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Arai S, Sasaki A, Tsugaya S, Nomura T, Milosevic M. Inhibition of tibialis anterior spinal reflex circuits using frequency-specific neuromuscular electrical stimulation. Artif Organs 2024; 48:891-901. [PMID: 38436108 DOI: 10.1111/aor.14737] [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: 11/29/2023] [Revised: 01/24/2024] [Accepted: 02/18/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Neuromuscular electrical stimulation (NMES) can generate muscle contractions and elicit excitability of neural circuits. However, the optimal stimulation frequency for effective neuromodulation remains unclear. METHODS Eleven able-bodied individuals participated in our study to examine the effects of: (1) low-frequency NMES at 25 Hz, (2) high-frequency NMES at 100 Hz; and (3) mixed-frequency NMES at 25 and 100 Hz switched every second. NMES was delivered to the right tibialis anterior (TA) muscle for 1 min in each condition. The order of interventions was pseudorandomized between participants with a washout of at least 15 min between conditions. Spinal reflexes were elicited using single-pulse transcutaneous spinal cord stimulation applied over the lumbar enlargement to evoke responses in multiple lower-limb muscles bilaterally and maximum motor responses (Mmax) were elicited in the TA muscle by stimulating the common peroneal nerve to assess fatigue at the baseline and immediately, 5, 10, and 15 min after each intervention. RESULTS Our results showed that spinal reflexes were significantly inhibited immediately after the mixed-frequency NMES, and for at least 15 min in follow-up. Low-frequency NMES inhibited spinal reflexes 5 min after the intervention, and also persisted for at least 10 min. These effects were present only in the stimulated TA muscle, while other contralateral and ipsilateral muscles were unaffected. Mmax responses were not affected by any intervention. CONCLUSIONS Our results indicate that even a short-duration (1 min) NMES intervention using low- and mixed-frequency NMES could inhibit spinal reflex excitability of the TA muscle without inducing fatigue.
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Affiliation(s)
- Suzufumi Arai
- Graduate School of Engineering Science, Department of Mechanical Science and Bioengineering, Osaka University, Toyonaka, Japan
| | - Atsushi Sasaki
- Graduate School of Engineering Science, Department of Mechanical Science and Bioengineering, Osaka University, Toyonaka, Japan
- The Miami Project to Cure Paralysis, University of Miami, Miami, Florida, USA
| | - Shota Tsugaya
- Graduate School of Engineering Science, Department of Mechanical Science and Bioengineering, Osaka University, Toyonaka, Japan
| | - Taishin Nomura
- Graduate School of Engineering Science, Department of Mechanical Science and Bioengineering, Osaka University, Toyonaka, Japan
- Global Center for Medical Engineering and Informatics, Osaka University, Suita, Japan
| | - Matija Milosevic
- Graduate School of Engineering Science, Department of Mechanical Science and Bioengineering, Osaka University, Toyonaka, Japan
- The Miami Project to Cure Paralysis, University of Miami, Miami, Florida, USA
- Department of Neurological Surgery, University of Miami, Miami, Florida, USA
- Department of Biomedical Engineering, University of Miami, Miami, Florida, USA
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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 2024:10.1007/s00421-024-05538-8. [PMID: 38940932 DOI: 10.1007/s00421-024-05538-8] [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: 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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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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Scalia M, Borzuola R, Parrella M, Borriello G, Sica F, Monteleone F, Maida E, Macaluso A. Neuromuscular Electrical Stimulation Does Not Influence Spinal Excitability in Multiple Sclerosis Patients. J Clin Med 2024; 13:704. [PMID: 38337396 PMCID: PMC10856365 DOI: 10.3390/jcm13030704] [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: 12/12/2023] [Revised: 01/16/2024] [Accepted: 01/24/2024] [Indexed: 02/12/2024] Open
Abstract
(1) Background: Neuromuscular electrical stimulation (NMES) has beneficial effects on physical functions in Multiple sclerosis (MS) patients. However, the neurophysiological mechanisms underlying these functional improvements are still unclear. This study aims at comparing acute responses in spinal excitability, as measured by soleus Hoffmann reflex (H-reflex), between MS patients and healthy individuals, under three experimental conditions involving the ankle planta flexor muscles: (1) passive NMES (pNMES); (2) NMES superimposed onto isometric voluntary contraction (NMES+); and (3) isometric voluntary contraction (ISO). (2) Methods: In total, 20 MS patients (MS) and 20 healthy individuals as the control group (CG) took part in a single experimental session. Under each condition, participants performed 15 repetitions of 6 s at 20% of maximal voluntary isometric contraction, with 6 s of recovery between repetitions. Before and after each condition, H-reflex amplitudes were recorded. (3) Results: In MS, H-reflex amplitude did not change under any experimental condition (ISO: p = 0.506; pNMES: p = 0.068; NMES+: p = 0.126). In CG, H-reflex amplitude significantly increased under NMES+ (p = 0.01), decreased under pNMES (p < 0.000) and was unaltered under ISO (p = 0.829). (4) Conclusions: The different H-reflex responses between MS and CG might reflect a reduced ability of MS patients in modulating spinal excitability.
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Affiliation(s)
- Martina Scalia
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy; (M.S.); (R.B.); (M.P.); (A.M.)
| | - Riccardo Borzuola
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy; (M.S.); (R.B.); (M.P.); (A.M.)
| | - Martina Parrella
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy; (M.S.); (R.B.); (M.P.); (A.M.)
| | - Giovanna Borriello
- Neurology Unit, San Pietro Fatebenefratelli Hospital, MS Centre, 00189 Rome, Italy
| | - Francesco Sica
- Santa Maria Goretti Hospital, 04100 Latina, Italy; (F.S.); (F.M.)
| | | | - Elisabetta Maida
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | - Andrea Macaluso
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy; (M.S.); (R.B.); (M.P.); (A.M.)
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Scalia M, Parrella M, Borzuola R, Macaluso A. Comparison of acute responses in spinal excitability between older and young people after neuromuscular electrical stimulation. Eur J Appl Physiol 2024; 124:353-363. [PMID: 37524980 DOI: 10.1007/s00421-023-05288-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/12/2023] [Indexed: 08/02/2023]
Abstract
PURPOSE This study aims at comparing acute responses in spinal excitability, as measured by H-reflex, between older and young individuals, following a single session of NMES superimposed onto voluntary isometric contractions of the ankle plantar-flexor muscles (NMES+), with respect to passive NMES (pNMES) and voluntary isometric contractions only (ISO). METHODS Thirty-two volunteers, 16 older (OLDER) and 16 young (YOUNG), were asked to sustain a constant force at 20% of maximal voluntary isometric contraction (MVIC) of the ankle plantar-flexor muscles in the dominant limb during each of the 3 conditions (NMES+ , pNMES and ISO). Fifteen repetitions of 6 s were performed, with a resting interval of 6 s between repetitions. Before and after each condition, soleus H-reflexes were elicited by percutaneous electrical stimulation of the posterior tibial nerve and H-reflex amplitudes recorded by surface EMG. RESULTS In OLDER, H-reflex amplitude did not change following any experimental condition (ISO: p = 0.203; pNMES: p = 0.542; NMES+: p = 0.431) compared to baseline. On the contrary, in YOUNG, H-reflex amplitudes significantly increased (p < 0.000) and decreased (p = 0.001) following NMES+ and pNMES, respectively, while there was no significant change in reflex responses following ISO (p = 0.772). CONCLUSION The lack of change in H-reflex responses following either NMES+ or pNMES might reflect a reduced ability of older people in modulating spinal excitability after the conditions. Specifically, an age-related alteration in controlling mechanisms at presynaptic level was suggested.
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Affiliation(s)
- Martina Scalia
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy.
| | - Martina Parrella
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Riccardo Borzuola
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Andrea Macaluso
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
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Papavasileiou A, Xenofondos A, Baudry S, Lapole T, Amiridis IG, Metaxiotis D, Tsatalas T, Patikas DA. Protocols Targeting Afferent Pathways via Neuromuscular Electrical Stimulation for the Plantar Flexors: A Systematic Review. SENSORS (BASEL, SWITZERLAND) 2023; 23:2347. [PMID: 36850945 PMCID: PMC9967278 DOI: 10.3390/s23042347] [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: 11/30/2022] [Revised: 02/02/2023] [Accepted: 02/17/2023] [Indexed: 06/18/2023]
Abstract
This systematic review documents the protocol characteristics of studies that used neuromuscular electrical stimulation protocols (NMES) on the plantar flexors [through triceps surae (TS) or tibial nerve (TN) stimulation] to stimulate afferent pathways. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement, was registered to PROSPERO (ID: CRD42022345194) and was funded by the Greek General Secretariat for Research and Technology (ERA-NET NEURON JTC 2020). Included were original research articles on healthy adults, with NMES interventions applied on TN or TS or both. Four databases (Cochrane Library, PubMed, Scopus, and Web of Science) were systematically searched, in addition to a manual search using the citations of included studies. Quality assessment was conducted on 32 eligible studies by estimating the risk of bias with the checklist of the Effective Public Health Practice Project Quality Assessment Tool. Eighty-seven protocols were analyzed, with descriptive statistics. Compared to TS, TN stimulation has been reported in a wider range of frequencies (5-100, vs. 20-200 Hz) and normalization methods for the contraction intensity. The pulse duration ranged from 0.2 to 1 ms for both TS and TN protocols. It is concluded that with increasing popularity of NMES protocols in intervention and rehabilitation, future studies may use a wider range of stimulation attributes, to stimulate motor neurons via afferent pathways, but, on the other hand, additional studies may explore new protocols, targeting for more optimal effectiveness. Furthermore, future studies should consider methodological issues, such as stimulation efficacy (e.g., positioning over the motor point) and reporting of level of discomfort during the application of NMES protocols to reduce the inherent variability of the results.
