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Matsuse H, Tajima H, Baba E, Iwanaga S, Omoto M, Hashida R, Nago T, Shiba N. Hybrid Training System Consisting of Synchronized Neuromuscular Electrical Stimulation for Voluntary Exercise Using an Articular Motion Sensor. Kurume Med J 2024; 70:83-89. [PMID: 39098028 DOI: 10.2739/kurumemedj.ms7034006] [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] [Indexed: 08/06/2024]
Abstract
Neuromuscular electrical stimulation (NMES) is widely used for improving muscle strength, preventing muscle atrophy, and decreasing pain. Recently, NMES has become a substitute for exercise therapy for metabolism improvement and functional capacity improvement. However, NMES has several disadvantages. First, slow-twitch muscle contractions are insufficient because the recruitment pattern of NMES does not obey Henneman's size principle. Second, when using surface electrodes, it is difficult to contract deep skeletal muscles at the application site. Third, electrical stimulation causes discomfort. Therefore, we devised a simultaneous combination of NMES and voluntary muscle contractions to overcome the weak points of NMES. A hybrid training system (HTS) that resists the motion of a volitionally contracting agonist muscle with force generated by its electrically stimulated antagonist was developed as a technique to combine the application of NMES and volitional contractions. This motion sensor makes it possible to simultaneously combine voluntary movements with NMES. Our HTS synchronizes with voluntary movements, enhancing safety and reducing discomfort. This HTS enhances the exercise effect of even simple exercise. So far, our HTS has been reported to be effective for muscle strength enhancement, prevention of muscle atrophy, improvement of physical function, pain relief, enhancement of physical fitness, and improvement of metabolic function. HTS are expected to be useful methods in environments where sufficient exercise load is not available or for individuals with low exercise tolerance.
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Affiliation(s)
- Hiroo Matsuse
- Rehabilitation center, Kurume University
- Department of Orthopedic Surgery, Kurume University School of Medicine
| | - Hiroshi Tajima
- Rehabilitation center, Kurume University
- Department of Orthopedic Surgery, Kurume University School of Medicine
| | - Eriko Baba
- Rehabilitation center, Kurume University
| | - Sohei Iwanaga
- Department of Orthopedic Surgery, Kurume University School of Medicine
| | - Masayuki Omoto
- Department of Orthopedic Surgery, Kurume University School of Medicine
| | - Ryuki Hashida
- Department of Orthopedic Surgery, Kurume University School of Medicine
| | - Takeshi Nago
- Rehabilitation center, Kurume University
- Department of Orthopedic Surgery, Kurume University School of Medicine
| | - Naoto Shiba
- Department of Orthopedic Surgery, Kurume University School of Medicine
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Flodin J, Amiri P, Juthberg R, Ackermann PW. Motorpoint Heatmap of the Hamstring Muscles to Facilitate Neuromuscular Electrical Stimulation. Ann Biomed Eng 2024:10.1007/s10439-024-03657-z. [PMID: 39609344 DOI: 10.1007/s10439-024-03657-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Accepted: 11/21/2024] [Indexed: 11/30/2024]
Abstract
The effectiveness of neuromuscular electrical stimulation (NMES) depends on electrode placement, with placement over the motor points (MPs) being the most effective. This study aimed to determine the MP-distribution and establish a heatmap indicating the probability of finding a MP in different areas of the hamstring (H) muscles. Additionally, inter-individual variations in the number of MPs were investigated. Thirty-one healthy participants (15 females, 16 males), aged 18-65 years, were included. The individual anatomy of the H-muscles, including the biceps femoris (BF), semitendinosus (ST), and semimembranosus (SM), was determined using ultrasound. MPs were located using a MP-search pen. The thigh anatomy was divided into 70 3x3cm areas, and the probability of finding a MP in each area was calculated using the Clopper-Pearson test to create a heatmap. Regression analysis was employed to determine if patient characteristics were associated with the number of MPs. The two best areas, found over BF and ST, exhibited a 39% probability of containing a MP and were significantly more likely to contain a MP compared to 85% of the remaining areas (p < 0.05). Two areas over SM had a 29% probability of containing a MP. BF exhibited a significantly higher number of MPs compared to SM and ST (p < 0.001). Male sex and higher physical activity were independent explanatory factors positively correlated with the number of MPs over BF in the multiple linear regression (R2 = 0.38, p = 0.001). The MP-heatmap of the H-muscles can effectively facilitate NMES application by highlighting areas with a higher probability of finding a MP. Large inter-individual variations in location and number of MPs were demonstrated.
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Affiliation(s)
- J Flodin
- Integrative Orthopedic Laboratory, Section of Orthopedics and Sports Medicine, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
- Department of Trauma, Acute Surgery and Orthopaedics, Karolinska University Hospital, 171 76, Stockholm, Sweden.
| | - P Amiri
- Integrative Orthopedic Laboratory, Section of Orthopedics and Sports Medicine, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Trauma, Acute Surgery and Orthopaedics, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - R Juthberg
- Integrative Orthopedic Laboratory, Section of Orthopedics and Sports Medicine, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Trauma, Acute Surgery and Orthopaedics, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - P W Ackermann
- Integrative Orthopedic Laboratory, Section of Orthopedics and Sports Medicine, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Trauma, Acute Surgery and Orthopaedics, Karolinska University Hospital, 171 76, Stockholm, Sweden
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Popesco T, Bet da Rosa Orssatto L, Hug F, Blazevich AJ, Trajano GS, Place N. Motoneuron persistent inward current contribution to increased torque responses to wide-pulse high-frequency neuromuscular electrical stimulation. Eur J Appl Physiol 2024; 124:3377-3386. [PMID: 38940932 PMCID: PMC11519318 DOI: 10.1007/s00421-024-05538-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 06/07/2024] [Indexed: 06/29/2024]
Abstract
PURPOSE To assess the effect of a remote handgrip contraction during wide-pulse high-frequency (WPHF) neuromuscular electrical stimulation (NMES) on the magnitude of extra torque, progressive increase in torque during stimulation, and estimates of the persistent inward current (PIC) contribution to motoneuron firing in the plantar flexors. METHODS Ten participants performed triangular shaped contractions to 20% of maximal plantar flexion torque before and after WPHF NMES with and without a handgrip contraction, and control conditions. Extra torque, the relative difference between the initial and final torque during stimulation, and sustained electromyographic (EMG) activity were assessed. High-density EMG was recorded during triangular shaped contractions to calculate ∆F, an estimate of PIC contribution to motoneuron firing, and its variation before vs after the intervention referred to as ∆F change score. RESULTS While extra torque was not significantly increased with remote contraction (WPHF + remote) vs WPHF (+ 37 ± 63%, p = 0.112), sustained EMG activity was higher in this condition than WPHF (+ 3.9 ± 4.3% MVC EMG, p = 0.017). Moreover, ∆F was greater (+ 0.35 ± 0.30 Hz) with WPHF + remote than control (+ 0.03 ± 0.1 Hz, p = 0.028). A positive correlation was found between ∆F change score and extra torque in the WPHF + remote (r = 0.862, p = 0.006). DISCUSSION The findings suggest that the addition of remote muscle contraction to WPHF NMES enhances the central contribution to torque production, which may be related to an increased PIC contribution to motoneuron firing. Gaining a better understanding of these mechanisms should enable NMES intervention optimization in clinical and rehabilitation settings, improving neuromuscular function in clinical populations.
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Affiliation(s)
- Timothée Popesco
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Lucas Bet da Rosa Orssatto
- Faculty of Health, School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Australia
| | - François Hug
- LAMHESS, Université Côte d'Azur, Nice, France
- School of Biomedical Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Anthony John Blazevich
- School of Medical and Health Sciences, Centre for Human Performance, Edith Cowan University, Joondalup, WA, Australia
| | - Gabriel Siqueira Trajano
- Faculty of Health, School of Exercise and Nutrition Sciences, Queensland University of Technology (QUT), Brisbane, Australia
| | - Nicolas Place
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland.
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Popesco T, Gardet Q, Bossard J, Maffiuletti NA, Place N. Centrally mediated responses to NMES are influenced by muscle group and stimulation parameters. Sci Rep 2024; 14:24918. [PMID: 39438501 PMCID: PMC11496505 DOI: 10.1038/s41598-024-75145-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 10/03/2024] [Indexed: 10/25/2024] Open
Abstract
Wide-pulse high-frequency neuromuscular electrical stimulation (WPHF NMES) can generate a progressive increase in tetanic force through reflexive recruitment of motor units, called extra force. This phenomenon has previously been observed on different muscle groups, but little is known on potential inter-muscle differences. We compared extra force and sustained electromyographic (EMG) activity induced by NMES between plantar flexors, knee extensors, elbow flexors and within muscle groups using pulse durations of 0.2, 1 and 2 ms and stimulation frequencies of 20, 50, 100 and 147 Hz. Extra force production and sustained EMG activity were higher for plantar flexors compared to elbow flexors at all tested parameters (except 0.2 ms for extra force). When compared to elbow flexors, extra force of the knee extensors was only higher at 100 Hz and with 1 ms while sustained EMG activity was higher at all frequencies with pulse durations of 0.2 and 2 ms. Peripheral nerve architecture as well as muscle typology and function could influence the occurrence and magnitude of centrally-mediated responses to NMES. The present findings suggest that the use of wide-pulse high-frequency NMES to promote reflexive recruitment seems to be more pertinent for lower limb muscles, plantar flexors in particular.
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Affiliation(s)
- Timothée Popesco
- Institute of Sport Sciences, University of Lausanne, Lausanne, 1015, Switzerland
| | - Quentin Gardet
- Institute of Sport Sciences, University of Lausanne, Lausanne, 1015, Switzerland
| | - Jonathan Bossard
- Institute of Sport Sciences, University of Lausanne, Lausanne, 1015, Switzerland
| | | | - Nicolas Place
- Institute of Sport Sciences, University of Lausanne, Lausanne, 1015, Switzerland.
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Descollonges M, Chaney R, Garnier P, Prigent-Tessier A, Brugniaux JV, Deley G. Electrical stimulation: a potential alternative to positively impact cerebral health? Front Physiol 2024; 15:1464326. [PMID: 39371600 PMCID: PMC11450234 DOI: 10.3389/fphys.2024.1464326] [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: 07/13/2024] [Accepted: 09/04/2024] [Indexed: 10/08/2024] Open
Abstract
An increasing body of evidence confirms the effectiveness of physical exercise (PE) in promoting brain health by preventing age-related cognitive decline and reducing the risk of neurodegenerative diseases. The benefits of PE are attributed to neuroplasticity processes which have been reported to enhance cerebral health. However, moderate to high-intensity PE is necessary to induce these responses and these intensities cannot always be achieved especially by people with physical limitations. As a countermeasure, electrical stimulation (ES) offers several benefits, particularly for improving physical functions, for various neurological diseases. This review aims to provide an overview of key mechanisms that could contribute to the enhancement in brain health in response to ES-induced exercise, including increases in cerebral blood flow, neuronal activity, and humoral pathways. This narrative review also focuses on the effects of ES protocols, applied to both humans and animals, on cognition. Despite a certain paucity of research when compared to the more classical aerobic exercise, it seems that ES could be of interest for improving cerebral health, particularly in people who have difficulty engaging in voluntary exercise.
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Affiliation(s)
- Maël Descollonges
- INSERM UMR 1093 – Laboratoire CAPS, « Cognition, Action et Plasticité Sensorimotrice », Université de Bourgogne, Dijon, France
- Kurage, Lyon, France
| | - Rémi Chaney
- INSERM UMR 1093 – Laboratoire CAPS, « Cognition, Action et Plasticité Sensorimotrice », Université de Bourgogne, Dijon, France
| | - Philippe Garnier
- INSERM UMR 1093 – Laboratoire CAPS, « Cognition, Action et Plasticité Sensorimotrice », Université de Bourgogne, Dijon, France
- Département Génie Biologique, IUT, Dijon, France
| | - Anne Prigent-Tessier
- INSERM UMR 1093 – Laboratoire CAPS, « Cognition, Action et Plasticité Sensorimotrice », Université de Bourgogne, Dijon, France
| | - Julien V. Brugniaux
- INSERM UMR 1300 – Laboratoire HP2, University Grenoble Alpes, CHU Grenoble Alpes, Grenoble, France
| | - Gaëlle Deley
- INSERM UMR 1093 – Laboratoire CAPS, « Cognition, Action et Plasticité Sensorimotrice », Université de Bourgogne, Dijon, France
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Harmon KK, Girts RM, Rodriguez G, Beausejour JP, Pagan JI, Carr JC, Garcia J, Roberts MD, Hahs‐Vaughn DL, Stout JR, Fukuda DH, Stock MS. Combined action observation and mental imagery versus neuromuscular electrical stimulation as novel therapeutics during short-term knee immobilization. Exp Physiol 2024; 109:1145-1162. [PMID: 38687158 PMCID: PMC11215482 DOI: 10.1113/ep091827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 03/28/2024] [Indexed: 05/02/2024]
Abstract
Limb immobilization causes rapid declines in muscle strength and mass. Given the role of the nervous system in immobilization-induced weakness, targeted interventions may be able to preserve muscle strength, but not mass, and vice versa. The purpose of this study was to assess the effects of two distinct interventions during 1 week of knee joint immobilization on muscle strength (isometric and concentric isokinetic peak torque), mass (bioimpedance spectroscopy and ultrasonography), and neuromuscular function (transcranial magnetic stimulation and interpolated twitch technique). Thirty-nine healthy, college-aged adults (21 males, 18 females) were randomized into one of four groups: immobilization only (n = 9), immobilization + action observation/mental imagery (AOMI) (n = 10), immobilization + neuromuscular electrical stimulation (NMES) (n = 12), or control group (n = 8). The AOMI group performed daily video observation and mental imagery of knee extensions. The NMES group performed twice daily stimulation of the quadriceps femoris. Based on observed effect sizes, it appears that AOMI shows promise as a means of preserving voluntary strength, which may be modulated by neural adaptations. Strength increased from PRE to POST in the AOMI group, with +7.2% (Cohen's d = 1.018) increase in concentric isokinetic peak torque at 30°/s. However, NMES did not preserve muscle mass. Though preliminary, our findings highlight the specific nature of clinical interventions and suggest that muscle strength can be independently targeted during rehabilitation. This study was prospectively registered: ClinicalTrials.gov NCT05072652.
