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Hasnan N, Hamzaid NA, Magenthran V, Davis GM. Exercise Responses During Outdoor Versus Virtual Reality Indoor Arm+FES-Leg Cycling in Individuals with Spinal Cord Injury. Games Health J 2024. [PMID: 38709784 DOI: 10.1089/g4h.2023.0047] [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: 05/08/2024] Open
Abstract
Background: Virtual reality (VR)-enhanced indoor hybrid cycling in people with spinal cord injury (SCI) can be comparable to outdoor hybrid cycling. Method: Eight individuals with chronic thoracic-lesion SCI performed voluntary arm and electrically assisted leg cycling on a hybrid recumbent tricycle. Exercises were conducted outdoors and indoors incorporating VR technology in which the outdoor environment was simulated on a large flat screen monitor. Electrical stimulation was applied bilaterally to the leg muscle groups. Oxygen uptake (VO2), heart rate, energy expenditures, and Ratings of Perceived Exertion were measured over a 30-minute outdoor test course that was also VR-simulated indoors. Immediately after each exercise, participants completed questionnaires to document their perceptual-psychological responses. Results: Mean 30-minute VO2 was higher for indoor VR exercise (average VO2-indoor VR-exercise: 1316 ± mL/min vs. outdoor cycling: 1255 ± 53 mL/min; highest VO2-indoor VR-exercise: 1615 ± 67 mL/min vs. outdoor cycling: 1725 ± 67 mL/min). Arm and leg activity counts were significantly higher during indoor VR-assisted hybrid functional electrical stimulation (FES) cycling than outdoors; 42% greater for the arms and 23% higher for the legs (P < 0.05). Similar responses were reported for exercise effort and perceptual-psychological outcomes during both modes. Conclusion: This study proposes that combining FES and VR technology provides new opportunities for physical activity promotion or exercise rehabilitation in the SCI population, since these modes have similar "dose-potency" and self-perceived effort. Human Research Ethics Committee of the University of Sydney Ref. No. 01-2010/12385.
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Affiliation(s)
- Nazirah Hasnan
- Department of Rehabilitation Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Nur Azah Hamzaid
- Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Vhinoth Magenthran
- Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Glen M Davis
- Discipline of Exercise and Sport Science, Sydney School of Health Sciences, Faculty of Medicine and Health. The University of Sydney, Sydney, New South Wales, Australia
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2
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Crossley CB, Diamond LE, Saxby DJ, de Sousa A, Lloyd DG, Che Fornusek, Pizzolato C. Joint contact forces during semi-recumbent seated cycling. J Biomech 2024; 168:112094. [PMID: 38640830 DOI: 10.1016/j.jbiomech.2024.112094] [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: 10/06/2023] [Revised: 03/07/2024] [Accepted: 04/14/2024] [Indexed: 04/21/2024]
Abstract
Semi-recumbent cycling performed from a wheelchair is a popular rehabilitation exercise following spinal cord injury (SCI) and is often paired with functional electrical stimulation. However, biomechanical assessment of this cycling modality is lacking, even in unimpaired populations, hindering the development of personalised and safe rehabilitation programs for those with SCI. This study developed a computational pipeline to determine lower limb kinematics, kinetics, and joint contact forces (JCF) in 11 unimpaired participants during voluntary semi-recumbent cycling using a rehabilitation ergometer. Two cadences (40 and 60 revolutions per minute) and three crank powers (15 W, 30 W, and 45 W) were assessed. A rigid body model of a rehabilitation ergometer was combined with a calibrated electromyogram-informed neuromusculoskeletal model to determine JCF at the hip, knee, and ankle. Joint excursions remained consistent across all cadence and powers, but joint moments and JCF differed between 40 and 60 revolutions per minute, with peak JCF force significantly greater at 40 compared to 60 revolutions per minute for all crank powers. Poor correlations were found between mean crank power and peak JCF across all joints. This study provides foundation data and computational methods to enable further evaluation and optimisation of semi-recumbent cycling for application in rehabilitation after SCI and other neurological disorders.
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Affiliation(s)
- Claire B Crossley
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Griffith University, Australia; School of Health Sciences and Social Work, Griffith University, Australia
| | - Laura E Diamond
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Griffith University, Australia; School of Health Sciences and Social Work, Griffith University, Australia
| | - David J Saxby
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Griffith University, Australia; School of Health Sciences and Social Work, Griffith University, Australia
| | - Ana de Sousa
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Griffith University, Australia; Research Centre for Biomedical Engineering (CREB) at the Universitat Politècnica de Catalunya (UPC), Barcelona, Spain
| | - David G Lloyd
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Griffith University, Australia; School of Health Sciences and Social Work, Griffith University, Australia
| | - Che Fornusek
- Exercise & Sports Science, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Claudio Pizzolato
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Griffith University, Australia; School of Health Sciences and Social Work, Griffith University, Australia.
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Lim D, Pei W, Lee JW, Musselman KE, Masani K. Feasibility of using a depth camera or pressure mat for visual feedback balance training with functional electrical stimulation. Biomed Eng Online 2024; 23:19. [PMID: 38347584 PMCID: PMC10863251 DOI: 10.1186/s12938-023-01191-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/07/2023] [Indexed: 02/15/2024] Open
Abstract
Individuals with incomplete spinal-cord injury/disease are at an increased risk of falling due to their impaired ability to maintain balance. Our research group has developed a closed-loop visual-feedback balance training (VFBT) system coupled with functional electrical stimulation (FES) for rehabilitation of standing balance (FES + VFBT system); however, clinical usage of this system is limited by the use of force plates, which are expensive and not easily accessible. This study aimed to investigate the feasibility of a more affordable and accessible sensor such as a depth camera or pressure mat in place of the force plate. Ten able-bodied participants (7 males, 3 females) performed three sets of four different standing balance exercises using the FES + VFBT system with the force plate. A depth camera and pressure mat collected centre of mass and centre of pressure data passively, respectively. The depth camera showed higher Pearson's correlation (r > 98) and lower root mean squared error (RMSE < 10 mm) than the pressure mat (r > 0.82; RMSE < 4.5 mm) when compared with the force plate overall. Stimulation based on the depth camera showed lower RMSE than that based on the pressure mat relative to the FES + VFBT system. The depth camera shows potential as a replacement sensor to the force plate for providing feedback to the FES + VFBT system.
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Affiliation(s)
- Derrick Lim
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - William Pei
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Jae W Lee
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Kristin E Musselman
- KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Rehabilitation Science Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Kei Masani
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada.
- KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.
