Hospital Rehabilitation Network, Brasilia, Brazil
| | | | | | | | - Rodrigo Luiz Carregaro
- Master Program in Rehabilitation Sciences, Universidade De Brasília (UnB), Campus UnB Ceilândia, Brasília, Brazil.
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Murray D, Keyser RE, Chin LMK, Bulea TC, Wutzke CJ, Guccione AA. EMG median frequency shifts without change in muscle oxygenation following novel locomotor training in individuals with incomplete spinal cord injury. Disabil Rehabil 2020; 44:52-58. [PMID: 32331508 PMCID: PMC10367183 DOI: 10.1080/09638288.2020.1755729] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Objectives: To examine the effect of muscle fiber recruitment patterns on muscle oxygen utilization during treadmill walking in a group of individuals who have incomplete spinal cord injury.Methods: 5 participants with motor incomplete spinal cord injury (Age; 42.2 ± 18.8 years, Male; n = 4) completed an over ground locomotor training program. Muscle utilization/oxygenation and activation of the medial gastrocnemius were measured by near infrared spectroscopy and surface electromyography pre- and post-over ground locomotor training during two separate treadmill walking bouts at self-selected speeds. Outcomes were changes in deoxygenation hemoglobin/myoglobin concentrations, and the change in median power of the power spectrum of the electromyography after training.Results: A significant increase in median power of the power spectrum of the electromyography signal was observed during both bouts of treadmill walking, 6-minute walking bout and longer fatiguing bout (49% p = 0.047 and 48% p = 0.035, respectively) post-over ground locomotor training. There was no significant change in muscle utilization/oxygenation post-over ground locomotor training. There was no significant effect of median power of the power spectrum on deoxygenation hemoglobin/myoglobin during either of the walking bouts.Conclusions: The main finding of the current study was that median power of the power spectrum significantly increased following 12 weeks of over ground locomotor training, with no significant change in deoxygenation hemoglobin/myoglobin. The recruitment of more and/or larger motor units was seen in conjunction with no changes in muscle oxygen utilization for the same walking task.Implications for RehabilitationThe reduction of skeletal muscle innervation in Spinal Cord Injury may adversely affect the orderly recruitment of motor units, which could in turn blunt the oxidative metabolic response during physical activity.Over-ground locomotor could be a useful tool in the rehabilitative process following an incomplete spinal cord injury.
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Affiliation(s)
- Donal Murray
- Department of Kinesiology, Western Illinois University, Macomb, IL, USA
| | - Randall E Keyser
- Department of Rehabilitation Science, George Mason University, Fairfax, VA, USA
| | - Lisa M K Chin
- Rehabilitation Medicine Department, National Institutes of Health, Clinical Center, Bethesda, MD, USA
| | - Thomas C Bulea
- Rehabilitation Medicine Department, National Institutes of Health, Clinical Center, Bethesda, MD, USA
| | - Clinton J Wutzke
- Department of Rehabilitation Science, George Mason University, Fairfax, VA, USA
| | - Andrew A Guccione
- Department of Rehabilitation Science, George Mason University, Fairfax, VA, USA
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Panza GS, Herrick JE, Chin LM, Gollie JM, Collins JP, O’Connell DG, Guccione AA. Effect of overground locomotor training on ventilatory kinetics and rate of perceived exertion in persons with cervical motor-incomplete spinal cord injury. Spinal Cord Ser Cases 2019; 5:80. [PMID: 31632738 PMCID: PMC6786384 DOI: 10.1038/s41394-019-0223-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/29/2019] [Accepted: 09/08/2019] [Indexed: 11/09/2022] Open
Abstract
Study design Pre-post, pilot study. Objectives To characterize ventilatory (VE) responses to exercise following warm-up walking in individuals with chronic incomplete spinal cord injury (iSCI) during constant work rate (CWR) exercise. Secondarily, to investigate VE and tidal volume (VT) variability, and ratings of perceived exertion (RPE) before and after overground locomotor training (OLT). Setting Research laboratory. Methods A 6-min CWR walking bout at preferred pace was used as a warm-up followed by 6 min of rest and a second 6-min CWR bout at above preferred walking pace. The second CWR bout was analyzed. Breath-by-breath ventilatory data were examined using a curvilinear least squares fitting procedure with a mono-exponential model. VE and VT variability was calculated as the difference between the observed and predicted values and RPE was taken every 2 min. Results Participants (n = 3, C4-C5) achieved a hyperpneic response to exercise in VE and VT. OLT resulted in faster ventilatory kinetics and reductions of 24 and 29% for VE and VT variability, respectively. A 30% reduction in RPE was concurrent with the reductions in ventilatory variability. Conclusions OLT may improve ventilatory control during CWR in patients with cervical motor-iSCI. These data suggest that in some participants with iSCI, ventilation may influence RPE during walking. Future research should investigate mechanisms of ventilatory variability and its implications in walking performance in patients with iSCI.
