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Dolbow DR, Bersch I, Gorgey AS, Davis GM. The Clinical Management of Electrical Stimulation Therapies in the Rehabilitation of Individuals with Spinal Cord Injuries. J Clin Med 2024; 13:2995. [PMID: 38792536 PMCID: PMC11122106 DOI: 10.3390/jcm13102995] [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: 04/11/2024] [Revised: 05/09/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024] Open
Abstract
Background: People with spinal cord injuries (SCIs) often have trouble remaining active because of paralysis. In the past, exercise recommendations focused on the non-paralyzed muscles in the arms, which provides limited benefits. However, recent studies show that electrical stimulation can help engage the paralyzed extremities, expanding the available muscle mass for exercise. Methods: The authors provide an evidence-based approach using expertise from diverse fields, supplemented by evidence from key studies toward the management of electrical stimulation therapies in individuals with SCIs. Literature searches were performed separately using the PubMed, Medline, and Google Scholar search engines. The keywords used for the searches included functional electrical stimulation cycling, hybrid cycling, neuromuscular electrical stimulation exercise, spinal cord injury, cardiovascular health, metabolic health, muscle strength, muscle mass, bone mass, upper limb treatment, diagnostic and prognostic use of functional electrical stimulation, tetraplegic hands, and hand deformities after SCI. The authors recently presented this information in a workshop at a major rehabilitation conference. Additional information beyond what was presented at the workshop was added for the writing of this paper. Results: Functional electrical stimulation (FES) cycling can improve aerobic fitness and reduce the risk of cardiovascular and metabolic diseases. The evidence indicates that while both FES leg cycling and neuromuscular electrical stimulation (NMES) resistance training can increase muscle strength and mass, NMES resistance training has been shown to be more effective for producing muscle hypertrophy in individual muscle groups. The response to the electrical stimulation of muscles can also help in the diagnosis and prognosis of hand dysfunction after tetraplegia. Conclusions: Electrical stimulation activities are safe and effective methods for exercise and testing for motor neuron lesions in individuals with SCIs and other paralytic or paretic conditions. They should be considered part of a comprehensive rehabilitation program in diagnosing, prognosing, and treating individuals with SCIs to improve function, physical activity, and overall health.
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Affiliation(s)
- David R. Dolbow
- Physical Therapy Program, College of Osteopathic Medicine, William Carey University, 710 William Carey Parkway, Hattiesburg, MS 39401, USA
| | - Ines Bersch
- International FES Centre®, Swiss Paraplegia Centre, CH-6207 Nottwil, Switzerland
| | - Ashraf S. Gorgey
- Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire VA Medical Center, Richmond, VA 23249, USA;
| | - Glen M. Davis
- Discipline of Exercise and Sport Sciences, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia
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Descollonges M, Marmier P, Marillier M, Jafari E, Brugniaux JV, Deley G. Effect of electrical muscle stimulation on cerebrovascular function and cognitive performance. Am J Physiol Heart Circ Physiol 2024; 326:H923-H928. [PMID: 38334969 DOI: 10.1152/ajpheart.00032.2024] [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] [Received: 01/18/2024] [Revised: 02/05/2024] [Accepted: 02/05/2024] [Indexed: 02/10/2024]
Abstract
It is known that electrical muscle stimulation (EMS) can enhance physical function, but its impact on cognition and cerebral hemodynamics is not well understood. Thus, the purpose of this study was to investigate the effects of one EMS session on cerebrovascular function and cognitive performance. The 17 recruited young healthy participants undertook a 25-min session of EMS and a resting control session (Ctrl group) in a random order. Cerebral blood flow velocity (CBFv) in the middle and posterior cerebral arteries (right MCAv and left PCAv, respectively), cerebral oxygenation, cardiac output, and heart rate were measured throughout the sessions, whereas cognitive function was assessed before and after each experimental condition. MCAv, cardiac output, heart rate, and cerebral oxygenation were increased throughout the EMS session, whereas PCAv remained unchanged. In addition, EMS led to improved scores at the Rey auditory verbal learning test-part B and congruent Stroop task versus Ctrl. The present study demonstrates that a single session of EMS may improve cognitive performance and concomitantly increase CBFv and cerebral oxygenation. Therefore, EMS appears to be a valuable surrogate for voluntary exercise and could therefore be advantageously used in populations with severe physical limitations who would not be able to perform physical exercise otherwise.NEW & NOTEWORTHY This study is the first to demonstrate that one session of EMS applied to the quadriceps increases cerebral blood flow velocity and cerebral oxygenation, which are pivotal factors for brain health. Thus, EMS has the potential to be used as an interesting option in rehabilitation to increase cerebral perfusion and defend if not improve cognitive function sustainably for people with severe physical limitations who would not be able to perform physical exercise voluntarily.
