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Cuadra C, De Boef A, Luong S, Wolf SL, Nichols TR, Lyle MA. Reduced inhibition from quadriceps onto soleus after acute quadriceps fatigue suggests Golgi tendon organ contribution to heteronymous inhibition. Eur J Neurosci 2024; 60:4317-4331. [PMID: 38853295 PMCID: PMC11304518 DOI: 10.1111/ejn.16438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 05/13/2024] [Accepted: 05/27/2024] [Indexed: 06/11/2024]
Abstract
Heteronymous inhibition between lower limb muscles is primarily attributed to recurrent inhibitory circuits in humans but could also arise from Golgi tendon organs (GTOs). Distinguishing between recurrent inhibition and mechanical activation of GTOs is challenging because their heteronymous effects are both elicited by stimulation of nerves or a muscle above motor threshold. Here, the unique influence of mechanically activated GTOs was examined by comparing the magnitude of heteronymous inhibition from quadriceps (Q) muscle stimulation onto ongoing soleus electromyographic at five Q stimulation intensities (1.5-2.5× motor threshold) before and after an acute bout of stimulation-induced Q fatigue. Fatigue was used to decrease Q stimulation evoked force (i.e., decreased GTO activation) despite using the same pre-fatigue stimulation currents (i.e., same antidromic recurrent inhibition input). Thus, a decrease in heteronymous inhibition after Q fatigue and a linear relation between stimulation-evoked torque and inhibition both before and after fatigue would support mechanical activation of GTOs as a source of inhibition. A reduction in evoked torque but no change in inhibition would support recurrent inhibition. After fatigue, Q stimulation-evoked knee torque, heteronymous inhibition magnitude and inhibition duration were significantly decreased for all stimulation intensities. In addition, heteronymous inhibition magnitude was linearly related to twitch-evoked knee torque before and after fatigue. These findings support mechanical activation of GTOs as a source of heteronymous inhibition along with recurrent inhibition. The unique patterns of heteronymous inhibition before and after fatigue across participants suggest the relative contribution of GTOs, and recurrent inhibition may vary across persons.
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Affiliation(s)
- Cristian Cuadra
- Division of Physical Therapy, Emory University, Atlanta, Georgia, USA
- Department of Rehabilitation Science, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
- Exercise and Rehabilitation Sciences Institute, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, Chile
| | - Adam De Boef
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Sarah Luong
- Division of Physical Therapy, Emory University, Atlanta, Georgia, USA
| | - Steven L Wolf
- Division of Physical Therapy, Emory University, Atlanta, Georgia, USA
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Health Care System, Atlanta, Georgia, USA
| | - T Richard Nichols
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Mark A Lyle
- Division of Physical Therapy, Emory University, Atlanta, Georgia, USA
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2
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Zero AM, Paris MT, Rice CL. Differential effects of stimulation frequency on isometric and concentric isotonic contractile function in human quadriceps. J Appl Physiol (1985) 2024; 137:111-124. [PMID: 38841755 DOI: 10.1152/japplphysiol.00075.2024] [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: 01/24/2024] [Revised: 04/26/2024] [Accepted: 05/28/2024] [Indexed: 06/07/2024] Open
Abstract
Electrically evoked contractions are used to assess the relationship between frequency input and contractile output to characterize inherent muscle function, and these have been done mostly with isometric contractions (i.e., no joint rotation). The purpose was to compare the electrically stimulated frequency and contractile function relationship during isometric (i.e., torque) with isotonic (i.e., concentric torque, angular velocity, and mechanical power) contractions. The knee extensors of 16 (5 female) young recreationally active participants were stimulated (∼1-2.5 s) at 14 frequencies from 1 to 100 Hz. This was done during four conditions, which were isometric and isotonic at loads of 0 (unloaded), 7.5%, and 15% isometric maximal voluntary contraction (MVC), and repeated on separate days. Comparisons across contractile parameters were made as a % of 100 Hz. Independent of the load, the mechanical power-frequency relationship was rightward shifted compared with isometric torque-frequency, concentric torque-frequency, and velocity-frequency relationships (all P ≤ 0.04). With increasing load (0%-15% MVC), the isotonic concentric torque-frequency relationship was shifted leftward systematically from 15 to 30 Hz (all P ≤ 0.04). Conversely, the same changes in load caused a rightward shift in the velocity-frequency relationship from 1 to 40 Hz (all P ≤ 0.03). Velocity was leftward shifted of concentric torque in the unloaded isotonic condition from 10 to 25 Hz (all P ≤ 0.03), but concentric torque was leftward shifted of velocity at 15% MVC isotonic condition from 10 to 50 Hz (all P ≤ 0.03). Therefore, isometric torque is not a surrogate to evaluate dynamic contractile function. Interpretations of evoked contractile function differ depending on contraction type, load, and frequency, which should be considered relative to the specific task.NEW & NOTEWORTHY In whole human muscle, we showed that the electrically stimulated power-frequency relationship was rightward shifted of the stimulated isometric torque-frequency relationship independent of isotonic load, indicating that higher stimulation frequencies are needed to achieve tetanus. Therefore, interpretations of evoked contractile function differ depending on contraction type (isometric vs. dynamic), load, and frequency. And thus, isometric measures may not be appropriate as a surrogate assessment when evaluating dynamic isotonic contractile function.
