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Magnuson FS, Christensen P, Krassioukov A, Rodriguez G, Emmanuel A, Kirshblum S, Krogh K. Neurogenic Bowel Dysfunction in Patients with Spinal Cord Injury and Multiple Sclerosis-An Updated and Simplified Treatment Algorithm. J Clin Med 2023; 12:6971. [PMID: 38002586 PMCID: PMC10672578 DOI: 10.3390/jcm12226971] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 10/27/2023] [Accepted: 11/02/2023] [Indexed: 11/26/2023] Open
Abstract
Neurogenic bowel dysfunction (NBD) is a common condition in individuals with spinal cord injury (SCI) or multiple sclerosis (MS). It usually entails constipation, difficult evacuation of the rectum, and fecal incontinence (FI); often in combination. It is highly burdensome for affected patients and is correlated with poor quality of life. The current treatment algorithm, or treatment pyramid, does not completely correspond to actual clinical practice, and the known and classical pyramid contains both treatments still in their experimental stage as well as several treatments which are not available at all treatment centers. Thus, an updated treatment algorithm is called upon, and the authors of this paper therefore propose a simplified version of the treatment pyramid, aiming to guide clinicians in treating NBD.
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Affiliation(s)
- Fredrika S. Magnuson
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, 8200 Aarhus, Denmark
| | - Peter Christensen
- Department of Surgery, Aarhus University Hospital, 8200 Aarhus, Denmark
| | - Andrei Krassioukov
- International Collaboration of Repair Discoveries (ICORD), Department of Medicine, Division of Physical Medicine and Rehabilitation, The University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Gianna Rodriguez
- Physical Medicine and Rehabilitation, Spinal Cord Injury Medicine, University of Michigan Health, Ann Arbor, MI 48108, USA
| | - Anton Emmanuel
- GI Physiology Unit, University College London Hospital, London WC1E 6DB, UK
| | - Steven Kirshblum
- Kessler Institute for Rehabilitation, West Orange, NJ 07052, USA;
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ 07103, USA
| | - Klaus Krogh
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, 8200 Aarhus, Denmark
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Kreydin E, Zhong H, Lavrov I, Edgerton VR, Gad P. The Effect of Non-invasive Spinal Cord Stimulation on Anorectal Function in Individuals With Spinal Cord Injury: A Case Series. Front Neurosci 2022; 16:816106. [PMID: 35250456 PMCID: PMC8891530 DOI: 10.3389/fnins.2022.816106] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/20/2022] [Indexed: 11/13/2022] Open
Abstract
Spinal cord injury (SCI) is a devastating condition that impacts multiple organ systems. Neurogenic bowel dysfunction (NBD) frequently occurs after a SCI leading to reduced sensation of bowel fullness and bowel movement often leading to constipation or fecal incontinence. Spinal Neuromodulation has been proven to be a successful modality to improve sensorimotor and autonomic function in patients with spinal cord injuries. The pilot data presented here represents the first demonstration of using spinal neuromodulation to activate the anorectal regions of patients with spinal cord injuries and the acute and chronic effects of stimulation. We observed that spinal stimulation induces contractions as well as changes in sensation and pressure profiles along the length of the anorectal region. In addition, we present a case report of a patient with a SCI and the beneficial effect of spinal neuromodulation on the patient’s bowel program.
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Affiliation(s)
- Evgeniy Kreydin
- Keck School of Medicine, Institute of Urology, University of Southern California, Los Angeles, CA, United States
- Rancho Los Amigos National Rehabilitation Center, Rancho Research Institute, Downey, CA, United States
- SpineX Inc., Los Angeles, CA, United States
| | - Hui Zhong
- Rancho Los Amigos National Rehabilitation Center, Rancho Research Institute, Downey, CA, United States
- Department of Neurobiology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Igor Lavrov
- Department of Neurology, Department of Biomedical Engineering, Mayo Clinic, Rochester, NY, United States
- Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
| | - V. Reggie Edgerton
- Department of Neurobiology, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, United States
- Brain Research Institute, University of California, Los Angeles, Los Angeles, CA, United States
- Institut Guttmann, Hospital de Neurorehabilitació, Institut Universitari Adscrit a la Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Parag Gad
- Rancho Los Amigos National Rehabilitation Center, Rancho Research Institute, Downey, CA, United States
- SpineX Inc., Los Angeles, CA, United States
- Department of Neurobiology, University of California, Los Angeles, Los Angeles, CA, United States
- *Correspondence: Parag Gad,
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Non-invasive neuromodulation for bowel, bladder and sexual restoration following spinal cord injury: A systematic review. Clin Neurol Neurosurg 2020; 194:105822. [DOI: 10.1016/j.clineuro.2020.105822] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/20/2020] [Accepted: 03/30/2020] [Indexed: 01/30/2023]
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Yun YC, Yoon YS, Kim ES, Lee YJ, Lee JG, Jo WJ, Lee KJ. Transabdominal Functional Magnetic Stimulation for the Treatment of Constipation in Brain-Injured Patients: A Randomized Controlled Trial. Ann Rehabil Med 2019; 43:19-26. [PMID: 30852867 PMCID: PMC6409655 DOI: 10.5535/arm.2019.43.1.19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 10/01/2018] [Indexed: 11/09/2022] Open
Abstract