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Affiliation(s)
- Anastasia Papavasileiou
- Laboratory of Neuromechanics, School of Physical Education and Sports Science at Serres, Aristotle University of Thessaloniki, 62110 Serres, Greece
| | - Anthi Xenofondos
- Physical Education and Sports Sciences, Frederick University, 1036 Nicosia, Cyprus
| | - Stéphane Baudry
- Laboratory of Applied Biology, Research Unit in Applied Neurophysiology (LABNeuro), Université Libre de Bruxelles, 1070 Brussels, Belgium
| | - Thomas Lapole
- Université Jean Monnet Saint-Etienne, Lyon 1, Université Savoie Mont-Blanc, Laboratoire Interuniversitaire de Biologie de la Motricité, F-42023 Saint-Etienne, France
| | - Ioannis G. Amiridis
- Laboratory of Neuromechanics, School of Physical Education and Sports Science at Serres, Aristotle University of Thessaloniki, 62110 Serres, Greece
| | | | - Themistoklis Tsatalas
- Department of Physical Education and Sport Science, University of Thessaly, 42100 Trikala, Greece
| | - Dimitrios A. Patikas
- Laboratory of Neuromechanics, School of Physical Education and Sports Science at Serres, Aristotle University of Thessaloniki, 62110 Serres, Greece
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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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Can motor imagery balance the acute fatigue induced by neuromuscular electrical stimulation? Eur J Appl Physiol 2023; 123:1003-1014. [PMID: 36622447 DOI: 10.1007/s00421-022-05129-5] [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: 07/04/2022] [Accepted: 12/26/2022] [Indexed: 01/10/2023]
Abstract
PURPOSE The combination of motor imagery (MI) and neuromuscular electrical stimulation (NMES) can increase the corticospinal excitability suggesting that such association could be efficient in motor performance improvement. However, differential effect has been reported at spinal level after MI and NMES alone. The purpose of this study was to investigate the acute effect on motor performance and spinal excitability following MI, NMES and combining MI and NMES. METHODS Ten participants were enrolled in three experimental sessions of MI, NMES and MI + NMES targeting plantar flexor muscles. Each session underwent 60 imagined, evoked (20% MVC) or imagined and evoked contractions simultaneously. Before, immediately after and 10 min after each session, maximal M-wave and H-reflex were evoked by electrical nerve stimulation applied at rest and during maximal voluntary contraction (MVC). RESULTS The MVC decreased significantly between PRE-POST (- 12.14 ± 6.12%) and PRE-POST 10 (- 8.1 ± 6.35%) for NMES session, while this decrease was significant only between PRE-POST 10 (- 7.16 ± 11.25%) for the MI + NMES session. No significant modulation of the MVC was observed after MI session. The ratio Hmax/Mmax was reduced immediately after NMES session only. CONCLUSION The combination of MI to NMES seems to delay the onset of neuromuscular fatigue compared to NMES alone. This delay onset of neuromuscular fatigue was associated with specific modulation of the spinal excitability. These results suggested that MI could compensate the neuromuscular fatigue induced acutely by NMES until 10 min after the combination of both modalities.
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Acute Effects of Neuromuscular Electrical Stimulation on Contralateral Plantar Flexor Neuromuscular Function. BIOLOGY 2022; 11:biology11111655. [DOI: 10.3390/biology11111655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 10/28/2022] [Accepted: 11/08/2022] [Indexed: 11/16/2022]
Abstract
Contralateral facilitation, i.e., the increase in contralateral maximal voluntary strength that is observed when neuromuscular electrical stimulation (NMES) is applied to the ipsilateral homonymous muscle, has previously been reported for the knee extensors but the neurophysiological mechanisms remain to be investigated. The aim of this study was to compare plantar flexor contralateral facilitation between a submaximal voluntary contraction (~10% MVC torque) and two evoked contractions (conventional and wide-pulse high-frequency NMES) of the ipsilateral plantar flexors, with respect to a resting condition. Contralateral MVC torque and voluntary activation level were measured in 22 healthy participants while the ipsilateral plantar flexors were at rest, voluntarily contracted or stimulated for 15 s. Additional neurophysiological parameters (soleus H-reflex and V-wave amplitude and tibialis anterior coactivation level) were quantified in a subgroup of 12 participants. Conventional and wide-pulse high-frequency NMES of the ipsilateral plantar flexors did not induce any contralateral facilitation of maximal voluntary strength and activation with respect to the resting condition. Similarly, no alteration of neurophysiological parameters was observed in the different conditions. This absence of contralateral facilitation contrasts with some results previously obtained on the knee extensors but is consistent with the absence of neurophysiological changes on the contralateral soleus.
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Ye X, Gockel N, Vala D, Devoe T, Brodoff P, Gaza V, Umali V, Walker H. Wide-Pulse High-Frequency Neuromuscular Electrical Stimulation Evokes Greater Relative Force in Women Than in Men: A Pilot Study. Sports (Basel) 2022; 10:134. [PMID: 36136389 PMCID: PMC9501951 DOI: 10.3390/sports10090134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 11/16/2022] Open
Abstract
This study aimed to examine the potential sex differences in wide-pulse high-frequency neuromuscular electrical stimulation (WPHF NMES)-evoked force. Twenty-two subjects (10 women) completed this study. Prior to the stimulation, the visual analogue scale (VAS) for discomfort and the rating of perceived exertion (RPE) were measured, followed by the isometric strength of the dominant elbow flexor muscles. The subjects then completed ten, 10-s on 10-s off WPHF NMES (pulse width: 1 ms, frequency: 100 Hz) at maximum tolerable intensities. The subjects' RPE was recorded after each set, and the VAS was measured following the last stimulation. The stimulation induced significant increase in discomfort for both sexes, with women having greater discomfort than men (men: 22.4 ± 14.9 mm, women: 39.7 ± 12.7 mm). The stimulation amplitude was significantly greater in men than in women (men: 16.2 ± 6.3 mA, women: 12.0 ± 4.5 mA). For the evoked force, only the relative NMES-evoked force was found greater in women than in men (men: 8.96 ± 6.51%, women: 17.08 ± 12.61%). In conclusion, even at the maximum tolerable intensity, WPHF NMES evoked larger relative elbow flexion force in women than in men, with women experiencing greater discomfort.
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Affiliation(s)
- Xin Ye
- Department of Rehabilitations Sciences, University of Hartford, West Hartford, CT 06117, USA
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Greve KR, Joseph CF, Berry BE, Schadl K, Rose J. Neuromuscular electrical stimulation to augment lower limb exercise and mobility in individuals with spastic cerebral palsy: A scoping review. Front Physiol 2022; 13:951899. [PMID: 36111153 PMCID: PMC9468780 DOI: 10.3389/fphys.2022.951899] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Neuromuscular Electrical Stimulation (NMES) is an emerging assistive technology applied through surface or implanted electrodes to augment skeletal muscle contraction. NMES has the potential to improve function while reducing the neuromuscular impairments of spastic cerebral palsy (CP). This scoping review examines the application of NMES to augment lower extremity exercises for individuals with spastic CP and reports the effects of NMES on neuromuscular impairments and function in spastic CP, to provide a foundation of knowledge to guide research and development of more effective treatment. Methods: A literature review of Scopus, Medline, Embase, and CINAHL databases were searched from 2001 to 2 November 2021 with identified inclusion and exclusion criteria. Results: Out of 168 publications identified, 33 articles were included. Articles on three NMES applications were identified, including NMES-assisted strengthening, NMES-assisted gait, and NMES for spasticity reduction. NMES-assisted strengthening included the use of therapeutic exercises and cycling. NMES-assisted gait included the use of NMES to improve gait patterns. NMES-spasticity reduction included the use of transcutaneous electrical stimulation or NMES to decrease tone. Thirteen studies investigated NMES-assisted strengthening, eleven investigated therapeutic exercise and demonstrated significant improvements in muscle structure, strength, gross motor skills, walking speed, and functional mobility; three studies investigated NMES-assisted cycling and demonstrated improved gross motor skills and walking distance or speed. Eleven studies investigated NMES-assisted gait and demonstrated improved muscle structure, strength, selective motor control, gross motor skills, and gait mechanics. Seven studies investigated NMES for spasticity reduction, and five of the seven studies demonstrated reduced spasticity. Conclusion: A growing body of evidence supports the use of NMES-assisted strengthening, NMES-assisted gait, and NMES for spasticity reduction to improve functional mobility for individuals with spastic CP. Evidence for NMES to augment exercise in individuals with spastic CP remains limited. NMES protocols and parameters require further clarity to translate knowledge to clinicians. Future research should be completed to provide richer evidence to transition to more robust clinical practice.