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Affiliation(s)
- Gino S. Panza
- John D. Dingell Veterans Affairs Medical Center, Detroit, MI USA
- Department of Physiology, Wayne State University School of Medicine, Detroit, MI USA
| | - Jeffrey E. Herrick
- Department of Exercise Physiology, University of Lynchburg, Lynchburg, VA USA
| | - Lisa M. Chin
- Rehabilitation Medicine Department, National Institutes of Health, Clinical Center, Bethesda, MD USA
| | | | | | | | - Andrew A. Guccione
- Department of Rehabilitation Science, George Mason University, Fairfax, VA USA
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Neville BT, Murray D, Rosen KB, Bryson CA, Collins JP, Guccione AA. Effects of Performance-Based Training on Gait and Balance in Individuals With Incomplete Spinal Cord Injury. Arch Phys Med Rehabil 2019; 100:1888-1893. [PMID: 31026461 DOI: 10.1016/j.apmr.2019.03.019] [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] [Received: 11/09/2018] [Revised: 03/11/2019] [Accepted: 03/13/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To determine changes in balance and gait following a task-specific, performance-based training protocol for overground locomotor training (OLT) in individuals with motor-incomplete spinal cord injury (iSCI). DESIGN Convenience sample, prepilot and postpilot study. SETTING Human performance research laboratory. PARTICIPANTS Adults (N=15; 12 men and 3 women; mean age [y] ± SD, 41.5±16.9), American Spinal Injury Association Impairment Scale C or D, >6 months post-spinal cord injury. INTERVENTIONS Two 90-minute OLT sessions per week over 12 to 15 weeks. OLT sessions were built on 3 principles of motor learning: practice variability, task specificity, and progressive overload (movement complexity, resistance, velocity, volume). Training used only voluntary movements without body-weight support, robotics, electrical stimulation, or bracing. Subjects used ambulatory assistive devices as necessary. MAIN OUTCOME MEASURES Berg Balance Scale (BBS), Spinal Cord Injury Functional Ambulation Inventory (SCI-FAI) gait parameters, spatiotemporal measures of gait (step length, step width, percent stance, stance:swing ratio) from 7 participants who walked across a pressure-sensitive walkway. RESULTS Fourteen participants completed the OLT protocol and 1 participant completed 15 sessions due to scheduled surgery. The BBS scores showed a mean improvement of 4.53±4.09 (P<.001). SCI-FAI scores showed a mean increase of 2.47±3.44 (P=.01). Spatiotemporal measures of gait showed no significant changes. CONCLUSION This pilot demonstrated improvements in balance and selected gait characteristics using a task-specific, performance-based OLT for chronic iSCI.
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Affiliation(s)
- Brian T Neville
- Department of Rehabilitation Science, George Mason University, Fairfax, Virginia
| | - Donal Murray
- Department of Rehabilitation Science, George Mason University, Fairfax, Virginia
| | - Kerry B Rosen
- Department of Rehabilitation Science, George Mason University, Fairfax, Virginia
| | - Caitlin A Bryson
- Department of Rehabilitation Science, George Mason University, Fairfax, Virginia
| | | | - Andrew A Guccione
- Department of Rehabilitation Science, George Mason University, Fairfax, Virginia.