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Affiliation(s)
- Kylie K. Harmon
- Department of Exercise ScienceSyracuse UniversitySyracuseNew YorkUSA
| | - Ryan M. Girts
- Department of Natural and Health SciencesPfeiffer UniversityMisenheimerNorth CarolinaUSA
| | - Gabriela Rodriguez
- Institute of Exercise Physiology and Rehabilitation Science, School of Kinesiology and Rehabilitation SciencesUniversity of Central FloridaOrlandoFloridaUSA
| | - Jonathan P. Beausejour
- Institute of Exercise Physiology and Rehabilitation Science, School of Kinesiology and Rehabilitation SciencesUniversity of Central FloridaOrlandoFloridaUSA
| | - Jason I. Pagan
- Institute of Exercise Physiology and Rehabilitation Science, School of Kinesiology and Rehabilitation SciencesUniversity of Central FloridaOrlandoFloridaUSA
| | - Joshua C. Carr
- Department of KinesiologyTexas Christian UniversityFort WorthTexasUSA
- Department of Medical EducationAnne Burnett Marion School of Medicine at Texas Christian UniversityFort WorthTexasUSA
| | - Jeanette Garcia
- School of Sport SciencesWest Virginia UniversityMorgantownWest VirginiaUSA
| | | | - Debbie L. Hahs‐Vaughn
- Department of Learning Sciences and Educational ResearchUniversity of Central FloridaOrlandoFloridaUSA
| | - Jeffrey R. Stout
- Institute of Exercise Physiology and Rehabilitation Science, School of Kinesiology and Rehabilitation SciencesUniversity of Central FloridaOrlandoFloridaUSA
| | - David H. Fukuda
- Institute of Exercise Physiology and Rehabilitation Science, School of Kinesiology and Rehabilitation SciencesUniversity of Central FloridaOrlandoFloridaUSA
| | - Matt S. Stock
- Institute of Exercise Physiology and Rehabilitation Science, School of Kinesiology and Rehabilitation SciencesUniversity of Central FloridaOrlandoFloridaUSA
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Lysak A, Farnebo S, Geuna S, Dahlin LB. Muscle preservation in proximal nerve injuries: a current update. J Hand Surg Eur Vol 2024; 49:773-782. [PMID: 38819009 DOI: 10.1177/17531934231216646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Optimal recovery of muscle function after proximal nerve injuries remains a complex and challenging problem. After a nerve injury, alterations in the affected muscles lead to atrophy, and later degeneration and replacement by fat-fibrous tissues. At present, several different strategies for the preservation of skeletal muscle have been reported, including various sets of physical exercises, muscle massage, physical methods (e.g. electrical stimulation, magnetic field and laser stimulation, low-intensity pulsed ultrasound), medicines (e.g. nutrients, natural and chemical agents, anti-inflammatory and antioxidants, hormones, enzymes and enzyme inhibitors), regenerative medicine (e.g. growth factors, stem cells and microbiota) and surgical procedures (e.g. supercharge end-to-side neurotization). The present review will focus on methods that aimed to minimize the damage to muscles after denervation based on our present knowledge.
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Affiliation(s)
- Andrii Lysak
- Institute of Traumatology and Orthopedics of National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
| | - Simon Farnebo
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Hand Surgery, Plastic Surgery and Burns, Linköping University Hospital, Linköping, Sweden
| | - Stefano Geuna
- Department of Clinical and Biological Sciences; Neuroscience Institute Cavalieri Ottolenghi, University of Torino, Torino, Italy
| | - Lars B Dahlin
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Translational Medicine - Hand Surgery, Lund University, Malmö, Sweden
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
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Flodin J, Reitzner SM, Emanuelsson EB, Sundberg CJ, Ackermann P. The effect of neuromuscular electrical stimulation on the human skeletal muscle transcriptome. Acta Physiol (Oxf) 2024; 240:e14129. [PMID: 38459757 DOI: 10.1111/apha.14129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 02/10/2024] [Accepted: 02/26/2024] [Indexed: 03/10/2024]
Abstract
AIM The influence on acute skeletal muscle transcriptomics of neuromuscular electrical stimulation (NMES), as compared to established exercises, is poorly understood. We aimed to investigate the effects on global mRNA-expression in the quadriceps muscle early after a single NMES-session, compared to the effects of voluntary knee extension exercise (EX), and to explore the discomfort level. METHODS Global vastus lateralis muscle gene expression was assessed (RNA-sequencing) in 30 healthy participants, before and 3 h after a 30-min session of NMES and/or EX. The NMES-treatment was applied using textile electrodes integrated in pants and set to 20% of each participant's pre-tested MVC mean (±SD) 200 (±80) Nm. Discomfort was assessed using Visual Analogue Scale (VAS, 0-10). The EX-protocol was performed at 80% of 1-repetition-maximum. RESULTS NMES at 20% of MVC resulted in VAS below 4 and induced 4448 differentially expressed genes (DEGs) with 80%-overlap of the 2571 DEGs of EX. Genes well-known to be up-regulated following exercise, for example, PPARGC1A, ABRA, VEGFA, and GDNF, were also up-regulated by NMES. Gene set enrichment analysis demonstrated many common pathways after EX and NMES. Also, some pathways were exclusive to either EX, for example, muscle tissue proliferation, or to NMES, for example, neurite outgrowth and connective tissue proliferation. CONCLUSION A 30-min NMES-session at 20% of MVC with NMES-pants, which can be applied with an acceptable level of discomfort, induces over 4000 DEGs, of which 80%-overlap with DEGs of EX. NMES can induce exercise-like molecular effects, that potentially can lead to health and performance benefits in individuals who are unable to perform resistance exercise.
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Affiliation(s)
- Johanna Flodin
- Integrative Orthopedic Laboratory, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Trauma, Acute Surgery and Orthopedics, Karolinska University Hospital, Stockholm, Sweden
| | - Stefan M Reitzner
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Eric B Emanuelsson
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Carl Johan Sundberg
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Department of Laboratory Medicine, Division of Clinical Physiology, Karolinska Institutet, Huddinge, Sweden
| | - Paul Ackermann
- Integrative Orthopedic Laboratory, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Trauma, Acute Surgery and Orthopedics, Karolinska University Hospital, Stockholm, Sweden
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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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Sergeeva KV, Tyganov SA, Zaripova KA, Bokov RO, Nikitina LV, Konstantinova TS, Kalamkarov GR, Shenkman BS. Mechanical and signaling responses of unloaded rat soleus muscle to chronically elevated β-myosin activity. Arch Biochem Biophys 2024; 754:109961. [PMID: 38492659 DOI: 10.1016/j.abb.2024.109961] [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: 10/26/2023] [Revised: 02/26/2024] [Accepted: 03/13/2024] [Indexed: 03/18/2024]
Abstract
It has been reported that muscle functional unloading is accompanied by an increase in motoneuronal excitability despite the elimination of afferent input. Thus, we hypothesized that pharmacological potentiation of spontaneous contractile soleus muscle activity during hindlimb unloading could activate anabolic signaling pathways and prevent the loss of muscle mass and strength. To investigate these aspects and underlying molecular mechanisms, we used β-myosin allosteric effector Omecamtiv Mekarbil (OM). We found that OM partially prevented the loss of isometric strength and intrinsic stiffness of the soleus muscle after two weeks of disuse. Notably, OM was able to attenuate the unloading-induced decrease in the rate of muscle protein synthesis (MPS). At the same time, the use of drug neither prevented the reduction in the markers of translational capacity (18S and 28S rRNA) nor activation of the ubiquitin-proteosomal system, which is evidenced by a decrease in the cross-sectional area of fast and slow muscle fibers. These results suggest that chemically-induced increase in low-intensity spontaneous contractions of the soleus muscle during functional unloading creates prerequisites for protein synthesis. At the same time, it should be assumed that the use of OM is advisable with pharmacological drugs that inhibit the expression of ubiquitin ligases.
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Affiliation(s)
- K V Sergeeva
- Institute of Biomedical Problems of the Russian Academy of Sciences, Moscow, Russia.
| | - S A Tyganov
- Institute of Biomedical Problems of the Russian Academy of Sciences, Moscow, Russia
| | - K A Zaripova
- Institute of Biomedical Problems of the Russian Academy of Sciences, Moscow, Russia
| | - R O Bokov
- Institute of Biomedical Problems of the Russian Academy of Sciences, Moscow, Russia
| | - L V Nikitina
- Institute of Immunology and Physiology, Ural Branch of the Russian Academy of Sciences, Ekaterinburg, Russia
| | - T S Konstantinova
- Emanuel Institute of Biochemical Physics, Russian Academy of Sciences, Moscow, Russia
| | - G R Kalamkarov
- Emanuel Institute of Biochemical Physics, Russian Academy of Sciences, Moscow, Russia
| | - B S Shenkman
- Institute of Biomedical Problems of the Russian Academy of Sciences, Moscow, Russia
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Pineau A, Martin A, Lepers R, Papaiordanidou M. Effect of combined electrical stimulation and brief muscle lengthening on torque development. J Appl Physiol (1985) 2024; 136:844-852. [PMID: 38357725 DOI: 10.1152/japplphysiol.00671.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 01/31/2024] [Accepted: 02/13/2024] [Indexed: 02/16/2024] Open
Abstract
This study aimed to evaluate torque production in response to the application of a brief muscle lengthening during neuromuscular electrical stimulation (NMES) applied over the posterior tibial nerve. Fifteen participants took part in three experimental sessions, where wide-pulse NMES delivered at 20 and 100 Hz (pulse duration of 1 ms applied during 15 s at an intensity evoking 5-10% of maximal voluntary contraction) was either applied alone (NMES condition) or in combination with a muscle lengthening at three distinct speeds (60, 180, or 300°/s; NMES + LEN condition). The torque-time integral (TTI) and the muscle activity following the stimulation trains [sustained electromyography (EMG)] were calculated for each condition. Results show that TTI and sustained EMG activity were higher for the NMES + LEN condition only when using 100-Hz stimulation, regardless of the lengthening speed (P = 0.029 and P = 0.007 for the two parameters, respectively). This indicates that superimposing a muscle lengthening to high-frequency NMES can enhance the total torque production, partly due to neural mechanisms, as evidenced by the higher sustained EMG activity. This finding has potential clinical relevance, especially when it comes to finding ways to enhance torque production to optimize the effectiveness of NMES training programs.NEW & NOTEWORTHY This study showed, for the first time, that the combined application of a brief muscle lengthening and wide-pulse neuromuscular electrical stimulation (NMES) delivered over the posterior tibial nerve can entail increased torque production as compared with the sole application of NMES. This observation, present only for high stimulation frequencies (100 Hz) and independently of the lengthening speed, is attributed to neural mechanisms, most probably related to increased afferents' solicitation, although muscular phenomena cannot be excluded.
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Affiliation(s)
- Antoine Pineau
- INSERM UMR1093-CAPS, Université Bourgogne, UFR des Sciences du Sport, Dijon, France
| | - Alain Martin
- INSERM UMR1093-CAPS, Université Bourgogne, UFR des Sciences du Sport, Dijon, France
| | - Romuald Lepers
- INSERM UMR1093-CAPS, Université Bourgogne, UFR des Sciences du Sport, Dijon, France
| | - Maria Papaiordanidou
- INSERM UMR1093-CAPS, Université Bourgogne, UFR des Sciences du Sport, Dijon, France
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Uçar N, Öner H, Kuş MA, Karaca H, Fırat T. The effect of neuromuscular electrical stimulation applied at different muscle lengths on muscle architecture and sarcomere morphology in rats. Anat Rec (Hoboken) 2024; 307:356-371. [PMID: 37194371 DOI: 10.1002/ar.25240] [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: 12/30/2022] [Revised: 04/04/2023] [Accepted: 04/26/2023] [Indexed: 05/18/2023]
Abstract
Neuromuscular electrical stimulation (NMES) is often used to increase muscle strength and functionality. Muscle architecture is important for the skeletal muscle functionality. The aim of this study was to investigate the effects of NMES applied at different muscle lengths on skeletal muscle architecture. Twenty-four rats were randomly assigned to four groups (two NMES groups and two control groups). NMES was applied on the extensor digitorum longus muscle at long muscle length, which is the longest and stretched position of the muscle at 170° plantar flexion, and at medium muscle length, which is the length of the muscle at 90° plantar flexion. A control group was created for each NMES group. NMES was applied for 8 weeks, 10 min/day, 3 days/week. After 8 weeks, muscle samples were removed at the NMES intervention lengths and examined macroscopically, and microscopically using a transmission electron microscope and streo-microscope. Muscle damage, and architectural properties of the muscle including pennation angle, fibre length, muscle length, muscle mass, physiological cross-sectional area, fibre length/muscle length, sarcomere length, sarcomere number were then evaluated. There was an increase in fibre length and sarcomere number, and a decrease in pennation angle at both lengths. In the long muscle length group, muscle length was increased, but widespread muscle damage was observed. These results suggest that the intervention of NMES at long muscle length can increase the muscle length but also causes muscle damage. In addition, the greater longitudinal increase in muscle length may be a result of the continuous degeneration-regeneration cycle.