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Affiliation(s)
- Kelly R. Greve
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Department of Rehabilitation, Exercise and Nutrition Sciences, University of Cincinnati, College of Allied Health Sciences, Cincinnati, OH, United States
| | - Christopher F. Joseph
- Department of Physical Therapy, Kennedy Krieger Institute, Baltimore, MD, United States
| | - Blake E. Berry
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Department of Rehabilitation, Exercise and Nutrition Sciences, University of Cincinnati, College of Allied Health Sciences, Cincinnati, OH, United States
| | - Kornel Schadl
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA, United States
- Motion and Gait Analysis Lab, Lucile Packard Children’s Hospital, Stanford Children’s Health, Stanford, CA, United States
| | - Jessica Rose
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA, United States
- Motion and Gait Analysis Lab, Lucile Packard Children’s Hospital, Stanford Children’s Health, Stanford, CA, United States
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Alahmari SK, Shield AJ, Trajano GS. Effects of three neuromuscular electrical stimulation methods on muscle force production and neuromuscular fatigue. Scand J Med Sci Sports 2022; 32:1456-1463. [PMID: 35844045 PMCID: PMC9545897 DOI: 10.1111/sms.14210] [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: 11/26/2021] [Revised: 02/18/2022] [Accepted: 06/22/2022] [Indexed: 11/29/2022]
Abstract
This study compared the acute responses of three neuromuscular electrical stimulation (NMES) methods on muscle torque-time integral (TTI) and neuromuscular fatigue. Narrow-pulse (0.2 ms; NP), wide-pulse (1 ms; WP), and tendon vibration superimposed onto wide-pulse (WP + VIB)-NMES conditions were applied to sixteen healthy individuals (n = 16) in three separate sessions in a randomized order. Stimulation intensity was set to elicit 20% of maximal voluntary contraction (MVC); the stimulus pattern comprised four sets of 20 repetitions (5 s On and 5 s Off) with a one-minute inter-set interval. TTI was measured for each NMES condition and MVC, voluntary activation (VA), peak twitch torque (Peaktwitch ), and peak soleus (EMGSOL ), medial (EMGMG ), and lateral gastrocnemius (EMGLG ) electromyography were measured before and immediately after each NMES condition. TTI was higher during WP + VIB (19.63 ± 6.34 MVC.s, mean difference = 3.66, p < 0.001, Cohen's d = 0.501) than during WP (15.97 ± 4.79 MVC.s) condition. TTI was higher during WP + VIB (mean difference = 3.79, p < 0.001, Cohen's d = 0.626) than during NP (15.84 ± 3.73 MVC.s) condition. MVC and Peaktwitch forces decreased (p ≤ 0.001) immediately after all conditions. No changes were observed for VA (p = 0.365). EMGSOL amplitude reduced (p = 0.040) only after NP, yet EMGLG and EMGMG amplitudes decreased immediately after all conditions (p = 0.003 and p = 0.013, respectively). WP + VIB produced a higher TTI than WP and NP-NMES, with similar amounts of neuromuscular fatigue across protocols. All NMES protocols induced similar amounts of peripheral fatigue and reduced EMG amplitudes.
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Affiliation(s)
- Sami K Alahmari
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Australia.,Department of Physical Therapy, College of Applied Medical Sciences, Taif University (TU), Taif, Mecca, Kingdom of Saudi Arabia
| | - Anthony J Shield
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Australia
| | - Gabriel S Trajano
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Australia
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Effects of Ankle Continuous Passive Motion on Soleus Hypertonia in Individuals with Cerebral Palsy: A Case Series. Biomed J 2021; 45:708-716. [PMID: 34332162 PMCID: PMC9486241 DOI: 10.1016/j.bj.2021.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 07/19/2021] [Accepted: 07/23/2021] [Indexed: 11/23/2022] Open
Abstract
Background Continuous passive motion device (CPM) provides repetitive movement over extended periods of time for those who have low functional ability. The purpose of this research was to evaluate the effects of a four-week program of continuous passive motion of the ankle joint on the changes in soleus hypertonia in individuals with cerebral palsy who suffered from life-long hypertonia. Methods A single group, repeated-measures study was conducted. Eight individuals (7 males and 1 female with a mean age of 21.8 ± 8.5 years) with spastic cerebral palsy underwent bilateral ankle CPM for 1 h a day, 5 days a week, for 4 weeks. The outcome measures included the Modified Ashworth Scale (MAS) score, passive range of motion (PROM) of the ankle, the ratio of maximum H reflex to maximum soleus M-response (H/M ratio), and post-activation depression (PAD). All outcomes were measured before and after the intervention. A paired t-test was used to examine treatment effects pre-versus post-intervention. Results Paired t-tests showed that the CPM program significantly decreased the MAS score (p = 0.006), decreased the maximum H/M ratio (p=0.001), improved PAD (p = 0.003, p = 0.040, and p = 0.032 at 0.2 Hz, 1 Hz, and 2 Hz, respectively), and increased the passive ankle range of motion (p = 0.049). Conclusion Ankle CPM not only reduced soleus hypertonia but also improved the PROM in individuals with cerebral palsy. The results of this study show ankle CPM to be an effective intervention for individuals with cerebral palsy.
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Bastos JAI, Martins W, Junior GC, Collins DF, Durigan JLQ. CONTRACTION FATIGUE, STRENGTH ADAPTATIONS, AND DISCOMFORT DURING CONVENTIONAL VERSUS WIDE-PULSE, HIGH-FREQUENCY, NEUROMUSCULAR ELECTRICAL STIMULATION: A SYSTEMATIC REVIEW. Appl Physiol Nutr Metab 2021; 46:1314-1321. [PMID: 34260861 DOI: 10.1139/apnm-2021-0269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Neuromuscular electrical stimulation (NMES) can be delivered in a conventional form (CONVNMES) and using relatively wide-pulses and high-frequencies (WPHFNMES). WPHFNMES is proposed to reduce contraction fatigability and generate larger contractions with less discomfort than CONVNMES, however, there are no systematic reviews to guide the selection of NMES types. This systematic review compared the effects of CONVNMES versus WPHFNMES on contraction fatigability, strength adaptations, and perceived discomfort in clinical and non-clinical populations. Eight studies were included. When averaged across all non-clinical participants in individual short- and long-term studies, there was either no difference between CONVNMES and WPHFNMES for all outcomes or WPHFNMES produced more fatigability. In a subset of non-clinical participants ("responders"), however, WPHFNMES reduced contraction fatigability during a single session. Long-term studies found no differences between protocols for strength adaptations in non-clinical participants and those with multiple sclerosis. We concluded that WPHFNMES reduces contraction fatigability only in the short-term and in non-clinical responder participants and may exacerbate fatigability in non-responders. This review was registered in the prospective international registry of systematic reviews/PROSPERO (Registration Number: CRD42020153907, accessed at https://www.crd.york.ac.uk/PROSPERO/). Novelty bullets: • WPHF NMES may reduce fatigue in some participants and exacerbate fatigue in others. • There were no differences in long-term between WPHF and CONV NMES on strength adaptations. • Future high-quality research is needed to optimize outcomes of NMES-based programs.
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Affiliation(s)
| | - Wagner Martins
- Universidade de Brasilia, 28127, Faculdade de Fisioterapia, Ceilândia , Distrito Federal, Brazil;
| | | | - David F Collins
- University of Alberta, 3158, Kinesiology, Sport, and Recreation, Edmonton, Alberta, Canada, T6G 2R3;
| | - Joao Luiz Quaglioti Durigan
- UnB, Physical Therapy, D- Graduate program of Science and Technology of Health and Graduate program of Physical Education, University of Brasília, Distrito Federal, Brazil, Brasiia, Select a State / Province, Brazil, 13560210;
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15
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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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16
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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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Mesquita RNO, Taylor JL, Kirk B, Blazevich AJ. Involuntary sustained firing of plantar flexor motor neurones: effect of electrical stimulation parameters during tendon vibration. Eur J Appl Physiol 2021; 121:881-891. [PMID: 33392744 PMCID: PMC7892516 DOI: 10.1007/s00421-020-04563-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 11/16/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Simultaneous application of tendon vibration and neuromuscular electrical stimulation (NMES) induces an involuntary sustained torque. We examined the effect of different NMES parameters (intensity, pattern of stimulation and pulse width) on the magnitude of the evoked involuntary torque. METHODS Plantar flexor torque was recorded during 33-s Achilles tendon vibration with simultaneous 20-Hz NMES bouts on triceps surae (n = 20; 13 women). Intensity was set to elicit 10, 20 or 30% of maximal voluntary contraction torque (MVC), pulse width was narrow (0.2 ms) or wide (1 ms), and the stimulus pattern varied (5 × 2-s or 10 × 1-s). Up to 12 different trials were performed in a randomized order, and then repeated in those who produced a sustained involuntary torque after the cessation of vibration. RESULTS Six of 7 men and 5 of 13 women produced a post-vibration sustained torque. Eight of 20 participants did not complete the 30% trials, as they were perceived as painful. Torque during vibration at the end of NMES and the increase in torque throughout the trial were significantly higher in 20 than 10% trials (n = 11; 9.7 ± 9.0 vs 7.1 ± 6.1% MVC and 4.3 ± 4.5 vs 3.6 ± 3.5% MVC, respectively). Post-vibration sustained torque was higher in wide pulse-width trials (5.4 ± 5.9 vs 4.1 ± 4.3% MVC). Measures of involuntary torque were not different between 20 and 30% trials (n = 8). CONCLUSION Bouts of 5 × 2-s NMES with wide pulse width eliciting 20% MVC provides the most robust responses and could be used to maximise the production of involuntary torque in triceps surae.