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Gorgey AS, Khalil RE, Carter W, Ballance B, Gill R, Khan R, Goetz L, Lavis T, Sima AP, Adler RA. Effects of two different paradigms of electrical stimulation exercise on cardio-metabolic risk factors after spinal cord injury. A randomized clinical trial. Front Neurol 2023; 14:1254760. [PMID: 37808500 PMCID: PMC10556465 DOI: 10.3389/fneur.2023.1254760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 08/30/2023] [Indexed: 10/10/2023] Open
Abstract
Objective To examine the combined effects of neuromuscular electrical stimulation-resistance training (NMES-RT) and functional electrical stimulation-lower extremity cycling (FES-LEC) compared to passive movement training (PMT) and FES-LEC in adults with SCI on (1) oxygen uptake (VO2), insulin sensitivity and glucose disposal in adults with SCI; (2) Metabolic and inflammatory biomarkers; (3) skeletal muscle, intramuscular fat (IMF) and visceral adipose tissue (VAT) cross-sectional areas (CSAs). Materials and methods Thirty-three participants with chronic SCI (AIS A-C) were randomized to 24 weeks of NMES-RT + FES or PMT + FES. The NMES-RT + FES group underwent 12 weeks of evoked surface NMES-RT using ankle weights followed by an additional 12 weeks of progressive FES-LEC. The control group, PMT + FES performed 12 weeks of passive leg extension movements followed by an additional 12 weeks of FES-LEC. Measurements were performed at baseline (BL; week 0), post-intervention 1 (P1; week 13) and post-intervention 2 (P2; week 25) and included FES-VO2 measurements, insulin sensitivity and glucose effectiveness using the intravenous glucose tolerance test; anthropometrics and whole and regional body composition assessment using dual energy x-ray absorptiometry (DXA) and magnetic resonance imaging to measure muscle, IMF and VAT CSAs. Results Twenty-seven participants completed both phases of the study. NMES-RT + FES group showed a trend of a greater VO2 peak in P1 [p = 0.08; but not in P2 (p = 0.25)] compared to PMT + FES. There was a time effect of both groups in leg VO2 peak. Neither intervention elicited significant changes in insulin, glucose, or inflammatory biomarkers. There were modest changes in leg lean mass following PMT + FES group. Robust hypertrophy of whole thigh muscle CSA, absolute thigh muscle CSA and knee extensor CSA were noted in the NMES-RT + FES group compared to PMT + FES at P1. PMT + FES resulted in muscle hypertrophy at P2. NMES-RT + FES resulted in a decrease in total VAT CSA at P1. Conclusion NMES-RT yielded a greater peak leg VO2 and decrease in total VAT compared to PMT. The addition of 12 weeks of FES-LEC in both groups modestly impacted leg VO2 peak. The addition of FES-LEC to NMES-RT did not yield additional increases in muscle CSA, suggesting a ceiling effect on signaling pathways following NMES-RT. Clinical trial registration identifier NCT02660073.
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Affiliation(s)
- Ashraf S. Gorgey
- Spinal Cord Injury and Disorders, Richmond VA Medical Center, Richmond, VA, United States
- Department of Physical Medicine & Rehabilitation, Virginia Commonwealth University, Richmond, VA, United States
| | - Refka E. Khalil
- Spinal Cord Injury and Disorders, Richmond VA Medical Center, Richmond, VA, United States
| | - William Carter
- Department of Physical Medicine & Rehabilitation, Virginia Commonwealth University, Richmond, VA, United States
| | - Boyd Ballance
- Spinal Cord Injury and Disorders, Richmond VA Medical Center, Richmond, VA, United States
| | - Ranjodh Gill
- Endocrinology Service, Richmond VA Medical Center, Richmond, VA, United States
- Endocrine Division, School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Rehan Khan
- Radiology Service, Richmond VA Medical Center, Richmond, VA, United States
| | - Lance Goetz
- Spinal Cord Injury and Disorders, Richmond VA Medical Center, Richmond, VA, United States
- Department of Physical Medicine & Rehabilitation, Virginia Commonwealth University, Richmond, VA, United States
| | - Timothy Lavis
- Spinal Cord Injury and Disorders, Richmond VA Medical Center, Richmond, VA, United States
- Department of Physical Medicine & Rehabilitation, Virginia Commonwealth University, Richmond, VA, United States
| | - Adam P. Sima
- Department of Biostatistics, School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Robert A. Adler
- Endocrinology Service, Richmond VA Medical Center, Richmond, VA, United States
- Endocrine Division, School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
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Figoni SF, Dolbow DR, Crawford EC, White ML, Pattanaik S. Does aerobic exercise benefit persons with tetraplegia from spinal cord injury? A systematic review. J Spinal Cord Med 2021; 44:690-703. [PMID: 32043944 PMCID: PMC8477928 DOI: 10.1080/10790268.2020.1722935] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
CONTEXT This review synthesizes the findings of previous research studies on the cardiovascular and metabolic benefits of aerobic exercise for individuals with tetraplegia secondary to spinal cord injury. They are often less active due to muscular paralysis, sensory loss, and sympathetic nervous system dysfunction that result from injury. Consequently, these persons are at higher risk for exercise intolerance and secondary health conditions. OBJECTIVE To evaluate the evidence concerning efficacy of aerobic exercise training for improving health and exercise performance in persons with tetraplegia from cervical injury. METHODS The search engines PubMed and Google Scholar were used to locate published research. The final 75 papers were selected on the basis of inclusion criteria. The studies were then rank-ordered using Physiotherapy Evidence Database. RESULTS Studies combining individuals with tetraplegia and paraplegia show that voluntary arm-crank training can increase mean peak power output by 33%. Functional electrical stimulation leg cycling was shown to induce higher peak cardiac output and stroke volume than arm-crank exercise. A range of peak oxygen uptake (VO2peak) values have been reported (0.57-1.32 L/min). Both VO2peak and cardiac output may be enhanced via increased muscle pump in the legs and venous return to the heart. Hybrid exercise (arm-crank and functional electrical stimulation leg cycling) can result in greater peak oxygen uptake and cardiovascular responses. CONCLUSION Evidence gathered from this systematic review of literature is inconclusive due to the lack of research focusing on those with tetraplegia. Higher power studies (level 1-3) are needed with the focus on those with tetraplegia.
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Affiliation(s)
- Stephen F Figoni
- Spinal Cord Injury/Disorders Healthcare Group (128), Tibor Rubin VA Medical Center, Long Beach, California, USA
| | - David R Dolbow
- Physical Therapy Program, William Carey University, Hattiesburg, Mississippi, USA
| | - Edwin C Crawford
- Physical Therapy Program, William Carey University, Hattiesburg, Mississippi, USA
| | - Margaret L White
- Physical Therapy Program, William Carey University, Hattiesburg, Mississippi, USA
| | - Sambit Pattanaik
- College of Osteopathic Medicine, William Carey University, Hattiesburg, Mississippi, USA
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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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Gurcay E, Karaahmet OZ, Cankurtaran D, Nazlı F, Umay E, Güzel Ş, Gurcay AG. Functional electrical stimulation cycling in patients with chronic spinal cord injury: a pilot study. Int J Neurosci 2021; 132:421-427. [PMID: 33998960 DOI: 10.1080/00207454.2021.1929212] [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: 10/21/2022]
Abstract
OBJECTIVE To examine the therapeutic value of lower extremity functional electrical stimulation (FES) - evoked cycling on functional independence, health status, gait parameters, pulmonary functions, and biochemical values in patients with chronic complete/incomplete spinal cord injury (SCI). MATERIALS AND METHODS Fifteen patients with SCI (duration of more than 6 months) who were able to stand up and walk with long leg braces or assistive devices and had stable neurological status and trunk balance undertook FES cycling for 6 weeks (three times per week). The main outcomes were: Functional Independence Measure (FIM), Nottingham Health Profile (NHP), 6-minute walk test (6MWT), and 20-meter walk test (20MWT). Secondary outcomes include measurements of pulmonary function tests and biochemical values. All parameters were evaluated at the beginning and end of the program. RESULTS Improvements were seen in motor and total scores of FIM (p = 0.007), physical mobility subscale of NHP (p = 0.011), 6MWT (p = 0.001), and 20MWT (p = 0.011). In pulmonary functions, only forced vital capacity (FVC) levels demonstrated a significant increase compared with baseline (p = 0.011). Biochemical values reached no significant level. CONCLUSION The results of this study showed that the FES cycling exercise program improves motor and total FIM scores, gait parameters, and FVC values of pulmonary functions in patients with chronic SCI experience. The FES cycle might be a valuable and well-tolerated intervention in clinical rehabilitation.