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Affiliation(s)
- Alexander M Zero
- Faculty of Health Sciences, School of Kinesiology, The University of Western Ontario, London, Ontario, Canada
| | - Michael T Paris
- Faculty of Health Sciences, School of Kinesiology, The University of Western Ontario, London, Ontario, Canada
- Faculty of Health, School of Kinesiology & Health Science, York University, Toronto, Ontario, Canada
| | - Charles L Rice
- Faculty of Health Sciences, School of Kinesiology, The University of Western Ontario, London, Ontario, Canada
- Department of Anatomy and Cell Biology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
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3
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Sousa MV, Goethel M, Becker KM, Diefenthaeler F, Fernandes RJ, de Santana Toro Batista I, Vilas-Boas JP, Ervilha U. Effect of experimentally induced muscle pain on neuromuscular control of force production. Hum Mov Sci 2024; 95:103219. [PMID: 38636393 DOI: 10.1016/j.humov.2024.103219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/20/2024] [Accepted: 04/12/2024] [Indexed: 04/20/2024]
Abstract
PURPOSE Neural and peripheral effects of induced muscle pain on explosive force production were investigated. METHODS Nine participants performed two maximal, six explosive, and six electrical stimulations induced (twitches and octets) isometric knee extensions before and after (15 min of rest) receiving an intramuscular injection of hypertonic saline (pain inducer) or isotonic (placebo) infusions in two laboratory visits separated by 7 days. RESULTS It was observed a reduction of peak torque production in maximal voluntary contraction in both conditions (9.3 and 3.3% for pain and placebo, respectively) and in the rate of torque development in placebo (7%). There was an increase in the rate of torque development for twitch and octets (10.5 and 15.8%, respectively) in the pain condition and peak torque for twitch (12%) in both conditions (as did the total rate of torque development for octets). CONCLUSION Force production decreases and increases during voluntary and involuntary contractions, respectively, suggesting that acute pain impairs force production via central mechanisms.
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Affiliation(s)
- Manoela Vieira Sousa
- Porto Biomechanics Laboratory, University of Porto, Porto 4200-450, Portugal; Center of Research, Education, Innovation and Intervention in Sport, Faculty of Sport, University of Porto, Porto 4200-450, Portugal.