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Affiliation(s)
- Ricardo N O Mesquita
- Centre for Exercise and Sports Science Research, School of Medical and Health Sciences, Edith Cowan University, Perth, Australia.
| | - Janet L Taylor
- Centre for Exercise and Sports Science Research, School of Medical and Health Sciences, Edith Cowan University, Perth, Australia.,Neuroscience Research Australia, Sydney, Australia
| | - Benjamin Kirk
- Centre for Exercise and Sports Science Research, School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
| | - Anthony J Blazevich
- Centre for Exercise and Sports Science Research, School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
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Chatel B, Bernit E, Vilmen C, Michel C, Bendahan D, Messonnier LA. In vivo muscle function and energetics in women with sickle cell anemia or trait: a 31P-magnetic resonance spectroscopy study. J Appl Physiol (1985) 2020; 130:737-745. [PMID: 33300856 DOI: 10.1152/japplphysiol.00790.2020] [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] Open
Abstract
Sickle cell anemia (SCA) is a genetic hemoglobinopathy associated with an impaired oxygen delivery to skeletal muscle that could alter ATP production processes and increase intramuscular acidosis. These alterations have been already reported in the Townes mouse model of SCA but the corresponding changes in humans have not been documented. In the present study, we used 31-phosphorus magnetic resonance spectroscopy to investigate in vivo the metabolic changes induced by a moderate-intensity exercise in twelve SCA patients, eight sickle cell trait (SCT) carriers, and twelve controls women. The rest-exercise-recovery protocol disclosed slight differences regarding phosphocreatine (PCr) consumption and lactate accumulation between SCA patients and controls but these differences did not reach a statistical significance. On that basis, the in vivo metabolic changes associated with a moderate-intensity muscle exercise were slightly altered in SCA patients and SCT carriers but within a normal range. The present results strongly support the fact that a moderate-intensity exercise is safe and could be recommended in stable SCA patients and SCT subjects.NEW & NOTEWORTHY The main finding of the present study was that the metabolic changes associated with a moderate-intensity muscle exercise were slightly modified in stable sickle cell anemia patients and sickle cell trait carriers as compared to controls but still in the normal range. The present results strongly support the safety of a moderate-intensity exercise for stable sickle cell anemia patients and sickle cell trait carriers.
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Affiliation(s)
- Benjamin Chatel
- Aix-Marseille Université, CNRS, CRMBM, Marseille, France.,CellMade, Le-Bourget-du-Lac, France
| | - Emmanuelle Bernit
- Service de Médecine Interne, Hôpital de la Timone, APHM, Marseille, France.,Centre de référence Antilles-Guyane pour la Drépanocytose, les Thalassémies et les maladies constitutives du Globule Rouge et de l'Erythropoïèse, Pointe à Pitre, Guadeloupe
| | | | | | - David Bendahan
- Aix-Marseille Université, CNRS, CRMBM, Marseille, France
| | - Laurent A Messonnier
- Aix-Marseille Université, CNRS, CRMBM, Marseille, France.,Université Savoie Mont Blanc, Laboratoire Interuniversitaire de Biologie de la Motricité EA7424, Chambéry, France
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Monjo F, Shemmell J. Probing the neuromodulatory gain control system in sports and exercise sciences. J Electromyogr Kinesiol 2020; 53:102442. [DOI: 10.1016/j.jelekin.2020.102442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 06/29/2020] [Accepted: 06/29/2020] [Indexed: 01/22/2023] Open
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Borzuola R, Labanca L, Macaluso A, Laudani L. Modulation of spinal excitability following neuromuscular electrical stimulation superimposed to voluntary contraction. Eur J Appl Physiol 2020; 120:2105-2113. [PMID: 32676751 PMCID: PMC7419370 DOI: 10.1007/s00421-020-04430-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 07/03/2020] [Indexed: 02/03/2023]
Abstract
Purpose Neuromuscular electrical stimulation (NMES) superimposed on voluntary muscle contraction has been recently shown as an innovative training modality within sport and rehabilitation, but its effects on the neuromuscular system are still unclear. The aim of this study was to investigate acute responses in spinal excitability, as measured by the Hoffmann (H) reflex, and in maximal voluntary contraction (MVIC) following NMES superimposed to voluntary isometric contractions (NMES + ISO) compared to passive NMES only and to voluntary isometric contractions only (ISO). Method Fifteen young adults were required to maintain an ankle plantar-flexor torque of 20% MVC for 20 repetitions during each experimental condition (NMES + ISO, NMES and ISO). Surface electromyography was used to record peak-to-peak H-reflex and motor waves following percutaneous stimulation of the posterior tibial nerve in the dominant limb. An isokinetic dynamometer was used to assess maximal voluntary contraction output of the ankle plantar flexor muscles. Results H-reflex amplitude was increased by 4.5% after the NMES + ISO condition (p < 0.05), while passive NMES and ISO conditions showed a decrease by 7.8% (p < 0.05) and no change in reflex responses, respectively. There was no change in amplitude of maximal motor wave and in MVIC torque during each experimental condition. Conclusion The reported facilitation of spinal excitability following NMES + ISO could be due to a combination of greater motor neuronal and corticospinal excitability, thus suggesting that NMES superimposed onto isometric voluntary contractions may provide a more effective neuromuscular stimulus and, hence, training modality compared to NMES alone.
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Affiliation(s)
- Riccardo Borzuola
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy.,Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Luciana Labanca
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Andrea Macaluso
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Luca Laudani
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK.
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Enoka RM, Amiridis IG, Duchateau J. Electrical Stimulation of Muscle: Electrophysiology and Rehabilitation. Physiology (Bethesda) 2020; 35:40-56. [DOI: 10.1152/physiol.00015.2019] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The generation of action potentials in intramuscular motor and sensory axons in response to an imposed external current source can evoke muscle contractions and elicit widespread responses throughout the nervous system that impact sensorimotor function. The benefits experienced by individuals exposed to several weeks of treatment with electrical stimulation of muscle suggest that the underlying adaptations involve several physiological systems, but little is known about the specific changes elicited by such interventions.
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Affiliation(s)
- Roger M. Enoka
- Department of Integrative Physiology, University of Colorado Boulder, Colorado
| | - Ioannis G. Amiridis
- Department of Physical Education and Sport Sciences at Serres, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Jacques Duchateau
- Laboratory of Applied Biology and Neurophysiology, ULB Neuroscience Institute, Université Libre de Bruxelles, Brussels, Belgium
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Neyroud D, Gonzalez M, Mueller S, Agostino D, Grosprêtre S, Maffiuletti NA, Kayser B, Place N. Neuromuscular adaptations to wide-pulse high-frequency neuromuscular electrical stimulation training. Eur J Appl Physiol 2019; 119:1105-1116. [DOI: 10.1007/s00421-019-04100-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 02/11/2019] [Indexed: 11/30/2022]
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23
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Minetto MA, Botter A, Gamerro G, Varvello I, Massazza G, Bellomo RG, Maffiuletti NA, Saggini R. Contralateral effect of short-duration unilateral neuromuscular electrical stimulation and focal vibration in healthy subjects. Eur J Phys Rehabil Med 2019. [DOI: 10.23736/s1973-9087.18.05004-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Mani D, Feeney DF, Enoka RM. The modulation of force steadiness by electrical nerve stimulation applied to the wrist extensors differs for young and older adults. Eur J Appl Physiol 2018; 119:301-310. [DOI: 10.1007/s00421-018-4025-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 10/22/2018] [Indexed: 12/16/2022]
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Vitry F, Martin A, Deley G, Papaiordanidou M. Effect of reflexive activation of motor units on torque development during electrically-evoked contractions of the triceps surae muscle. J Appl Physiol (1985) 2018; 126:386-392. [PMID: 30212303 DOI: 10.1152/japplphysiol.00463.2018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The aim of the study was to identify stimulation conditions permitting the occurrence of extra torque (ET) and to examine their impact on spinal and corticospinal excitabilities. Twelve subjects received stimulation trains over the tibial nerve (20 s duration, 1 ms pulse duration) that were delivered at 3 stimulation frequencies (20, 50, and 100 Hz) and at 5 intensities (110%, 120%, 130%, 140%, and 150% of the motor threshold). Torque-time integral (TTI) of each stimulation train was calculated. Spinal [maximum H-reflex (Hmax)/maximal M-wave (Mmax)] and corticospinal [maximal motor evoked potential amplitude (MEPmax)/Mmax] excitabilities were assessed at rest before and after each stimulation train by tibial nerve stimulation and by transcranial magnetic stimulation, respectively. Moreover, a twitch at each stimulation intensity was delivered before and after each stimulation train. The EMG activity associated with this twitch was analyzed to identify the initial motor unit (MU) recruitment pathway before each stimulation train and discriminate trials to H-trials (indirect recruitment) and M-trials (direct recruitment). TTI was higher for H-trials compared with M-trials for all tested frequencies. There was a decrease in Hmax/Mmax for the 20 Hz-H trials and an increase for the 100 Hz-H trials, whereas MEPmax/Mmax remained unchanged at post measurements. Present results demonstrate that the initial MU recruitment pattern plays a main role in the ET occurrence, with the indirect recruitment via the afferent volley being substantial for its development. The modulations of Hmax/Mmax without changes in MEPmax/Mmax suggest that the ET development affects spinal excitability and that these changes are frequency dependent. NEW & NOTEWORTHY This study brings new insights into the stimulation conditions permitting the development of extra torque. An initial indirect recruitment of motor units, inducing reflex activation of spinal neurons through Ia afferent solicitation, appears a prerequisite for extra torque development. Under these conditions, spinal excitability modulations were frequency dependent.