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Affiliation(s)
- Eda Gurcay
- Gaziler Physical Therapy and Rehabilitation Education and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Ozgur Zeliha Karaahmet
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Damla Cankurtaran
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Fatma Nazlı
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Ebru Umay
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Şükran Güzel
- Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Baskent University, Ankara, Turkey
| | - Ahmet Gurhan Gurcay
- School of Medicine, Department of Neurosurgery, Yıldırım Beyazıt University, Ankara, Turkey
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Lim D, Castillo MD, Bergquist AJ, Milosevic M, Masani K. Contribution of Each Motor Point of Quadriceps Femoris to Knee Extension Torque During Neuromuscular Electrical Stimulation. IEEE Trans Neural Syst Rehabil Eng 2021; 29:389-396. [PMID: 33465028 DOI: 10.1109/tnsre.2021.3052853] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Transcutaneous neuromuscular electrical stimulation (NMES) can be used to activate the quadriceps femoris muscle to produce knee extension torque via seven distinct motor points, defined as the most sensitive locations on the muscle belly to electrical stimuli. However, it remains unclear how much individual motor points of the quadriceps femoris muscle contribute to the knee joint torque. Here we systematically investigated the contribution of each motor point of the quadriceps femoris muscle to the knee joint torque produced by paired electrical stimuli. Ten able-bodied individuals participated in this study. Paired electrical stimuli was applied by delivering electrical impulses on the motor points in all combinations among seven motor points (i.e., totaling to 127 combinations) at two different stimulation intensities (i.e., 25% and 50% of the maximum) while recording isometric knee joint torque. The contribution of individual motor points was estimated using statistical analyses. We found that a linear addition of twitch torques induced by single motor point stimulus overestimated the twitch torques induced by multiple motor point stimulations, suggesting overlaps in muscle fibres activated by each motor point. Using multiple linear regressions, we identified the average contribution of each motor point to the knee extension torque during paired electrical stimuli and found significant differences between these torque contributions. We demonstrated that seven distinct motor points can be activated for the quadriceps muscle group using paired electrical stimuli and identified the contribution of each motor point to knee extension torque during twitch muscle contraction; these findings provide useful information to design rehabilitation using NMES on quadriceps femoris muscles.
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9
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Evaluating functional electrical stimulation (FES) cycling on cardiovascular, musculoskeletal and functional outcomes in adults with multiple sclerosis and mobility impairment: A systematic review. Mult Scler Relat Disord 2019; 37:101485. [PMID: 31706166 DOI: 10.1016/j.msard.2019.101485] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 10/03/2019] [Accepted: 10/28/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND People with Multiple Sclerosis (PwMS) are at an increased risk of diseases associated with low levels of physical activity (PA). Deconditioning may lead to an acceleration in the development of secondary complications from MS, impairing physical function and exacerbating disease progression. Functional Electrical Stimulation (FES) Cycling may provide a suitable lower limb exercise intervention for PwMS with mobility impairment. The effects of FES cycling on cardiovascular, musculoskeletal and functional outcomes for PwMS with mobility impairment are yet to be investigated to date. OBJECTIVE The objective of this review was to systematically examine the outcomes of PwMS with mobility impairment following FES cycling intervention. METHODS A systematic search of four electronic databases (MEDLINE, Web of Science, CINAHL and PEDro) from their inception to 8th January 2019 was performed. Inclusion criteria was (1) include human participants with definite diagnosis of MS (2) participants had to be aged 18 years or older (3) include participants with mobility impairment (determined as an average participant EDSS ≥ 6.0) (4) evaluate FES cycling as an intervention study. RESULTS Initial searches found 1163 studies. 9 of which met the full inclusion criteria: 5 pre-post studies with no control group, 2 randomised controlled trials (RCTs), 1 retrospective study and 1 case study. Two studies had the same participant group and intervention but reported different outcomes. Outcome data was available for n = =76 unique participants, with n = =82 completing a FES cycling intervention. Of the n = =4 papers with clear dropout rates, pooled dropout rate was 25.81%. Two papers reported non-significant improvements in aerobic capacity following a FES cycling intervention. Four papers reported no change in lower limb strength and two papers reported significant reductions in spasticity post training. Four studies failed to provide information regarding adverse events with the other studies reporting n = =10 adverse events across 36 participants. CONCLUSION Findings suggest FES cycle training may reduce CVD risk alongside trends for a reduction in spasticity post training, however the low quality of the literature precludes any definitive conclusions. FES cycle training appears to be well tolerated in PwMS with mobility impairment, with no serious adverse events.
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Savikj M, Ruby MA, Kostovski E, Iversen PO, Zierath JR, Krook A, Widegren U. Retained differentiation capacity of human skeletal muscle satellite cells from spinal cord-injured individuals. Physiol Rep 2019; 6:e13739. [PMID: 29906337 PMCID: PMC6003643 DOI: 10.14814/phy2.13739] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 05/16/2018] [Accepted: 05/18/2018] [Indexed: 02/07/2023] Open
Abstract
Despite the well‐known role of satellite cells in skeletal muscle plasticity, the effect of spinal cord injury on their function in humans remains unknown. We determined whether spinal cord injury affects the intrinsic ability of satellite cells to differentiate and produce metabolically healthy myotubes. We obtained vastus lateralis biopsies from eight spinal cord‐injured and six able‐bodied individuals. Satellite cells were isolated, grown and differentiated in vitro. Gene expression was measured by quantitative PCR. Abundance of differentiation markers and regulatory proteins was determined by Western blotting. Protein synthesis and fatty acid oxidation were measured by radioactive tracer‐based assays. Activated satellite cells (myoblasts) and differentiated myotubes derived from skeletal muscle of able‐bodied and spinal cord‐injured individuals expressed similar (P > 0.05) mRNA levels of myogenic regulatory factors. Myogenic differentiation factor 1 expression was higher in myoblasts from spinal cord‐injured individuals. Desmin and myogenin protein content was increased upon differentiation in both groups, while myotubes from spinal cord‐injured individuals contained more type I and II myosin heavy chain. Phosphorylated and total protein levels of Akt‐mechanistic target of rapamycin and forkhead box protein O signalling axes and protein synthesis rate in myotubes were similar (P > 0.05) between groups. Additionally, fatty acid oxidation of myotubes from spinal cord‐injured individuals was unchanged (P > 0.05) compared to able‐bodied controls. Our results indicate that the intrinsic differentiation capacity of satellite cells and metabolic characteristics of myotubes are preserved following spinal cord injury. This may inform potential interventions targeting satellite cell activation to alleviate skeletal muscle atrophy.
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Affiliation(s)
- Mladen Savikj
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Science Department, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway.,Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Maxwell A Ruby
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Nutrition and Preventive Medicine, Norwich Medical School, University of East Anglia, Norwich, Norfolk, United Kingdom
| | - Emil Kostovski
- Science Department, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Per O Iversen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.,Department of Haematology, Oslo University Hospital, Oslo, Norway
| | - Juleen R Zierath
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Anna Krook
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Ulrika Widegren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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11
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Rashnavadi T, Macnab A, Cheung A, Shadgan A, Kwon BK, Shadgan B. Monitoring spinal cord hemodynamics and tissue oxygenation: a review of the literature with special focus on the near-infrared spectroscopy technique. Spinal Cord 2019; 57:617-625. [PMID: 31164734 DOI: 10.1038/s41393-019-0304-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 05/21/2019] [Accepted: 05/22/2019] [Indexed: 01/05/2023]
Abstract
STUDY DESIGN Review. OBJECTIVES Clinical studies have shown that the hemodynamic management of patients following acute spinal cord injury (SCI) is an important aspect of their treatment for maintaining spinal cord (SC) perfusion and minimizing ischemic secondary injury to the SC. While this highlights the importance of ensuring adequate perfusion and oxygenation to the injured cord, a method for the real-time monitoring of these hemodynamic measures within the SC is lacking. The purpose of this review is to discuss current and potential methods for SC hemodynamic monitoring with special focus on applications using near-infrared spectroscopy (NIRS). METHODS A literature search using the PubMed database. All peer-reviewed articles on NIRS monitoring of SC published from inception to May 2019 were reviewed. RESULTS Among 125 papers related to SC hemodynamics monitoring, 26 focused on direct/indirect NIRS monitoring of the SC. DISCUSSION Current options for continuous, non-invasive, and real-time monitoring of SC hemodynamics are challenging and limited in scope. As a relatively new technique, NIRS has been successfully used for monitoring human cerebral hemodynamics, and has shown promising results in intraoperative assessment of SC hemodynamics in both human and animal models. Although utilizing NIRS to monitor the SC has been validated, applying NIRS clinically following SCI requires further development and investigation. CONCLUSIONS NIRS is a promising non-invasive technique with the potential to provide real-time monitoring of relevant parameters in the SC. Currently, in its first developmental stages, further clinical and experimental studies are mandatory to ensure the validity and safety of NIRS techniques.