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Affiliation(s)
- Maël Descollonges
- INSERM UMR 1093-Laboratoire CAPS, Université de Bourgogne, UFR des Sciences du Sport, Dijon, France
- Kurage, Lyon, France
| | - Paul Marmier
- INSERM UMR 1093-Laboratoire CAPS, Université de Bourgogne, UFR des Sciences du Sport, Dijon, France
| | - Mathieu Marillier
- HP2 Laboratory, Université de Grenoble Alpes, INSERM, CHU Grenoble Alpes, Grenoble, France
| | - Ehsan Jafari
- Ecole Normale Supérieure de Lyon, CNRS, Laboratoire de Physique, Lyon, France
- Kurage, Lyon, France
| | - Julien V Brugniaux
- HP2 Laboratory, Université de Grenoble Alpes, INSERM, CHU Grenoble Alpes, Grenoble, France
| | - Gaëlle Deley
- INSERM UMR 1093-Laboratoire CAPS, Université de Bourgogne, UFR des Sciences du Sport, Dijon, France
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Farkas GJ, Caldera LJ, Nash MS. Assessing the efficacy of duration and intensity prescription for physical activity in mitigating cardiometabolic risk after spinal cord injury. Curr Opin Neurol 2023; 36:531-540. [PMID: 37865846 DOI: 10.1097/wco.0000000000001206] [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: 10/23/2023]
Abstract
PURPOSE OF REVIEW Spinal cord injury (SCI) heightens susceptibility to cardiometabolic risk (CMR), predisposing individuals to cardiovascular disease. This monograph aims to assess the optimal duration and intensity of physical activity (PA) for managing CMR factors, particularly obesity, after SCI and provide modality-specific PA durations for optimal energy expenditure. RECENT FINDINGS PA guidelines recommend at least 150 min/week of moderate-intensity activity. However, non-SCI literature supports the effectiveness of engaging in vigorous-intensity PA (≥6 METs) and dedicating 250-300 min/week (≈2000 kcal/week) to reduce CMR factors. Engaging in this volume of PA has shown a dose-response relationship, wherein increased activity results in decreased obesity and other CMR factors in persons without SCI. SUMMARY To optimize cardiometabolic health, individuals with SCI require a longer duration and higher intensity of PA to achieve energy expenditures comparable to individuals without SCI. Therefore, individuals with SCI who can engage in or approach vigorous-intensity PA should prioritize doing so for at least 150 min/wk. At the same time, those unable to reach such intensities should engage in at least 250-300 min/week of PA at a challenging yet comfortable intensity, aiming to achieve an optimal intensity level based on their abilities. Given the potential to decrease CMR after SCI, increasing PA duration and intensity merits careful consideration in future SCI PA directives.
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Affiliation(s)
- Gary J Farkas
- Department of Physical Medicine and Rehabilitation, University of Miami
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis
| | - Lizeth J Caldera
- Department of Physical Medicine and Rehabilitation, University of Miami
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis
| | - Mark S Nash
- Department of Physical Medicine and Rehabilitation, University of Miami
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis
- The Miami Project to Cure Paralysis, Department of Neurological Surgery
- Department of Physical Therapy, University of Miami, Miami, FL, USA
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Descollonges M, Marmier P, Mater A, Di Marco J, Deley G. FES-rowing: a well-tolerated and highly beneficial exercise for a patient with Brown-Sequard syndrome. J Spinal Cord Med 2023; 46:986-990. [PMID: 37010847 PMCID: PMC10653739 DOI: 10.1080/10790268.2023.2165369] [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: 04/04/2023] Open
Abstract
CONTEXT Brown-Séquard Syndrome (BSS) is a rare neurological condition associated with Spinal Cord Injury (SCI). Hemisection of the spinal cord causes paralysis of the homolateral side, and thermoalgesic dysfunction on the opposite side. Cardiopulmonary and metabolic alterations have been reported. For all these patients, regular physical activity is highly recommended and functional electrical stimulation (FES) may be a good option, especially for those with paraplegia. However, to our knowledge, the effects of FES have primarily been studied in those with complete SCI and data regarding application and effects in patients with incomplete lesions (with sensory feedback) is lacking. The present case report therefore evaluated the feasibility and effectiveness of a 3-month FES-rowing program in a patient with BSS. METHODS Knee extensor muscle strength and thickness, walking and rowing capacities as well as quality of life were evaluated before and after 3 months of FES-rowing (two sessions per week) in a 54 year old patient with BSS. RESULTS The individual had excellent tolerance and adherence to the training protocol. All measured parameters were greatly improved after 3 months: on average, + 30% rowing capacity, + 26% walking capacity, + 24.5% isometric strength, + 21.9% quadriceps muscle thickness, + 34.5% quality of life. CONCLUSION FES-rowing appears to be well tolerated and highly beneficial for a patient with incomplete SCI and could therefore be considered as an appealing exercise option for these patients.