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Affiliation(s)
- Florian Vitry
- INSERM UMR1093-CAPS, Université Bourgogne Franche-Comté, UFR des Sciences du Sport, Dijon , France
| | - Alain Martin
- INSERM UMR1093-CAPS, Université Bourgogne Franche-Comté, UFR des Sciences du Sport, Dijon , France
| | - Gaëlle Deley
- INSERM UMR1093-CAPS, Université Bourgogne Franche-Comté, UFR des Sciences du Sport, Dijon , France
| | - Maria Papaiordanidou
- INSERM UMR1093-CAPS, Université Bourgogne Franche-Comté, UFR des Sciences du Sport, Dijon , France
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Hamilton LD, Mani D, Almuklass AM, Davis LA, Vieira T, Botter A, Enoka RM. Electrical nerve stimulation modulates motor unit activity in contralateral biceps brachii during steady isometric contractions. J Neurophysiol 2018; 120:2603-2613. [PMID: 30156959 DOI: 10.1152/jn.00235.2018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The purpose of our study was to compare the influence of five types of electrical nerve stimulation delivered through electrodes placed over the right biceps brachii on motor unit activity in the left biceps brachii during an ongoing steady isometric contraction. The electrical stimulation protocols comprised different combinations of pulse duration (0.2 and 1.0 ms), stimulus frequency (50 and 90 Hz), and stimulus current (greater or less than motor threshold). The electrical nerve stimulation protocols were applied over the muscle of the right elbow flexors of 13 participants (26 ± 3 yr) while they performed voluntary contractions with the left elbow flexors to match a target force set at 10% of maximum. All five types of electrical nerve stimulation increased the absolute amplitude of the electromyographic (EMG) signal recorded from the left biceps brachii with high-density electrodes. Moreover, one stimulation condition (1 ms, 90 Hz) had a consistent influence on the centroid location of the EMG amplitude distribution and the average force exerted by the left elbow flexors. Another stimulation condition (0.2 ms, 90 Hz) reduced the coefficient of variation for force during the voluntary contraction, and both low-frequency conditions (50 Hz) increased the duration of the mean interspike interval of motor unit action potentials after the stimulation had ended. The findings indicate that the contralateral effects of electrical nerve stimulation on the motor neuron pool innervating the homologous muscle can be influenced by both stimulus pulse duration and stimulus frequency. NEW & NOTEWORTHY Different types of electrical nerve stimulation delivered through electrodes placed over the right biceps brachii modulated the ongoing motor unit activity in the left biceps brachii. Although the effects varied with stimulus pulse duration, frequency, and current, all five types of electrical nerve stimulation increased the amplitude of the electromyographic activity in the left biceps brachii. Moreover, most of the effects in the left arm occurred after the electrical nerve stimulation of the right arm had been terminated.
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Affiliation(s)
- Landon D Hamilton
- Department of Integrative Physiology, University of Colorado , Boulder, Colorado
| | - Diba Mani
- Department of Integrative Physiology, University of Colorado , Boulder, Colorado
| | - Awad M Almuklass
- Department of Integrative Physiology, University of Colorado , Boulder, Colorado.,College of Medicine, King Saud bin Abdulaziz University for Health Sciences , Riyadh , Saudi Arabia
| | - Leah A Davis
- Department of Integrative Physiology, University of Colorado , Boulder, Colorado
| | - Taian Vieira
- LISiN, Department of Electronics and Telecommunications, Politecnico di Torino, Torino , Italy
| | - Alberto Botter
- LISiN, Department of Electronics and Telecommunications, Politecnico di Torino, Torino , Italy
| | - Roger M Enoka
- Department of Integrative Physiology, University of Colorado , Boulder, Colorado
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Presynaptic inhibition mechanisms may subserve the spinal excitability modulation induced by neuromuscular electrical stimulation. J Electromyogr Kinesiol 2018; 40:95-101. [DOI: 10.1016/j.jelekin.2018.04.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 03/30/2018] [Accepted: 04/23/2018] [Indexed: 11/20/2022] Open
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Rongsawad K, Ratanapinunchai J. Effects of Very High Stimulation Frequency and Wide-Pulse Duration on Stimulated Force and Fatigue of Quadriceps in Healthy Participants. Ann Rehabil Med 2018; 42:250-259. [PMID: 29765878 PMCID: PMC5940601 DOI: 10.5535/arm.2018.42.2.250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 08/02/2017] [Indexed: 11/13/2022] Open
Abstract
Objective To determine the effect of very high stimulation frequency (150 and 200 Hz) with wide pulse duration versus 50 Hz with wide pulse duration on stimulated force and fatigue of quadriceps femoris in healthy participants. Methods Thirty-four healthy participants underwent fatigue test using three stimulation frequency conditions (50, 150, and 200 Hz) with pulse duration of 0.9 ms. Normalized force values at the end of each fatigue protocol and curve fitting patterns were compared among stimulated frequencies. Results Very high stimulation frequency (150 and 200 Hz) conditions showed a trend of having more decline in normalized stimulated force during fatigue test compared to a low stimulation frequency at 50 Hz. However, the difference was not statistically significant. Responder group showed the same slope of a linear fitting pattern, implying the same pattern of muscle fatigue among three stimulation frequency conditions (−3.32 in 50 Hz, −2.88 in 150 Hz, and −3.14 in 200 Hz, respectively). Conclusion There were high inter-subject variations in the response to different frequency stimulation conditions. However, very high stimulation frequency generated the same fatigue pattern as the low stimulation frequency in the responder group. Further research is needed to explore the mechanism involved.
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Affiliation(s)
- Kitima Rongsawad
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Jonjin Ratanapinunchai
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
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Papcke C, Krueger E, Olandoski M, Nogueira-Neto GN, Nohama P, Scheeren EM. Investigation of the Relationship Between Electrical Stimulation Frequency and Muscle Frequency Response Under Submaximal Contractions. Artif Organs 2018; 42:655-663. [PMID: 29574805 DOI: 10.1111/aor.13083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 10/16/2017] [Accepted: 10/26/2017] [Indexed: 11/30/2022]
Abstract
Neuromuscular electrical stimulation (NMES) is a common tool that is used in clinical and laboratory experiments and can be combined with mechanomyography (MMG) for biofeedback in neuroprostheses. However, it is not clear if the electrical current applied to neuromuscular tissues influences the MMG signal in submaximal contractions. The objective of this study is to investigate whether the electrical stimulation frequency influences the mechanomyographic frequency response of the rectus femoris muscle during submaximal contractions. Thirteen male participants performed three maximal voluntary isometric contractions (MVIC) recorded in isometric conditions to determine the maximal force of knee extensors. This was followed by the application of nine modulated NMES frequencies (20, 25, 30, 35, 40, 45, 50, 75, and 100 Hz) to evoke 5% MVIC. Muscle behavior was monitored by the analysis of MMG signals, which were decomposed into frequency bands by using a Cauchy wavelet transform. For each applied electrical stimulus frequency, the mean MMG spectral/frequency response was estimated for each axis (X, Y, and Z axes) of the MMG sensor with the values of the frequency bands used as weights (weighted mean). Only with respect to the Z (perpendicular) axis of the MMG signal, the stimulus frequency of 20 Hz did not exhibit any difference with the weighted mean (P = 0.666). For the frequencies of 20 and 25 Hz, the MMG signal displayed the bands between 12 and 16 Hz in the three axes (P < 0.050). In the frequencies from 30 to 100 Hz, the muscle presented a higher concentration of the MMG signal between the 22 and 29 Hz bands for the X and Z axes, and between 16 and 34 Hz bands for the Y axis (P < 0.050 for all cases). We observed that MMG signals are not dependent on the applied NMES frequency, because their frequency contents tend to mainly remain between the 20- and 25-Hz bands. Hence, NMES does not interfere with the use of MMG in neuroprosthesis.