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Affiliation(s)
- Tahereh Rashnavadi
- The University of British Columbia, School of Biomedical Engineering, Vancouver, BC, V6T 1Z1, Canada
| | - Andrew Macnab
- International Collaborations on Repair Discoveries (ICORD), Blusson Spinal Cord Centre, Vancouver, Canada
| | - Amanda Cheung
- International Collaborations on Repair Discoveries (ICORD), Blusson Spinal Cord Centre, Vancouver, Canada
| | - Armita Shadgan
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, Canada
| | - Brian K Kwon
- International Collaborations on Repair Discoveries (ICORD), Blusson Spinal Cord Centre, Vancouver, Canada.,Department of Orthopaedics, Faculty of Medicine, The University of British Columbia, Vancouver, Canada
| | - Babak Shadgan
- The University of British Columbia, School of Biomedical Engineering, Vancouver, BC, V6T 1Z1, Canada. .,International Collaborations on Repair Discoveries (ICORD), Blusson Spinal Cord Centre, Vancouver, Canada. .,Department of Orthopaedics, Faculty of Medicine, The University of British Columbia, Vancouver, Canada.
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12
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Hasnan N, Mohamad Saadon NS, Hamzaid NA, Teoh MXH, Ahmadi S, Davis GM. Muscle oxygenation during hybrid arm and functional electrical stimulation-evoked leg cycling after spinal cord injury. Medicine (Baltimore) 2018; 97:e12922. [PMID: 30412097 PMCID: PMC6221724 DOI: 10.1097/md.0000000000012922] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study compared muscle oxygenation (StO2) during arm cranking (ACE), functional electrical stimulation-evoked leg cycling (FES-LCE), and hybrid (ACE+FES-LCE) exercise in spinal cord injury individuals. Eight subjects with C7-T12 lesions performed exercises at 3 submaximal intensities. StO2 was measured during rest and exercise at 40%, 60%, and 80% of subjects' oxygen uptake (VO2) peak using near-infrared spectroscopy. StO2 of ACE showed a decrease whereas in ACE+FES-LCE, the arm muscles demonstrated increasing StO2 from rest in all of VO2) peak respectively. StO2 of FES-LCE displayed a decrease at 40% VO2 peak and steady increase for 60% and 80%, whereas ACE+FES-LCE revealed a steady increase from rest at all VO2 peak. ACE+FES-LCE elicited greater StO2 in both limbs which suggested that during this exercise, upper- and lower-limb muscles have higher blood flow and improved oxygenation compared to ACE or FES-LCE performed alone.
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Affiliation(s)
- Nazirah Hasnan
- Department of Rehabilitation Medicine, Faculty of Medicine
| | | | - Nur Azah Hamzaid
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Mira Xiao-Hui Teoh
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Sirous Ahmadi
- Clinical Exercise and Rehabilitation Unit, Discipline of Exercise and Sport Sciences, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Glen M. Davis
- Clinical Exercise and Rehabilitation Unit, Discipline of Exercise and Sport Sciences, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
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Galea MP, Dunlop SA, Geraghty T, Davis GM, Nunn A, Olenko L, Hurley M, Rehab R, Marshall R, Clark J, Acland R, Nunnerley J. SCIPA Full-On: A Randomized Controlled Trial Comparing Intensive Whole-Body Exercise and Upper Body Exercise After Spinal Cord Injury. Neurorehabil Neural Repair 2018; 32:557-567. [DOI: 10.1177/1545968318771213] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. While upper body training has been effective for improving aerobic fitness and muscle strength after spinal cord injury (SCI), activity-based therapies intended to activate the paralyzed extremities have been reported to promote neurological improvement. Objective. To compare the effectiveness of intensive whole-body exercise compared with upper body exercise for people with chronic SCI. Methods. A parallel-group randomized controlled trial was conducted. Participants with a range of SCI levels and severity were randomized to either full-body exercise (FBE) or upper body exercise (UBE) groups (3 sessions per week over 12 weeks). FBE participants underwent locomotor training, functional electrical stimulation-assisted leg cycling, and trunk and lower extremity exercises, while UBE participants undertook upper body strength and aerobic fitness training only. The primary outcome measure was the American Spinal Injury Association (ASIA) motor score for upper and lower extremities. Adverse events were systematically recorded. Results. A total of 116 participants were enrolled and included in the primary analysis. The adjusted mean between-group difference was −0.04 (95% CI −1.12 to 1.04) for upper extremity motor scores, and 0.90 (95% CI −0.48 to 2.27) for lower extremity motor scores. There were 15 serious adverse events in UBE and 16 in FBE, but only one of these was definitely related to the experimental intervention (bilateral femoral condyle and tibial plateau subchondral fractures). No significant between-group difference was found for adverse events, or functional or behavioral variables. Conclusions. Full-body training did not lead to improved ASIA motor scores compared with upper body training in people with chronic SCI.
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Affiliation(s)
- Mary P. Galea
- The University of Melbourne, Parkville, Victoria, Australia
| | - Sarah A. Dunlop
- The University of Western Australia, Crawley, Western Australia, Australia
| | - Timothy Geraghty
- The Hopkins Centre, Research for Rehabilitation and Resilience, Metro South Health, and Griffith University, Logan Campus, Queensland, Australia
- Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Glen M. Davis
- The University of Sydney, Lidcombe, New South Wales, Australia
| | - Andrew Nunn
- Austin Health, Heidelberg, Victoria, Australia
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Medrinal C, Prieur G, Combret Y, Quesada AR, Debeaumont D, Bonnevie T, Gravier FE, Dupuis Lozeron E, Quieffin J, Contal O, Lamia B. Functional Electrical Stimulation-A New Therapeutic Approach to Enhance Exercise Intensity in Chronic Obstructive Pulmonary Disease Patients: A Randomized, Controlled Crossover Trial. Arch Phys Med Rehabil 2018. [PMID: 29524398 DOI: 10.1016/j.apmr.2018.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To evaluate the effect of quadriceps functional electrical stimulation (FES)-cycling on exertional oxygen uptake (V˙o2) compared with placebo FES-cycling in patients with chronic obstructive pulmonary disease (COPD). DESIGN A randomized, single-blind, placebo-controlled crossover trial. SETTING Pulmonary rehabilitation department. PARTICIPANTS Consecutive patients (N=23) with COPD Global Initiative for Chronic Obstructive Lung Disease stage 2, 3, or 4 (mean forced expiratory volume during the first second, 1.4±0.4L [50.3% predicted]) who had recently begun a respiratory rehabilitation program. INTERVENTION Two consecutive 30-minute sessions were carried out at a constant load with active and placebo FES-cycling. MAIN OUTCOME MEASURES The primary outcome was mean V˙o2 during the 30-minute exercise session. The secondary outcomes were respiratory gas exchange and hemodynamic parameters averaged over the 30-minute endurance session. Lactate values, dyspnea, and perceived muscle fatigue were evaluated at the end of the sessions. RESULTS FES-cycling increased the physiological response more than the placebo, with a greater V˙o2 achieved of 36.6mL/min (95% confidence interval [CI], 8.9-64.3mL/min) (P=.01). There was also a greater increase in lactate after FES-cycling (+1.5mmol/L [95% CI, .05-2.9mmol/L]; P=.01). FES-cycling did not change dyspnea or muscle fatigue compared with the placebo condition. CONCLUSIONS FES-cycling effectively increased exercise intensity in patients with COPD. Further studies should evaluate longer-term FES-cycling rehabilitation programs.