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Affiliation(s)
- Maël Descollonges
- INSERM UMR 1093 – CAPS, Université de Bourgogne Franche-Comté, UFR des Sciences du Sport, Dijon, France
| | - Paul Marmier
- INSERM UMR 1093 – CAPS, Université de Bourgogne Franche-Comté, UFR des Sciences du Sport, Dijon, France
| | - Adrien Mater
- INSERM UMR 1093 – CAPS, Université de Bourgogne Franche-Comté, UFR des Sciences du Sport, Dijon, France
| | - Julie Di Marco
- Center of Rehabilitation Val Rosay,Saint Didier au Mont d’or, France
| | - Gaëlle Deley
- INSERM UMR 1093 – CAPS, Université de Bourgogne Franche-Comté, UFR des Sciences du Sport, Dijon, France
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The Effects of Physical Exercise on Depression for Individuals with Spinal Cord Injury: a Systematic Review. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2022. [DOI: 10.1007/s40141-022-00370-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2022]
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Trauma of Peripheral Innervation Impairs Content of Epidermal Langerhans Cells. Diagnostics (Basel) 2022; 12:diagnostics12030567. [PMID: 35328120 PMCID: PMC8947052 DOI: 10.3390/diagnostics12030567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/26/2022] [Accepted: 02/17/2022] [Indexed: 12/10/2022] Open
Abstract
Langerhans cells represent the first immune cells that sense the entry of external molecules and microorganisms at the epithelial level in the skin. In this pilot case-study, we evaluated Langerhans cells density and progression of epidermal atrophy in permanent spinal cord injury (SCI) patients suffering with either lower motor neuron lesions (LMNSCI) or upper motor neuron lesions (UMNSCI), both submitted to surface electrical stimulation. Skin biopsies harvested from both legs were analyzed before and after 2 years of home-based Functional Electrical Stimulation for denervated degenerating muscles (DDM) delivered at home (h-bFES) by large anatomically shaped surface electrodes placed on the skin of the anterior thigh in the cases of LMNSCI patients or by neuromuscular electrical stimulation (NMES) for innervated muscles in the cases of UMNSCI persons. Using quantitative histology, we analyzed epidermal thickness and flattening and content of Langerhans cells. Linear regression analyses show that epidermal atrophy worsens with increasing years of LMNSCI and that 2 years of skin electrostimulation reverses skin changes, producing a significant recovery of epidermis thickness, but not changes in Langerhans cells density. In UMNSCI, we did not observe any statistically significant changes of the epidermis and of its content of Langerhans cells, but while the epidermal thickness is similar to that of first year-LMNSCI, the content of Langerhans cells is almost twice, suggesting that the LMNSCI induces an early decrease of immunoprotection that lasts at least 10 years. All together, these are original clinically relevant results suggesting a possible immuno-repression in epidermis of the permanently denervated patients.
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Ely MR, Taylor JA. The Practical Utility of Functional Electrical Stimulation Exercise for Cardiovascular Health in Individuals with Spinal Cord Injury. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2021. [DOI: 10.1007/s40141-021-00315-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Deley G, Laroche D, Quenot JP. Early rehabilitation in ICU for COVID-19: what about FES-cycling? CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2021; 25:94. [PMID: 33685453 PMCID: PMC7938268 DOI: 10.1186/s13054-021-03526-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 03/02/2021] [Indexed: 12/26/2022]
Affiliation(s)
- Gaëlle Deley
- INSERM UMR1093 - CAPS, Faculty of Sport Sciences, University of Bourgogne Franche-Comté, 21000, Dijon, France.
| | - Davy Laroche
- INSERM UMR1093 - CAPS, Faculty of Sport Sciences, University of Bourgogne Franche-Comté, 21000, Dijon, France
| | - Jean-Pierre Quenot
- Department of Intensive Care, François-Mitterrand University Hospital, 21000, Dijon, France
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Schmoll M, Le Guillou R, Lobato Borges D, Fattal C, Fachin-Martins E, Azevedo Coste C. Standardizing fatigue-resistance testing during electrical stimulation of paralysed human quadriceps muscles, a practical approach. J Neuroeng Rehabil 2021; 18:11. [PMID: 33478556 PMCID: PMC7818559 DOI: 10.1186/s12984-021-00805-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 01/11/2021] [Indexed: 11/10/2022] Open
Abstract
Background Rapid onset of muscular fatigue is still one of the main issues of functional electrical stimulation (FES). A promising technique, known as distributed stimulation, aims to activate sub-units of a muscle at a lower stimulation frequency to increase fatigue-resistance. Besides a general agreement on the beneficial effects, the great heterogeneity of evaluation techniques, raises the demand for a standardized method to better reflect the requirements of a practical application. Methods This study investigated the fatigue-development of 6 paralysed quadriceps muscles over the course of 180 dynamic contractions, evaluating different electrode-configurations (conventional and distributed stimulation). For a standardized comparison, fatigue-testing was performed at 40% of the peak-torque during a maximal evoked contraction (MEC). Further, we assessed the isometric torque for each electrode-configuration at different knee-extension-angles (70°–170°, 10° steps). Results Our results showed no significant difference in the fatigue-index for any of the tested electrode-configurations, compared to conventional-stimulation. We conjecture that the positive effects of distributed stimulation become less pronounced at higher stimulation amplitudes. The isometric torque produced at different knee-extension angles was similar for most electrode-configurations. Maximal torque-production was found at 130°–140° knee-extension-angle, which correlates with the maximal knee-flexion-angles during running. Conclusion In most practical applications, FES is intended to initiate dynamic movements. Therefore, it is crucial to assess fatigue-resistance by using dynamic contractions. Reporting the relationship between produced torque and knee-extension-angle can help to observe the stability of a chosen electrode-configuration for a targeted range-of-motion. Additionally, we suggest to perform fatigue testing at higher forces (e.g. 40% of the maximal evoked torque) in pre-trained subjects with SCI to better reflect the practical demands of FES-applications.
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Affiliation(s)
- Martin Schmoll
- INRIA - LIRMM, Université de Montpellier, Montpellier, France.
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10
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Home-Based Functional Electrical Stimulation of Human Permanent Denervated Muscles: A Narrative Review on Diagnostics, Managements, Results and Byproducts Revisited 2020. Diagnostics (Basel) 2020; 10:diagnostics10080529. [PMID: 32751308 PMCID: PMC7460102 DOI: 10.3390/diagnostics10080529] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/26/2020] [Accepted: 07/27/2020] [Indexed: 02/07/2023] Open
Abstract
Spinal cord injury (SCI) produces muscle wasting that is especially severe after complete and permanent damage of lower motor neurons, as can occur in complete conus and cauda equina syndrome. Even in this worst-case scenario, mass and function of permanently denervated quadriceps muscle can be rescued by surface functional electrical stimulation using a purpose designed home-based rehabilitation strategy. Early diagnostics is a key factor in the long-term success of this management. Function of quadriceps muscle was quantitated by force measurements. Muscle gross cross-sections were evaluated by quantitative color computed tomography (CT) and muscle and skin biopsies by quantitative histology, electron microscopy, and immunohistochemistry. Two years of treatment that started earlier than 5 years from SCI produced: (a) an increase in cross-sectional area of stimulated muscles; (b) an increase in muscle fiber mean diameter; (c) improvements in ultrastructural organization; and (d) increased force output during electrical stimulation. Improvements are extended to hamstring muscles and skin. Indeed, the cushioning effect provided by recovered tissues is a major clinical benefit. It is our hope that new trials start soon, providing patients the benefits they need.