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Affiliation(s)
- Caluê Papcke
- Graduate Program in Health Technology, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Eddy Krueger
- Graduate Program in Rehabilitation Sciences, Anatomy Department, Universidade Estadual de Londrina, Londrina, Brazil.,Graduate Program in Biomedical Engineering, Universidade Tecnológica Federal do Paraná, Curitiba, Brazil
| | - Marcia Olandoski
- Medical School, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | | | - Percy Nohama
- Graduate Program in Health Technology, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
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Bochkezanian V, Newton RU, Trajano GS, Vieira A, Pulverenti TS, Blazevich AJ. Effect of tendon vibration during wide-pulse neuromuscular electrical stimulation (NMES) on muscle force production in people with spinal cord injury (SCI). BMC Neurol 2018; 18:17. [PMID: 29433467 PMCID: PMC5809925 DOI: 10.1186/s12883-018-1020-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 02/02/2018] [Indexed: 12/13/2022] Open
Abstract
Background Neuromuscular electrical stimulation (NMES) is commonly used in skeletal muscles in people with spinal cord injury (SCI) with the aim of increasing muscle recruitment and thus muscle force production. NMES has been conventionally used in clinical practice as functional electrical stimulation (FES), using low levels of evoked force that cannot optimally stimulate muscular strength and mass improvements, and thus trigger musculoskeletal changes in paralysed muscles. The use of high intensity intermittent NMES training using wide-pulse width and moderate-intensity as a strength training tool could be a promising method to increase muscle force production in people with SCI. However, this type of protocol has not been clinically adopted because it may generate rapid muscle fatigue and thus prevent the performance of repeated high-intensity muscular contractions in paralysed muscles. Moreover, superimposing patellar tendon vibration onto the wide-pulse width NMES has been shown to elicit further increases in impulse or, at least, reduce the rate of fatigue in repeated contractions in able-bodied populations, but there is a lack of evidence to support this argument in people with SCI. Methods Nine people with SCI received two NMES protocols with and without superimposing patellar tendon vibration on different days (i.e. STIM and STIM+vib), which consisted of repeated 30 Hz trains of 58 wide-pulse width (1000 μs) symmetric biphasic pulses (0.033-s inter-pulse interval; 2 s stimulation train; 2-s inter-train interval) being delivered to the dominant quadriceps femoris. Starting torque was 20% of maximal doublet-twitch torque and stimulations continued until torque declined to 50% of the starting torque. Total knee extensor impulse was calculated as the primary outcome variable. Results Total knee extensor impulse increased in four subjects when patellar tendon vibration was imposed (59.2 ± 15.8%) but decreased in five subjects (− 31.3 ± 25.7%). However, there were no statistically significant differences between these sub-groups or between conditions when the data were pooled. Conclusions Based on the present results there is insufficient evidence to conclude that patellar tendon vibration provides a clear benefit to muscle force production or delays muscle fatigue during wide-pulse width, moderate-intensity NMES in people with SCI. Trial registration ACTRN12618000022268. Date: 11/01/2018. Retrospectively registered.
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Affiliation(s)
- Vanesa Bochkezanian
- Department of Exercise and Health Sciences, School of Health, Medical and Applied Sciences, Central Queensland University, Building 34.1.02, Bruce Highway, North Rockhampton, Qld, 4702, Australia. .,Exercise Medicine Research Clinic, Edith Cowan University, Perth, Australia. .,Centre for Sports and Exercise Science, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia.
| | - Robert U Newton
- Exercise Medicine Research Clinic, Edith Cowan University, Perth, Australia.,Centre for Sports and Exercise Science, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia.,UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia
| | - Gabriel S Trajano
- School of Exercise and Nutrition Sciences, Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT), Brisbane, Australia
| | | | - Timothy S Pulverenti
- Centre for Sports and Exercise Science, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | - Anthony J Blazevich
- Centre for Sports and Exercise Science, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
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31
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Martin A, Grosprêtre S, Vilmen C, Guye M, Mattei JP, LE Fur Y, Bendahan D, Gondin J. The Etiology of Muscle Fatigue Differs between Two Electrical Stimulation Protocols. Med Sci Sports Exerc 2017; 48:1474-84. [PMID: 27031743 DOI: 10.1249/mss.0000000000000930] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE This study aimed at investigating the mechanisms involved in the force reduction induced by two electrical stimulation (ES) protocols that were designed to activate motor units differently. METHODS The triceps surae of 11 healthy subjects (8 men; age, ~28 yr) was activated using ES applied over the tibial nerve. Two ES protocols (conventional [CONV]: 20 Hz, 0.05 ms vs wide-pulse high-frequency [WPHF]: 80 Hz, 1 ms) were performed and involved 40 trains (6 s on-6 s off) delivered at an intensity (IES) evoking 20% of maximal voluntary contraction. To analyze the mechanical properties of the motor units activated at IES, force-frequency relation was evoked before and after each protocol. H-reflex and M-wave responses evoked by the last stimulation pulse were also assessed during each ES protocol. Electromyographic responses (∑EMG) were recorded after each train to analyze the behavior of the motor units activated at IES. Metabolic variables, including relative concentrations of phosphocreatine and inorganic phosphate as well as intracellular pH, were assessed using P-MR spectroscopy during each protocol. RESULTS Larger H-reflex amplitudes were observed during WPHF as compared with CONV, whereas opposite findings were observed for M-wave amplitudes. Despite this difference, both the force reduction (-26%) and metabolic changes were similar between the two protocols. The CONV protocol induced a rightward shift of the force-frequency relation, whereas a significant reduction of the ∑EMG evoked at IES was observed only for the WPHF. CONCLUSIONS These results suggest that a decreased number of active motor units mainly contributed to WPHF-induced force decrease, whereas intracellular processes were most likely involved in the force reduction occurring during CONV stimulation.
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Affiliation(s)
- Alain Martin
- 1Aix-Marseille University, CNRS, Center for Magnetic Resonance in Biology and Medicine (CRMBM) UMR 7339, Marseille, FRANCE; 2INSERM, Cognition, Action, and Sensorimotor Plasticity (CAPS) UMR 1093, University of Burgundy, Faculty of Sport Sciences, Dijon, FRANCE; 3APHM, La Timone Hospital, Imaging Center, CEMEREM, Marseille, FRANCE; and 4Deparment of Rheumatology, Sainte Marguerite Hospital, Marseille, FRANCE
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Neyroud D, Grosprêtre S, Gondin J, Kayser B, Place N. Test-retest reliability of wide-pulse high-frequency neuromuscular electrical stimulation evoked force. Muscle Nerve 2017; 57:E70-E77. [PMID: 28722822 DOI: 10.1002/mus.25747] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 07/05/2017] [Accepted: 07/15/2017] [Indexed: 01/13/2023]
Abstract
INTRODUCTION We compare forces evoked by wide-pulse high-frequency (WPHF) neuromuscular electrical stimulation (NMES) delivered to a nerve trunk versus muscle belly and assess their test-retest intraindividual and interindividual reliability. METHODS Forces evoked during 2 sessions with WPHF NMES delivered over the tibial nerve trunk and 2 sessions over the triceps surae muscle belly were compared. Ten individuals participated in 4 sessions involving ten 20-s WPHF NMES contractions interspaced by 40-s recovery. Mean evoked force and force time integral of each contraction were quantified. RESULTS For both nerve trunk and muscle belly stimulation, intraindividual test-retest reliability was good (intraclass correlation coefficient > 0.9), and interindividual variability was large (coefficient of variation between 140% and 180%). Nerve trunk and muscle belly stimulation resulted in similar evoked forces. DISCUSSION WPHF NMES locations might be chosen by individual preference because intraindividual reliability was relatively good for both locations. Muscle Nerve 57: E70-E77, 2018.
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Affiliation(s)
- Daria Neyroud
- Institute of Sport Sciences, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Sidney Grosprêtre
- EA4660-C3S Laboratory, Culture, Sport, Health and Society, University of Bourgogne Franche-Comté, Besançon, France
| | - Julien Gondin
- Institut NeuroMyoGène, Université Claude Bernard Lyon 1, INSERM U1217, CNRS UMR 5310, Villeurbanne, France
| | - Bengt Kayser
- Institute of Sport Sciences, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Nicolas Place
- Institute of Sport Sciences, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
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GROSPRÊTRE SIDNEY, GUEUGNEAU NICOLAS, MARTIN ALAIN, LEPERS ROMUALD. Central Contribution to Electrically Induced Fatigue depends on Stimulation Frequency. Med Sci Sports Exerc 2017; 49:1530-1540. [DOI: 10.1249/mss.0000000000001270] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Wegrzyk J, Ranjeva JP, Fouré A, Kavounoudias A, Vilmen C, Mattei JP, Guye M, Maffiuletti NA, Place N, Bendahan D, Gondin J. Specific brain activation patterns associated with two neuromuscular electrical stimulation protocols. Sci Rep 2017; 7:2742. [PMID: 28577338 PMCID: PMC5457446 DOI: 10.1038/s41598-017-03188-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 04/27/2017] [Indexed: 11/24/2022] Open
Abstract
The influence of neuromuscular electrical stimulation (NMES) parameters on brain activation has been scarcely investigated. We aimed at comparing two frequently used NMES protocols - designed to vary in the extent of sensory input. Whole-brain functional magnetic resonance imaging was performed in sixteen healthy subjects during wide-pulse high-frequency (WPHF, 100 Hz–1 ms) and conventional (CONV, 25 Hz–0.05 ms) NMES applied over the triceps surae. Each protocol included 20 isometric contractions performed at 10% of maximal force. Voluntary plantar flexions (VOL) were performed as control trial. Mean force was not different among the three protocols, however, total current charge was higher for WPHF than for CONV. All protocols elicited significant activations of the sensorimotor network, cerebellum and thalamus. WPHF resulted in lower deactivation in the secondary somatosensory cortex and precuneus. Bilateral thalami and caudate nuclei were hyperactivated for CONV. The modulation of the NMES parameters resulted in differently activated/deactivated regions related to total current charge of the stimulation but not to mean force. By targeting different cerebral brain regions, the two NMES protocols might allow for individually-designed rehabilitation training in patients who can no longer execute voluntary movements.