| | - Márcio Goethel
- Porto Biomechanics Laboratory, University of Porto, Porto 4200-450, Portugal; Center of Research, Education, Innovation and Intervention in Sport, Faculty of Sport, University of Porto, Porto 4200-450, Portugal
| | - Klaus M Becker
- Porto Biomechanics Laboratory, University of Porto, Porto 4200-450, Portugal; Center of Research, Education, Innovation and Intervention in Sport, Faculty of Sport, University of Porto, Porto 4200-450, Portugal
| | - Fernando Diefenthaeler
- Biomechanics Laboratory, Federal University of Santa Catarina, Florianópolis 88040-900, Brazil
| | - Ricardo J Fernandes
- Porto Biomechanics Laboratory, University of Porto, Porto 4200-450, Portugal; Center of Research, Education, Innovation and Intervention in Sport, Faculty of Sport, University of Porto, Porto 4200-450, Portugal
| | - Isabella de Santana Toro Batista
- Laboratory of Physical Activity Sciences, School of Arts, Sciences, and Humanities, University of São Paulo, 03828-000 São Paulo, Brazil
| | - João Paulo Vilas-Boas
- Porto Biomechanics Laboratory, University of Porto, Porto 4200-450, Portugal; Center of Research, Education, Innovation and Intervention in Sport, Faculty of Sport, University of Porto, Porto 4200-450, Portugal
| | - Ulysses Ervilha
- Center of Research, Education, Innovation and Intervention in Sport, Faculty of Sport, University of Porto, Porto 4200-450, Portugal; Laboratory of Physical Activity Sciences, School of Arts, Sciences, and Humanities, University of São Paulo, 03828-000 São Paulo, Brazil
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Ziemkiewicz N, Au J, Chauvin HM, Garg K. Electrically stimulated eccentric contraction training enhances muscle mass, function, and size following volumetric muscle loss. J Orthop Res 2023; 41:2588-2598. [PMID: 37132367 DOI: 10.1002/jor.25591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 03/14/2023] [Accepted: 05/01/2023] [Indexed: 05/04/2023]
Abstract
Volumetric muscle loss (VML) overwhelms muscle's innate capacity for repair and can lead to permanent disability. The standard of care for VML injuries includes physical therapy, which can improve muscle function. The objective of this study was to develop and evaluate a rehabilitative therapy using electrically stimulated eccentric contraction training (EST) and determine the structural, biomolecular, and functional response of the VML-injured muscle. This study implemented EST using three different frequencies (50, 100, and 150 Hz) in VML-injured rats starting at 2 weeks postinjury. Four weeks of EST at 150 Hz showed a progressive increase in eccentric torque with an improvement in muscle mass (~39%), myofiber cross-sectional area, and peak isometric torque (~37.5%) relative to the untrained VML-injured sham group. EST at 150 Hz group also increased the number of large type 2B fibers (>5000 µm2 ). Elevated gene expression of markers associated with angiogenesis, myogenesis, neurogenesis, and an anti-inflammatory response was also observed. These results suggest that VML-injured muscles can respond and adapt to eccentric loading. The results of this study may aid in developing physical therapy regimens for traumatized muscles.
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Affiliation(s)
- Natalia Ziemkiewicz
- Department of Biomedical Engineering, Parks College of Engineering, Aviation and Technology, Saint Louis University, St. Louis, Missouri, USA
| | - Jeffrey Au
- Department of Biomedical Engineering, Parks College of Engineering, Aviation and Technology, Saint Louis University, St. Louis, Missouri, USA
| | - Hannah M Chauvin
- Department of Biomedical Engineering, Parks College of Engineering, Aviation and Technology, Saint Louis University, St. Louis, Missouri, USA
| | - Koyal Garg
- Department of Biomedical Engineering, Parks College of Engineering, Aviation and Technology, Saint Louis University, St. Louis, Missouri, USA
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Cuadra C, Wolf SL, Lyle MA. Differential effect of heteronymous feedback from femoral nerve and quadriceps muscle stimulation onto soleus H-reflex. PLoS One 2023; 18:e0290078. [PMID: 37578948 PMCID: PMC10424854 DOI: 10.1371/journal.pone.0290078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 07/31/2023] [Indexed: 08/16/2023] Open
Abstract
Excitatory feedback from muscle spindles, and inhibitory feedback from Golgi tendon organs and recurrent inhibitory circuits are widely distributed within the spinal cord to modulate activity between human lower limb muscles. Heteronymous feedback is most commonly studied in humans by stimulating peripheral nerves, but the unique effect of non-spindle heteronymous feedback is difficult to determine due to the lower threshold of excitatory spindle axons. A few studies suggest stimulation of the muscle belly preferentially elicits non-spindle heteronymous feedback. However, there remains a lack of consensus on the differential effect of nerve and muscle stimulation onto the H-reflex, and the relation of the heteronymous effects onto H-reflex compared to that onto ongoing EMG has not been determined. In this cross-sectional study, we compared excitatory and inhibitory effects from femoral nerve and quadriceps muscle belly stimulation onto soleus H-reflex size in 15 able-bodied participants and in a subset also compared heteronymous effects onto ongoing soleus EMG at 10% and 20% max. Femoral nerve stimulation elicited greater excitation of the H-reflex compared to quadriceps stimulation. The differential effect was also observed onto ongoing soleus EMG at 20% max but not 10%. Femoral nerve and quadriceps stimulation elicited similar inhibition of the soleus H-reflexes, and these results were better associated with soleus EMG at 20%. The results support surface quadriceps muscles stimulation as a method to preferentially study heteronymous inhibition at least in healthy adults. The primary benefit of using muscle stimulation is expected to be in persons with abnormal, prolonged heteronymous excitation. These data further suggest heteronymous feedback should be evaluated with H-reflex or onto ongoing EMG of at least 20% max to identify group differences or modulation of heteronymous feedback in response to treatment or task.