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Mercier HW, Picard G, Taylor JA, Vivodtzev I. Gains in aerobic capacity with whole-body functional electrical stimulation row training and generalization to arms-only exercise after spinal cord injury. Spinal Cord 2020; 59:74-81. [PMID: 32719528 PMCID: PMC7855132 DOI: 10.1038/s41393-020-0527-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 07/16/2020] [Accepted: 07/17/2020] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Longitudinal study in adults (n = 27; 19-40 years old) with tetraplegic or paraplegic spinal cord injury (SCI). OBJECTIVES Determine physiological adaptations and generalizable fitness effects of 6 months of whole-body exercise training using volitional arm and functional electrical stimulation (FES) leg rowing. SETTING Outpatient hospital-based exercise facility and laboratory. METHODS Participants enrolled in hybrid FES-row training (FESRT) and performed peak exercise tests with arms-only (AO; baseline and 6 months) and FES rowing (baseline, 3, 6 months). RESULTS Participants demonstrated increased aerobic capacity (VO2peak) after FESRT (p < 0.001, np2 = 0.56) that tended to be higher when assessed with FES than AO rowing tests (0.15 ± 0.20 vs. 0.04 ± 0.22 L/min; p = 0.10). Changes in FES and AO VO2peak were significantly correlated (r = 0.55; p < 0.01), and 11 individuals demonstrated improvements (>6%) on both test formats. Younger age was the only difference between those who showed generalization of training effects and those who did not (mean age 26.6 ± 5.6 vs. 32.0 ± 5.7 years; p < 0.05) but changes in FES VO2peak correlated to time since injury in individuals <2 years post-SCI (r = -0.51, p < 0.01, n = 24). Lastly, VO2peak improvements were greater during the first 3 months vs. months 4-6 (+7.0% vs. +3.9%; p < 0.01) which suggests early training adaptations during FESRT. CONCLUSIONS Gains in aerobic capacity after whole-body FESRT are better reflected during FES-row testing format. They relate to high-intensity exercise and appear early during training, but they may not generalize to equivalent increases in AO exercise in all individuals with SCI.
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Affiliation(s)
- Hannah W Mercier
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA. .,Spaulding Rehabilitation Hospital, Cardiovascular Research Laboratory, Cambridge, MA, USA.
| | - Glen Picard
- Spaulding Rehabilitation Hospital, Cardiovascular Research Laboratory, Cambridge, MA, USA
| | - J Andrew Taylor
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA.,Spaulding Rehabilitation Hospital, Cardiovascular Research Laboratory, Cambridge, MA, USA
| | - Isabelle Vivodtzev
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA.,Spaulding Rehabilitation Hospital, Cardiovascular Research Laboratory, Cambridge, MA, USA.,Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005, Paris, France
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12
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Qiu S, Draghici AE, Picard G, Taylor JA. Muscle Fatigue in Response to Electrical Stimulation Pattern and Frequency in Spinal Cord Injury. PM R 2019; 12:699-705. [PMID: 31702873 DOI: 10.1002/pmrj.12282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 10/23/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Functional electrical stimulation (FES) is widely used to induce functional movements for paralyzed muscles. However, rapid muscle fatigue during FES-induced muscle contractions limits FES clinical efficacy. OBJECTIVE To investigate muscle fatigue response across stimulation patterns and frequencies during FES in able-bodied individuals and in those with spinal cord injury (SCI). DESIGN Four stimulation protocols combining 20 and 40 Hz average frequency with either constant frequency trains (CFTs) or with doublet frequency trains (DFTs) were applied to the quadriceps of seven adults with SCI and eight able-bodied participants. SETTING A FES-row training laboratory. PARTICIPANTS Seven individuals with SCI (one female; age range, 25 ± 6 years) and eight age-matched able-bodied participants (one female). INTERVENTION None. MAIN OUTCOME MEASURES Fatigue was defined as the number of contractions until force decreased by 20% from the target level of 25% maximal contraction force. The number of contractions and the stimulation current used during the four stimulation protocols were compared. RESULTS There was a significant effect of frequency, as well as interaction between group and stimulation pattern (P < .05). In both groups, 20-Hz trains increased the number of contractions to fatigue compared to 40-Hz trains. However, the responses to the pattern of stimulation differed. In the able-bodied participants, CFT increased the number of contractions to fatigue compared to DFT, whereas in those with SCI, DFT increased the number of contractions to fatigue. In fact, DFT resulted in similar number of contractions to fatigue in both populations. CONCLUSIONS These results indicate that DFT at 20 Hz may be a better stimulation protocol to delay fatigue onset in the SCI population than the other three protocols. In addition, this work implies that results from able-bodied persons may not be directly applicable to those with SCI.