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Affiliation(s)
- Clément Medrinal
- Normandy University, UNIROUEN, and the Institute for Research and Innovation in Biomedicine, Rouen, France; Pulmonology Department, Le Havre Hospital, Montivilliers, France.
| | - Guillaume Prieur
- Pulmonology Department, Le Havre Hospital, Montivilliers, France
| | - Yann Combret
- Institute for Experimental Research, Pulmonology, ORL & Dermatology, Catholic University of Louvain, Brussels, Belgium; Physiotherapy Department, Le Havre Hospital, Montivilliers, France
| | | | - David Debeaumont
- Exercise and Respiratory Physiology Department, Bois Guillaume Hospital, Rouen University Hospital, Rouen Cedex, France
| | - Tristan Bonnevie
- Normandy University, UNIROUEN, and the Institute for Research and Innovation in Biomedicine, Rouen, France; ADIR Association, Bois Guillaume, France
| | | | - Elise Dupuis Lozeron
- Division of Clinical Epidemiology, Geneva University Hospitals, Geneva, Switzerland
| | - Jean Quieffin
- Pulmonology Department, Le Havre Hospital, Montivilliers, France
| | - Olivier Contal
- University of Applied Sciences and Arts of Western Switzerland (HES-SO), Lausanne, Switzerland
| | - Bouchra Lamia
- Normandy University, UNIROUEN, and the Institute for Research and Innovation in Biomedicine, Rouen, France; Pulmonology Department, Le Havre Hospital, Montivilliers, France; Intensive Care Unit, Respiratory Department, Rouen University Hospital, Rouen, France
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Sijobert B, Fattal C, Daubigney A, Azevedo-Coste C. Participation to the first Cybathlon: an overview of the FREEWHEELS team FES-cycling solution. Eur J Transl Myol 2017; 27:7120. [PMID: 29299223 PMCID: PMC5745382 DOI: 10.4081/ejtm.2017.7120] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 11/13/2017] [Indexed: 12/27/2022] Open
Abstract
This article is a contribution to a special issue aiming at collecting data and documenting the different specificities of the teams which participated into Cybathlon 2016 FES-bike discipline. Our team prepared one paraplegic pilot over one year and developed a FES-cycling device based on existing commercial products. Our pilot (47 y.o, spinal cord lesion T3 AIS A since year 1995) was qualified for the final race and finished in 6th position over 12 participants in the discipline, covering a total distance of 750m at an average speed of 5.71km/h, propelled by his own quadriceps and hamstrings muscles.
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Affiliation(s)
- Benoît Sijobert
- INRIA - LIRMM Université de Montpellier, Montpellier, France
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Guimarães JA, da Fonseca LO, Dos Santos-Couto-Paz CC, Bó APL, Fattal C, Azevedo-Coste C, Fachin-Martins E. Towards Parameters and Protocols to Recommend FES-Cycling in Cases of Paraplegia: A Preliminary Report. Eur J Transl Myol 2016; 26:6085. [PMID: 27990239 PMCID: PMC5128972 DOI: 10.4081/ejtm.2016.6085] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Functional Electrical Stimulation assisted cycling (FES-Cycling) is increasingly becoming an alternative option recommended to people with spinal cord injury struggling with paraplegia and interested in practicing sports. In order to propose preconditions to guide FES-Cycling recommendation, we aimed to investigate some features and their potential relationships with responsiveness to Neuromuscular Electrical Stimulation (NMES). Fourteen volunteers attended a public recruitment forum to be assessed about their responsiveness through the 16-sessions of NMES. Volunteers were separated in two groups (responsive and non-responsive to NMES) which were investigated in the light of some personal, clinical, structural and functional features. Fifty seven percent of the initial sample responded to electrical stimulation with a visual contraction. This responsive group was predominantly composed by subjects presenting traumatic spinal cord injuries above T12 vertebral level. Only two subjects became responsive at the 3rd and 16th sessions. Among the observed features, the etiology and level of injuries seems to be more associated to responsiveness. Our observations seem to indicate that subjects with traumatic spinal cord injury above T12 level were the best potential candidates for FES-cycling.
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Affiliation(s)
| | - Lucas Oliveira da Fonseca
- NTAAI, Faculdade de Ceilândia, Universidade de Brasília, Brasília, Brazil; LARA, Faculdade de Tecnologia, Universidade de Brasília, Brasília, Brazil
| | | | - Antônio Padilha Lanari Bó
- NTAAI, Faculdade de Ceilândia, Universidade de Brasília, Brasília, Brazil; LARA, Faculdade de Tecnologia, Universidade de Brasília, Brasília, Brazil
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Functional electrical stimulation: cardiorespiratory adaptations and applications for training in paraplegia. Sports Med 2015; 45:71-82. [PMID: 25205000 DOI: 10.1007/s40279-014-0250-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Regular exercise can be broadly beneficial to health and quality of life in humans with spinal cord injury (SCI). However, exercises must meet certain criteria, such as the intensity and muscle mass involved, to induce significant benefits. SCI patients can have difficulty achieving these exercise requirements since the paralysed muscles cannot contribute to overall oxygen consumption. One solution is functional electrical stimulation (FES) and, more importantly, hybrid training that combines volitional arm and electrically controlled contractions of the lower limb muscles. However, it might be rather complicated for therapists to use FES because of the wide variety of protocols that can be employed, such as stimulation parameters or movements induced. Moreover, although the short-term physiological and psychological responses during different types of FES exercises have been extensively reported, there are fewer data regarding the long-term effects of FES. Therefore, the purpose of this brief review is to provide a critical appraisal and synthesis of the literature on the use of FES for exercise in paraplegic individuals. After a short introduction underlying the importance of exercise for SCI patients, the main applications and effects of FES are reviewed and discussed. Major findings reveal an increased physiological demand during FES hybrid exercises as compared with arms only exercises. In addition, when repeated within a training period, FES exercises showed beneficial effects on muscle characteristics, force output, exercise capacity, bone mineral density and cardiovascular parameters. In conclusion, there appears to be promising evidence of beneficial effects of FES training, and particularly FES hybrid training, for paraplegic individuals.
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Galea MP, Dunlop SA, Marshall R, Clark J, Churilov L. Early exercise after spinal cord injury ('Switch-On'): study protocol for a randomised controlled trial. Trials 2015; 16:7. [PMID: 25563584 PMCID: PMC4320571 DOI: 10.1186/1745-6215-16-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Accepted: 12/15/2014] [Indexed: 01/09/2023] Open
Abstract
Background Spinal cord injury (SCI) leads to a profound muscular atrophy, bone loss and bone fragility. While there is evidence that exercising paralysed muscles may lead to reversal of muscle atrophy in the chronic period after SCI, there is little evidence that exercise can prevent muscle changes early after injury. Moreover, whether exercise can prevent bone loss and microarchitectural decay is not clear. Methods/Design A multi-centre, parallel group, assessor-blinded randomised controlled trial will be conducted. Fifty participants with acute spinal cord injury will be recruited from four SCI units in Australia and New Zealand. Participants will be stratified by site and AIS status and randomised to an experimental or control group. Experimental participants will receive a 12-week programme of functional electrical stimulation (FES)-assisted cycling. Control participants will receive a 12-week programme of passive cycling. The primary outcome is muscle cross-sectional area of the thigh and calf measured using magnetic resonance images (MRI) of the leg. Secondary outcomes include serum biomarkers of SCI osteoporosis (sclerostin, P1NP and β-CTX), markers of immune function (IL-6, IL-10, FGF2, INF-γ, TNF-α), neurological function, body composition, depression and quality of life. Leg MRIs will be measured by a single blinded assessor based in Melbourne. Serum samples will be analysed in a central laboratory. All other characteristics will be measured at baseline and 12 weeks by blinded and trained assessors at each site. The first participant was randomised on 27 November 2012. Discussion The results of this trial will determine the relative effectiveness of a 12-week programme of FES-assisted cycling versus passive cycling in preventing muscle atrophy and maintaining skeletal integrity after spinal cord injury. Trial registration ACTRN12611001079932 (18 October 2011)
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Affiliation(s)
- Mary P Galea
- Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Parkville, VIC 3010, Australia.