Objective To investigate the effects of the transabdominal functional magnetic stimulation (A-FMS) for constipation in stroke or brain-injured patients. Methods Twenty-four brain-injured patients (11 males and 13 females; median age, 65 years; 22 cases of stroke and 2 cases of traumatic brain injury) with constipation, who were admitted to the rehabilitation department, were enrolled and randomly divided into magnetic stimulation (MS) group and sham stimulation (Sham) group. Several parameters related with constipation such as total and segmental colon transit time (CTT), defecation frequency, and Bristol Stool Scale (BSS) before and after 2 weeks of A-FMS (5 times per week, total 10 times of A-FMS) were evaluated. The Korean version of the Modified Barthel Index (K-MBI) was also evaluated. Results A significant decrease in segmental CTT in the left colon (-8.2±3.9 vs. 4.1±2.5 hours; p<0.05 by paired sample t-test) and a significant increase in the frequency of defecation (1.5±0.2 vs 0.7±0.3; p<0.05 by paired sample t-test) were observed in the MS group compared with the Sham group. Stool hardness became significantly softer in the MS group compared with the Sham group (2.3–3.5 in the MS and 2.6–3.1 in the Sham; p<0.05 by chi-square test) as evaluated by BSS. No difference in the K-MBI was observed between the two groups. Conclusion The present study suggests that A-FMS can be an additional therapeutic tool for managing constipation in brain-injured patients with abnormal bowel movement, defecation frequency, and stool hardness.
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Affiliation(s)
- Young-Cheol Yun
- Department of Physical Medicine and Rehabilitation, Presbyterian Medical Center, Jeonju, Korea
| | - Yong-Soon Yoon
- Department of Physical Medicine and Rehabilitation, Presbyterian Medical Center, Jeonju, Korea.,Medical Device Clinical Trial Center, Presbyterian Medical Center, Jeonju, Korea
| | - Eun-Sil Kim
- Department of Physical Medicine and Rehabilitation, Presbyterian Medical Center, Jeonju, Korea
| | - Young-Jae Lee
- Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Jin-Gyeong Lee
- Department of Physical Medicine and Rehabilitation, Presbyterian Medical Center, Jeonju, Korea
| | - Won-Jae Jo
- Department of Physical Medicine and Rehabilitation, Presbyterian Medical Center, Jeonju, Korea
| | - Kwang Jae Lee
- Department of Physical Medicine and Rehabilitation, Presbyterian Medical Center, Jeonju, Korea.,Medical Device Clinical Trial Center, Presbyterian Medical Center, Jeonju, Korea
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Abstract
PURPOSE OF REVIEW To evaluate and report current evidence regarding the management of bowel dysfunction in spinal cord injury. There is a paucity of high-quality large studies on which to base management advice. RECENT FINDINGS Recent research has focused on defining the nature of symptomatology of bowel dysfunction in SCI and describing the effects on quality of life and social interactions. Technical aspects of colonoscopy have received attention, and aspects of understanding the pathophysiology in relation to both neural and non-neural dysfunction have been studied. There has been refinement and expansion of the pharmacological and non-pharmacological treatment options for bowel dysfunction in SCI. Management of bowel dysfunction in SCI requires a comprehensive and individualized approach, encompassing lifestyle, toileting routine, stimulation, diet, medications, and surgery. Further high-quality research is required to inform best practice.
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Affiliation(s)
- Zhengyan Qi
- Neurogastroenterology Unit and Department of Gastroenterology, Royal North Shore Hospital, Reserve Road, St Leonards, NSW, 2065, Australia
- The University of Sydney, Sydney, Australia
| | - James W Middleton
- John Walsh Centre for Rehabilitation Research, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Kolling Institute of Medical Research, Level 12, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
| | - Allison Malcolm
- Neurogastroenterology Unit and Department of Gastroenterology, Royal North Shore Hospital, Reserve Road, St Leonards, NSW, 2065, Australia.
- The University of Sydney, Sydney, Australia.
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Influence of repetitive peripheral magnetic stimulation on neural plasticity in the motor cortex related to swallowing. Int J Rehabil Res 2016; 39:263-6. [PMID: 27262135 DOI: 10.1097/mrr.0000000000000180] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study was to evaluate the effect of repetitive peripheral magnetic stimulation at two different frequencies (20 and 30 Hz) on cortical excitability in motor areas related to swallowing in healthy individuals. The study participants were 10 healthy normal volunteers (two women and eight men, age range 25-36 years). Repetitive peripheral magnetic stimulation was applied to the submandibular muscle using a parabolic coil at the site where contraction of the suprahyoid muscles was elicited. Stimulation was continued for 10 min (total 1200 pulses) at 20 Hz on 1 day and at 30 Hz on another day, with the stimulation strength set at 90% of the intensity that elicited pain. The motor-evoked potential amplitude of suprahyoid muscles was assessed before, immediately after, and 30 min after stimulation. Stimulations at both 20 and 30 Hz significantly increased motor-evoked potential amplitude (P<0.05), with the increase maintained until 30 min after stimulation. The motor-evoked potential amplitude immediately after stimulation was not significantly different between the 20 and 30 Hz frequencies. The results indicated that repetitive magnetic stimulation increased motor-evoked potential amplitude of swallowing muscles, suggesting facilitation of the motor cortex related to swallowing in healthy individuals.