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Affiliation(s)
- Shuang Qiu
- Cardiovascular Research Laboratory, Spaulding Hospital Cambridge, Cambridge, MA.,Department of Physical Medicine & Rehabilitation, Harvard Medical School, Cambridge, MA.,Research Center for Brain-Inspired Intelligence, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Adina E Draghici
- Cardiovascular Research Laboratory, Spaulding Hospital Cambridge, Cambridge, MA.,Department of Physical Medicine & Rehabilitation, Harvard Medical School, Cambridge, MA
| | - Glen Picard
- Cardiovascular Research Laboratory, Spaulding Hospital Cambridge, Cambridge, MA
| | - J Andrew Taylor
- Cardiovascular Research Laboratory, Spaulding Hospital Cambridge, Cambridge, MA.,Department of Physical Medicine & Rehabilitation, Harvard Medical School, Cambridge, MA
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Functional Electrical Stimulation Cycling Exercise for People with Multiple Sclerosis. Curr Treat Options Neurol 2019; 21:54. [PMID: 31705304 DOI: 10.1007/s11940-019-0597-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE OF REVIEW There has been substantial interest in the role of exercise for managing impairments, limitations, and disability progression among persons with multiple sclerosis (MS). Despite established benefits of exercise training for persons who have mild-to-moderate MS, the ability to deliver exercise to persons who experience higher disability remains challenging. One promising approach for exercise in this population is functional electrical stimulation (FES) cycling. This review provides a summary of the current evidence for FES cycling as an exercise training modality in persons with MS with respect to prescription, safety, tolerability, and acute and chronic effects. RECENT FINDINGS We searched the literature for studies involving FES cycling exercise in persons with MS published in English up until July 2019. Eight studies were retrieved: two studies examined acute effects, two studies examined chronic effects, and four studies reported on both acute and chronic effects of FES cycling exercise. The overall quality of the studies was low, with only one, small, randomized controlled trial (RCT). There is limited but promising evidence for the application of FES cycling exercise among persons with MS who have moderate-to-severe disability. Participants were capable of engaging in regular FES cycling exercise (~ 30 min, 2-3×/week), with few, mild adverse events experienced. Preliminary evidence from small, mostly uncontrolled trials supports the potential benefits of FES cycling on physiological fitness, walking mobility, and symptoms of fatigue and pain. High-quality RCTs of FES cycling exercise are necessary for providing recommendations for integrating exercise training in the management of advanced MS.
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Cardiometabolic Challenges Provided by Variable Assisted Exoskeletal Versus Overground Walking in Chronic Motor-incomplete Paraplegia: A Case Series. J Neurol Phys Ther 2019; 43:128-135. [PMID: 30883500 DOI: 10.1097/npt.0000000000000262] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE People with spinal cord injury (SCI) experience secondary complications including low levels of cardiometabolic activity and associated health risks. It is unknown whether overground bionic ambulation (OBA) enhances cardiometabolic challenge during walking in those with motor-incomplete SCI, thereby providing additional therapeutic benefits. CASE DESCRIPTIONS One man and one woman with chronic motor-incomplete paraplegia due to SCI. INTERVENTION Assessment of functional walking capacity with the 10-m and 6-minute walk tests. Participants underwent cardiometabolic measurements including heart rate (HR), oxygen consumption ((Equation is included in full-text article.)O2), energy expenditure (EE), and substrate utilization patterns during OBA and overground walking for 6 minutes each. OUTCOMES The female participant had low functional walking capacity (walking speed = 0.23 m/s; 6-minute walk = 230 ft). She had higher cardiorespiratory responses during OBA versus overground walking (Δ(Equation is included in full-text article.)O2 = -3.6 mL/kg/min, ΔEE = 12 kcal) despite similar mean HR values (ΔHR = -1 beats per minute). She was able to sustain continuous walking only during the OBA trial. The male participant had greater walking capacity (walking speed = 0.33 m/s, 6 minutes = 386ft) and lower responses during OBA versus overground walking (Δ(Equation is included in full-text article.)O2 = -6.0 mL/kg/min, ΔEE = -18 kcal, ΔHR = -6 beats per minute). He was able to walk continuously in both conditions. DISCUSSION The participant with lower walking capacity experienced a higher cardiometabolic challenge and was able to sustain exercise efforts for longer period with OBA versus overground walking. Therefore, OBA presents a superior alternative to overground training for cardiometabolic conditioning and associated health benefits in this participant. For the participant with higher walking capacity, OBA represented a lower challenge and appears to be an inferior cardiometabolic training option to overground walking. The cardiometabolic response to OBA differs depending on functional capacity; OBA warrants study as an approach to cardiometabolic training for individuals with motor-incomplete SCI who have limited lower extremity function.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A259).
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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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Taylor MJ, Fornusek C, Ruys AJ. Reporting for Duty: The duty cycle in Functional Electrical Stimulation research. Part I: Critical commentaries of the literature. Eur J Transl Myol 2018; 28:7732. [PMID: 30662695 PMCID: PMC6317136 DOI: 10.4081/ejtm.2018.7732] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 02/07/2023] Open
Abstract
There are several parameters that can be modulated during electrical stimulation-induced muscle contraction to obtain external work, i.e., Functional Electrical Stimulation (FES). The literature has several reports of the relationships of parameters such as frequency, pulse width, amplitude and physiological or biomechanical outcomes (i.e., torque) when these parameters are changed. While these relationships are well-described, lesser known across the literature is how changing the duty cycle (time ON and time OFF) of stimulation affects the outcomes. This review provides an analysis of the literature pertaining to the duty cycle in electrical stimulation experiments. There are two distinct sections of this review - an introduction to the duty cycle and definitions from literature (part I); and contentions from the literature and proposed frameworks upon which duty cycle can be interpreted (part II). It is envisaged that the two reviews will highlight the importance of modulating the duty cycle in terms of muscle fatigue in mimicking physiological activities. The frameworks provided will ideally assist in unifying how researchers consider the duty cycle in electrical stimulation (ES) of muscles.