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Affiliation(s)
- Jennifer Wegrzyk
- Aix Marseille Univ, CNRS, CRMBM, UMR 7339, 13385, Marseille, France
| | | | - Alexandre Fouré
- Aix Marseille Univ, CNRS, CRMBM, UMR 7339, 13385, Marseille, France
| | - Anne Kavounoudias
- Aix Marseille Univ, CNRS, Laboratoire Neurosciences Intégratives et Adaptatives, UMR 7260, 13385, Marseille, France
| | | | - Jean-Pierre Mattei
- Aix Marseille Univ, CNRS, CRMBM, UMR 7339, 13385, Marseille, France.,AP-HM, Hôpital de Sainte Marguerite, Service de Rhumatologie, Pôle Appareil Locomoteur, 13005, Marseille, France
| | - Maxime Guye
- Aix Marseille Univ, CNRS, CRMBM, UMR 7339, 13385, Marseille, France.,AP-HM, Hôpital de la Timone, CEMEREM, Pôle Imagerie Médicale, 13005, Marseille, France
| | | | - Nicolas Place
- University of Lausanne, Faculty of Biology and Medicine, Institute of Sport Sciences and Department of Physiology, Lausanne, Switzerland
| | - David Bendahan
- Aix Marseille Univ, CNRS, CRMBM, UMR 7339, 13385, Marseille, France
| | - Julien Gondin
- Aix Marseille Univ, CNRS, CRMBM, UMR 7339, 13385, Marseille, France. .,Institut NeuroMyoGène, Université Claude Bernard Lyon 1, INSERM U1217, CNRS UMR 5310, Villeurbanne, France.
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35
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Dideriksen J, Leerskov K, Czyzewska M, Rasmussen R. Relation Between the Frequency of Short-Pulse Electrical Stimulation of Afferent Nerve Fibers and Evoked Muscle Force. IEEE Trans Biomed Eng 2017; 64:2737-2745. [PMID: 28237919 DOI: 10.1109/tbme.2017.2671853] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Objective: Functional electrical stimulation (FES) is conventionally performed by the stimulation of motor axons causing the muscle fibers innervated by these axons to contract. An alternative strategy that may evoke contractions with more natural motor unit behavior is to stimulate afferent fibers (primarily type Ia) to excite the motor neurons at the spinal level. The aim of the study was to investigate the range of forces that can be evoked in this way and the degree to which the torque can be controlled. Methods: We stimulated the tibial nerve of ten healthy participants at amplitudes at which the highest H-reflex with minimal M-wave was present. The evoked plantar flexion torque was recorded following short stimulation pulses (0.4 ms) with frequencies ranging from 20 to 200 Hz. Results: Across all subjects, the median highest evocable torque was 38.3% (quartiles: 16.9-51.0) of the maximum voluntary contraction torque (MVC). The average torque variability (standard deviation) was 1.7 +/- 0.7% MVC. For most subjects, the relation between stimulation frequency and evoked torque was well characterized by sigmoidal curves (median root mean square error: 6.4% MVC). The plateau of this sigmoid curve (indicating the range of frequencies over which torque amplitude could be modulated) was reached at 56.0 (quartiles: 29.4-81.9) Hz. Conclusion: Using the proposed method for FES, substantial evoked torques that could be controlled by stimulation frequency were achieved. Significance: Stimulation of afferent fibers could be a useful and fatigue-resistant strategy for several applications of FES.Objective: Functional electrical stimulation (FES) is conventionally performed by the stimulation of motor axons causing the muscle fibers innervated by these axons to contract. An alternative strategy that may evoke contractions with more natural motor unit behavior is to stimulate afferent fibers (primarily type Ia) to excite the motor neurons at the spinal level. The aim of the study was to investigate the range of forces that can be evoked in this way and the degree to which the torque can be controlled. Methods: We stimulated the tibial nerve of ten healthy participants at amplitudes at which the highest H-reflex with minimal M-wave was present. The evoked plantar flexion torque was recorded following short stimulation pulses (0.4 ms) with frequencies ranging from 20 to 200 Hz. Results: Across all subjects, the median highest evocable torque was 38.3% (quartiles: 16.9-51.0) of the maximum voluntary contraction torque (MVC). The average torque variability (standard deviation) was 1.7 +/- 0.7% MVC. For most subjects, the relation between stimulation frequency and evoked torque was well characterized by sigmoidal curves (median root mean square error: 6.4% MVC). The plateau of this sigmoid curve (indicating the range of frequencies over which torque amplitude could be modulated) was reached at 56.0 (quartiles: 29.4-81.9) Hz. Conclusion: Using the proposed method for FES, substantial evoked torques that could be controlled by stimulation frequency were achieved. Significance: Stimulation of afferent fibers could be a useful and fatigue-resistant strategy for several applications of FES.
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Affiliation(s)
- Jakob Dideriksen
- Sensory-Motor Interaction, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Kasper Leerskov
- Sensory-Motor Interaction, Department of Health Science and TechnologyAalborg University
| | - Magdalena Czyzewska
- Sensory-Motor Interaction, Department of Health Science and TechnologyAalborg University
| | - Rune Rasmussen
- Sensory-Motor Interaction, Department of Health Science and TechnologyAalborg University
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Gueugneau N, Grosprêtre S, Stapley P, Lepers R. High-frequency neuromuscular electrical stimulation modulates interhemispheric inhibition in healthy humans. J Neurophysiol 2016; 117:467-475. [PMID: 27832594 DOI: 10.1152/jn.00355.2016] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 10/27/2016] [Indexed: 01/29/2023] Open
Abstract
High-frequency neuromuscular electrical stimulation (HF NMES) induces muscular contractions through neural mechanisms that partially match physiological motor control. Indeed, a portion of the contraction arises from central mechanisms, whereby spinal motoneurons are recruited through the evoked sensory volley. However, the involvement of supraspinal centers of motor control during such stimulation remains poorly understood. Therefore, we tested whether a single HF NMES session applied to the upper limb influences interhemispheric inhibition (IHI) from left to right motor cortex (M1). Using noninvasive electrophysiology and transcranial magnetic stimulation, we evaluated the effects of a 10-min HF NMES session applied to a right wrist flexor on spinal and corticospinal excitability of both arms, as well as IHI, in healthy subjects. HF NMES induced a rapid decline in spinal excitability on the right stimulated side that closely matched the modulation of evoked force during the protocol. More importantly, IHI was significantly increased by HF NMES, and this increase was correlated to the electromyographic activity within the contralateral homologous muscle. Our study highlights a new neurophysiological mechanism, suggesting that HF NMES has an effect on the excitability of the transcallosal pathway probably to regulate the lateralization of the motor output. The data suggest that HF NMES can modify the hemispheric balance between both M1 areas. These findings provide important novel perspectives for the implementation of HF NMES in sport training and neurorehabilitation. NEW & NOTEWORTHY High-frequency neuromuscular electrical stimulation (HF NMES) induces muscular contractions that partially match physiological motor control. Here, we tested whether HF NMES applied to the upper limb influences interhemispheric inhibition. Our results show that interhemispheric inhibition was increased after HF NMES and that this increase was correlated to the electromyographic activity within the contralateral homologous muscle. This opens up original perspectives for the implementation of HF NMES in sport training and neurorehabilitation.
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Affiliation(s)
- Nicolas Gueugneau
- Institut National de la Santé et de la Recherche Médicale CAPS UMR 1093, Dijon, France; .,University of Bourgogne-Franche Comté, CAPS UMR 1093, Dijon, France; and
| | - Sidney Grosprêtre
- Institut National de la Santé et de la Recherche Médicale CAPS UMR 1093, Dijon, France.,University of Bourgogne-Franche Comté, CAPS UMR 1093, Dijon, France; and
| | - Paul Stapley
- Neural Control of Movement Laboratory, Faculty of Science, Medicine, and Health, School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Romuald Lepers
- Institut National de la Santé et de la Recherche Médicale CAPS UMR 1093, Dijon, France.,University of Bourgogne-Franche Comté, CAPS UMR 1093, Dijon, France; and
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De Marchis C, Santos Monteiro T, Simon-Martinez C, Conforto S, Gharabaghi A. Multi-contact functional electrical stimulation for hand opening: electrophysiologically driven identification of the optimal stimulation site. J Neuroeng Rehabil 2016; 13:22. [PMID: 26955873 PMCID: PMC4782521 DOI: 10.1186/s12984-016-0129-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 02/24/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Functional Electrical Stimulation (FES) is increasingly applied in neurorehabilitation. Particularly, the use of electrode arrays may allow for selective muscle recruitment. However, detecting the best electrode configuration constitutes still a challenge. METHODS A multi-contact set-up with thirty electrodes was applied for combined FES and electromyography (EMG) recording of the forearm. A search procedure scanned all electrode configurations by applying single, sub-threshold stimulation pulses while recording M-waves of the extensor digitorum communis (EDC), extensor carpi radialis (ECR) and extensor carpi ulnaris (ECU) muscles. The electrode contacts with the best electrophysiological response were then selected for stimulation with FES bursts while capturing finger/wrist extension and radial/ulnar deviation with a kinematic glove. RESULTS The stimulation electrodes chosen on the basis of M-waves of the EDC/ECR/ECU muscles were able to effectively elicit the respective finger/wrist movements for the targeted extension and/or deviation with high specificity in two different hand postures. CONCLUSIONS A subset of functionally relevant stimulation electrodes could be selected fast, automatic and non-painful from a multi-contact array on the basis of muscle responses to subthreshold stimulation pulses. The selectivity of muscle recruitment predicted the kinematic pattern. This electrophysiologically driven approach would thus allow for an operator-independent positioning of the electrode array in neurorehabilitation.