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Affiliation(s)
- Nehir Uçar
- Department of Therapy and Rehabilitation, Vocational School of Health Sciences, University of Burdur Mehmet Akif Ersoy, Burdur, Turkey
| | - Hakan Öner
- Department of Histology and Embryology, Faculty of Veterinary Medicine, University of Burdur Mehmet Akif Ersoy, Burdur, Turkey
| | - Murat Abdulgani Kuş
- Department of Emergency Aid and Disaster Management, University of Burdur Mehmet Akif Ersoy, Burdur, Turkey
| | - Harun Karaca
- Department of Histology and Embryology, Faculty of Veterinary Medicine, University of Burdur Mehmet Akif Ersoy, Burdur, Turkey
| | - Tüzün Fırat
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
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Frazão M, Cipriano G, Silva PE. Does inflammation and altered metabolism impede efficacy of functional electrical stimulation in critically ill patients? Unleashing the potential of individualized functional electrical stimulation-cycling in critical illness. Crit Care 2024; 28:8. [PMID: 38167053 PMCID: PMC10759332 DOI: 10.1186/s13054-023-04788-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 01/05/2024] Open
Affiliation(s)
- Murillo Frazão
- Lauro Wanderley University Hospital, Avenida Ruy Carneiro, 412, Miramar, João Pessoa, PB, 58302-100, Brazil.
- Health Sciences and Technologies Graduate Program, University of Brasilia (UnB), Brasilia, DF, Brazil.
| | - Gerson Cipriano
- Health Sciences and Technologies Graduate Program, University of Brasilia (UnB), Brasilia, DF, Brazil
- Graduate Program in Human Movement, Rehabilitation of Evangelical University of Goias, Anapolis, Brazil
| | - Paulo Eugênio Silva
- University of São Paulo Medical School, São Paulo, SP, Brazil
- Hospital de Base Do Distrito Federal-IGESDF, Brasília, DF, Brazil
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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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Osborne JO, Tallent J, Girard O, Marshall PW, Kidgell D, Buhmann R. Neuromuscular electrical stimulation during maximal voluntary contraction: a Delphi survey with expert consensus. Eur J Appl Physiol 2023; 123:2203-2212. [PMID: 37247005 PMCID: PMC10492693 DOI: 10.1007/s00421-023-05232-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 05/16/2023] [Indexed: 05/30/2023]
Abstract
PURPOSE The use of electrical stimulation to assess voluntary activation of muscle/s is a popular method employed in numerous exercise science and health research settings. This Delphi study aimed to collate expert opinion and provide recommendations for best practice when using electrical stimulation during maximal voluntary contractions. METHODS A two-round Delphi study was undertaken with 30 experts who completed a 62-item questionnaire (Round 1) comprising of open- and closed-ended questions. Consensus was assumed if ≥ 70% of experts selected the same response; such questions were removed from the subsequent Round 2 questionnaire. Responses were also removed if they failed to meet a 15% threshold. Open-ended questions were analysed and converted into closed-ended questions for Round 2. It was assumed there was no clear consensus if a question failed to achieve a ≥ 70% response in Round 2. RESULTS A total of 16 out of 62 (25.8%) items reached consensus. Experts agreed that electrical stimulation provides a valid assessment of voluntary activation in specific circumstances, such as during maximal contraction, and this stimulation can be applied at either the muscle or the nerve. Experts recommended using doublet stimuli, self-adhesive electrodes, a familiarisation session, real-time visual or verbal feedback during the contraction, a minimum current increase of + 20% to ensure supramaximal stimulation, and manually triggering stimuli. CONCLUSION The results of this Delphi consensus study can help researchers make informed decisions when considering technical parameters when designing studies involving electrical stimulation for the assessment of voluntary activation.
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Affiliation(s)
- J O Osborne
- School of Sport Sciences, UiT The Arctic University of Norway, Medisin- Og Helsebygget, UiT, 9037, Tromsø, Norway.
| | - J Tallent
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, UK
- Monash Exercise Neuroplasticity Research Unit, Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, VA, Australia
| | - O Girard
- School of Human Sciences (Exercise and Sport Sciences), The University of Western Australia, Perth, WA, Australia
| | - P W Marshall
- School of Health Sciences, Western Sydney University, Penrith, NSW, Australia
- Department of Exercise Science, University of Auckland, Auckland, New Zealand
| | - D Kidgell
- Monash Exercise Neuroplasticity Research Unit, Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, VA, Australia
| | - R Buhmann
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Maroochydore, QLD, Australia
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Sundström C, Juthberg R, Flodin J, Guo L, Persson NK, Ackermann PW. Effects on hemodynamic enhancement and discomfort of a new textile electrode integrated in a sock during calf neuromuscular electrical stimulation. Eur J Appl Physiol 2023; 123:2013-2022. [PMID: 37145130 PMCID: PMC10460736 DOI: 10.1007/s00421-023-05212-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 04/25/2023] [Indexed: 05/06/2023]
Abstract
PURPOSE To compare fixed transverse textile electrodes (TTE) knitted into a sock versus motor point placed standard gel electrodes (MPE) on peak venous velocity (PVV) and discomfort, during calf neuromuscular electrical stimulation (calf-NMES). METHODS Ten healthy participants received calf-NMES with increasing intensity until plantar flexion (measurement level I = ML I), and an additional mean 4 mA intensity (ML II), utilizing TTE and MPE. PVV was measured with Doppler ultrasound in the popliteal and femoral veins at baseline, ML I and II. Discomfort was assessed with a numerical rating scale (NRS, 0-10). Significance was set to p < 0.05. RESULTS TTE and MPE both induced significant increases in PVV from baseline to ML I and significantly higher increases to ML II, in both the popliteal and femoral veins (all p < 0.001). The popliteal increases of PVV from baseline to both ML I and II were significantly higher with TTE versus MPE (p < 0.05). The femoral increases of PVV from baseline to both ML I and II were not significantly different between TTE and MPE. TTE versus MPE resulted at ML I in higher mA and NRS (p < 0.001), and at ML II in higher mA (p = 0.005) while NRS was not significantly different. CONCLUSION TTE integrated in a sock produces intensity-dependent increases of popliteal and femoral hemodynamics comparable to MPE, but results in more discomfort at plantar flexion due to higher current required. TTE exhibits in the popliteal vein higher increases of PVV compared to MPE. TRIAL REGISTRATION Trial_ID: ISRCTN49260430. Date: 11/01/2022. Retrospectively registered.
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Affiliation(s)
- C Sundström
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - R Juthberg
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - J Flodin
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - L Guo
- Polymeric E- Textiles and Smart Textiles University of Borås, Borås, Sweden
| | - N-K Persson
- Polymeric E- Textiles and Smart Textiles University of Borås, Borås, Sweden
| | - P W Ackermann
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
- Department of Trauma, Acute Surgery and Orthopaedics, Karolinska University Hospital, 171 76, Stockholm, Sweden.
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17
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Juthberg R, Flodin J, Guo L, Rodriguez S, Persson NK, Ackermann PW. Neuromuscular electrical stimulation in garments optimized for compliance. Eur J Appl Physiol 2023; 123:1739-1748. [PMID: 37010623 PMCID: PMC10363034 DOI: 10.1007/s00421-023-05181-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 03/10/2023] [Indexed: 04/04/2023]
Abstract
PURPOSE Physical inactivity is associated with muscle atrophy and venous thromboembolism, which may be prevented by neuromuscular electrical stimulation (NMES). This study aimed to investigate the effect on discomfort, current amplitude and energy consumption when varying the frequency and phase duration of low-intensity NMES (LI-NMES) via a sock with knitting-integrated transverse textile electrodes (TTE). METHODS On eleven healthy participants (four females), calf-NMES via a TTE sock was applied with increasing intensity (mA) until ankle-plantar flexion at which point outcomes were compared when testing frequencies 1, 3, 10 and 36 Hz and phase durations 75, 150, 200, 300 and 400 µs. Discomfort was assessed with a numerical rating scale (NRS, 0-10) and energy consumption was calculated and expressed in milli-Joule (mJ). Significance set to p ≤ 0.05. RESULTS 1 Hz yielded a median (inter-quartile range) NRS of 2.4 (1.0-3.4), significantly lower than both 3 Hz with NRS 2.8 (1.8-4.2), and 10 Hz with NRS 3.4 (1.4-5.4) (both p ≤ .014). Each increase in tested frequency resulted in significantly higher energy consumption, e.g. 0.6 mJ (0.5-0.8) for 1 Hz vs 14.9 mJ (12.3-21.2) for 36 Hz (p = .003). Longer phase durations had no significant effect on discomfort despite generally requiring significantly lower current amplitudes. Phase durations 150, 200 and 400 µs required significantly lower energy consumption compared to 75 µs (all p ≤ .037). CONCLUSION LI-NMES applied via a TTE sock produces a relevant plantar flexion of the ankle with the best comfort and lowest energy consumption using 1 Hz and phase durations 150, 200 or 400 µs.
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Affiliation(s)
- R Juthberg
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
| | - J Flodin
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - L Guo
- Smart Textiles and Polymeric E-textiles, Swedish School of Textiles, University of Borås, Borås, Sweden
| | - S Rodriguez
- School of Electrical Engineering and Computer Science, KTH Royal Institute of Technology, Stockholm, Sweden
| | - N K Persson
- Smart Textiles and Polymeric E-textiles, Swedish School of Textiles, University of Borås, Borås, Sweden
| | - P W Ackermann
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Trauma, Acute Surgery and Orthopaedics, Karolinska University Hospital, Stockholm, Sweden
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18
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Maffiuletti NA, Dirks ML, Stevens-Lapsley J, McNeil CJ. Electrical stimulation for investigating and improving neuromuscular function in vivo: Historical perspective and major advances. J Biomech 2023; 152:111582. [PMID: 37088030 DOI: 10.1016/j.jbiomech.2023.111582] [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: 04/03/2023] [Accepted: 04/04/2023] [Indexed: 04/25/2023]
Abstract
This historical review summarizes the major advances - particularly from the last 50 years - in transcutaneous motor-level electrical stimulation, which can be used either as a tool to investigate neuromuscular function and its determinants (electrical stimulation for testing; EST) or as a therapeutic/training modality to improve neuromuscular and physical function (neuromuscular electrical stimulation; NMES). We focus on some of the most important applications of electrical stimulation in research and clinical settings, such as the investigation of acute changes, chronic adaptations and pathological alterations of neuromuscular function with EST, as well as the enhancement, preservation and restoration of muscle strength and mass with NMES treatment programs in various populations. For both EST and NMES, several major advances converge around understanding and optimizing motor unit recruitment during electrically-evoked contractions, also taking into account the influence of stimulation site (e.g., muscle belly vs nerve trunk) and type (e.g., pulse duration, frequency, and intensity). This information is equally important both in the context of mechanistic research of neuromuscular function as well as for clinicians who believe that improvements in neuromuscular function are required to provide health-related benefits to their patients.
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Affiliation(s)
| | - Marlou L Dirks
- Department of Public Health and Sports Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK; Human and Animal Physiology, Wageningen University, Wageningen, The Netherlands
| | - Jennifer Stevens-Lapsley
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA; VA Eastern Colorado Geriatric Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, CO, USA
| | - Chris J McNeil
- Integrated Neuromuscular Physiology Laboratory, School of Health and Exercise Sciences, University of British Columbia, Kelowna, Canada
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Flodin J, Juthberg R, Ackermann PW. Motor point heatmap guide for neuromuscular electrical stimulation of the quadriceps muscle. J Electromyogr Kinesiol 2023; 70:102771. [PMID: 37054655 DOI: 10.1016/j.jelekin.2023.102771] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/31/2023] [Accepted: 04/04/2023] [Indexed: 04/15/2023] Open
Abstract
PURPOSE To create an anatomical chart that indicates the probability of finding a motor point (MP) in different areas of the quadriceps muscle. METHODS On 31 healthy adults, the individual anatomy of the vastus medialis (VM), rectus femoris (RF) and vastus lateralis (VL) was determined using ultrasound. Thereafter, a 3 Hz neuromuscular electrical stimulation (NMES) MP-search with a MP-pen was performed. The thigh anatomy was normalized and divided into 112 (8x14) 3x3cm areas, and the probability of finding a MP in the different areas was calculated to create a MP heat-map. RESULTS The heat-map displayed the two best 3x3cm areas, over VL and VM respectively, each with a probability greater than 50% of finding a MP and a higher probability compared to all other areas (p <.05). RF exhibited two areas with a 29% probability of finding a MP. A higher number of MPs on the quadriceps, mean (±SD) 9.4 ± 1, was in regression analysis found to be significantly associated with two independent factors higher physical activity level and lower body fat (R2 = 0.42, p=<.0001). CONCLUSION Large inter-individual variations in location, and number of MPs were found, but the heat-map displayed areas with higher probability of finding a MP and can be used to facilitate NMES-application.
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Affiliation(s)
- J Flodin
- Integrative Orthopedic Laboratory, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Trauma, Acute Surgery and Orthopaedics, Karolinska University Hospital, Stockholm, Sweden.
| | - R Juthberg
- Integrative Orthopedic Laboratory, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Trauma, Acute Surgery and Orthopaedics, Karolinska University Hospital, Stockholm, Sweden.
| | - P W Ackermann
- Integrative Orthopedic Laboratory, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Trauma, Acute Surgery and Orthopaedics, Karolinska University Hospital, Stockholm, Sweden.
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Schriwer E, Juthberg R, Flodin J, Ackermann PW. Motor point heatmap of the calf. J Neuroeng Rehabil 2023; 20:28. [PMID: 36859293 PMCID: PMC9976413 DOI: 10.1186/s12984-023-01152-5] [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: 12/23/2021] [Accepted: 02/14/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Contractions of muscles in the calf induced by neuromuscular electrical stimulation (NMES) may prevent venous thromboembolism, help rehabilitation and optimize strength training, among other uses. However, compliance to NMES-treatment is limited by the use of suboptimal stimulation points which may cause discomfort and less effectivity. Knowledge of where one is most likely to find muscle motor points (MP) could improve NMES comfort and compliance. AIMS To anatomically map the MPs of the calf as well as to calculate the probability of finding a MP in different areas of the calf. MATERIAL AND METHODS On 30 healthy participants (mean age 37 years) anatomical landmarks on the lower limbs were defined. The location of the four most responsive MPs on respectively the medial and lateral head of gastrocnemius were determined in relation to these anatomical landmarks using a MP search pen and a pre-set MP search program with 3 Hz continuous stimulation (Search range:4.0-17.5 mA). The anatomy of the calves was normalized and subdivided into a matrix of 48 (6 × 8) smaller areas (3 × 3 cm), from upper medial to lower lateral, in order to calculate the probability of finding a MP in one of these areas. The probability of finding a MP was then calculated for each area and presented with a 95% confidence interval. RESULTS The MP heatmap displayed a higher concentration of MPs proximally and centrally on the calf. However, there were wide inter-individual differences in the location of the MPs. The highest probability of finding a MP was in area 4, located centrally and medially, and in area 29, located centrolaterally and around the maximum circumference, both with 50% probability (95% CI: 0.31-0.69). The second highest probability of finding MPs was in areas 9, 10, 16, proximally and medially, all with 47% probability (95% CI: 0.28-0.66). These areas 4, 9, 10, 16 and 29 exhibited significantly higher probability of finding motor points than all areas with a mean probability of 27% and lower (p < 0.05) The lateral and distal outskirts exhibited almost zero probability of finding MPs. CONCLUSIONS This MP heatmap of the calf could be used to expedite electrode placement and to improve compliance in order to receive consistent and enhanced results of NMES treatments.