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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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17
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Tong RKY, Wang X, Leung KWC, Lee GTY, Lau CCY, Wai HW, Pang PMK, Leung HC. How to prepare a person with complete spinal cord injury to use surface electrodes for FES trike cycling. IEEE Int Conf Rehabil Robot 2018; 2017:801-805. [PMID: 28813918 DOI: 10.1109/icorr.2017.8009346] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Functional Electrical Stimulation (FES) cycling could benefit people with Spinal Cord Injury (SCI). The FES cycling involves large muscle groups during the training, and thus improves the cardiovascular function, increases the muscle bulk and reduces the secondary complications. This study developed an outdoor FES exercise cycling system for complete SCI persons to exercise their lower limbs without putting extra load on upper extremities. The mechanical structure of the cycling system was specially redesigned to secure the SCI persons in the cycling system. A six-phase-angle-driven control algorithm was designed to stimulate the quadriceps and hamstrings muscles. Two training modes, i.e., continuous mode and on-off mode, were designed and tested to increase the duration of the electrical stimulation to reduce muscle fatigue. A complete SCI volunteer participated in this training for six months. Beneficial effects could be observed such as paralyzed lower limb muscles had regained the muscle mass and reduced edema from the improved blood circulation. Moreover, the SCI volunteer attended the Cybathlon FES-bike competition in Zurich in October 2016 with Team Phoenix from the CUHK.
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Leung KW, Tong RK, Wang X, Lee GT, Pang PM, Wai HW, Leung HC. The Effectiveness of Functional Electrical Stimulation (FES) in On-Off Mode for Enhancing the Cycling Performance of Team Phoenix at 2016 Cybathlon. Eur J Transl Myol 2017; 27:7132. [PMID: 29299224 PMCID: PMC5745388 DOI: 10.4081/ejtm.2017.7132] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 12/01/2017] [Indexed: 12/17/2022] Open
Abstract
In this study we designed a Functional Electrical Stimulation (FES) trike for a female subject with spinal cord injury to exercise her lower limbs and improve her lower limb muscle condition for attending the 2016 Cybathlon FES bike competition. Our FES pilot was the only female participant, in the FES cycling competition and she rode for Team Phoenix from the Chinese University of Hong Kong. Due to the weakness of muscles in the lower limb of the subject, and due to scoliosis over her thoracolumbar aéra, the mechanical structure of the trike had to be tailor-made to ensure she sat on the bike in a safe and secure position. A six-phase angle-driven stimulation pattern was developed to stimulate quadriceps and hamstrings without gluteus muscles for contraction through four surface electrodes, thereby creating a cycling movement. To improve the cycling endurance and reduce the muscle fatigue, an on-off mode was developed for controlling the stimulation time that allowed the subject to cycle for 20s, then pause while the trike advanced without stimulation for 5s, followed by a subsequent 20 sec stimulation, to continue cycling. The pilot participated in the training procedure including training exercise at home, trike fitting in the trike by modifying the mechanical structure, and conducting the cycling exercise for six months. We observed significant improvements in the pilot’s lower limb condition. The on-off mode enabled our pilot to extend her cycling endurance effectively, from 1 min to 2.5 mins and the distance from 62m to 100m. Over the eight minutes time limit, our team successfully finished 100 m in the Cybathlon FES.
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Affiliation(s)
- Kenry Wc Leung
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong
| | - Raymond Ky Tong
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong
| | - Xiaojun Wang
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong
| | - Ginny Ty Lee
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong
| | - Peter Mk Pang
- Industrial Centre, The Hong Kong Polytechnic University, Hong kong
| | - H W Wai
- Industrial Centre, The Hong Kong Polytechnic University, Hong kong
| | - H C Leung
- Industrial Centre, The Hong Kong Polytechnic University, Hong kong
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Fonseca LOD, Bó APL, Guimarães JA, Gutierrez ME, Fachin-Martins E. Cadence Tracking and Disturbance Rejection in Functional Electrical Stimulation Cycling for Paraplegic Subjects: A Case Study. Artif Organs 2017; 41:E185-E195. [PMID: 29148135 DOI: 10.1111/aor.13055] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Functional electrical stimulation cycling has been proposed as an assistive technology with numerous health and fitness benefits for people with spinal cord injury, such as improvement in cardiovascular function, increase in muscular mass, and reduction of bone mass loss. However, some limitations, for example, lack of optimal control strategies that would delay fatigue, may still prevent this technology from achieving its full potential. In this work, we performed experiments on a person with complete spinal cord injury using a stationary tadpole trike when both cadence tracking and disturbance rejection were evaluated. In addition, two sets of experiments were conducted 6 months apart and considering activation of different muscles. The results showed that reference tracking is achieved above the cadence of 25 rpm with mean absolute errors between 1.9 and 10% when only quadriceps are activated. The disturbance test revealed that interferences may drop the cadence but do not interrupt a continuous movement if the cadence does not drop below 25 rpm, again when only quadriceps are activated. When other muscle groups were added, strong spasticity caused larger errors on reference tracking, but not when a disturbance was applied. In addition, spasticity caused the last experiments to result in less smooth cycling.