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Sisto SA, Evans N. Activity and Fitness in Spinal Cord Injury: Review and Update. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2014. [DOI: 10.1007/s40141-014-0057-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Mayson TA, Harris SR. Functional electrical stimulation cycling in youth with spinal cord injury: A review of intervention studies. J Spinal Cord Med 2014; 37:266-77. [PMID: 24621033 PMCID: PMC4064576 DOI: 10.1179/2045772313y.0000000183] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
CONTEXT Preliminary research suggests that functional electrical stimulation cycling (FESC) might be a promising intervention for youth with spinal cord injury (SCI). OBJECTIVE To review the evidence on FESC intervention in youth with SCI. METHODS Systematic literature searches were conducted during December 2012. Two reviewers independently selected titles, abstracts, and full-text articles. Of 40 titles retrieved, six intervention studies met inclusion criteria and were assessed using American Academy for Cerebral Palsy and Developmental Medicine Levels of Evidence and Conduct Questions for Group Design. RESULTS The study results were tabulated based on levels of evidence, with outcomes categorized according to the International Classification of Functioning, Disability, and Health framework. Evidence from the six included studies suggests that FESC is safe for youth with SCI, with no increase in knee/hip injury or hip displacement. Results from one level II randomized controlled trial suggest that a thrice weekly, 6-month FESC program can positively influence VO2 levels when compared with passive cycling, as well as quadriceps strength when compared with electrical stimulation and passive cycling. CONCLUSIONS FESC demonstrates limited yet encouraging results as a safe modality to mitigate effects of inactivity in youth with SCI. More rigorous research involving a greater number of participants is needed before clinicians can be confident of its effectiveness.
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Affiliation(s)
- Tanja A. Mayson
- Correspondence to: Tanja A. Mayson, Therapy Department, Sunny Hill Health Centre for Children, 3644 Slocan St. Vancouver, BC, Canada, V5M 3E8.
| | - Susan R. Harris
- Department of Physical Therapy, University of British Columbia, Friedman Building, Vancouver, BC, Canada
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Vieira PJC, Chiappa AMG, Cipriano G, Umpierre D, Arena R, Chiappa GR. Neuromuscular electrical stimulation improves clinical and physiological function in COPD patients. Respir Med 2014; 108:609-20. [PMID: 24418570 DOI: 10.1016/j.rmed.2013.12.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Revised: 12/19/2013] [Accepted: 12/20/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Neuromuscular electrical stimulation (NMES) improves muscle performance and exercise tolerance in chronic obstructive pulmonary disease (COPD) patients. In contrast, no study has assessed the effect of NMES on dynamic hyperinflation (DH) in COPD. This study investigated the effect of short-term, high-frequency NMES on DH in patients with COPD. METHODS Twenty patients were randomly allocated to either a NMES applied bilaterally to the quadriceps muscles (n = 11: 8 weeks, 5 days/week, twice/day, 45 min/session) or a control group (n = 09). All patients received respiratory physical therapy and stretching exercises. Free fat mass, pulmonary function, time to exercise tolerance (Tlim), 6-min walk test distance (6-MWTD), tumor necrosis factor (TNF-α) and β-endorphin levels, Borg dyspnea and leg score (BDS and BLS) and quality of life by the St. George's Respiratory Questionnaire score (SGRQ) were examined before and after the intervention. RESULTS Compared with the control group, NMES increased FEV1 and FEV1/FVC, 6-MWD and Tlim (P < 0.01) and reduced BDS and SGRQ (P < 0.01). Additionally, changes in the Tlim were positively correlated with respiratory improvements in FEV1 (rho = 0.48, P < 0.01). Also, NMES reduced TNF-α and increased β-endorphin levels, compared with the control group (P < 0.001). CONCLUSION In summary, 8 weeks of NMES promotes reduction of the perceived sensation of dyspnea during exercise in patients with COPD. This finding is accompanied by improvements in FEV1, exercise tolerance and quality of life, and DH. Interestingly, these findings may be associated with enhanced vasodilatory function and a reduction in inflammatory responses. CLINICAL TRIAL REGISTRATION NCT01695421.
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Affiliation(s)
- Paulo J C Vieira
- Exercise Pathophysiology Research Laboratory and Cardiology Division, Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Gerson Cipriano
- Physical Therapy Division, University of Brasilia, Brasília, Brazil
| | - Daniel Umpierre
- Exercise Pathophysiology Research Laboratory and Cardiology Division, Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL, USA
| | - Gaspar R Chiappa
- Exercise Pathophysiology Research Laboratory and Cardiology Division, Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil; Serra Gaucha College, Physical Therapy Division, Brazil.
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Galea MP, Dunlop SA, Davis GM, Nunn A, Geraghty T, Hsueh YSA, Churilov L. Intensive exercise program after spinal cord injury ("Full-On"): study protocol for a randomized controlled trial. Trials 2013; 14:291. [PMID: 24025260 PMCID: PMC3848453 DOI: 10.1186/1745-6215-14-291] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Accepted: 08/27/2013] [Indexed: 11/13/2022] Open
Abstract
Background Rehabilitation after spinal cord injury (SCI) has traditionally involved teaching compensatory strategies for identified impairments and deficits in order to improve functional independence. There is some evidence that regular and intensive activity-based therapies, directed at activation of the paralyzed extremities, promotes neurological improvement. The aim of this study is to compare the effects of a 12-week intensive activity-based therapy program for the whole body with a program of upper body exercise. Methods/Design A multicenter, parallel group, assessor-blinded randomized controlled trial will be conducted. One hundred eighty-eight participants with spinal cord injury, who have completed their primary rehabilitation at least 6 months prior, will be recruited from five SCI units in Australia and New Zealand. Participants will be randomized to an experimental or control group. Experimental participants will receive a 12-week program of intensive exercise for the whole body, including locomotor training, trunk exercises and functional electrical stimulation-assisted cycling. Control participants will receive a 12-week intensive upper body exercise program. The primary outcome is the American Spinal Injuries Association (ASIA) Motor Score. Secondary outcomes include measurements of sensation, function, pain, psychological measures, quality of life and cost effectiveness. All outcomes will be measured at baseline, 12 weeks, 6 months and 12 months by blinded assessors. Recruitment commenced in January 2011. Discussion The results of this trial will determine the effectiveness of a 12-week program of intensive exercise for the whole body in improving neurological recovery after spinal cord injury. Trial registration NCT01236976 (10 November 2010), ACTRN12610000498099 (17 June 2010).
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Affiliation(s)
- Mary P Galea
- Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Parkville, VIC 3010, Australia.
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Martin R, Sadowsky C, Obst K, Meyer B, McDonald J. Functional electrical stimulation in spinal cord injury:: from theory to practice. Top Spinal Cord Inj Rehabil 2013; 18:28-33. [PMID: 23459150 DOI: 10.1310/sci1801-28] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
This article outlines steps to practical application of functional electrical stimulation (FES) within activity-based restorative therapy (ABRT). Drawing from current evidence, specific applications of FES intended to help restore function lost to spinal cord injury and associated neurologic disease are discussed. The medical and therapeutic indications, precautions, and contraindications are reviewed to help participants with appropriate patient selection, treatment planning, and assessment. Also included are the physiological implications of FES and alterable parameters, including dosing and timing, for a desired response. Finally, approaches to improve cortical representation and motor learning and to transition emerging movement into functional tasks are reviewed.