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Affiliation(s)
- Cristian Cuadra
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America
- Exercise and Rehabilitation Sciences Laboratory, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, Chile
| | - Steven L. Wolf
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America
- Senior Research Scientist, Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Health Care System, Atlanta, Georgia, United States of America
| | - Mark A. Lyle
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America
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Qi F, Nitsche MA, Ren X, Wang D, Wang L. Top-down and bottom-up stimulation techniques combined with action observation treatment in stroke rehabilitation: a perspective. Front Neurol 2023; 14:1156987. [PMID: 37497013 PMCID: PMC10367110 DOI: 10.3389/fneur.2023.1156987] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 06/26/2023] [Indexed: 07/28/2023] Open
Abstract
Stroke is a central nervous system disease that causes structural lesions and functional impairments of the brain, resulting in varying types, and degrees of dysfunction. The bimodal balance-recovery model (interhemispheric competition model and vicariation model) has been proposed as the mechanism of functional recovery after a stroke. We analyzed how combinations of motor observation treatment approaches, transcranial electrical (TES) or magnetic (TMS) stimulation and peripheral electrical (PES) or magnetic (PMS) stimulation techniques can be taken as accessorial physical therapy methods on symptom reduction of stroke patients. We suggest that top-down and bottom-up stimulation techniques combined with action observation treatment synergistically might develop into valuable physical therapy strategies in neurorehabilitation after stroke. We explored how TES or TMS intervention over the contralesional hemisphere or the lesioned hemisphere combined with PES or PMS of the paretic limbs during motor observation followed by action execution have super-additive effects to potentiate the effect of conventional treatment in stroke patients. The proposed paradigm could be an innovative and adjunctive approach to potentiate the effect of conventional rehabilitation treatment, especially for those patients with severe motor deficits.
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Affiliation(s)
- Fengxue Qi
- Sports, Exercise and Brain Sciences Laboratory, Beijing Sport University, Beijing, China
| | - Michael A. Nitsche
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
| | - Xiping Ren
- College of Physical Education and Health Sciences, Zhejiang Normal University, Jinhua, China
| | - Duanwei Wang
- Shandong Mental Health Center, Shandong University, Jinan, Shandong, China
| | - Lijuan Wang
- Key Laboratory of Exercise and Physical Fitness, Ministry of Education, Beijing Sport University, Beijing, China
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China
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7
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Charlesworth JD, Adlou B, Singh H, Buchfuhrer MJ. Bilateral high-frequency noninvasive peroneal nerve stimulation evokes tonic leg muscle activation for sleep-compatible reduction of restless legs syndrome symptoms. J Clin Sleep Med 2023; 19:1199-1209. [PMID: 36856064 PMCID: PMC10315589 DOI: 10.5664/jcsm.10536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 03/02/2023]
Abstract
STUDY OBJECTIVES Restless legs syndrome (RLS) is a prevalent sleep disorder with limited treatment options. Bilateral high-frequency noninvasive peroneal nerve stimulation (NPNS) reduces RLS symptoms. Here, we sought to characterize the mechanism of action for NPNS and identify predictors of treatment response. We hypothesized that, similar to voluntary leg movements, NPNS reduces RLS symptoms by activating leg muscles. METHODS For 20 adults with moderate-severe RLS, we tested this hypothesis by recording surface electromyography (EMG) from the tibialis anterior leg muscle while administering NPNS at varying amplitudes to determine the minimum NPNS amplitude that evoked EMG activity (motor threshold) and maximal NPNS amplitude that was not distracting (therapeutic intensity level). Afterwards, participants self-administered NPNS (at the therapeutic intensity level) and sham control for 14 days, each in randomized order. Efficacy was defined as International RLS Study Group Rating Scale (IRLS) score difference for NPNS compared with sham. RESULTS NPNS consistently activated leg muscles; NPNS evoked EMG activity at the therapeutic intensity level for 19 of 20 participants (mean TIL: 26.6 mA, mean MT: 18.3 mA). Evoked EMG activity was tonic (not phasic) and sustained over time. Evoked EMG activity predicted efficacy; participants with lower motor thresholds had greater IRLS improvement (r = .45, P = .046). NPNS treatment did not interfere with self-reported sleep onset (NPNS: 16% of nights; sham: 11%; P = .629) and frequently improved self-reported sleep onset (NPNS: 52% of nights; sham: 15%; P = .002). CONCLUSIONS These results demonstrate that NPNS reduces RLS symptoms by activating afferent pathways, thereby generating tonic and sustained leg muscle activity without interfering with sleep. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: Noninvasive Peripheral Nerve Stimulation for Restless Legs Syndrome; URL: https://clinicaltrials.gov/ct2/show/NCT04700683; Identifier: NCT04700683. CITATION Charlesworth JD, Adlou B, Singh H, Buchfuhrer MJ. Bilateral high-frequency noninvasive peroneal nerve stimulation evokes tonic leg muscle activation for sleep-compatible reduction of restless legs syndrome symptoms. J Clin Sleep Med. 2023;19(7):1199-1209.
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Affiliation(s)
| | | | | | - Mark J. Buchfuhrer
- Stanford University School of Medicine, Stanford, California
- Private practice, Downey, California
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8
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Trout MA, Harrison AT, Brinton MR, George JA. A portable, programmable, multichannel stimulator with high compliance voltage for noninvasive neural stimulation of motor and sensory nerves in humans. Sci Rep 2023; 13:3469. [PMID: 36859464 PMCID: PMC9977866 DOI: 10.1038/s41598-023-30545-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 02/24/2023] [Indexed: 03/03/2023] Open
Abstract
Most neural stimulators do not have a high enough compliance voltage to pass current through the skin. The few stimulators that meet the high compliance voltage necessary for transcutaneous stimulation are typically large benchtop units that are not portable, and the stimulation waveforms cannot be readily customized. To address this, we present the design and validation of a portable, programmable, multichannel, noninvasive neural stimulator that can generate three custom bipolar waveforms at ± 150 V with microsecond temporal resolution. The design is low-cost, open-source, and validated on the benchtop and with a healthy population to demonstrate its functionality for sensory and motor stimulation. Sensory stimulation included electrocutaneous stimulation targeting cutaneous mechanoreceptors at the surface of the skin and transcutaneous nerve stimulation targeting the median nerve at the wrist. Both electrocutaneous stimulation on the hand and transcutaneous stimulation at the wrist can elicit isolated tactile percepts on the hand but changes in pulse frequency are more discriminable for electrocutaneous stimulation. Also, neuromuscular electrical stimulation of the flexor digiti profundus is evoked by applying electrical stimulation directly above the muscle in the forearm and to the median and ulnar nerves in the upper arm. Muscle and nerve stimulation evoked similar grip forces and force rise times, but nerve stimulation had a significantly slower fatigue rate. The development and validation of this noninvasive stimulator and direct comparison of common sensory and motor stimulation targets in a human population constitute an important step towards more widespread use and accessibility of neural stimulation for education and research.
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Affiliation(s)
- Marshall A Trout
- Department of Electrical and Computer Engineering, University of Utah, Salt Lake City, USA.
| | - Abigail T Harrison
- Department of Biomedical Engineering, University of Utah, Salt Lake City, USA
| | - Mark R Brinton
- Department of Engineering and Physics, Elizabethtown College, Elizabethtown, USA
| | - Jacob A George
- Department of Electrical and Computer Engineering, University of Utah, Salt Lake City, USA.
- Department of Biomedical Engineering, University of Utah, Salt Lake City, USA.
- Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, USA.
- Department of Mechanical Engineering, University of Utah, Salt Lake City, USA.