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Abnormal feeding behaviour in spinalised rats is mediated by hypothalamus: Restorative effect of exposure to extremely low frequency magnetic field. Spinal Cord 2016; 54:1076-1087. [PMID: 27163452 DOI: 10.1038/sc.2016.32] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Revised: 02/14/2016] [Accepted: 02/16/2016] [Indexed: 01/26/2023]
Abstract
STUDY DESIGN Experimental study. OBJECTIVES To investigate the role of hypothalamus in abnormal feeding behaviour after spinal cord injury (SCI) and the effect of exposure to extremely low frequency magnetic field (ELF-MF) on it. SETTING India. METHODS Male Wistar rats (n=44) were divided into Sham (laminectomy), SCI (complete transection of T13 spinal cord), SCI+MF (ELF-MF exposure to SCI rats), VMHL (lesion of ventromedial hypothalamus; VMH), SCI+VMHL (VMHL after SCI) and SCI+VMHL+MF (ELF-MF exposure to SCI+VMHL rats) groups. Food intake (FI), water intake (WI), calorie intake (CI), body weight (BWT), taste preference and sucrose-induced biphasic (SIB) response to noxious stimulus were studied pre and post surgery. Neuronal activity at VMH was assessed by c-Fos immunohistochemistry. The extent of neuronal degeneration and regeneration in spinal cord was assessed microscopically. RESULTS Data revealed post-SCI decrease in FI, WI, CI and BWT, preference for sodium chloride and citric acid, prolonged analgesic phase of SIB and increased c-Fos immunoreactivity in VMH of SCI rats vs Sham rats. VMH lesion increased FI, WI, CI, BW, preference for sweet tastants and abolished SIB, whereas in SCI+VMHL rats it abolished the effects of SCI on these parameters indicating probable involvement of VMH in SCI-induced alteration in feeding behaviour. Exposure to MF improved the study parameters in SCI rats and reduced the c-Fos immunoreactivity in VMH besides reduction in lesion volume, greater myelination and neuronal regeneration at SCI site. CONCLUSION SCI influences VMH, leading to alteration in feeding behaviour, which is improved by exposure to ELF-MF.
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Momosaki R, Abo M, Watanabe S, Kakuda W, Yamada N, Kinoshita S. Repetitive Peripheral Magnetic Stimulation With Intensive Swallowing Rehabilitation for Poststroke Dysphagia: An Open-Label Case Series. Neuromodulation 2015; 18:630-4; discussion 634-5. [PMID: 25950817 DOI: 10.1111/ner.12308] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 03/04/2015] [Accepted: 04/01/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose of this pilot study was to determine the safety and feasibility of a six-day protocol of in-hospital repetitive peripheral magnetic stimulation combined with intensive swallowing rehabilitation (rPMS-ISR) for poststroke dysphagia. METHODS The subjects were eight patients with dysphagia caused by bilateral cerebral infarction (age: 62-70; time from onset of stroke: 27-39 months). rPMS was applied to the suprahyoid muscles, at strength set at 90% of the minimal intensity that elicited pain with a parabolic coil. One train of stimuli comprised 20 Hz for 3 sec followed by 27-sec rest. A single session included delivery of repetitive 20 trains of stimuli over 10 min, followed by 20 min of swallowing rehabilitation. Each patient received this combination treatment twice daily, morning and afternoon, over six consecutive days. Swallowing function was evaluated before and after intervention. RESULTS rPMS-ISR induced significant improvement in swallowing ability, laryngeal elevation delay time, penetration aspiration scale, and swallowing quality of life (p < 0.01), but had no significant effect on the functional oral intake scale. CONCLUSION The six-day in-hospital RPMS-ISR protocol seems safe and feasible for poststroke patients with dysphagia. The combination protocol improved swallowing function. Further larger studies are needed to confirm its efficacy.