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Affiliation(s)
- Rebecca Martin
- The International Center for Spinal Cord Injury at Kennedy Krieger Institute , Baltimore , Maryland
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Maximizing Usability of Evidence in Rehabilitation Practice: Tips for Researchers. Arch Phys Med Rehabil 2013; 94:S43-8. [DOI: 10.1016/j.apmr.2012.05.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Revised: 05/18/2012] [Accepted: 05/22/2012] [Indexed: 11/15/2022]
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Fornusek C, Davis GM, Russold MF. Pilot study of the effect of low-cadence functional electrical stimulation cycling after spinal cord injury on thigh girth and strength. Arch Phys Med Rehabil 2012; 94:990-3. [PMID: 23123504 DOI: 10.1016/j.apmr.2012.10.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Revised: 10/06/2012] [Accepted: 10/16/2012] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To investigate the long-term effects of functional electrical stimulation (FES)-evoked cycle training cadence on leg muscle hypertrophy and electrically evoked strength. DESIGN Open intervention study. SETTING Laboratory setting. PARTICIPANTS Untrained individuals with chronic spinal cord injury (N=8). INTERVENTIONS Six weeks (3d/wk) of training on an isokinetic FES cycle ergometer. For each subject, 1 leg was randomly allocated to cycling at 10 revolutions per minute (rpm) (LOW) for 30min/d, and the other cycling at 50rpm (HIGH) for 30min/d. MAIN OUTCOME MEASURES Pre- and posttraining measurements of lower limb circumference were performed at the distal and middle position of each thigh. Electrically evoked quadriceps muscle torque during an isometric contraction was also assessed. RESULTS Six weeks of FES cycle training significantly increased thigh girth in both LOW and HIGH groups. At midthigh, girth increases induced by LOW (6.6%±1.2%) were significantly greater than those by HIGH (3.6%±0.8%). LOW also produced greater gains in electrically evoked isometric torque than HIGH after training. CONCLUSIONS These results suggest that lower pedaling cadences evoke greater muscle hypertrophy and electrically stimulated muscle strength compared with higher cadences.
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Affiliation(s)
- Ché Fornusek
- Clinical Exercise and Rehabilitation Unit, Exercise Health and Performance Research Group, The University of Sydney, Sydney, Australia.
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Hakansson NA, Hull ML. Can the efficacy of electrically stimulated pedaling using a commercially available ergometer BE improved by minimizing the muscle stress-time integral? Muscle Nerve 2012; 45:393-402. [PMID: 22334174 DOI: 10.1002/mus.22302] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The cardiorespiratory and muscular strength benefits of functional electrical stimulation (FES) pedaling for spinal cord injury (SCI) subjects are limited because the endurance of electrically stimulated muscle is low. METHODS We tested new electrical stimulation timing patterns (Stim3, designed using a forward dynamic simulation to minimize the muscle stress-time integral) to determine whether SCI subjects could increase work and metabolic responses when pedaling a commercial FES ergometer. Work, rate of oxygen uptake (VO(2)), and blood lactate data were taken from 11 subjects (injury level T4-T12) on repeated trials. RESULTS Subjects performed 11% more work pedaling with Stim3 than with existing stimulation patterns (StimErg) (P = 0.043). Average (VO(2)) and blood lactate concentrations were not significantly different between Stim3 (442 ml/min, 5.9 mmol/L) and StimErg (417 ml/min, 5.9 mmol/L). CONCLUSION The increased mechanical work performed with Stim3 supports the use of patterns that minimize the muscle stress-time integral to prolong FES pedaling.
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Affiliation(s)
- Nils A Hakansson
- Mechanical Engineering Department, University of Delaware, 126 Spencer Laboratory, Newark, Delaware 19711, USA.
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McDonald JW, Sadowsky CL, Stampas A. The changing field of rehabilitation: optimizing spontaneous regeneration and functional recovery. HANDBOOK OF CLINICAL NEUROLOGY 2012; 109:317-336. [PMID: 23098722 DOI: 10.1016/b978-0-444-52137-8.00020-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
For neurorehabilitation of patients with spinal cord injury (SCI), the traditional emphasis on social adaptation is being expanded to include strategies that promote plasticity and regeneration in the central nervous system. Such strategies are needed to optimize recovery of neurological function. For example, the known dependence of most cellular processes on physical activity has led to the novel concept that activity is important in neural repair. This hypothesis has given rise to activity-based restoration therapies (ABRT), which aim to optimize neural activity in the damaged spinal cord, particularly below the injury level. Here, we review the basic science and clinical evidence supporting the lifelong use of ABRT for recovery from spinal cord injury. We define and describe ABRT, and discuss its components, its clinical applications, its relationship to medical management of spinal cord injury, and the potential influences of medications on recovery. We also discuss the health benefits of ABRT under physiological and pathological conditions. We stress that lifelong ABRT is required to optimize return of function and to allow patients to benefit from any "cures" that will be discovered.
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Affiliation(s)
- John W McDonald
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Estigoni EH, Fornusek C, Smith RM, Davis GM. Evoked EMG and muscle fatigue during isokinetic FES-cycling in individuals with SCI. Neuromodulation 2011; 14:349-55; discussion 355. [PMID: 21992430 DOI: 10.1111/j.1525-1403.2011.00354.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE This study investigated whether muscle fatigue during functional electrical stimulation (FES)-induced cycling was associated with changes occurring in evoked electromyographic signals (eEMG, M-waves) in individuals with spinal cord injury. We also explored the effects of recovery intervals between exercise sessions on the relationship between eEMG and muscle torque. METHODS Eight individuals with spinal cord injury performed three FES-cycling sessions of 15-min duration, with 5 min of recovery between them. The quadriceps muscles were electrically stimulated as the prime agonist to produce cycling. Pedal torques and surface eEMG signals were synchronously processed and recorded for offline analysis. RESULTS Large Torque decreases (20-44%) were observed in the first 5 min of cycling during the three exercise bouts, while changes of similar magnitude did not occur on any of the M-wave time-series (less than 19%). Between 5 and 15 min of cycling, muscle fatigue lowered the plateau baselines of Torque (ranging from 41% to 62%), M-wave peak-to-peak amplitude (PtpA) and Area (ranging from 60% to 98%) time-series, yet the magnitudes of these reductions were not consistent between them. CONCLUSION We concluded that muscle fatigue during FES-cycling was not associated with, nor could be predicted by, eEMG signals. Nonetheless, the consistency between M-waves and Torque time-curves in their direction of change clearly warrants further investigation.
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Affiliation(s)
- Eduardo H Estigoni
- Clinical Exercise and Rehabilitation Unit, The University of Sydney, Sydney, NSW, Australia
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Collins EG, Gater D, Kiratli J, Butler J, Hanson K, Langbein WE. Energy cost of physical activities in persons with spinal cord injury. Med Sci Sports Exerc 2011; 42:691-700. [PMID: 19952846 DOI: 10.1249/mss.0b013e3181bb902f] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The objectives of this descriptive study were (a) to determine the energy expenditure of activities commonly performed by individuals with a spinal cord injury (SCI) and summarize this information and (b) to measure resting energy expenditure and establish the value of 1 MET for individuals with SCI. METHODS One-hundred seventy adults with SCI were partitioned by gender, anatomical level of SCI, and American Spinal Injury Association designations for motor function. Twenty-seven physical activities, 12 recreational/sport and 15 daily living, were performed, while energy expenditure was measured continuously via a COSMED K4b portable metabolic system. In addition, 66 adult males with SCI completed 30 min of supine resting energy testing in a quiet environment. RESULTS Results for the 27 measured activities are reported in kilocalories per minute (kcal·min(-1)) and VO2 (mL·min(-1) and mL·kg(-1)·min(-1)). One MET for a person with SCI should be adjusted using 2.7 mL·kg(-1)·min(-1). Using 2.7 mL·kg(-1)·min(-1), the MET range for persons in the motor incomplete SCI group was 1.17 (supported standing) to 6.22 (wheeling on grass), and 2.26 (billiards) to 16.25 (hand cycling) for activities of daily living and fitness/recreation, respectively. The MET range for activities of daily living for persons in the group with motor complete SCI was 1.27 (dusting) to 4.96 (wheeling on grass) and 1.47 (bait casting) to 7.74 (basketball game) for fitness/recreation. CONCLUSIONS The foundation for a compendium of energy expenditure for physical activities for persons with SCI has been created with the completion of this study. In the future, others will update and expand the content of this compendium as has been the case with the original compendium for the able-bodied.