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Affiliation(s)
- Elias Schriwer
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Robin Juthberg
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Johanna Flodin
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Paul W Ackermann
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. .,Department of Trauma, Acute Surgery and Orthopaedics, Karolinska University Hospital, Stockholm, Sweden.
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Zhang X, Wang X, Dou Z, Wen H. A Novel Approach to Severe Chronic Neurogenic Dysphagia Using Pharyngeal Sensory Electrical Stimulation. Am J Phys Med Rehabil 2023; 102:e32-e35. [PMID: 36194834 PMCID: PMC9940831 DOI: 10.1097/phm.0000000000002116] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT The treatment options for severe chronic neurogenic dysphagia are limited. A patient, after resection of medulla oblongata hemangioblastoma, who failed to respond to 7 mos of traditional dysphagia rehabilitation therapy, was treated with prolonged pharyngeal sensory electrical stimulation for 39 sessions over 57 days. For the first time, this case report showed improvement in hypopharyngeal peak pressure (9.1 vs. 90.8 mm Hg) using high-resolution manometry. Reductions in the penetration and aspiration scale, secretion, and residue of the vallecular and pyriform sinus were verified by videofluoroscopic swallowing study and flexible endoscopic evaluation of swallowing. The Functional Oral Intake Scale score increased from 1 to 6. No adverse event was observed. This case report presented a potential therapeutic protocol for severe chronic neurogenic dysphagia, which might be instructive for clinical practice.
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Wide-pulse electrical stimulation of the quadriceps allows greater maximal evocable torque than conventional stimulation. Eur J Appl Physiol 2023; 123:1209-1214. [PMID: 36753001 DOI: 10.1007/s00421-023-05145-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/23/2023] [Indexed: 02/09/2023]
Abstract
PURPOSE The effectiveness of a neuromuscular electrical stimulation (NMES) program has been shown to be proportional to the maximal evocable torque (MET), which is potentially influenced by pulse characteristics such as duration and frequency. The aim of this study was to compare MET between conventional and wide-pulse NMES at two different frequencies. METHODS MET-expressed as a percentage of maximal voluntary contraction (MVC) torque-and maximal tolerable current intensity were quantified on 71 healthy subjects. The right quadriceps was stimulated with three NMES protocols using different pulse duration/frequency combinations: conventional NMES (0.2 ms/50 Hz; CONV), wide-pulse NMES at 50 Hz (1 ms/50 Hz; WP50) and wide-pulse NMES at 100 Hz (1 ms/100 Hz; WP100). The proportion of subjects reaching the maximal stimulator output (100 mA) before attaining maximal tolerable current intensity was also quantified. RESULTS The proportion of subjects attaining maximal stimulator output was higher for CONV than WP50 and WP100 (p < 0.001). In subjects who did not attain maximal stimulator output in any protocol, MET was higher for both WP50 and WP100 than for CONV (p < 0.001). Maximal tolerable current intensity was lower for both WP50 and WP100 than for CONV and was also lower for WP100 than for WP50 (p < 0.001). CONCLUSION When compared to conventional NMES, wide-pulse protocols resulted in greater MET and lower maximal tolerable current intensity. Overall, this may lead to better NMES training/rehabilitation effectiveness and less practical issues associated with maximal stimulator output limitations.
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Effects of Kilohertz Frequency, Burst Duty Cycle, and Burst Duration on Evoked Torque, Perceived Discomfort and Muscle Fatigue: A Systematic Review. Am J Phys Med Rehabil 2023; 102:175-183. [PMID: 35121683 DOI: 10.1097/phm.0000000000001982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
ABSTRACT Kilohertz-frequency alternating current is used to minimize muscle atrophy and muscle weakness and improve muscle performance. However, no systematic reviews have evaluated the best Kilohertz-frequency alternating current parameters for this purpose. We investigated the effects of the carrier frequency, burst duty cycles, and burst durations on evoked torque, perceived discomfort, and muscle fatigue. A search of eight data sources by two independent reviewers resulted in 13 peer-reviewed studies being selected, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and rated using the PEDro scale to evaluate the methodological quality of the studies. Most studies showed that carrier frequencies up to 1 kHz evoked higher torque, while carrier frequencies between 2.5 and 5 kHz resulted in lower perceived discomfort. In addition, most studies showed that shorter burst duty cycles (10%-50%) induced higher evoked torque and lower perceived discomfort. Methodological quality scores ranged from 5 to 8 on the PEDro scale. We conclude that Kilohertz-frequency alternating current develops greater evoked torque for carrier frequencies between 1 and 2.5 kHz and burst duty cycles less than 50%. Lower perceived discomfort was generated using Kilohertz-frequency alternating currents between 2.5 and 5 kHz and burst duty cycles less than 50%.
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Millet GP, Chamari K. Look to the stars-Is there anything that public health and rehabilitation can learn from elite sports? Front Sports Act Living 2023; 4:1072154. [PMID: 36755563 PMCID: PMC9900137 DOI: 10.3389/fspor.2022.1072154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 12/01/2022] [Indexed: 01/24/2023] Open
Affiliation(s)
- Grégoire P. Millet
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland,Correspondence: Grégoire P. Millet
| | - Karim Chamari
- Aspetar, Orthopedic and Sports Medicine Hospital, FIFA Medical Center of Excellence, Doha, Qatar
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Kilohertz Frequency Alternating Current Induces Less Evoked Torque and Less Neuromuscular Efficiency Than Pulsed Current in Healthy People: A Randomized Crossover Trial. J Sport Rehabil 2023:1-9. [PMID: 36812919 DOI: 10.1123/jsr.2022-0159] [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: 04/24/2022] [Revised: 11/29/2022] [Accepted: 12/28/2022] [Indexed: 02/24/2023]
Abstract
CONTEXT Pulsed current and kilohertz frequency alternating current are 2 types of neuromuscular electrical stimulation (NMES) currents often used by clinicians during rehabilitation. However, the low methodological quality and the different NMES parameters and protocols used in several studies might explain their inconclusive results in terms of their effects in the evoked torque and the discomfort level. In addition, the neuromuscular efficiency (ie, the NMES current type that evokes the highest torque with the lowest current intensity) has not been established yet. Therefore, our objective was to compare the evoked torque, current intensity, neuromuscular efficiency (evoked torque/current intensity ratio), and discomfort between pulsed current and kilohertz frequency alternating current in healthy people. DESIGN A double-blind, randomized crossover trial. METHODS Thirty healthy men (23.2 [4.5] y) participated in the study. Each participant was randomized to 4 current settings: 2 kilohertz frequency alternating currents with 2.5 kHz of carrier frequency and similar pulse duration (0.4 ms) and burst frequency (100 Hz) but with different burst duty cycles (20% and 50%) and burst durations (2 and 5 ms); and 2 pulsed currents with similar pulse frequency (100 Hz) and different pulse duration (2 and 0.4 ms). The evoked torque, current intensity at the maximal tolerated intensity, neuromuscular efficiency, and discomfort level were evaluated. RESULTS Both pulsed currents generated higher evoked torque than the kilohertz frequency alternating currents, despite the similar between-currents discomfort levels. The 2 ms pulsed current showed lower current intensity and higher neuromuscular efficiency compared with both alternated currents and with the 0.4 ms pulsed current. CONCLUSIONS The higher evoked torque, higher neuromuscular efficiency, and similar discomfort of the 2 ms pulsed current compared with 2.5-kHz frequency alternating current suggests this current as the best choice for clinicians to use in NMES-based protocols.
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Brusola G, Garcia E, Albosta M, Daly A, Kafes K, Furtado M. Effectiveness of physical therapy interventions on post-stroke spasticity: An umbrella review. NeuroRehabilitation 2023; 52:349-363. [PMID: 36806522 DOI: 10.3233/nre-220275] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
BACKGROUND Post-stroke spasticity is often one of the primary impairments addressed in rehabilitation. However, limited guidance exists on the effectiveness of physical therapy (PT) interventions for post-stroke spasticity. OBJECTIVE To evaluate the quality of evidence of PT interventions for post-stroke spasticity. METHODS Ovid (Medline), Cochrane Library, CINAHL, Scopus, PEDro, and PROSPERO were searched to identify reviews based on the following criteria: 1) published between 2012 and 2021, 2) participants older than 18 years old, 3) post-stroke spasticity, 4) PT interventions, 5) clinical or neurophysiological measures of spasticity as primary outcomes. Assessment of Multiple Systematic Reviews 2 and the Grades of Recommendations Assessment, Development, and Evaluation assessed methodological quality. RESULTS Eight articles were included in the analysis. No high-quality evidence was found. Moderate quality evidence exists for transcutaneous electrical nerve stimulation, neuromuscular electrical stimulation, resistance training, and lower extremity ergometer training with or without functional electrical stimulation. Low quality evidence exists for dynamic stretching, botulinum toxin with constraint-induced movement therapy, and static stretching using positional orthoses. CONCLUSION Findings suggest that PT should prioritize a combination of active strategies over passive interventions, but further studies are needed prioritizing analyses of the movement system in managing post-stroke spasticity in conjunction with medical therapies.
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Affiliation(s)
- Gregory Brusola
- Department of Physical Therapy, School of Health Professions, University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Erica Garcia
- Department of Physical Therapy, School of Health Professions, University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Meagan Albosta
- Department of Physical Therapy, School of Health Professions, University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Audrey Daly
- Department of Physical Therapy, School of Health Professions, University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Konstandinos Kafes
- Department of Physical Therapy, School of Health Professions, University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Michael Furtado
- Department of Physical Therapy, School of Health Professions, University of Texas Medical Branch at Galveston, Galveston, TX, USA
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Tourillon R, Bothorel H, McKeon PO, Gojanovic B, Fourchet F. Effects of a Single Electrical Stimulation Session on Foot Force Production, Foot Dome Stability, and Dynamic Postural Control. J Athl Train 2023; 58:51-59. [PMID: 35142810 PMCID: PMC9913059 DOI: 10.4085/1062-6050-0561.21] [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] [Indexed: 11/09/2022]
Abstract
CONTEXT Mounting evidence suggests neuromuscular electrical stimulation (NMES) as a promising modality for enhancing lower limb muscle strength, yet the functional effects of a single electrical stimulation session for improving the function of the intrinsic foot muscles (IFM) has not been evaluated. OBJECTIVE To investigate the immediate effects of an NMES session compared with a sham stimulation session on foot force production, foot dome stability, and dynamic postural control in participants with static foot pronation. DESIGN Randomized controlled clinical trial. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 46 participants (23 males, 23 females) with static foot pronation according to their Foot Posture Index (score ≥ 6) were randomly assigned to an NMES (n = 23) or control (n = 23) group. INTERVENTION(S) The NMES group received a single 15-minute NMES session on the dominant foot across the IFM. The control group received a 15-minute sham electrical stimulation session. MAIN OUTCOME MEASURE(S) All outcome measurements were assessed before and after the intervention and consisted of foot force production on a pressure platform, foot dome stability, and dynamic postural control. Statistical analysis was based on the responsiveness of the outcome measures and responder analysis using the minimum detectable change scores for each outcome measure. RESULTS In the NMES group, 78% of participants were classified as responders for at least 2 of the 3 outcomes, compared with only 22% in the control group. The relative risk of being a responder in the NMES group compared with the control group was 3.6 (95% CI = 1.6, 8.1]. Interestingly, we found that all participants who concomitantly responded to foot strength and navicular drop (n = 8) were also responders in dynamic postural control. CONCLUSIONS Compared with a sham stimulation session, a single NMES session was effective in immediately improving foot function and dynamic postural control in participants with static foot pronation. These findings support the role of NMES for improving IFM function in this population.
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Affiliation(s)
- Romain Tourillon
- UJM-Saint-Etienne Interuniversity Laboratory of Human Movement Biology, EA 7424, University of Lyon, France
- Motion Analysis Lab, Physiotherapy and Sports Medicine Department, Swiss Olympic Medical Center, La Tour Hospital, Meyrin, Switzerland
| | - Hugo Bothorel
- Research Department, La Tour Hospital, Meyrin, Switzerland
| | - Patrick O. McKeon
- Department of Exercise Science and Athletic Training, Ithaca College, NY
| | - Boris Gojanovic
- Motion Analysis Lab, Physiotherapy and Sports Medicine Department, Swiss Olympic Medical Center, La Tour Hospital, Meyrin, Switzerland
| | - François Fourchet
- UJM-Saint-Etienne Interuniversity Laboratory of Human Movement Biology, EA 7424, University of Lyon, France
- Motion Analysis Lab, Physiotherapy and Sports Medicine Department, Swiss Olympic Medical Center, La Tour Hospital, Meyrin, Switzerland
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Fang Y, Li J, Liu S, Wang Y, Li J, Yang D, Wang Q. Optimization of electrical stimulation for the treatment of lower limb dysfunction after stroke: A systematic review and Bayesian network meta-analysis of randomized controlled trials. PLoS One 2023; 18:e0285523. [PMID: 37167257 PMCID: PMC10174537 DOI: 10.1371/journal.pone.0285523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/25/2023] [Indexed: 05/13/2023] Open
Abstract
OBJECTIVE To compare the treatment effect of five electrical stimulation methods commonly used in the treatment of stroke patients with lower limb dysfunction. METHODS We implemented a systematic search of 3915 studies published up to January 2023 from eight databases and two clinical trial registries. First, two independent reviewers critically evaluated trial eligibility according to the inclusion and exclusion criteria. Next, they selected and extracted data. Then, they assessed the risk of bias. Pairwise meta-analysis and Bayesian network meta-analysis were conducted to estimate the effectiveness and ranking of the five electrical stimulation methods. RESULTS A total of 33 trials with a final total of 2246 subjects were included in the analysis. By combining the comprehensive Rehabilitation Treatment (RT), the treatment effects of using five electrical stimulation methods were surperior to those of using RT only. In the meantime, RT+transcranial Direct Current Stimulation(tDCS) and RT+Functional Electrical Stimulation(FES) could be the optimal electric stimulation schemes for restoring lower limb motor function(SMD 8.35, 95%CI [3.05, 13.34]/ SMD 5.64, 95%CI [3.68, 7.56]), improving balance (SMD 9.80, 95%CI [0.67, 20.93]/ SMD 6.54, 95%CI [3.85, 10.95]) and activities of daily living(SMD 18.95, 95%CI [0.401, 36.9]/ SMD 15.47, 95%CI [7.89, 22.75]), and the treatment effects would be even better using RT+FES+tDCS combination. CONCLUSION tDCS and FES superior to other electrical stimulation methods based on RT in the treatment of lower limb dysfunction after stroke.