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Affiliation(s)
- Ryo Momosaki
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Minato-Ku, Tokyo, Japan
| | - Masahiro Abo
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Minato-Ku, Tokyo, Japan
| | - Shu Watanabe
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Minato-Ku, Tokyo, Japan
| | - Wataru Kakuda
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Minato-Ku, Tokyo, Japan
| | - Naoki Yamada
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Minato-Ku, Tokyo, Japan
| | - Shoji Kinoshita
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Minato-Ku, Tokyo, Japan
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Pal A, Singh A, Nag TC, Chattopadhyay P, Mathur R, Jain S. Iron oxide nanoparticles and magnetic field exposure promote functional recovery by attenuating free radical-induced damage in rats with spinal cord transection. Int J Nanomedicine 2013; 8:2259-72. [PMID: 23818782 PMCID: PMC3693820 DOI: 10.2147/ijn.s44238] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Iron oxide nanoparticles (IONPs) can attenuate oxidative stress in a neutral pH environment in vitro. In combination with an external electromagnetic field, they can also facilitate axon regeneration. The present study demonstrates the in vivo potential of IONPs to recover functional deficits in rats with complete spinal cord injury. METHODS The spinal cord was completely transected at the T11 vertebra in male albino Wistar rats. Iron oxide nanoparticle solution (25 μg/mL) embedded in 3% agarose gel was implanted at the site of transection, which was subsequently exposed to an electromagnetic field (50 Hz, 17.96 μT for two hours daily for five weeks). RESULTS Locomotor and sensorimotor assessment as well as histological analysis demonstrated significant functional recovery and a reduction in lesion volume in rats with IONP implantation and exposure to an electromagnetic field. No collagenous scar was observed and IONPs were localized intracellularly in the immediate vicinity of the lesion. Further, in vitro experiments to explore the cytotoxic effects of IONPs showed no effect on cell survival. However, a significant decrease in H2O2-mediated oxidative stress was evident in the medium containing IONPs, indicating their free radical scavenging properties. CONCLUSION These novel findings indicate a therapeutic role for IONPs in spinal cord injury and other neurodegenerative disorders mediated by reactive oxygen species.
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Affiliation(s)
- Ajay Pal
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
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Neurostimulation for neurogenic bowel dysfunction. Gastroenterol Res Pract 2013; 2013:563294. [PMID: 23573076 PMCID: PMC3618949 DOI: 10.1155/2013/563294] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 02/20/2013] [Indexed: 12/11/2022] Open
Abstract
Background. Loss of normal bowel function caused by nerve injury, neurological disease or congenital defects of the nervous system is termed neurogenic bowel dysfunction (NBD). It usually includes combinations of fecal incontinence, constipation, abdominal pain and bloating. When standard treatment of NBD fails surgical procedures are often needed. Neurostimulation has also been investigated, but no consensus exists about efficacy or clinical use. Methods. A systematic literature search of NBD treated by sacral anterior root stimulation (SARS), sacral nerve stimulation (SNS), peripheral nerve stimulation, magnetic stimulation, and nerve re-routing was made in Pubmed, Embase, Scopus, and the Cochrane Library. Results. SARS improves bowel function in some patients with complete spinal cord injury (SCI). Nerve re-routing is claimed to facilitate defecation through mechanical stimulation of dermatomes in patients with complete or incomplete SCI or myelomeningocele. SNS can reduce NBD in selected patients with a variety of incomplete neurological lesions. Peripheral stimulation using electrical stimulation or magnetic stimulation may represent non-invasive alternatives. Conclusion. Numerous methods of neurostimulation to treat NBD have been investigated in pilot studies or retrospective studies. Therefore, larger controlled trials with well-defined inclusion criteria and endpoints are recommended before widespread clinical use of neurostimulation against NBD.
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Krassioukov A, Eng JJ, Claxton G, Sakakibara BM, Shum S. Neurogenic bowel management after spinal cord injury: a systematic review of the evidence. Spinal Cord 2010; 48:718-33. [PMID: 20212501 PMCID: PMC3118252 DOI: 10.1038/sc.2010.14] [Citation(s) in RCA: 126] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
STUDY DESIGN Randomized-controlled trials (RCTs), prospective cohort, case-control, pre-post studies, and case reports that assessed pharmacological and non-pharmacological intervention for the management of the neurogenic bowel after spinal cord injury (SCI) were included. OBJECTIVE To systematically review the evidence for the management of neurogenic bowel in individuals with SCI. SETTING Literature searches were conducted for relevant articles, as well as practice guidelines, using numerous electronic databases. Manual searches of retrieved articles from 1950 to July 2009 were also conducted to identify literature. METHODS Two independent reviewers evaluated each study's quality, using Physiotherapy Evidence Database scale for RCTs and Downs and Black scale for all other studies. The results were tabulated and levels of evidence assigned. RESULTS A total of 2956 studies were found as a result of the literature search. On review of the titles and abstracts, 57 studies met the inclusion criteria. Multifaceted programs are the first approach to neurogenic bowel and are supported by lower levels of evidence. Of the non-pharmacological (conservative and non-surgical) interventions, transanal irrigation is a promising treatment to reduce constipation and fecal incontinence. When conservative management is not effective, pharmacological interventions (for example prokinetic agents) are supported by strong evidence for the treatment of chronic constipation. When conservative and pharmacological treatments are not effective, surgical interventions may be considered and are supported by lower levels of evidence in reducing complications. CONCLUSIONS Often, more than one procedure is necessary to develop an effective bowel routine. Evidence is low for non-pharmacological approaches and high for pharmacological interventions.
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Affiliation(s)
- A Krassioukov
- International Collaboration on Repair Discoveries, Vancouver, British Columbia, Canada.