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Affiliation(s)
- Lucas O da Fonseca
- LARA - Laboratório de Automação e Robótica and Programa de Pós-Graduação em Engenharia de Sistemas e de Automação, Departamento de Engenharia Elétrica, Faculdade de Tecnologia, Brasília, Brazil
| | - Antônio P L Bó
- LARA - Laboratório de Automação e Robótica and Programa de Pós-Graduação em Engenharia de Sistemas e de Automação, Departamento de Engenharia Elétrica, Faculdade de Tecnologia, Brasília, Brazil
| | - Juliana A Guimarães
- NTAAI - Núcleo de Tecnologia Assistiva, Acessibilidade e Inovação and Programa de Pós-Graduação em Ciências e Tecnologias em Saúde, Faculdade de Ceilândia, Universidade de Brasília, Brasília, Brazil
| | - Miguel E Gutierrez
- LARA - Laboratório de Automação e Robótica and Programa de Pós-Graduação em Engenharia de Sistemas e de Automação, Departamento de Engenharia Elétrica, Faculdade de Tecnologia, Brasília, Brazil
| | - Emerson Fachin-Martins
- NTAAI - Núcleo de Tecnologia Assistiva, Acessibilidade e Inovação and Programa de Pós-Graduação em Ciências e Tecnologias em Saúde, Faculdade de Ceilândia, Universidade de Brasília, Brasília, Brazil
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20
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Qiu S, Alzhab S, Picard G, Taylor JA. Ventilation Limits Aerobic Capacity after Functional Electrical Stimulation Row Training in High Spinal Cord Injury. Med Sci Sports Exerc 2017; 48:1111-8. [PMID: 26784276 DOI: 10.1249/mss.0000000000000880] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE In the able-bodied, exercise training results in increased ventilatory capacity to meet increased aerobic demands of trained skeletal muscle. However, after spinal cord injury (SCI), peak ventilation can be limited by pulmonary muscle denervation. In fact, peak ventilation may restrict aerobic capacity in direct relation to injury level. Hybrid functional electrical stimulation (FES) exercise training results in increased aerobic capacity and dissociation between aerobic capacity and injury level in those with injuries at T3 and below. However, injuries above T3 have the greatest pulmonary denervation, and ventilatory capacity may restrict the increase in aerobic capacity with hybrid FES training. METHODS We assessed relationships among injury level, peak ventilation, and peak aerobic capacity and calculated oxygen uptake efficiency slope during hybrid FES exercise in 12 individuals (1 female) with SCI at level T2 to C4 (injury duration = 0.33-33 yr, age = 20-60 yr), before and after 6 months of FES-row training (FES-RT). RESULTS Training increased peak aerobic capacity by 12% (P = 0.02) with only a modest increase in peak ventilation (7 of 12 subjects, P = 0.09). Both before and after training, injury level was directly related to peak ventilation (R = 0.48 and 0.43) and peak aerobic capacity (R = 0.70 and 0.55). Before training, the relationship of peak aerobic capacity to peak ventilation was strong (R = 0.62), however, after training, this relationship became almost completely linearized (R = 0.84). In addition, oxygen uptake efficiency slope increased by 11% (P < 0.05) after FES-RT. CONCLUSION Despite the ability to increase exercise capacity via hybrid FES exercise, the inability to increase peak ventilation beyond limits set by SCI level in those with high-level injuries (above T3) appears to restrict aerobic capacity.
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Affiliation(s)
- Shuang Qiu
- 1Department of Biomedical Engineering, Tianjin University, Tianjin, CHINA; 2Cardiovascular Research Laboratory, Spaulding Hospital Cambridge, Cambridge, MA; and 3Department of Physical Medicine & Rehabilitation, Harvard Medical School, Cambridge, MA
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Deley G, Denuziller J, Casillas JM, Babault N. One year of training with FES has impressive beneficial effects in a 36-year-old woman with spinal cord injury. J Spinal Cord Med 2017; 40:107-112. [PMID: 26832125 PMCID: PMC5376139 DOI: 10.1080/10790268.2015.1117192] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
CONTEXT Reductions of muscular and cardiorespiratory functions are often observed in people with spinal cord injury (SCI) and several studies demonstrated the benefits of aerobic and strengthening exercise training for this population. Functional Electrical Stimulation (FES) of paralyzed muscles has been proposed as a strategy to assist patients in executing functional movement but its utilization during long durations has never been investigated. The purpose of the present study was to assess the effects of a one-year training program with FES (strengthening and rowing) in one subject with SCI. Evoked torque, quadriceps muscle thickness, aerobic exercise capacity and bone mineral density were tested. FINDINGS All parameters increased after training: average evoked torque +151%, quadriceps muscle thickness +136%, thigh circumference +14%, bone density +19%, maximal oxygen uptake +76% and oxygen uptake at ventilatory threshold +111%. CONCLUSION These impressive improvements demonstrate that FES training offers several interesting clinical benefits in a patient with SCI.