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Affiliation(s)
- Yu Fang
- Department of Neurology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jiang Li
- General Practice Department, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Shanyu Liu
- Department of Neurology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yan Wang
- Department of Neurology, The Fifth People's Hospital of Chengdu/ The Fifth Affiliated Hospital of Chengdu University of traditional Chinese Medicine, Chengdu, China
| | - Jiaming Li
- Department of Neurology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Dongdong Yang
- Department of Neurology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qiaoling Wang
- Department of Ministry of Science, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Thapa N, Yang JG, Bae S, Kim GM, Park HJ, Park H. Effect of Electrical Muscle Stimulation and Resistance Exercise Intervention on Physical and Brain Function in Middle-Aged and Older Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:101. [PMID: 36612423 PMCID: PMC9819342 DOI: 10.3390/ijerph20010101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/12/2022] [Accepted: 12/14/2022] [Indexed: 06/17/2023]
Abstract
This study investigated the effectiveness of electrical muscle stimulation (EMS) with resistance exercise training (ERT) and resistance exercise training (RT) on physical and brain function in middle-aged and older women. Method: Forty-eight participants were randomly allocated into three groups: (i) ERT (n = 16), (ii) RT (n = 16), and (iii) control group (n = 16). The intervention session was 50 min long and performed three times/week for four weeks. The ERT group performed quadriceps setting, straight leg raises, and ankle pump exercises while constantly receiving EMS on their quadriceps muscle on both legs. The RT group performed the same exercise without EMS. Physical function was measured using skeletal muscle mass index (SMI), handgrip strength, gait speed, five times sit-to-stand test (FTSS) and timed up-and-go test (TUG). Brain function was assessed with electroencephalogram measurement of whole brain activity. Results: After four-week intervention, significant improvements were observed in SMI (p < 0.01), phase angle (p < 0.05), and gait speed (p < 0.05) in the ERT group compared to the control group. ERT also increased muscle strength (p < 0.05) and mobility in lower limbs as observed in FTSS and TUG tests (p < 0.05) at post-intervention compared to the baseline. In the ERT group, significant positive changes were observed in Beta1 band power, Theta band power, and Alpha1 band whole brain connectivity (p < 0.005) compared to the control group. Conclusions: Our findings showed that ERT can improve muscle and brain function in middle-aged and older adults during a four-week intervention program whereas significant improvements were not observed with RT. Therefore might be one of the feasible alternative intervention to RT for the prevention of muscle loss whilst improving brain function for middle-aged and older population.
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Affiliation(s)
- Ngeemasara Thapa
- Department of Health Sciences, Graduate School, Dong-A University, Busan 49315, Republic of Korea
- Laboratory of Smart Healthcare, Dong-A University, Busan 49315, Republic of Korea
| | - Ja-Gyeong Yang
- Department of Health Sciences, Graduate School, Dong-A University, Busan 49315, Republic of Korea
- Laboratory of Smart Healthcare, Dong-A University, Busan 49315, Republic of Korea
| | - Seongryu Bae
- Department of Health Sciences, Graduate School, Dong-A University, Busan 49315, Republic of Korea
- Laboratory of Smart Healthcare, Dong-A University, Busan 49315, Republic of Korea
| | - Gwon-Min Kim
- Medical Research Institute, Pusan National University, Busan 49241, Republic of Korea
| | - Hye-Jin Park
- Department of Health Sciences, Graduate School, Dong-A University, Busan 49315, Republic of Korea
- Laboratory of Smart Healthcare, Dong-A University, Busan 49315, Republic of Korea
| | - Hyuntae Park
- Department of Health Sciences, Graduate School, Dong-A University, Busan 49315, Republic of Korea
- Laboratory of Smart Healthcare, Dong-A University, Busan 49315, Republic of Korea
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Zhang X, Liang Y, Wang X, Shan Y, Xie M, Li C, Hong J, Chen J, Wan G, Zhang Y, Lin Y, Zhao F, He Z, Dou Z, Wen H. Effect of Modified Pharyngeal Electrical Stimulation on Patients with Severe Chronic Neurogenic Dysphagia: A Single-Arm Prospective Study. Dysphagia 2022:10.1007/s00455-022-10536-z. [DOI: 10.1007/s00455-022-10536-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 10/26/2022] [Indexed: 11/22/2022]
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Zhang X, Xie H, Wang X, Li Z, Song R, Shan Y, Li C, Chen J, Hong J, Li X, Wan G, Zhang Y, An D, Dou Z, Wen H. Modulating swallowing-related functional connectivity and behavior via modified pharyngeal electrical stimulation: A functional near-infrared spectroscopy evidence. Front Neurol 2022; 13:1006013. [PMID: 36299270 PMCID: PMC9589107 DOI: 10.3389/fneur.2022.1006013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 09/21/2022] [Indexed: 01/10/2023] Open
Abstract
Introduction Modified pharyngeal electrical stimulation (mPES) is a novel therapeutic modality for patients with neurogenic dysphagia. However, the underlying neural mechanism remains poorly understood. This study aimed to use functional near-infrared spectroscopy (fNIRS) to explore the influence of mPES on swallowing-related frequency-specific neural networks and ethology. Methods Twenty-two healthy right-handed volunteers participated in the study. Each participant was randomly assigned to either the sham or the mPES group and provided a 10-min intervention program every day for 5 days. Oxyhemoglobin and deoxyhemoglobin concentration changes verified by fNIRS were recorded on days 1, 3, and 5. Five characteristic frequency signals (0.0095-2 Hz) were identified using the wavelet transform method. To calculate frequency-specific functional connectivity, wavelet phase coherence (WPCO) was adopted. Furthermore, behavioral performance was assessed pre- and post-mPES using a 150 ml-water swallowing stress test. Results Compared with sham stimulation on day 1, the significantly decreased WPCO values were mainly associated with the dorsolateral prefrontal lobe, Broca's area, and middle temporal lobe. Compared with the sham mPES on day 1, the mPES showed a noticeable effect on the total swallow duration. Compared with the baseline, the WPCO values on days 3 and 5 showed a stepwise decrease in connectivity with the application of mPES. Furthermore, the decreased WPCO was associated with a shortened time per swallow after mPES. Conclusions The mPES could modulate swallowing-related frequency-specific neural networks and evoke swallowing cortical processing more efficiently. This was associated with improved performance in a water swallowing stress test in healthy participants.
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Affiliation(s)
- Xue Zhang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Hui Xie
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Center for Rehabilitation Technical Aids, Beijing, China,Key Laboratory for Biomechanics and Mechanobiology of the Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Xiaolu Wang
- Key Laboratory of Sensing Technology and Biomedical Instruments of Guangdong Province, School of Biomedical Engineering of Sun Yat-sen University, Guangzhou, China
| | - Zengyong Li
- Key Laboratory for Biomechanics and Mechanobiology of the Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Rong Song
- Key Laboratory of Sensing Technology and Biomedical Instruments of Guangdong Province, School of Biomedical Engineering of Sun Yat-sen University, Guangzhou, China
| | - Yilong Shan
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Chao Li
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jiemei Chen
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jiena Hong
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xin Li
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Guifang Wan
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yaowen Zhang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Delian An
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zulin Dou
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China,Zulin Dou
| | - Hongmei Wen
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China,*Correspondence: Hongmei Wen
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Prevention of muscle atrophy in ICU patients without nerve injury by neuromuscular electrical stimulation: a randomized controlled study. BMC Musculoskelet Disord 2022; 23:780. [PMID: 35974369 PMCID: PMC9380284 DOI: 10.1186/s12891-022-05739-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 08/05/2022] [Indexed: 11/10/2022] Open
Abstract
Background Extensive muscle atrophy is a common occurrence in orthopaedics patients who are bedridden or immobilized. The incidence is higher in intensive care unit (ICU) inpatients. There is still controversy about how to use neuromuscular electrical stimulation (NMES) in ICU patients. We aim to compare the effectiveness and safety of NMES to prevent muscle atrophy in intensive care unit (ICU) patients without nerve injury. Methods ICU patients without central and peripheral nerve injury were randomized into experimental group I (Exp I: active and passive activity training (APAT) + NMES treatment on the gastrocnemius and tibialis anterior muscle), experimental group II (Exp II: APAT + NMES treatment on gastrocnemius alone), and control group (Ctl: APAT alone). Changes in the strength of gastrocnemius, the ankle range of motion, and the muscle cross-section area of the lower leg were evaluated before and after the intervention. Also, changes in prothrombin time, lactic acid, and C-reactive protein were monitored during the treatment. Results The gastrocnemius muscle strength, ankle joint range of motion, and cross-sectional muscle area of the lower leg in the three groups showed a downward trend, indicating that the overall trend of muscle atrophy in ICU patients was irreversible. The decrease in gastrocnemius muscle strength in Exp I and Exp II was smaller than that in the control group (P < 0.05), but there was no difference between Exp I and Exp II. The decrease in active ankle range of motion and cross-sectional area of the lower leg Exp I and Exp II was smaller than that in the control group (P < 0.05), and the decrease in Exp I was smaller than that of Exp II (all P < 0.05). The curative effect in Exp I was better than in Exp II. There were no significant differences in the dynamic changes of prothrombin time, lactic acid, and C-reactive protein during the three groups (P > 0.05). Conclusion In addition to early exercise training, NMES should be applied to prevent muscle atrophy for patients without nerve injury in ICU. Also, simultaneous NMES treatment on agonist/antagonist muscle can enhance the effect of preventing muscle atrophy. Trial registration This study was prospectively registered in China Clinical Trial Registry (www.chictr.org.cn) on 16/05/2020 as ChiCTR2000032950.
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Baron MV, Silva PE, Koepp J, Urbanetto JDS, Santamaria AFM, Dos Santos MP, de Mello Pinto MV, Brandenburg C, Reinheimer IC, Carvalho S, Wagner MB, Miliou T, Poli-de-Figueiredo CE, Pinheiro da Costa BE. Efficacy and safety of neuromuscular electrical stimulation in the prevention of pressure injuries in critically ill patients: a randomized controlled trial. Ann Intensive Care 2022; 12:53. [PMID: 35695996 PMCID: PMC9188909 DOI: 10.1186/s13613-022-01029-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 06/05/2022] [Indexed: 11/30/2022] Open
Abstract
Background Pressure injuries (PIs), especially in the sacral region are frequent, costly, and increase morbidity and mortality of patients in an intensive care unit (ICU). These injuries can occur as a result of prolonged pressure and/or shear forces. Neuromuscular electrical stimulation (NMES) can increase muscle mass and improve local circulation, potentially reducing the incidence of PI. Methods We performed a randomized controlled trial to assess the efficacy and safety of NMES in preventing PI in critically ill patients. We included patients with a period of less than 48 h in the ICU, aged ≥ 18 years. Participants were randomly selected (1:1 ratio) to receive NMES and usual care (NMES group) or only usual care (control group—CG) until discharge, death, or onset of a PI. To assess the effectiveness of NMES, we calculated the relative risk (RR) and number needed to treat (NNT). We assessed the muscle thickness of the gluteus maximus by ultrasonography. To assess safety, we analyzed the effects of NMES on vital signs and checked for the presence of skin burns in the stimulated areas. Clinical outcomes were assessed by time on mechanical ventilation, ICU mortality rate, and length of stay in the ICU. Results We enrolled 149 participants, 76 in the NMES group. PIs were present in 26 (35.6%) patients in the CG and 4 (5.3%) in the NMES group (p ˂ 0.001). The NMES group had an RR = 0.15 (95% CI 0.05–0.40) to develop a PI, NNT = 3.3 (95% CI 2.3–5.9). Moreover, the NMES group presented a shorter length of stay in the ICU: Δ = − 1.8 ± 1.2 days, p = 0.04. There was no significant difference in gluteus maximus thickness between groups (CG: Δ = − 0.37 ± 1.2 cm vs. NMES group: Δ = 0 ± 0.98 cm, p = 0.33). NMES did not promote deleterious changes in vital signs and we did not detect skin burns. Conclusions NMES is an effective and safe therapy for the prevention of PI in critically ill patients and may reduce length of stay in the ICU. Trial registration RBR-8nt9m4. Registered prospectively on July 20th, 2018, https://ensaiosclinicos.gov.br/rg/RBR-8nt9m4
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Affiliation(s)
- Miriam Viviane Baron
- Pontifical Catholic University of Rio Grande do Sul, Rio Grande do Sul, Porto Alegre, Brazil. .,Instituto Interdisciplinar de Educação, Ciência e Saúde, Fortaleza, Ceará, Brazil.
| | - Paulo Eugênio Silva
- Secretaria de Estado de Saúde do Distrito Federal, Hospital de Base do Distrito Federal, Distrito Federal, Brasília, Brazil
| | - Janine Koepp
- University of Santa Cruz do Sul, Santa Cruz do Sul, Rio Grande do Sul, Brazil
| | | | | | | | | | - Cristine Brandenburg
- Faculdade de Educação, Ciências e Letras do Sertão Central, Quixadá, Ceará, Brazil.,Instituto Interdisciplinar de Educação, Ciência e Saúde, Fortaleza, Ceará, Brazil
| | | | - Sonia Carvalho
- Rigshospital, Inge Lehmannsvej, Copenhagen East, Denmark
| | - Mário Bernardes Wagner
- Pontifical Catholic University of Rio Grande do Sul, Rio Grande do Sul, Porto Alegre, Brazil
| | - Thomas Miliou
- State University of Campinas, Campinas, São Paulo, Brazil
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Larocerie-Salgado J, Chinchalkar S, Ross DC, Gillis J, Doherty CD, Miller TA. Rehabilitation Following Nerve Transfer Surgery. Tech Hand Up Extrem Surg 2022; 26:71-77. [PMID: 34619740 DOI: 10.1097/bth.0000000000000359] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Nerve transfer surgery is an important new addition to the treatment paradigm following nerve trauma. The following rehabilitation plan has been developed over the past 15 years, in an interdisciplinary, tertiary peripheral nerve program at the "Roth|McFarlane Hand and Upper Limb Centre." This center evaluates more than 400 patients with complex nerve injuries annually and has been routinely using nerve transfers since 2005. The described rehabilitation program includes input from patients, therapists, physiatrists, and surgeons and has evolved based on experience and updated science. The plan is comprised of phases which are practical, reproducible and will serve as a framework to allow other peripheral nerve programs to adapt and improve the "Roth|McFarlane Hand and Upper Limb Centre" paradigm to enhance patient outcomes.