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Lim J, Gorman RB, Saboisky JP, Gandevia SC, Butler JE. Optimal electrode placement for noninvasive electrical stimulation of human abdominal muscles. J Appl Physiol (1985) 2007; 102:1612-7. [PMID: 17185493 DOI: 10.1152/japplphysiol.00865.2006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abdominal muscles are the most important expiratory muscles for coughing. Spinal cord-injured patients have respiratory complications because of abdominal muscle weakness and paralysis and impaired ability to cough. We aimed to determine the optimal positioning of stimulating electrodes on the trunk for the noninvasive electrical activation of the abdominal muscles. In six healthy subjects, we compared twitch pressures produced by a single electrical pulse through surface electrodes placed either posterolaterally or anteriorly on the trunk with twitch pressures produced by magnetic stimulation of nerve roots at the T10level. A gastroesophageal catheter measured gastric pressure (Pga) and esophageal pressure (Pes). Twitches were recorded at increasing stimulus intensities at functional residual capacity (FRC) in the seated posture. The maximal intensity used was also delivered at total lung capacity (TLC). At FRC, twitch pressures were greatest with electrical stimulation posterolaterally and magnetic stimulation at T10and smallest at the anterior site (Pga, 30 ± 3 and 33 ± 6 cmH2O vs. 12 ± 3 cmH2O; Pes 8 ± 2 and 11 ± 3 cmH2O vs. 5 ± 1 cmH2O; means ± SE). At TLC, twitch pressures were larger. The values for posterolateral electrical stimulation were comparable to those evoked by thoracic magnetic stimulation. The posterolateral stimulation site is the optimal site for generating gastric and esophageal twitch pressures with electrical stimulation.
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Affiliation(s)
- Julianne Lim
- Prince of Wales Medical Research Institute and University of New South Wales, Randwick, Sydney, Australia
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Shimada Y, Sakuraba T, Matsunaga T, Misawa A, Kawatani M, Itoi E. Effects of therapeutic magnetic stimulation on acute muscle atrophy in rats after hindlimb suspension. Biomed Res 2006; 27:23-7. [PMID: 16543662 DOI: 10.2220/biomedres.27.23] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
In most subjects with spinal cord injury, the spinal neurons below the level of injury are spared. Therefore, it is conceivable that the skeletal muscles innervated by these spinal nerves can be activated by applying therapeutic magnetic stimulation along the dorsal spine. The purpose of this study was to evaluate the ability of magnetic stimulation to prevent acute muscle atrophy in rats after hindlimb suspension. Forty adult male Wistar rats were randomly assigned to stimulated and non-stimulated (control) groups. Their hindlimbs were unweighted using a suspension method, causing muscle atrophy. In the stimulation group, magnetic stimulation (20 Hz, 60 min per day) was applied to the sciatic nerve for 10 days. After the stimulation period, the tibialis anterior (TA) and extensor digitorum longus (EDL) were surgically removed and histologically measured. The lesser diameters of type 1, 2A, and 2B muscle fibers were significantly greater in the stimulated group than in the non-stimulated group for both the TA and EDL (p < 0.05). The mean difference in lesser fiber diameter was 20% (range, 14%-27%). These results suggest that therapeutic magnetic stimulation is an effective method of preventing muscle atrophy.
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Affiliation(s)
- Yoichi Shimada
- Rehabilitation Division, Akita University School of Medicine, Akita, Japan.
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14
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Lin VWH, Zhu E, Sasse SA, Sassoon C, Hsiao IN. Optimal arrangement of magnetic coils for functional magnetic stimulation of the inspiratory muscles in dogs. IEEE Trans Neural Syst Rehabil Eng 2005; 13:490-6. [PMID: 16425831 DOI: 10.1109/tnsre.2005.857693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In an attempt to maximize inspiratory pressure and volume, the optimal position of a single or of dual magnetic coils during functional magnetic stimulation (FMS) of the inspiratory muscles was evaluated in twenty-three dogs. Unilateral phrenic magnetic stimulation (UPMS) or bilateral phrenic magnetic stimulation (BPMS), posterior cervical magnetic stimulation (PCMS), anterior cervical magnetic stimulation (ACMS) as well as a combination of PCMS and ACMS were performed. Trans-diaphragmatic pressure (Pdi), flow, and lung volume changes with an open airway were measured. Transdiaphragmatic pressure was also measured with an occluded airway. Changes in inspiratory parameters during FMS were compared with 1) electrical stimulation of surgically exposed bilateral phrenic nerves (BPES) and 2) ventral root electrical stimulation at C5-C7 (VRES C5-C7). Relative to the Pdi generated by BPES of 36.3 +/- 4.5 cm H2O (Mean +/- SEM), occluded Pdi(s) produced by UPMS, BPMS, PCMS, ACMS, and a combined PCMS + ACMS were 51.7%, 61.5%, 22.4%, 100.3%, and 104.5% of the maximal Pdi, respectively. Pdi(s) produced by UPMS, BPMS, PCMS, ACMS, and combined ACMS + PCMS were 38.0%, 45.2%, 16.5%, 73.8%, and 76.8%, respectively, of the Pdi induced by VRES (C5-C7) (48.0 +/- 3.9 cm H2O). The maximal Pdi(s) generated during ACMS and combined PCMS + ACMS were higher than the maximal Pdi(s) generated during UPMS, BPMS, or PCMS (p < 0.05). ACMS alone induced 129.8% of the inspiratory flow (73.0 +/- 9.4 L/ min) and 77.5% of the volume (626 +/- 556 ml) induced by BPES. ACMS and combined PCMS + ACMS produce a greater inspiratory pressure than UPMS, BPMS or PCMS. ACMS can be used to generate sufficient inspiratory pressure, flow, and volume for activation of the inspiratory muscles.