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Affiliation(s)
- Gaëlle Deley
- Centre d'Expertise de la Performance Gilles Cometti, Faculté des Sciences du Sport, Dijon, France,INSERM – U1093 Cognition, Action, et Plasticité Sensorimotrice, Université de Bourgogne, BP 27877, 21078 Dijon Cedex, France,Correspondence to: Gaëlle Deley, INSERM – U1093 Coginition, Action et Plasticité Sensorimotrice, Université de Bourgogne, BP 27877, 21078 Dijon Cedex, France.
| | - Jérémy Denuziller
- Centre d'Expertise de la Performance Gilles Cometti, Faculté des Sciences du Sport, Dijon, France,INSERM – U1093 Cognition, Action, et Plasticité Sensorimotrice, Université de Bourgogne, BP 27877, 21078 Dijon Cedex, France
| | - Jean-Marie Casillas
- INSERM – U1093 Cognition, Action, et Plasticité Sensorimotrice, Université de Bourgogne, BP 27877, 21078 Dijon Cedex, France
| | - Nicolas Babault
- Centre d'Expertise de la Performance Gilles Cometti, Faculté des Sciences du Sport, Dijon, France,INSERM – U1093 Cognition, Action, et Plasticité Sensorimotrice, Université de Bourgogne, BP 27877, 21078 Dijon Cedex, France
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Pilutti LA, Motl RW, Edwards TA, Wilund KR. Rationale and design of a randomized controlled clinical trial of functional electrical stimulation cycling in persons with severe multiple sclerosis. Contemp Clin Trials Commun 2016; 3:147-152. [PMID: 29736463 PMCID: PMC5935873 DOI: 10.1016/j.conctc.2016.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 04/27/2016] [Accepted: 05/11/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND This randomized controlled trial (RCT) will examine the efficacy of supervised functional electrical stimulation (FES) cycling on walking performance and physiological function among persons with multiple sclerosis (MS) with severe mobility disability. METHODS/DESIGN This RCT will recruit 16 persons with MS that require unilateral or bilateral assistance for ambulation (i.e., Expanded Disability Status Scale (EDSS) score = 6.0-6.5). Participants will be randomized to one of two conditions: supervised FES cycling or passive cycling. The FES cycling condition will involve mild electrical stimulation that will generate an activation pattern that results in cycling the leg ergometer. The passive cycling condition will not provide any electrical stimulation, rather the movement of the pedals will be controlled by the electrical motor. Both conditions will be delivered 3 days/week for the same duration, over 6 months. Primary outcomes will include walking performance assessed as walking speed, endurance, and agility. Secondary outcomes will include physiological function assessed as cardiorespiratory fitness, muscular strength, and balance. Assessments will take place at baseline, mid-point (3-months), and immediately following the intervention (6-months). DISCUSSION This study will lay the foundation for the design of a future RCT by: (1) providing effect sizes that can be included in a power analysis for optimal sample size estimation; and (2) identifying cardiorespiratory fitness, muscular strength, and balance (i.e., physiological function) as mechanisms for the beneficial effects of FES cycling on walking performance. This trial will provide important information on a novel exercise rehabilitation therapy for managing walking impairment in persons with severe MS.
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Affiliation(s)
- Lara A Pilutti
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, 906 S. Goodwin Ave., Urbana, IL 61801, USA
| | - Robert W Motl
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, 906 S. Goodwin Ave., Urbana, IL 61801, USA
| | - Thomas A Edwards
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, 906 S. Goodwin Ave., Urbana, IL 61801, USA
| | - Kenneth R Wilund
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, 906 S. Goodwin Ave., Urbana, IL 61801, USA
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Cometti C, Babault N, Deley G. Effects of Constant and Doublet Frequency Electrical Stimulation Patterns on Force Production of Knee Extensor Muscles. PLoS One 2016; 11:e0155429. [PMID: 27167066 PMCID: PMC4864221 DOI: 10.1371/journal.pone.0155429] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 04/28/2016] [Indexed: 11/30/2022] Open
Abstract
This study compared knee extensors’ neuromuscular fatigue in response to two 30-minute stimulation patterns: constant frequency train (CFT) and doublet frequency train (DFT). Fifteen men underwent two separate sessions corresponding to each pattern. Measurements included torque evoked by each contraction and maximal voluntary contractions (MVC) measured before and immediately after the stimulation sessions. In addition, activation level and torque evoked during doublets (Pd) and tetanic contractions at 80-Hz (P80) and 20-Hz (P20) were determined in six subjects. Results indicated greater mean torque during the DFT stimulation session as compared with CFT. But, no difference was obtained between the two stimulation patterns for MVC and evoked torque decreases. Measurements conducted in the subgroup depicted a significant reduction of Pd, P20 and P80. Statistical analyses also revealed bigger P20 immediate reductions after CFT than after DFT. We concluded that DFT could be a useful stimulation pattern to produce and maintain greater force with quite similar fatigue than CFT.
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Affiliation(s)
- Carole Cometti
- INSERM U1093, "Cognition, Action, et Plasticité Sensorimotrice", Faculté des Sciences du Sport, Université de Bourgogne-Franche-Comté, Dijon, France
- Centre d'Expertise de la Performance, Faculté des Sciences du Sport, Université de Bourgogne-Franche-Comté, Dijon, France
| | - Nicolas Babault
- INSERM U1093, "Cognition, Action, et Plasticité Sensorimotrice", Faculté des Sciences du Sport, Université de Bourgogne-Franche-Comté, Dijon, France
- Centre d'Expertise de la Performance, Faculté des Sciences du Sport, Université de Bourgogne-Franche-Comté, Dijon, France
- * E-mail:
| | - Gaëlle Deley
- INSERM U1093, "Cognition, Action, et Plasticité Sensorimotrice", Faculté des Sciences du Sport, Université de Bourgogne-Franche-Comté, Dijon, France
- Centre d'Expertise de la Performance, Faculté des Sciences du Sport, Université de Bourgogne-Franche-Comté, Dijon, France
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