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Affiliation(s)
- Eileen G Collins
- Center for Management of Complex Chronic Care, Edward Hines Jr., VA Hospital, Hines, IL 60141, USA.
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Duffell LD, Rowlerson AM, Donaldson NDN, Harridge SDR, Newham DJ. Effects of endurance and strength-directed electrical stimulation training on the performance and histological properties of paralyzed human muscle: a pilot study. Muscle Nerve 2010; 42:756-63. [PMID: 20976779 DOI: 10.1002/mus.21746] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Electrical stimulation (ES) improves muscle properties after spinal cord injury (SCI), but cycling power output (PO) remains low. We investigated the effect of endurance and strength ES training on these parameters. Assessments of quadriceps strength and fatigue resistance, cycling PO, and muscle biopsies were made in four well-trained SCI subjects (three cyclists and one rower) before and after additional weight training in the cyclists and once in the rower. Weight training improved muscle strength, but cycling PO was low in all subjects. There was no effect of training type on biopsy data. Biopsies showed non-specific signs of pathology, predominance of type IIa fibers, and uniform metabolic activity. Oxidative activity was low, as were capillary:fiber ratios in the cyclists. Cycling PO is limited by factors other than muscle strength. Future ES training studies should attempt to improve muscle oxidative capacity to optimize the potential benefits of ES exercise.
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Affiliation(s)
- Lynsey D Duffell
- Division of Applied Biomedical Research, King's College London, London, UK
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Alon G, Conroy VM, Donner TW. Intensive training of subjects with chronic hemiparesis on a motorized cycle combined with functional electrical stimulation (FES): a feasibility and safety study. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2010; 16:81-91. [PMID: 21110414 DOI: 10.1002/pri.475] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2009] [Revised: 03/23/2010] [Accepted: 04/01/2010] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND PURPOSE This study tested the safety and ability of subjects with chronic hemiplegia to tolerate intensive training using a motorized cycle combined with functional electrical stimulation (FES) system. METHODS A case series of 10 subjects with chronic stroke participated in 30-minute three times per week cycling on a stationary motorized cycling system combined with FES (RT300(TM) ). The stimulation activated the dorsal and plantar flexors, the quadriceps and the hamstrings using four channels and a stimulation pattern that assisted cycling motion of the paretic lower limb. Patients were instructed to cycle as close as possible to 60 rpm and the resistance to cycling was gradually increased using a computer-based algorithm. The training lasted eight weeks. RESULTS All 10 participants completed the training without adverse reactions to the training or the FES. The kcal utilized during the training increased significantly (p = 0.0003) between session 1 (2.2 ± 0.47), session 12 (4.3 ± 1.2) and session 24 (7.5 ± 1.8). Peak pedaling power increased from 6.5 ± 0.5 W pre-training to 18.0 ± 5.4 W post-training. Locomotion variables that improved significantly were time to complete the get up and go test (45.4 ± 54.9 seconds vs. 34.0 ± 31.8 seconds) a 24.6% improvement (p = 0.03) and gait velocity, which increased 25.0% from 0.4 ± 0.3 m/sec to 0.5 ± 0.4 m/sec (p = 0.01). CONCLUSION Using a motorized cycle combined with FES intensive training appears safe and can be tolerated by patients with chronic stroke of wide age range, diverse severity of cardio-pulmonary deconditioning, motor loss and locomotor deficits.
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Affiliation(s)
- Gad Alon
- Physical Therapy and Rehabilitation Sciences, University of Maryland, School of Medicine, MD 21201, USA.
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Duffell LD, Donaldson NDN, Newham DJ. Power Output During Functional Electrically Stimulated Cycling in Trained Spinal Cord Injured People. Neuromodulation 2009; 13:50-7. [DOI: 10.1111/j.1525-1403.2009.00245.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lagerquist O, Walsh LD, Blouin JS, Collins DF, Gandevia SC. Effect of a peripheral nerve block on torque produced by repetitive electrical stimulation. J Appl Physiol (1985) 2009; 107:161-7. [DOI: 10.1152/japplphysiol.91635.2008] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Neuromuscular electrical stimulation (NMES) generates contractions by activation of motor axons (peripheral mechanism), but the afferent volley also contributes by recruiting spinal motoneurons synaptically (central mechanism), which recruits motoneurons according to Henneman's size principle. Thus, we hypothesized that contractions that develop due to a combination of peripheral and central mechanisms will fatigue less rapidly than when electrically evoked contractions are generated by the activation of motor axons alone. Plantar-flexion torque evoked by NMES over the triceps surae was compared in five able-bodied subjects before (Intact) and during (Blocked) a complete anesthetic block of the tibial and common peroneal nerves. In the Blocked condition, plantar-flexion torque could only develop from the direct activation of motor axons beneath the stimulating electrodes. NMES was delivered using three protocols: protocol A, constant 100 Hz for 30 s; protocol B, four 2-s bursts of 100 Hz alternating with 20-Hz stimulation; and protocol C, alternating 100 Hz bursts (1 s on, 1 s off) for 30 s. The percent change in evoked plantar flexion torque from the beginning to the end of the stimulation differed ( P < 0.05) between Intact and Blocked conditions for all protocols (Intact: protocol A = +125%, B = +230%, C = +78%; Blocked: protocol A = −79%, B = −15%, C = −35%). These results corroborate previous evidence that NMES can evoke contractions via the recruitment of spinal motoneurons in addition to the direct recruitment of motor axons. We now show that NMES delivered for periods of up to 30 s generates plantar-flexion torque which decreases when only motor axons are recruited and increases when the central nervous system can contribute.
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Hamzaid NA, Davis G. Health and Fitness Benefits of Functional Electrical Stimulation-Evoked Leg Exercise for Spinal Cord–Injured Individuals. Top Spinal Cord Inj Rehabil 2009. [DOI: 10.1310/sci1404-88] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Vercruyssen F, Brisswalter J. Which factors determine the freely chosen cadence during submaximal cycling? J Sci Med Sport 2009; 13:225-31. [PMID: 19342296 DOI: 10.1016/j.jsams.2008.12.631] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2008] [Revised: 11/12/2008] [Accepted: 12/04/2008] [Indexed: 11/16/2022]
Abstract
The present review of cycling science focuses on the identification of criteria that affect the freely chosen cadence (FCC) during submaximal exercise of short and prolonged durations. Cadence selection during submaximal cycling constitutes a potential parameter affecting the endurance performance in subjects of varying aerobic fitness level and experience. The activity constraints such as specificity (e.g. cycle bout of triathlon) and exercise duration may play an important role in the selection of cadence and must be taken into consideration in the task description. The 'holistic' approach of this review is based on a multifactorial analysis considering the cycling constraints, and the physiological and biomechanical factors of cadence selection so as to establish any interrelationships between these factors. During cycle bouts of short duration (<15 min), it has been well argued that experienced cyclists, trained runners and triathletes adopt high cadences (80-100 rpm) systematically above the energetically optimal cadence (EOC) at which the oxygen uptake is minimal (55-65 rpm). The choice of a high cadence has been shown to be dependent upon several factors, such as the aerobic fitness level, the reduction in forces applied to the cranks, the lower extremity net joint moments and minimal neuromuscular fatigue. However, with increasing exercise duration the FCC has been reported to be close to the EOC exclusively in endurance athletes practising a variety of activities, suggesting an impact of training mode on the muscular adaptations and the organisation of the movement pattern.
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Affiliation(s)
- Fabrice Vercruyssen
- Laboratoire Handibio, groupe Efficience et mouvement altéré, UFR STAPS, Université de Toulon-Var, 83957 La Garde Cedex, France.
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