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Affiliation(s)
- Vernon Weh-Hau Lin
- Functional Magnetic Stimulation Laboratory, Spinal Cord Institute, Long Beach Veterans Affairs (VA) Healthcare System, CA 90822, USA.
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Zhou Yi Syuu W, Hsiao I, Lin VWH, Longhurst JC. Modulation of cardiovascular excitatory responses in rats by transcutaneous magnetic stimulation: role of the spinal cord. J Appl Physiol (1985) 2005; 100:926-32. [PMID: 16269522 DOI: 10.1152/japplphysiol.01130.2005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This study investigated the efficacy of magnetic stimulation on the reflex cardiovascular responses induced by gastric distension in anesthetized rats and compared these responses to those influenced by electroacupuncture (EA). Unilateral magnetic stimulation (30% intensity, 2 Hz) at the Jianshi-Neiguan acupoints (pericardial meridian, P 5-6) overlying the median nerve on the forelimb for 24 min significantly decreased the reflex pressor response by 32%. This effect was noticeable by 20 min of magnetic stimulation and continued for 24 min. Median nerve denervation abolished the inhibitory effect of magnetic stimulation, indicating the importance of somatic afferent input. Unilateral EA (0.3-0.5 mA, 2 Hz) at P 5-6 using similar durations of stimulation similarly inhibited the response (35%). The inhibitory effects of EA occurred earlier and were marginally longer (20 min) than magnetic stimulation. Magnetic stimulation at Guangming-Xuanzhong acupoints (gallbladder meridian, GB 37-39) overlying the superficial peroneal nerve on the hindlimb did not attenuate the reflex. Intravenous naloxone immediately after termination of magnetic stimulation reversed inhibition of the cardiovascular reflex, suggesting involvement of the opioid system. Also, intrathecal injection of delta- and kappa-opioid receptors antagonists, ICI174,864 (n=7) and nor-binaltorphimine (n=6) immediately after termination of magnetic stimulation reversed inhibition of the cardiovascular reflex. In contrast, the mu-opioid antagonist CTOP (n=7) failed to alter the cardiovascular reflex. The endogenous neurotransmitters for delta- and kappa-opioid receptors, enkephalins and dynorphin but not beta-endorphin, therefore appear to play significant roles in the spinal cord in mediating magnetic stimulation-induced modulation of cardiovascular reflex responses.
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MESH Headings
- Afferent Pathways/physiology
- Animals
- Blood Pressure/physiology
- Cardiovascular Physiological Phenomena
- Cardiovascular System/drug effects
- Cardiovascular System/innervation
- Electroacupuncture
- Enkephalin, Leucine/analogs & derivatives
- Enkephalin, Leucine/pharmacology
- Magnetics
- Male
- Median Nerve/physiology
- Naloxone/pharmacology
- Neurotransmitter Agents/physiology
- Opioid Peptides/physiology
- Rats
- Rats, Sprague-Dawley
- Receptors, Opioid, delta/analysis
- Receptors, Opioid, delta/antagonists & inhibitors
- Receptors, Opioid, delta/physiology
- Receptors, Opioid, kappa/analysis
- Receptors, Opioid, kappa/antagonists & inhibitors
- Receptors, Opioid, kappa/physiology
- Receptors, Opioid, mu/analysis
- Receptors, Opioid, mu/physiology
- Reflex/drug effects
- Reflex/physiology
- Spinal Cord/chemistry
- Spinal Cord/physiology
- Stomach/physiology
- Sympathetic Nervous System/drug effects
- Sympathetic Nervous System/physiology
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Affiliation(s)
- Wei Zhou Yi Syuu
- Department of Medicine, Medical Science 1 C240, College of Medicine, Univ. of California, Irvine, CA 92697-4075, USA.
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Sakuraba T, Shimada Y, Takahashi S, Matsunaga T, Itoi E, Kawatani M. The effect of magnetic stimulation on unloaded soleus muscle of rat: changes in myosin heavy chain mRNA isoforms. Biomed Res 2005; 26:15-9. [PMID: 15806979 DOI: 10.2220/biomedres.26.15] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This study assessed the potential application and the effectiveness of functional magnetic stimulation (FMS) for preventing skeletal muscle atrophy in adult rats. FMS using magnetic stimulator was performed to rat soleus muscle by placing a round magnetic coil on the back of 3rd-5th lumbar vertebral level at 20 Hz frequency for 60 min/day up to 10 days. A reverse transcriptase-polymerase chain reaction was applied to evaluate relative amounts of mRNAs specific to four myosin heavy chain (MHC) isoforms [MHCIbeta, MHCIIa, MHCIIb, and MHCIId(x)] in rat soleus muscle during contractile activity by magnetic stimulation. Ten-day unloading by hindlimb suspension induced a drastic decrease of MHCIbeta and MHCIIa mRNA expressions, while MHCIIb and MHCIId(x) mRNA was not decreased. The magnetic stimulation resuscitated the down-regulation of the mRNA levels of MHCIbeta and MHCIIa. These results suggest that magnetic stimulation on acute atrophied muscles is useful for preventing the muscle atrophy.