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Affiliation(s)
- Juliana Larocerie-Salgado
- Roth| McFarlane Hand and Upper Limb Centre and the Peripheral Nerve Clinic, Western University, London, ON
| | - Shrikant Chinchalkar
- Roth| McFarlane Hand and Upper Limb Centre and the Peripheral Nerve Clinic, Western University, London, ON
| | - Douglas C Ross
- Roth| McFarlane Hand and Upper Limb Centre and the Peripheral Nerve Clinic, Western University, London, ON
| | - Joshua Gillis
- Roth| McFarlane Hand and Upper Limb Centre and the Peripheral Nerve Clinic, Western University, London, ON
| | - Christopher D Doherty
- Department of Surgery, Division of Plastic Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Thomas A Miller
- Roth| McFarlane Hand and Upper Limb Centre and the Peripheral Nerve Clinic, Western University, London, ON
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Balke M, Teschler M, Schäfer H, Pape P, Mooren FC, Schmitz B. Therapeutic Potential of Electromyostimulation (EMS) in Critically Ill Patients—A Systematic Review. Front Physiol 2022; 13:865437. [PMID: 35615672 PMCID: PMC9124773 DOI: 10.3389/fphys.2022.865437] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 03/01/2022] [Indexed: 12/15/2022] Open
Abstract
Ample evidence exists that intensive care unit (ICU) treatment and invasive ventilation induce a transient or permanent decline in muscle mass and function. The functional deficit is often called ICU-acquired weakness with critical illness polyneuropathy (CIP) and/or myopathy (CIM) being the major underlying causes. Histopathological studies in ICU patients indicate loss of myosin filaments, muscle fiber necrosis, atrophy of both muscle fiber types as well as axonal degeneration. Besides medical prevention of risk factors such as sepsis, hyperglycemia and pneumonia, treatment is limited to early passive and active mobilization and one third of CIP/CIM patients discharged from ICU never regain their pre-hospitalization constitution. Electromyostimulation [EMS, also termed neuromuscular electrical stimulation (NMES)] is known to improve strength and function of healthy and already atrophied muscle, and may increase muscle blood flow and induce angiogenesis as well as beneficial systemic vascular adaptations. This systematic review aimed to investigate evidence from randomized controlled trails (RCTs) on the efficacy of EMS to improve the condition of critically ill patients treated on ICU. A systematic search of the literature was conducted using PubMed (Medline), CENTRAL (including Embase and CINAHL), and Google Scholar. Out of 1,917 identified records, 26 articles (1,312 patients) fulfilled the eligibility criteria of investigating at least one functional measure including muscle function, functional independence, or weaning outcomes using a RCT design in critically ill ICU patients. A qualitative approach was used, and results were structured by 1) stimulated muscles/muscle area (quadriceps muscle only; two to four leg muscle groups; legs and arms; chest and abdomen) and 2) treatment duration (≤10 days, >10 days). Stimulation parameters (impulse frequency, pulse width, intensity, duty cycle) were also collected and the net EMS treatment time was calculated. A high grade of heterogeneity between studies was detected with major cofactors being the analyzed patient group and selected outcome variable. The overall efficacy of EMS was inconclusive and neither treatment duration, stimulation site or net EMS treatment time had clear effects on study outcomes. Based on our findings, we provide practical recommendations and suggestions for future studies investigating the therapeutic efficacy of EMS in critically ill patients. Systematic Review Registration: [https://www.crd.york.ac.uk/prospero/], identifier [CRD42021262287].
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Affiliation(s)
- Maryam Balke
- St. Marien Hospital Cologne, Department of Early Rehabilitation, Cologne, Germany
- Department of Rehabilitation Sciences, Faculty of Health, University of Witten/Herdecke, Witten, Germany
- *Correspondence: Maryam Balke,
| | - Marc Teschler
- Department of Rehabilitation Sciences, Faculty of Health, University of Witten/Herdecke, Witten, Germany
- DRV Clinic Königsfeld, Center for Medical Rehabilitation, Ennepetal, Germany
| | - Hendrik Schäfer
- Department of Rehabilitation Sciences, Faculty of Health, University of Witten/Herdecke, Witten, Germany
- DRV Clinic Königsfeld, Center for Medical Rehabilitation, Ennepetal, Germany
| | - Pantea Pape
- St. Marien Hospital Cologne, Department of Early Rehabilitation, Cologne, Germany
| | - Frank C. Mooren
- Department of Rehabilitation Sciences, Faculty of Health, University of Witten/Herdecke, Witten, Germany
- DRV Clinic Königsfeld, Center for Medical Rehabilitation, Ennepetal, Germany
| | - Boris Schmitz
- Department of Rehabilitation Sciences, Faculty of Health, University of Witten/Herdecke, Witten, Germany
- DRV Clinic Königsfeld, Center for Medical Rehabilitation, Ennepetal, Germany
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KiloHertz currents on aspects of muscle function: A scoping review. J Bodyw Mov Ther 2022; 32:110-119. [DOI: 10.1016/j.jbmt.2022.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 05/15/2022] [Indexed: 11/19/2022]
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Panda AK, Sitaramgupta VSN, Pandya HJ, Basu B. Electrical waveform dependent osteogenesis on PVDF/BaTiO 3 composite using a customized and programmable cell stimulator. Biotechnol Bioeng 2022; 119:1578-1597. [PMID: 35244212 DOI: 10.1002/bit.28076] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 11/07/2022]
Abstract
Directing cellular functionalities using biomaterial-based bioelectronic stimulation remains a significant constraint in translating research outcomes to address specific clinical challenges. Electrical stimulation is now being clinically used as a therapeutic treatment option to promote bone tissue regeneration and to improve neuromuscular functionalities. However, the nature of the electrical waveforms during the stimulation and underlying biophysical rationale are still not scientifically well explored. Furthermore, bone-mimicking implant-based bioelectrical regulation of osteoinductivity has not been translated to clinics. The present study demonstrates the role of the waveform in electrical signal to direct differentiation of stem cells on an electroactive polymeric substrate, using monophasic DC, square wave, and biphasic wave. In this regard, an in-house electrical stimulation device has been fabricated for the uninterrupted delivery of programmed electrical signals to stem cells in culture. To provide a functional platform for stem cells to differentiate, barium titanate (BaTiO3 , BT) reinforced PVDF has been developed with mechanical properties similar to bone. The electrical stimulation of human mesenchymal stem cells (hMSCs) on PVDF/BT composite inhibited proliferation rate at day 7, indicating early commitment for differentiation. The phenotypical characteristics of DC stimulated hMSCs provided signatures of differentiation towards osteogenic lineage, which was subsequently confirmed using ALP assay, collagen deposition, matrix mineralization, and genetic expression. Our findings suggest that DC stimulation induced early osteogenesis in hMSCs with a higher level of intracellular reactive oxygen species (ROS), whereas the stimulation with square wave directed late osteogenesis with a lower ROS regeneration. In summary, the present study critically analyzes the role of electrical stimulation and its waveforms in regulating osteogenesis, without external biochemical differentiation inducers, on a bone-mimicking functional substrate. Such a strategy can potentially be adopted to develop orthopedic implant-based bioelectronic medicine for bone regeneration. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Asish Kumar Panda
- Laboratory for Biomaterials, Materials Research Centre, Indian Institute of Science, Bangalore, India
| | - V S N Sitaramgupta
- Department of Electronic Systems Engineering, Indian Institute of Science, Bangalore, India
| | - Hardik J Pandya
- Department of Electronic Systems Engineering, Indian Institute of Science, Bangalore, India
- Centre for Product Design and Manufacturing, Indian Institute of Science, Bangalore, India
| | - Bikramjit Basu
- Laboratory for Biomaterials, Materials Research Centre, Indian Institute of Science, Bangalore, India
- Centre for Biosystems Science and Engineering, Indian Institute of Science, Bangalore, India
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Wellauer V, Item JF, Bizzini M, Maffiuletti NA. Home-Based Nonoperative-Side Quadriceps Neuromuscular Electrical Stimulation Prevents Muscle Weakness Following Anterior Cruciate Ligament Reconstruction. J Clin Med 2022; 11:jcm11020466. [PMID: 35054160 PMCID: PMC8781752 DOI: 10.3390/jcm11020466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/12/2022] [Accepted: 01/14/2022] [Indexed: 02/06/2023] Open
Abstract
We compared the effectiveness of a home-based neuromuscular electrical stimulation (NMES) program applied to the quadriceps of the nonoperative side against sham-NMES as a complement to standard rehabilitation on knee extensor neuromuscular function in patients following anterior cruciate ligament (ACL) reconstruction. Twenty-four patients completed the 6 week NMES (n = 12) and sham-NMES (n = 12) post-operative interventions and were tested at different time points for neuromuscular function and self-reported knee function. Isometric, concentric, and eccentric strength deficits (muscle weakness) increased significantly from pre-surgery to 24 weeks post-surgery in the sham-NMES group (p < 0.05), while no significant changes were observed in the NMES group. On the stimulated (nonoperative) side, quadriceps voluntary activation and muscle thickness were respectively maintained (p > 0.05) and increased (p < 0.001) as a result of the NMES intervention, contrary to sham-NMES. Self-reported knee function improved progressively during the post-operative phase (p < 0.05), with no difference between the two groups. Compared to a sham-NMES intervention, a 6 week home-based NMES program applied to the quadriceps of the nonoperative side early after ACL reconstruction prevented the occurrence of knee extensor muscle weakness 6 months after surgery. We conclude that nonoperative-side NMES may help counteract muscle weakness after ACL reconstruction.
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Affiliation(s)
- Vanessa Wellauer
- Human Performance Lab., Schulthess Clinic, 8008 Zurich, Switzerland; (V.W.); (J.F.I.); (M.B.)
- Performance Diagnostics, Schulthess Clinic, 8008 Zurich, Switzerland
| | - Julia F. Item
- Human Performance Lab., Schulthess Clinic, 8008 Zurich, Switzerland; (V.W.); (J.F.I.); (M.B.)
| | - Mario Bizzini
- Human Performance Lab., Schulthess Clinic, 8008 Zurich, Switzerland; (V.W.); (J.F.I.); (M.B.)
| | - Nicola A. Maffiuletti
- Human Performance Lab., Schulthess Clinic, 8008 Zurich, Switzerland; (V.W.); (J.F.I.); (M.B.)
- Correspondence: ; Tel.: +41-(0)4-4385-7975
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Du J, Wang S, Cheng Y, Xu J, Li X, Gan Y, Zhang L, Zhang S, Cui X. Effects of Neuromuscular Electrical Stimulation Combined with Repetitive Transcranial Magnetic Stimulation on Upper Limb Motor Function Rehabilitation in Stroke Patients with Hemiplegia. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:9455428. [PMID: 35027944 PMCID: PMC8752218 DOI: 10.1155/2022/9455428] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/04/2021] [Accepted: 12/09/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To investigate the effect of neuromuscular electrical stimulation (NMES) combined with repetitive transcranial magnetic stimulation (rTMS) on upper limb motor dysfunction in stroke patients with hemiplegia. METHODS A total of 240 stroke patients with hemiplegia who met the inclusion criteria were selected and randomly divided into 4 groups (60 cases in each group): control group, NMES group, rTMS group, and NMES + rTMS group. Before treatment and 4 weeks after treatment, we evaluated and compared the results including Fugl-Meyer assessment of upper extremity (FMA-UE) motor function, modified Barthel index (MBI), modified Ashworth scale (MAS), and motor nerve electrophysiological results among the 4 groups. RESULTS Before treatment, there was no significant difference in the scores of FMA-UE, MBI, MAS, and motor nerve electrophysiological indexes among the four groups, with comparability. Compared with those before treatment, the scores of the four groups were significantly increased and improved after treatment. And the score of the NMES + rTMS group was notably higher than those in the other three groups. CONCLUSION NMES combined with rTMS can conspicuously improve the upper extremity motor function and activities of daily life of stroke patients with hemiplegia, which is worthy of clinical application and promotion.