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Chin LMK, Chan L, Drinkard B, Keyser RE. Oxygen uptake on-kinetics before and after aerobic exercise training in individuals with traumatic brain injury. Disabil Rehabil 2018; 41:2949-2957. [PMID: 29961351 DOI: 10.1080/09638288.2018.1483432] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objective: The high prevalence of fatigue among persons with traumatic brain injury (TBI) may be related to poor cardiorespiratory fitness observed in this population. Oxygen uptake on-kinetics is a method of assessing cardiorespiratory fitness and may be used to examine performance fatigability (decline in performance during a given activity) in persons with TBI.Purpose: To examine the effect of aerobic exercise training on oxygen uptake on-kinetics during treadmill walking in individuals with TBI.Methods: Seven ambulatory adults with chronic non-penetrating TBI performed short moderate-intensity (3-6 metabolic equivalents) walking bouts on a treadmill, prior to and following an aerobic exercise training program (clinicaltrials.gov: NCT01294332). The 12-week training program consisted of vigorous-intensity exercise on a treadmill for 30 min, 3 times a week. Breath-by-breath pulmonary gas exchange was measured throughout the bouts, and oxygen uptake on-kinetics described the time taken to achieve a steady-state response.Results: Faster oxygen uptake on-kinetics was observed after exercise training, for both the absolute and relative intensity as pre-training.Conclusions: Faster oxygen uptake on-kinetics following aerobic exercise training suggests an attenuated decline in physical performance during a standardized walking bout and improved performance fatigability in these individuals with TBI.Implications for rehabilitationSevere fatigue is a common complaint among persons with traumatic brain injury (TBI).Oxygen uptake on-kinetics may be used as an objective physiological measure of performance fatigability in persons with TBI.Faster oxygen uptake on-kinetics following aerobic exercise training suggests improved performance fatigability in these individuals with TBI.Aerobic exercise training appeared beneficial for reducing performance fatigability and may be considered as part of the rehabilitative strategy for those living with TBI.
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Affiliation(s)
- Lisa M K Chin
- Department of Rehabilitation Science, George Mason University, Fairfax, VA, USA.,Rehabilitation Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD, USA.,Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Leighton Chan
- Rehabilitation Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD, USA.,Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Bart Drinkard
- Rehabilitation Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Randall E Keyser
- Department of Rehabilitation Science, George Mason University, Fairfax, VA, USA.,Rehabilitation Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD, USA.,Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Gollie JM. Fatigability during volitional walking in incomplete spinal cord injury: cardiorespiratory and motor performance considerations. Neural Regen Res 2018; 13:786-790. [PMID: 29862998 PMCID: PMC5998625 DOI: 10.4103/1673-5374.232461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2018] [Indexed: 02/06/2023] Open
Abstract
Fatigability describes the decline in force production (i.e., performance fatigability) and/or changes in sensations regulating performance (i.e., perceived fatigability) during whole-body activity and poses a major challenge to those living with spinal cord injuries (SCI). After SCI, the inability to overcome disruptions to metabolic homeostasis due to cardiorespiratory limitations and physical deconditioning may contribute to increased fatigability severity. The increased susceptibility to fatigability may have implications for motor control strategies and motor learning. Locomotor training approaches designed to reduce fatigability and enhance aerobic capacity in combination with motor learning may be advantageous for promoting functional recovery after SCI. Future research is required to advance the understanding of the relationship between fatigability, cardiorespiratory function and motor performance following SCI.
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Affiliation(s)
- Jared M. Gollie
- Muscle Morphology, Mechanics and Performance Laboratory, Clinical Research Center-Human Performance Research Unit, Veteran Affairs Medical Center Washington, DC, USA
- Department of Health, Human Function, and Rehabilitation Sciences, School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
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