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Affiliation(s)
- Tsutomu Sakuraba
- Department of Orthopaedic Surgery, Section of Neuro and Locomotor Science, Akita University School of Medicine, Akita 010-8543
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Reitz A, Knapp PA, Frey S, Schurch B. Functional magnetic stimulation of the spinal cord?a urodynamic study in healthy humans. Neurourol Urodyn 2004; 23:148-53. [PMID: 14983427 DOI: 10.1002/nau.20014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
AIMS To study the effects of functional magnetic stimulation of the spinal cord in healthy subjects on somatic and autonomic pathways innervating the anal and the external urethral sphincter, bladder, bladder neck, and rectum. METHODS Eight healthy male volunteers gave their written informed consent and underwent functional magnetic stimulation of the thoracolumbar and sacral spinal cord. A two-channel microtip pressure transducer catheter was placed rectally measuring the abdominal and anal sphincter pressure. A three-channel microtip pressure transducer catheter was inserted into the urethra measuring the bladder, the bladder neck, and the external urethral sphincter pressure. A comprehensive protocol of single and repetitive magnetic stimulations was performed. Frequency, location, and duration of stimulation were varied while the intensity of stimulation was adapted to the maximum the subjects could tolerate. In four subjects, the degree of bladder filling was changed and the protocol was repeated when the subjects reported a full bladder and desire to void. RESULTS Continuous magnetic stimulation of the thoracolumbar spinal cord and the sacral roots applied with different frequencies (5, 15, 30, 60, 100 Hz) and different duration of stimulation (10, 30, 120 sec) evoked sphincter contraction of both anal and urethral sphincters. The stimulation could not evoke contractions of the bladder, the bladder neck, or the rectum. Also with filled bladder and present desire to void, the magnetic stimulation could not activate autonomic pathways innervating these structures. CONCLUSIONS Considering our results, we suggest that in individuals with preserved sensibility magnetic stimulation of the spinal cord with intensities below the pain threshold is ineffective in activating autonomic nerve fibres innervating bladder, bladder neck, and rectum.
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Affiliation(s)
- Andre Reitz
- Neuro-Urology, Swiss Paraplegic Center, Balgrist University Hospital, Zurich, Switzerland.
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de Assis Gondim F, Lopes AC, Rodrigues CL, da Graca JRV, Rola FH. Gastric emptying and gastrointestinal motility abnormalities after spinal cord injury. Arch Phys Med Rehabil 2002; 83:1479. [PMID: 12370892 DOI: 10.1016/s0003-9993(02)70077-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Lin VWH, Kim KH, Hsiao I, Brown W. Functional magnetic stimulation facilitates gastric emptying. Arch Phys Med Rehabil 2002; 83:806-10. [PMID: 12048659 DOI: 10.1053/apmr.2002.32644] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate the effect of functional magnetic stimulation (FMS) on gastric emptying in able-bodied and spinal cord injury (SCI) subjects. DESIGN A prospective, nonrandomized clinical experiment. SETTING SCI and disorder center in a Veterans Affairs medical facility. PARTICIPANTS Five healthy, able-bodied subjects and 4 subjects with SCI. INTERVENTION A commercially available magnetic stimulator was used; a round magnetic coil was placed along the T9 spinous process. The intensity of the magnetic stimulation was 60%, with a frequency of 20 Hz, and a burst length of 2 seconds for the gastric emptying protocol. Man Outcome Measures: Rate of gastric emptying and time required to reach gastric emptying half-time (GE(t1/2)) with and without FMS. Data fit into linear regression curve. RESULTS Accelerated gastric emptying was achieved in both able-bodied and SCI subjects. The mean +/- standard error of mean of the GE(t1/2) at baseline and with FMS was 36+/-2.9 minutes and 33+/-3.1 minutes, respectively, for able-bodied subjects, and 84+/-11.1 minutes and 59+/-12.7 minutes, respectively, for SCI subjects. CONCLUSION Gastric emptying was enhanced by FMS in able-bodied subjects and was greatly enhanced in SCI subjects. FMS can be a useful noninvasive therapeutic tool to facilitate gastric emptying in humans.
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Affiliation(s)
- Vernon W-H Lin
- Functional Magnetic Stimulation Laboratory, Spinal Cord Injury/Disorder Health Care Group, VA Long Beach Health Care System, Long Beach, CA 90822, USA.