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Affiliation(s)
- Junqiu Du
- Department of Rehabilitation Medicine, Huai'an Second People's Hospital (The Affiliated Huai'an Hospital of Xuzhou Medical University), Huai'an, Jiangsu 223002, China
| | - Shouyong Wang
- Department of Neurology, Huai'an NO.3 People's Hospital, Huai'an, Jiangsu 223002, China
| | - Yun Cheng
- Department of Rehabilitation Medicine, Huai'an NO.3 People's Hospital, Huai'an, Jiangsu 223002, China
| | - Jiang Xu
- Department of Rehabilitation Medicine, Huai'an Second People's Hospital (The Affiliated Huai'an Hospital of Xuzhou Medical University), Huai'an, Jiangsu 223002, China
| | - Xuejing Li
- Department of Rehabilitation Medicine, Huai'an Second People's Hospital (The Affiliated Huai'an Hospital of Xuzhou Medical University), Huai'an, Jiangsu 223002, China
| | - Yimin Gan
- Department of Rehabilitation Medicine, Huai'an Second People's Hospital (The Affiliated Huai'an Hospital of Xuzhou Medical University), Huai'an, Jiangsu 223002, China
| | - Liying Zhang
- Department of Rehabilitation Medicine, Lianshui County People's Hospital (Affiliated Hospital of Kangda College, Nanjing Medical University), Huai'an, Jiangsu 223400, China
| | - Song Zhang
- Department of Rehabilitation Medicine, Lianshui County People's Hospital (Affiliated Hospital of Kangda College, Nanjing Medical University), Huai'an, Jiangsu 223400, China
| | - Xiaorui Cui
- Department of Rehabilitation Medicine, Lianshui County People's Hospital (Affiliated Hospital of Kangda College, Nanjing Medical University), Huai'an, Jiangsu 223400, China
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Hughes L, Hackney KJ, Patterson SD. Optimization of Exercise Countermeasures to Spaceflight Using Blood Flow Restriction. Aerosp Med Hum Perform 2022; 93:32-45. [PMID: 35063054 DOI: 10.3357/amhp.5855.2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION: During spaceflight missions, astronauts work in an extreme environment with several hazards to physical health and performance. Exposure to microgravity results in remarkable deconditioning of several physiological systems, leading to impaired physical condition and human performance, posing a major risk to overall mission success and crew safety. Physical exercise is the cornerstone of strategies to mitigate physical deconditioning during spaceflight. Decades of research have enabled development of more optimal exercise strategies and equipment onboard the International Space Station. However, the effects of microgravity cannot be completely ameliorated with current exercise countermeasures. Moreover, future spaceflight missions deeper into space require a new generation of spacecraft, which will place yet more constraints on the use of exercise by limiting the amount, size, and weight of exercise equipment and the time available for exercise. Space agencies are exploring ways to optimize exercise countermeasures for spaceflight, specifically exercise strategies that are more efficient, require less equipment, and are less time-consuming. Blood flow restriction exercise is a low intensity exercise strategy that requires minimal equipment and can elicit positive training benefits across multiple physiological systems. This method of exercise training has potential as a strategy to optimize exercise countermeasures during spaceflight and reconditioning in terrestrial and partial gravity environments. The possible applications of blood flow restriction exercise during spaceflight are discussed herein.Hughes L, Hackney KJ, Patterson SD. Optimization of exercise countermeasures to spaceflight using blood flow restriction. Aerosp Med Hum Perform. 2021; 93(1):32-45.
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Vaz MA, Fröhlich M, Júnior DPDS, Schildt A, Thomé PRO, Muller AF, Tondin BR, Sbruzzi G, Maffiuletti NA, Sanches PRS. Development and reliability of a new system for bedside evaluation of non-volitional knee extension force. Med Eng Phys 2021; 98:28-35. [PMID: 34848035 DOI: 10.1016/j.medengphy.2021.10.007] [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: 11/05/2020] [Revised: 08/31/2021] [Accepted: 10/11/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Neuromuscular electrical stimulation (NMES) is a widely-used technique for diagnostic and therapeutic purposes. Here we developed and tested the reliability of a new NMES-dynamometer system for bedside evaluation of knee extensor muscle function. MATERIALS AND METHODS Thirty-two healthy participants (16 men, 16 women; 27±5 years) completed two testing sessions, 7 days apart. On day 1, a single experienced rater, who repeated the evaluation on day 2 with two other raters, completed a standardized testing procedure. Participants were placed supine, with knees flexed and legs connected to the dynamometer. Maximal voluntary knee extensor isometric force (MVF) and supramaximal twitch force (TwF) were obtained. RESULTS High intra-rater intraclass correlation coefficients were observed for both MVF (0.91) and TwF (0.94). MVF and TwF standard error of measurements (8.2%, 5.9%) and minimal detectable changes (16%, 11.6%) were low compared to mean values. High intraclass correlation coefficients were also observed for inter-rater comparisons of MVF (0.89) and TwF (0.86). Standard errors of measurements (MVF: 8.7%, TwF: 5.5%) and minimal detectable changes (MVF: 17.2%, TwF: 10.8%) were similar to intra-rater comparisons. CONCLUSION The good reliability of the novel NMES-dynamometer system suggests it as an appropriate tool for the bedside evaluation of knee extensor muscle function.
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Affiliation(s)
- Marco Aurélio Vaz
- School of Physical Education, Physical Therapy and Dance, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil.
| | - Matias Fröhlich
- School of Physical Education, Physical Therapy and Dance, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Danton Pereira da Silva Júnior
- Biomedical Engineering Research and Development Service of the Porto Alegre's Clinical Hospital, Porto Alegre, RS, Brazil
| | - Alessandro Schildt
- Biomedical Engineering Research and Development Service of the Porto Alegre's Clinical Hospital, Porto Alegre, RS, Brazil
| | - Paulo Ricardo Oppermann Thomé
- Biomedical Engineering Research and Development Service of the Porto Alegre's Clinical Hospital, Porto Alegre, RS, Brazil
| | - André Frotta Muller
- Biomedical Engineering Research and Development Service of the Porto Alegre's Clinical Hospital, Porto Alegre, RS, Brazil
| | - Bruno Rodriguez Tondin
- Biomedical Engineering Research and Development Service of the Porto Alegre's Clinical Hospital, Porto Alegre, RS, Brazil
| | - Graciele Sbruzzi
- School of Physical Education, Physical Therapy and Dance, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | - Paulo Roberto Stefani Sanches
- Biomedical Engineering Research and Development Service of the Porto Alegre's Clinical Hospital, Porto Alegre, RS, Brazil
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Non-invasive brain stimulation for treating neurogenic dysarthria: A systematic review. Ann Phys Rehabil Med 2021; 65:101580. [PMID: 34626861 DOI: 10.1016/j.rehab.2021.101580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 07/08/2021] [Accepted: 07/19/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Although non-invasive central and peripheral stimulations are accruing support as promising treatments in different neurological conditions, their effects on dysarthria have not been systematically investigated. OBJECTIVE The purpose of this review was to examine the evidence base of non-invasive stimulation for treating dysarthria, identify which stimulation parameters have the most potential for treatment and determine safety risks. METHODS A systematic review with meta-analysis, when possible, involving publications indexed in MEDLINE, PsychINFO, EMBASE CINHAL the Linguistics and Language Behavioral Abstracts, Web of Science, Cochrane Register of Control Trials and 2 trial registries was completed. Articles were searched in December 2018 and updated in June 2021 using keywords related to brain and electrical stimulation, dysarthria and research design. We included trials with randomised, cross-over or quasi-experimental designs; involving a control group; and investigating treatment of neurogenic dysarthria with non-invasive stimulation. Methodological quality was determined with the Cochrane's Risk of Bias-2 tool. RESULTS In total, 6186 studies were identified; 10 studies (6 randomised controlled trials and 4 cross-over studies) fulfilled the inclusion criteria. All 10 trials (268 adults with Parkinson's disease, stroke and neurodegenerative cerebellar ataxia) focused on brain stimulation (6 repetitive transcranial magnetic stimulation; 3 transcranial direct current stimulation; and 1 repetitive transorbital alternating current stimulation). Adjunct speech-language therapy was delivered in 2 trials. Most trials reported one or more positive effects of stimulation on dysarthria-related features; however, given the overall high risk of bias and heterogeneity in participant, trial and outcome measurement characteristics, no conclusions can be drawn. Post-treatment size effects for 2 stroke trials demonstrated no statistically significant differences between active and sham stimulation across 3 dysarthria outcomes. CONCLUSIONS Evidence for use of non-invasive brain stimulation in treating dysarthria remains inconclusive. Research trials that provide reliable and replicable findings are required.
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Assessment of the Strength Parameters of the Quadriceps Femoris Muscles in Polish University Students after a 3-Week Program of Neuromuscular Electrical Stimulation Using the RSQ1 Method. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111717. [PMID: 34770233 PMCID: PMC8583690 DOI: 10.3390/ijerph182111717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/03/2021] [Accepted: 11/04/2021] [Indexed: 11/21/2022]
Abstract
A rehabilitative program for patients who lose strength and muscle mass along with the ability to perform intensive exercises is lacking. We developed a 3-week training program based on neuromuscular electrical stimulation (NMES) using a RSQ1 device (modulated current resulting from the overlapping of two-component currents) for RSQ1 electrostimulation to improve strength parameters of the quadricep femoris muscles and compare its effectiveness to isometric training. Nineteen university students were randomly divided into the NMES group (10 sessions) and the control group who trained. We measured the circumference of the thigh, as well as peak torques of the flexor and extensor muscles before and after the start and after the end of the training program. Both tested training programs gave similar results. Differences between measured parameters were not significant except for differences in the peak torques of the knee flexors (9.9% for left limb; p = 0.2135 vs. 7.8% for rift limb; p = 0.2135) and the circumference of the left thigh—2% for both (left p = 0.5839 and right p = 0.1088). Comparable results of the tested training programs suggest that NMES is a good alternative for people who cannot perform exercises, but want to maintain or improve their physical fitness.
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Chen YC, Davies RG, Hengist A, Carroll HA, Perkin OJ, Betts JA, Thompson D. Effects of neuromuscular electrical stimulation on energy expenditure and postprandial metabolism in healthy men. Appl Physiol Nutr Metab 2021; 47:1-7. [PMID: 34403626 DOI: 10.1139/apnm-2021-0361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
It is unclear whether neuromuscular electrical stimulation (NMES) has meaningful metabolic effects when users have the opportunity to self-select the intensity to one that can be comfortably tolerated. Nine healthy men aged 28 ± 9 y (mean ± SD) with a body mass index 22.3 ± 2.3 kg/m2 completed 3 trials involving a 2-h oral glucose tolerance test whilst, in a randomised counterbalanced order, (1) sitting motionless (SIT), (2) standing motionless (STAND); and (3) sitting motionless with NMES of quadriceps and calves at a self-selected tolerable intensity. The mean (95% confidence interval [CI]) total energy expenditure was greater in the NMES trial (221 [180-262] kcal/2 h) and STAND trial (178 [164-191] kcal/2 h) than during SIT (159 [150-167] kcal/2 h) (both, p < 0.05). This was primarily driven by an increase in carbohydrate oxidation in the NMES and STAND trials compared with the SIT trial (p < 0.05). Postprandial insulin iAUC was lower in both NMES and STAND compared with SIT (16.4 [7.7-25.1], 17 [7-27] and 22.6 [10.8-34.4] nmol·120 min/L, respectively; both, p < 0.05). Compared with sitting, both NMES and STAND increased energy expenditure and whole-body carbohydrate oxidation and reduced postprandial insulin concentrations in healthy men, with more pronounced effects seen with NMES. Self-selected NMES is a potential strategy for improving metabolic health. This trial is registered at ClinicalTrials.gov (ID: NCT04389736). Novelty: NMES at a comfortable intensity enhances energy expenditure and carbohydrate oxidation, and reduces postprandial insulinemia. Thus, self-selected NMES represents a potential strategy to improve metabolic health.
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Affiliation(s)
- Yung-Chih Chen
- Department of Physical Education and Sport Sciences, National Taiwan Normal University, Taipei, Taiwan
- Department for Health, University of Bath, Bath, United Kingdom
| | | | - Aaron Hengist
- Department for Health, University of Bath, Bath, United Kingdom
| | - Harriet A Carroll
- Department for Health, University of Bath, Bath, United Kingdom
- Clinical Research Centre, Cardiovascular Research-Hypertension, Lund University, Malmo, Sweden
| | - Oliver J Perkin
- Department for Health, University of Bath, Bath, United Kingdom
| | - James A Betts
- Department for Health, University of Bath, Bath, United Kingdom
| | - Dylan Thompson
- Department for Health, University of Bath, Bath, United Kingdom
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Barss TS, Sallis BWM, Miller DJ, Collins DF. Does increasing the number of channels during neuromuscular electrical stimulation reduce fatigability and produce larger contractions with less discomfort? Eur J Appl Physiol 2021; 121:2621-2633. [PMID: 34131798 DOI: 10.1007/s00421-021-04742-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 06/08/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Neuromuscular electrical stimulation (NMES) is often delivered at frequencies that recruit motor units (MUs) at unphysiologically high rates, leading to contraction fatigability. Rotating NMES pulses between multiple electrodes recruits subpopulations of MUs from each site, reducing MU firing rates and fatigability. This study was designed to determine whether rotating pulses between an increasing number of stimulation channels (cathodes) reduces contraction fatigability and increases the ability to generate torque during NMES. A secondary outcome was perceived discomfort. METHODS Fifteen neurologically intact volunteers completed four sessions. NMES was delivered over the quadriceps through 1 (NMES1), 2 (NMES2), 4 (NMES4) or 8 (NMES8) channels. Fatigability was assessed over 100 contractions (1-s on/1-s off) at an initial contraction amplitude that was 20% of a maximal voluntary contraction. Torque-frequency relationships were characterized over six frequencies from 20 to 120 Hz. RESULTS NMES4 and NMES8 resulted in less decline in peak torque (42 and 41%) over the 100 contractions than NMES1 and NMES2 (53 and 50% decline). Increasing frequency from 20 to 120 Hz increased torque by 7, 13, 21 and 24% MVC, for NMES1, NMES2, NMES4 and NMES8, respectively. Perceived discomfort was highest during NMES8. CONCLUSION NMES4 and NMES8 reduced contraction fatigability and generated larger contractions across a range of frequencies than NMES1 and NMES2. NMES8 produced the most discomfort, likely due to small electrodes and high current density. During NMES, more is not better and rotating pulses between four channels may be optimal to reduce contraction fatigability and produce larger contractions with minimal discomfort compared to conventional NMES configurations.