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9
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Nakagawa K, Fok KL, Masani K. Neuromuscular recruitment pattern in motor point stimulation. Artif Organs 2023; 47:537-546. [PMID: 36305730 DOI: 10.1111/aor.14445] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 09/27/2022] [Accepted: 10/11/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Transcutaneous electrical stimulation on the motor points over muscle belly, i.e., motor point stimulation (MPS), is widely used in clinical settings, however it is not fully understood how MPS recruits motor nerves. Here we investigated the recruitment pattern of the motor nerve and twitch force during MPS and compared to the recruitment during peripheral nerve stimulation (PNS). METHODS Ten healthy individuals participated in this study. Using MPS on the soleus muscle and PNS on the tibial nerve, a single pulse stimulation was applied with various stimulation intensities from subthreshold to the maximum intensity. We measured the evoked potentials in the lower leg muscles and twitch force. Between MPS and PNS, we compared the recruitment curves of M-waves and the dynamics of twitch force such as duration from force onset to peak (time-to-peak). RESULTS The maximum M-wave was not different between MPS and PNS in the soleus muscle, while it was much smaller in MPS than in PNS in the other lower leg muscles. This reflected the smaller twitch force of plantarflexion in MPS than PNS. In addition, the slope of the recruitment curve for the soleus M-wave was smaller in MPS than PNS. CONCLUSION Therefore, unlike PNS, MPS can efficiently and selectively recruit motor nerves of the target muscle and gradually increase the recruitment of the motor nerve.
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Affiliation(s)
- Kento Nakagawa
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada.,Japan Society for the Promotion of Science, Tokyo, Japan.,Faculty of Sport Sciences, Waseda University, Tokorozawa, Saitama, Japan
| | - Kai Lon Fok
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada.,Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Kei Masani
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada.,Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
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10
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Lyle MA, Cuadra C, Wolf SL. Quadriceps muscle stimulation evokes heteronymous inhibition onto soleus with limited Ia activation compared to femoral nerve stimulation. Exp Brain Res 2022; 240:2375-2388. [PMID: 35881156 PMCID: PMC10314715 DOI: 10.1007/s00221-022-06422-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 07/12/2022] [Indexed: 11/30/2022]
Abstract
Heteronymous excitatory feedback from muscle spindles and inhibitory feedback from Golgi tendon organs and recurrent inhibitory circuits can influence motor coordination. The functional role of inhibitory feedback is difficult to determine, because nerve stimulation, the primary method used in humans, cannot evoke inhibition without first activating the largest diameter muscle spindle axons. Here, we tested the hypothesis that quadriceps muscle stimulation could be used to examine heteronymous inhibition more selectively when compared to femoral nerve stimulation by comparing the effects of nerve and muscle stimulation onto ongoing soleus EMG held at 20% of maximal effort. Motor threshold and two higher femoral nerve and quadriceps stimulus intensities matched by twitch evoked torque magnitudes were examined. We found that significantly fewer participants exhibited excitation during quadriceps muscle stimulation when compared to nerve stimulation (14-29% vs. 64-71% of participants across stimulation intensities) and the magnitude of heteronymous excitation from muscle stimulation, when present, was much reduced compared to nerve stimulation. Muscle and nerve stimulation resulted in heteronymous inhibition that significantly increased with increasing stimulation evoked torque magnitudes. This study provides novel evidence that muscle stimulation may be used to more selectively examine inhibitory heteronymous feedback between muscles in the human lower limb when compared to nerve stimulation.
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Affiliation(s)
- Mark A Lyle
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, 1441 Clifton Road, N.E. Room 236D, Atlanta, GA, 30322, USA.