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Gittler MS, McKinley WO, Stiens SA, Groah SL, Kirshblum SC. Spinal cord injury medicine. 3. Rehabilitation outcomes. Arch Phys Med Rehabil 2002; 83:S65-71, S90-8. [PMID: 11973699 DOI: 10.1053/apmr.2002.32160] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
UNLABELLED This self-directed learning module highlights rehabilitation outcomes in spinal cord injury (SCI). It is part of the chapter on SCI medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article focuses on the multiple concerns for functional recovery after SCI, chiefly, the potential for ambulation, upper-extremity recovery, options for functional neuromuscular stimulation (FNS), sexual activity, and optimal outcome after a metastatic lesion. Motor incomplete patients have a better prognosis for ambulation than persons with sensory incomplete injury. Positive predictors for ambulation, including pinprick and lower-extremity motor scores greater than 20, are discussed. Meaningful recovery can occur in the upper extremities for at least 1 year. FNS options have been developed to promote functional control of the upper extremities for persons with tetraplegia, phrenic pacing, and bladder continence. A critical component of an individual's expression of self is his/her sexuality; sexual function after SCI is described in detail, including options for treatment of erectile dysfunction and various birth control methods for women. Expectations for an appropriate rehabilitation stay for a person with metastatic SCI differ for an individual with traumatic SCI. Differences may include changing routine pathways and timelines to focus on patient-centered quality of life for transition to home. OVERALL ARTICLE OBJECTIVE To identify potential outcomes in ambulation, upper-extremity function, FNS, and sexual function after SCI and after metastatic cancer.
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Affiliation(s)
- Michelle S Gittler
- Department of Physical Medicine and Rehabilitation, Schwab Rehabilitation Hospital, Chicago, IL 60608, USA
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Chapter 25 Electric fields and currents of the small intestine and their effects on Escherichia coli. ACTA ACUST UNITED AC 2002. [DOI: 10.1016/s1877-1823(09)70141-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Lin VW, Hsiao I, Goodwin D, Perkash I. Functional magnetic stimulation facilitates colonic transit in rats. Arch Phys Med Rehabil 2001; 82:969-72. [PMID: 11441387 DOI: 10.1053/apmr.2001.23290] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To investigate the effect of functional magnetic stimulation (FMS) on colonic transit in rats. DESIGN Experimental. SETTING Functional magnetic stimulation laboratory in a Veterans Administration health care system. ANIMALS Twenty-four female Wistar rats, divided into an experimental group and a control group. INTERVENTIONS All rats had technetium 99m (Tc 99m) infused through a cecal catheter to assess colonic transit times. FMS was performed over the cervical region; a figure of 8 magnetic coil was used in the experimental group. The colon was removed and sectioned into 10 segments, and a stool sample was taken in both groups. MAIN OUTCOME MEASURES Distribution of radioactivity within the large intestine and stool were measured. RESULTS Geometric center calculations showed significant differences (p <.001) between the control group and the experimental group when the distribution of radioactivity along the colon was measured. The percentage of Tc 99m recovered from the stool in the experimental group was significantly higher than the percentage recovered from the control group. CONCLUSION FMS facilitates colonic transit in a rat model.
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Affiliation(s)
- V W Lin
- Functional Magnetic Stimulation Laboratory, Spinal Cord Injury/Disorder Health Care Group, VA Long Beach Health Care System, Long Beach, CA 90822-5201, USA
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Lin VW, Hsiao IN, Zhu E, Perkash I. Functional magnetic stimulation for conditioning of expiratory muscles in patients with spinal cord injury. Arch Phys Med Rehabil 2001; 82:162-6. [PMID: 11239305 DOI: 10.1053/apmr.2001.18230] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of functional magnetic stimulation (FMS) in conditioning expiratory muscles patients with spinal cord injury (SCI). DESIGN A prospective before-after trial. SETTING The Functional Magnetic Stimulation Laboratory of the SCI Health Care Group, VA Long Beach Health Care System, and the Spinal Cord Injury Services, Department of Veterans Affairs, Palo Alto Health Care System. PARTICIPANTS Eight men with tetraplegia. INTERVENTION Expiratory muscle training was achieved by placing a magnetic stimulator with a round magnetic coil along subjects' lower thoracic spine. MAIN OUTCOME MEASURES Measures taken were the maximal expired pressure at total lung capacity (MEP-TLC) and at functional residual capacity (MEP-FRC), expiratory reserve volume (ERV), and the forced expiratory flow rate at TLC (FEF-TLC) and at FRC (FEF-FRC) by subjects' voluntary maximal efforts. RESULTS After 4 weeks of conditioning, the mean +/- standard error of the mean values were: MEP-TLC, 55.3 +/- 8.6cmH(2)O; MEP-FRC, 29.6 +/- 5.6cmH(2)O; ERV,.57 +/-.08L; FEF-TLC, 4.3 +/- 0.5L/s; and FEF-FRC, 1.9 +/- 0.2L/s. These values correspond to, respectively, 129%, 137%, 162%, 109%, and 127% of pre-FMS conditioning values. When FMS was discontinued for 2 weeks, the MEP-TLC returned to its pre-FMS training value. CONCLUSION A 4-week protocol of FMS of the expiratory muscles improves voluntary expiratory muscle strength significantly, indicating that FMS can be a noninvasive therapeutic technology in respiratory muscle training for persons with tetraplegia.
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Affiliation(s)
- V W Lin
- Functional Magnetic Stimulation Laboratory, Spinal Cord Injury/Disorder, Health Care Group, VA Long Beach Health Care System, Long Beach, CA 90822, USA
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