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Affiliation(s)
- Trevor S Barss
- Human Neurophysiology Laboratory, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, 4-219 Van Vliet Complex, Edmonton, AB, T6G 2H9, Canada.,Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
| | - Bailey W M Sallis
- Human Neurophysiology Laboratory, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, 4-219 Van Vliet Complex, Edmonton, AB, T6G 2H9, Canada.,Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
| | - Dylan J Miller
- Human Neurophysiology Laboratory, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, 4-219 Van Vliet Complex, Edmonton, AB, T6G 2H9, Canada.,Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
| | - David F Collins
- Human Neurophysiology Laboratory, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, 4-219 Van Vliet Complex, Edmonton, AB, T6G 2H9, Canada. .,Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada.
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Espeit L, Rozand V, Millet GY, Gondin J, Maffiuletti NA, Lapole T. Influence of wide-pulse neuromuscular electrical stimulation frequency and superimposed tendon vibration on occurrence and magnitude of extra torque. J Appl Physiol (1985) 2021; 131:302-312. [PMID: 34080917 DOI: 10.1152/japplphysiol.00968.2020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Low-frequency and high-frequency wide-pulse neuromuscular electrical stimulation (NMES) can generate extra torque (ET) via afferent pathways. Superimposing tendon vibration (TV) to NMES can increase the activation of these afferent pathways and favor ET generation. Knowledge of the characteristics of ET is essential to implement these stimulation paradigms in clinical practice. Thus, we aimed to investigate the effects of frequency and TV superimposition on the occurrence and magnitude of ET in response to wide-pulse NMES. NMES-induced isometric plantar flexion torque was recorded in 30 healthy individuals who performed five NMES protocols: wide-pulse low-frequency (1 ms; 20 Hz; WPLF) and wide-pulse high-frequency (1 ms; 100 Hz; WPHF) without and with superimposed TV (1 mm; 100 Hz) and conventional NMES (50 µs; 20 Hz; reference protocol). Each NMES protocol consisted of three 20-s trains interspersed by 90 s of rest, with NMES intensity being adjusted to reach 10% of maximal voluntary contraction. The ET occurrence was similar for WPLF and WPHF (P = 0.822). In the responders, the ET magnitude was greater for WPHF than WPLF (P < 0.001). There was no effect of superimposed TV on ET characteristics. This study reported an effect of NMES frequency on ET magnitude, whereas TV superimposition did not affect this parameter. In the context of our experimental design decisions, the present findings question the clinical use of wide-pulse NMES and its combination with superimposed TV. Yet, further research is needed to maximize force production through the occurrence and magnitude of ET.NEW & NOTEWORTHY This study is the first to assess the effect of stimulation frequency and superimposed tendon vibration on extra torque characteristics generated by wide-pulse neuromuscular electrical stimulation. The percentage of subjects showing extra torque (i.e., considered as responders) was similar for low-frequency and high-frequency wide-pulse neuromuscular electrical stimulation. In the responders, the extra torque was greater for high-frequency than for low-frequency wide-pulse neuromuscular electrical stimulation. The superimposition of tendon vibration had no effect on extra torque occurrence or magnitude.
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Affiliation(s)
- Loïc Espeit
- Univ Lyon, UJM-Saint-Etienne, Inter-university Laboratory of Human Movement Biology, EA 7424, Saint-Etienne, France
| | - Vianney Rozand
- Univ Lyon, UJM-Saint-Etienne, Inter-university Laboratory of Human Movement Biology, EA 7424, Saint-Etienne, France
| | - Guillaume Y Millet
- Univ Lyon, UJM-Saint-Etienne, Inter-university Laboratory of Human Movement Biology, EA 7424, Saint-Etienne, France.,Institut Universitaire de France, Paris, France
| | - Julien Gondin
- Institut NeuroMyoGène, Université Claude Bernard Lyon 1, CNRS UMR-5310, INSERM U-1217, Lyon, France
| | | | - Thomas Lapole
- Univ Lyon, UJM-Saint-Etienne, Inter-university Laboratory of Human Movement Biology, EA 7424, Saint-Etienne, France
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Paz IDA, Rigo GT, Sgarioni A, Baroni BM, Frasson VB, Vaz MA. Alternating Current Is More Fatigable Than Pulsed Current in People Who Are Healthy: A Double-Blind, Randomized Crossover Trial. Phys Ther 2021; 101:6131761. [PMID: 33561279 DOI: 10.1093/ptj/pzab056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 09/12/2020] [Accepted: 12/27/2020] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Tolerance level and rapid fatigue onset are limitations in the use of neuromuscular electrical stimulation (NMES) as an electrotherapeutic resource in rehabilitation and training protocols; however, it is unclear if pulsed current (PC) and alternating current (AC) produce different fatigue levels when applied at submaximal contraction level. The purpose of this study was to compare fatigue and discomfort levels between PC and AC during a submaximal contraction protocol in people who are healthy. METHODS In this double-blind, randomized crossover trial conducted in a laboratory setting, 30 male volunteers [23.23 years of age (SD = 4.59)] performed 2 submaximal fatigue protocols (with a 7-day interval) in a randomized order: PC (pulse duration = 2 milliseconds, pulse frequency = 100 Hz) and AC (2.5 kHz, pulse duration = 0.4 milliseconds, burst frequency = 100 Hz). NMES currents were applied to the knee extensor motor point of the dominant limb. The NMES protocol consisted of 80 evoked contractions (time on:off = 5:10 seconds) and lasted 20 minutes. The current was maintained at a constant intensity throughout the NMES protocol. The primary outcome measures were maximal voluntary isometric contraction, fatigue index (evoked torque decline), fatigability (number of contractions for a 50% drop in evoked-torque from the protocol start), total evoked torque-time integral (TTI), decline in TTI, and discomfort level. RESULTS AC at 2.5 kHz demonstrated higher maximal voluntary isometric contraction decline post-fatigue, higher fatigue index, higher fatigability (ie, fewer contractions to reach the 50% evoked torque decline from the protocol start), smaller total TTI, and higher TTI decline compared with PC. No between-currents difference was observed in discomfort level. CONCLUSION PC is less fatigable than AC at 2.5 kHz. IMPACT Based on this study, PC is the preferred current choice when the NMES goal is to generate higher muscle work, higher mechanical load, and smaller fatigability during training both for athletes who are healthy and for rehabilitation programs for people with disease or injury.
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Affiliation(s)
- Isabel de Almeida Paz
- Exercise Research Laboratory, School of Physical Education, Physical Therapy and Dance, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Graciane Taglian Rigo
- Exercise Research Laboratory, School of Physical Education, Physical Therapy and Dance, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Amanda Sgarioni
- Exercise Research Laboratory, School of Physical Education, Physical Therapy and Dance, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Bruno Manfredini Baroni
- Graduate Program in Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS, Brazil
| | - Viviane Bortoluzzi Frasson
- Graduate Program in Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS, Brazil.,Physique Centro de Fisioterapia, Porto Alegre, RS, Brazil
| | - Marco Aurélio Vaz
- Exercise Research Laboratory, School of Physical Education, Physical Therapy and Dance, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil.,Physique Centro de Fisioterapia, Porto Alegre, RS, Brazil
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Modulation of torque evoked by wide-pulse, high-frequency neuromuscular electrical stimulation and the potential implications for rehabilitation and training. Sci Rep 2021; 11:6399. [PMID: 33737664 PMCID: PMC7973712 DOI: 10.1038/s41598-021-85645-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 03/01/2021] [Indexed: 11/09/2022] Open
Abstract
The effectiveness of neuromuscular electrical stimulation (NMES) for rehabilitation is proportional to the evoked torque. The progressive increase in torque (extra torque) that may develop in response to low intensity wide-pulse high-frequency (WPHF) NMES holds great promise for rehabilitation as it overcomes the main limitation of NMES, namely discomfort. WPHF NMES extra torque is thought to result from reflexively recruited motor units at the spinal level. However, whether WPHF NMES evoked force can be modulated is unknown. Therefore, we examined the effect of two interventions known to change the state of spinal circuitry in opposite ways on evoked torque and motor unit recruitment by WPHF NMES. The interventions were high-frequency transcutaneous electrical nerve stimulation (TENS) and anodal transcutaneous spinal direct current stimulation (tsDCS). We show that TENS performed before a bout of WPHF NMES results in lower evoked torque (median change in torque time-integral: - 56%) indicating that WPHF NMES-evoked torque might be modulated. In contrast, the anodal tsDCS protocol used had no effect on any measured parameter. Our results demonstrate that WPHF NMES extra torque can be modulated and although the TENS intervention blunted extra torque production, the finding that central contribution to WPHF NMES-evoked torques can be modulated opens new avenues for designing interventions to enhance WPHF NMES.
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Gonzatti N, Castagna L, Carvalho MTX, Santos TDD, Cardoso DM, Callegaro CC, Albuquerque IMD. Estimulação elétrica funcional associada ao treinamento combinado pós-CRM: ensaio clínico randomizado. FISIOTERAPIA E PESQUISA 2021. [DOI: 10.1590/1809-2950/20031628012021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Os efeitos da adição da estimulação elétrica funcional (EEF) ao treinamento aeróbico e resistido (treino combinado) de curto prazo em pacientes submetidos à cirurgia de revascularização do miocárdio (CRM) ainda não foram estabelecidos. O objetivo do presente estudo é avaliar o impacto da adição da EEF ao treino combinado no fluxo arterial periférico, na capacidade funcional e na qualidade de vida de pacientes pós-CRM participantes de um programa de reabilitação cardíaca - Fase II. Trata-se de um ensaio clínico randomizado, duplo cego, composto por 17 pacientes (54,8±10,5 anos, 12 homens) randomizados ou em grupo intervenção (GI, n=8,) submetido à EEF no músculo quadríceps associada ao treino combinado, ou em grupo sham (GS, n=9), que realizou a EEF sham em associação ao treino combinado. Os desfechos avaliados foram: fluxo arterial periférico (índice tornozelo-braquial), capacidade funcional (distância percorrida no teste de caminhada de seis minutos - DTC6M) e qualidade de vida (questionário MacNew). Na comparação entre os grupos, o aumento do índice tornozelo-braquial (GI: 0,14±0,08 mmHg vs. GC: 0,05±0,04 mmHg; p=0,020) e do escore do domínio global do questionário MacNew (GI: 1,1±0,3 pontos vs. GC: 0,6±0,4 pontos; p=0,020) foi maior no GI. Entretanto, não foi observada diferença entre os grupos para a DTC6M (GI: 130,9±73,7 m vs. GS: 73,7±32,6 m; p=0,072). A adição da EEF, durante curto período, potencializou os efeitos do exercício aeróbico e resistido sobre o fluxo arterial periférico e a qualidade de vida em pacientes pós CRM em Fase II da reabilitação cardíaca.
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Seitz AM, Murrmann M, Ignatius A, Dürselen L, Friemert B, von Lübken F. Neuromapping of the Capsuloligamentous Knee Joint Structures. Arthrosc Sports Med Rehabil 2021; 3:e555-e563. [PMID: 34027469 PMCID: PMC8129484 DOI: 10.1016/j.asmr.2020.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 12/29/2020] [Indexed: 11/26/2022] Open
Abstract
Purpose To investigate neuromuscular electromyographic response of the of the upper and lower leg muscles after the application of an intraoperative, isolated mechanical stimulus of the capsuloligamentous structures, including the anterior (ACL) and posterior cruciate ligaments (PCL), lateral (LM) and medial menisci (MM), plica mediopatellaris (PM), and Hoffa’s fat pat (HFP). Methods The electromyographic response of the upper and lower leg muscles (M. rectus femoris; M. vastus medialis; M. semitendinosus; M. biceps femoris; M. gastrocnemius lateralis) of 15 male patients were measured after an isolated mechanical stimulus of the capsuloligamentous structures during an arthroscopic intervention using a customized intraoperative setup. Target parameters were the short (SLR; <30 milliseconds) and medium latency responses (MLR; >30 milliseconds) after the mechanically-induced trigger. Results The ACL, PCL, LM, and MM displayed high interindividual reproducibility of >76%. The MM was the only structure indicating both an SLR and MLR for all muscles. Although signals could be detected, there was no reproducibility in electromyographic signal activation for the HFP. The most rapid MLR was observed for the PM (quadriceps: 37 milliseconds). Conclusions Each stimulated structure displayed an individual MLR response, which allowed us to create neuromapping combining the anatomical and quantitative representations of the individual muscular activation patterns after isolated mechanical stimulation of the capsuloligamentous knee joint structures, corroborating our hypothesis. Level of Evidence Diagnostic - Level II.
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Affiliation(s)
- Andreas Martin Seitz
- Institute of Orthopedic Research and Biomechanics Institute of Orthopedic Research and Biomechanics Center for Trauma Research Ulm, Ulm University Medical Center, Ulm, Germany
| | - Miriam Murrmann
- Institute of Orthopedic Research and Biomechanics Institute of Orthopedic Research and Biomechanics Center for Trauma Research Ulm, Ulm University Medical Center, Ulm, Germany
| | - Anita Ignatius
- Institute of Orthopedic Research and Biomechanics Institute of Orthopedic Research and Biomechanics Center for Trauma Research Ulm, Ulm University Medical Center, Ulm, Germany
| | - Lutz Dürselen
- Institute of Orthopedic Research and Biomechanics Institute of Orthopedic Research and Biomechanics Center for Trauma Research Ulm, Ulm University Medical Center, Ulm, Germany
| | - Benedikt Friemert
- Department of Trauma and Orthopedic Surgery, Hospital of the Federal Armed Forces Ulm, Ulm, Germany
| | - Falk von Lübken
- Department of Trauma and Orthopedic Surgery, Hospital of the Federal Armed Forces Ulm, Ulm, Germany
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