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Affiliation(s)
- Cristiano De Marchis
- Division of Functional and Restorative Neurosurgery, Department of Neurosurgery, Eberhard Karls University, Otfried-Mueller-Str.45, 72076, Tübingen, Germany. .,Neuroprosthetics Research, Centre for Integrative Neuroscience, Eberhard Karls University, Tübingen, Germany. .,Laboratory of Bioengineering BioLab3, Department of Engineering, University Roma TRE, Via Vito Volterra 62, 00146, Rome, Italy.
| | - Thiago Santos Monteiro
- Division of Functional and Restorative Neurosurgery, Department of Neurosurgery, Eberhard Karls University, Otfried-Mueller-Str.45, 72076, Tübingen, Germany.,Neuroprosthetics Research, Centre for Integrative Neuroscience, Eberhard Karls University, Tübingen, Germany
| | - Cristina Simon-Martinez
- Division of Functional and Restorative Neurosurgery, Department of Neurosurgery, Eberhard Karls University, Otfried-Mueller-Str.45, 72076, Tübingen, Germany.,Neuroprosthetics Research, Centre for Integrative Neuroscience, Eberhard Karls University, Tübingen, Germany
| | - Silvia Conforto
- Laboratory of Bioengineering BioLab3, Department of Engineering, University Roma TRE, Via Vito Volterra 62, 00146, Rome, Italy
| | - Alireza Gharabaghi
- Division of Functional and Restorative Neurosurgery, Department of Neurosurgery, Eberhard Karls University, Otfried-Mueller-Str.45, 72076, Tübingen, Germany. .,Neuroprosthetics Research, Centre for Integrative Neuroscience, Eberhard Karls University, Tübingen, Germany.
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Contribution of Corticospinal Modulation and Total Electrical Energy for Peripheral-Nerve-Stimulation-Induced Neuroplasticity as Indexed by Additional Muscular Force. Brain Stimul 2016; 9:133-40. [DOI: 10.1016/j.brs.2015.09.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 09/22/2015] [Accepted: 09/23/2015] [Indexed: 01/17/2023] Open
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Wegrzyk J, Fouré A, Le Fur Y, Maffiuletti NA, Vilmen C, Guye M, Mattei JP, Place N, Bendahan D, Gondin J. Responders to Wide-Pulse, High-Frequency Neuromuscular Electrical Stimulation Show Reduced Metabolic Demand: A 31P-MRS Study in Humans. PLoS One 2015; 10:e0143972. [PMID: 26619330 PMCID: PMC4664273 DOI: 10.1371/journal.pone.0143972] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 11/11/2015] [Indexed: 01/08/2023] Open
Abstract
Conventional (CONV) neuromuscular electrical stimulation (NMES) (i.e., short pulse duration, low frequencies) induces a higher energetic response as compared to voluntary contractions (VOL). In contrast, wide-pulse, high-frequency (WPHF) NMES might elicit--at least in some subjects (i.e., responders)--a different motor unit recruitment compared to CONV that resembles the physiological muscle activation pattern of VOL. We therefore hypothesized that for these responder subjects, the metabolic demand of WPHF would be lower than CONV and comparable to VOL. 18 healthy subjects performed isometric plantar flexions at 10% of their maximal voluntary contraction force for CONV (25 Hz, 0.05 ms), WPHF (100 Hz, 1 ms) and VOL protocols. For each protocol, force time integral (FTI) was quantified and subjects were classified as responders and non-responders to WPHF based on k-means clustering analysis. Furthermore, a fatigue index based on FTI loss at the end of each protocol compared with the beginning of the protocol was calculated. Phosphocreatine depletion (ΔPCr) was assessed using 31P magnetic resonance spectroscopy. Responders developed four times higher FTI's during WPHF (99 ± 37 × 10(3) N.s) than non-responders (26 ± 12 × 10(3) N.s). For both responders and non-responders, CONV was metabolically more demanding than VOL when ΔPCr was expressed relative to the FTI. Only for the responder group, the ∆PCr/FTI ratio of WPHF (0.74 ± 0.19 M/N.s) was significantly lower compared to CONV (1.48 ± 0.46 M/N.s) but similar to VOL (0.65 ± 0.21 M/N.s). Moreover, the fatigue index was not different between WPHF (-16%) and CONV (-25%) for the responders. WPHF could therefore be considered as the less demanding NMES modality--at least in this subgroup of subjects--by possibly exhibiting a muscle activation pattern similar to VOL contractions.
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Affiliation(s)
- Jennifer Wegrzyk
- Aix-Marseille Université, CNRS, CRMBM UMR 7339, Marseille, France
| | - Alexandre Fouré
- Aix-Marseille Université, CNRS, CRMBM UMR 7339, Marseille, France
| | - Yann Le Fur
- Aix-Marseille Université, CNRS, CRMBM UMR 7339, Marseille, France
| | | | | | - Maxime Guye
- Aix-Marseille Université, CNRS, CRMBM UMR 7339, Marseille, France
- APHM, Hôpital Sainte-Marguerite, Service de Rhumatologie, Pôle Appareil Locomoteur, Marseille, France
| | - Jean-Pierre Mattei
- Aix-Marseille Université, CNRS, CRMBM UMR 7339, Marseille, France
- APHM, Hôpital Sainte-Marguerite, Service de Rhumatologie, Pôle Appareil Locomoteur, Marseille, France
| | - Nicolas Place
- ISSUL, Institute of Sport Sciences, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Department of Physiology, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - David Bendahan
- Aix-Marseille Université, CNRS, CRMBM UMR 7339, Marseille, France
| | - Julien Gondin
- Aix-Marseille Université, CNRS, CRMBM UMR 7339, Marseille, France
- * E-mail:
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Neyroud D, Armand S, De Coulon G, Da Silva SRD, Wegrzyk J, Gondin J, Kayser B, Place N. Wide-pulse-high-frequency neuromuscular electrical stimulation in cerebral palsy. Clin Neurophysiol 2015; 127:1530-1539. [PMID: 26232132 DOI: 10.1016/j.clinph.2015.07.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Revised: 06/30/2015] [Accepted: 07/08/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The present study assesses whether wide-pulse-high-frequency (WPHF) neuromuscular electrical stimulation (NMES) could result in extra-force production in cerebral palsy (CP) patients as previously observed in healthy individuals. METHODS Ten CP and 10 age- and sex-matched control participants underwent plantar flexors NMES. Two to three 10-s WPHF (frequency: 100 Hz, pulse duration: 1 ms) and conventional (CONV, frequency 25 Hz, pulse duration: 50 μs) trains as well as two to three burst-like stimulation trains (2s at 25 Hz, 2s at 100 Hz, 2s at 25 Hz; pulse duration: 1 ms) were evoked. Resting soleus and gastrocnemii maximal H-reflex amplitude (Hmax) was normalized by maximal M-wave amplitude (Mmax) to quantify α-motoneuron modulation. RESULTS Similar Hmax/Mmax ratio was found in CP and control participants. Extra-force generation was observed both in CP (+18 ± 74%) and control individuals (+94 ± 124%) during WPHF (p<0.05). Similar extra-forces were found during burst-like stimulations in both groups (+108 ± 110% in CP and +65 ± 85% in controls, p>0.05). CONCLUSION Although the mechanisms underlying extra-force production may differ between WPHF and burst-like NMES, similar increases were observed in patients with CP and healthy controls. SIGNIFICANCE Development of extra-forces in response to WPHF NMES evoked at low stimulation intensity might open new possibilities in neuromuscular rehabilitation.
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Affiliation(s)
- D Neyroud
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland; Department of Physiology, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland; Institute of Movement Sciences and Sports Medicine, University of Geneva, Geneva, Switzerland
| | - S Armand
- Willy Taillard Laboratory of Kinesiology, Geneva University Hospitals and Geneva University, Switzerland
| | - G De Coulon
- Service of Pediatric Orthopaedics, Department of Child and Adolescent Health, Geneva University Hospitals and Geneva University, Geneva, Switzerland
| | - S R D Da Silva
- Institute of Movement Sciences and Sports Medicine, University of Geneva, Geneva, Switzerland; School of Physical Education and Sport, University of São Paulo, Ribeirão Preto, Brazil
| | - J Wegrzyk
- Aix Marseille Université, CNRS, CRMBM UMR 7339, Marseille, France
| | - J Gondin
- Aix Marseille Université, CNRS, CRMBM UMR 7339, Marseille, France
| | - B Kayser
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland; Department of Physiology, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland; Institute of Movement Sciences and Sports Medicine, University of Geneva, Geneva, Switzerland
| | - N Place
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland; Department of Physiology, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.
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Frigon A. Responders and non-responders in motor control research: A framework to study physiological mechanisms of inter-individual variability. Clin Neurophysiol 2014; 126:1284-5. [PMID: 25468235 DOI: 10.1016/j.clinph.2014.10.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Accepted: 10/21/2014] [Indexed: 11/19/2022]
Affiliation(s)
- Alain Frigon
- Department of Physiology and Biophysics, Faculty of Medicine and Health Sciences, Centre de Recherche du CHUS, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, Quebec J1H 5N4, Canada.
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