| | - Cristian Cuadra
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, 1441 Clifton Road, N.E. Room 236D, Atlanta, GA, 30322, USA
- Exercise and Rehabilitation Sciences Laboratory, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, 7591538, Santiago, Chile
| | - Steven L Wolf
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, 1441 Clifton Road, N.E. Room 236D, Atlanta, GA, 30322, USA
- Senior Research Scientist, Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Health Care System, Atlanta, GA, USA
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11
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Drouin PJ, Forbes SPA, Liu T, Lew LA, McGarity-Shipley E, Tschakovsky ME. Muscle contraction force conforms to muscle oxygenation during constant activation voluntary forearm exercise. Exp Physiol 2022; 107:1360-1374. [PMID: 35971738 DOI: 10.1113/ep090576] [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: 06/06/2022] [Accepted: 08/11/2022] [Indexed: 11/08/2022]
Abstract
NEW FINDINGS What is the central question of this study? In electrically stimulated skeletal muscle, force production is downregulated when oxygen delivery is compromised and rapidly restored upon oxygen delivery restoration. Whether "oxygen conforming" of force production occurs during voluntary muscle activation in humans and whether it is exercise intensity dependent remains unknown. What is the main finding and its importance? Here we show in humans that force at a given voluntary muscle activation does conform to a decrease in oxygen delivery and rapidly and completely recovers with restoration of oxygen delivery. This oxygen conforming response of contraction force appears to happen only at higher intensities. ABSTRACT In electrically stimulated skeletal muscle, force production is downregulated when oxygen delivery is compromised and rapidly restored upon oxygen delivery restoration in the absence of cellular disturbance. Whether this "oxygen conforming" response of force occurs and is exercise intensity dependent during stable voluntary muscle activation in humans is unknown. In 12-participants (6-female), handgrip force, forearm muscle activation (electromyography; EMG), muscle oxygenation, and forearm blood flow (FBF) were measured during rhythmic handgrip exercise at forearm EMG achieving 50, 75 or 90% critical impulse (CI). 4-min of brachial artery compression to reduce FBF by ∼60% (Hypoperfusion) or sham compression (adjacent to artery; Control) was performed during exercise. Sham compression had no effect. Hypoperfusion rapidly reduced muscle oxygenation at all exercise intensities, resulting in contraction force per muscle activation (force/EMG) progressively declining over 4 min by ∼16% in 75 and 90% CI. No force/EMG decline occurred in 50% CI. Rapid restoration of muscle oxygenation post-compression was closely followed by force/EMG such that it was not different from Control within 30-sec for 90% CI and after 90-sec for 75% CI. Our findings reveal an oxygen conforming response does occur in voluntary exercising muscle in humans. Within the exercise modality and magnitude of fluctuation of oxygenation in this study, the oxygen conforming response appears to be exercise intensity dependent. Mechanisms responsible for this oxygen conforming response have implications for exercise tolerance and warrant investigation. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Patrick J Drouin
- Human Vascular Control Laboratory, School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, K7L 3N6, Canada
| | - Stacey P A Forbes
- Human Vascular Control Laboratory, School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, K7L 3N6, Canada
| | - Taylor Liu
- Human Vascular Control Laboratory, School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, K7L 3N6, Canada
| | - Lindsay A Lew
- Cardiovascular Stress Response Laboratory, School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, K7L 3N6, Canada
| | - Ellen McGarity-Shipley
- Cardiovascular Stress Response Laboratory, School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, K7L 3N6, Canada
| | - Michael E Tschakovsky
- Human Vascular Control Laboratory, School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, K7L 3N6, Canada
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12
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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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13
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Bekhet AH, Jahan AM, Bochkezanian V, Musselman KE, Elsareih AA, Gorgey AS. Effects of Electrical Stimulation Training on Body Composition Parameters After Spinal Cord Injury: A Systematic Review. Arch Phys Med Rehabil 2022; 103:1168-1178. [PMID: 34687676 DOI: 10.1016/j.apmr.2021.09.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 08/10/2021] [Accepted: 09/05/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine the effects of neuromuscular electrical stimulation (NMES) or functional electrical stimulation (FES), or both, training on different body composition parameters in individuals with spinal cord injury. DATA SOURCES Three independent reviewers searched PubMed, Web of Science, Scopus, Cochrane Central, and Virtual Health Library until March 2020. STUDY SELECTION Studies were included if they applied NMES/FES on the lower limb muscles after spinal cord injury, reported stimulation parameters (frequency, pulse duration, and amplitude of current), and body composition parameters, which included muscle cross-sectional area (CSA), fat-free mass, lean mass (LM), fat mass, visceral adipose tissue, and intramuscular fat. DATA SYNTHESIS A total of 46 studies were included in the final analysis with a total sample size of 414 subjects. NMES loading exercise and FES cycling exercise were commonly used for training. Increases in muscle CSA ranged from 5.7-75%, with an average of 26% (n=33). Fifteen studies reported changes (both increase and decrease) in LM or fat-free mas ranged from -4% to 35%, with an average of less than 5%. Changes in fat mass (n=10) were modest. The effect on ectopic adipose tissue is inconclusive, with 2 studies showing an average reduction in intramuscular fat by 9.9%. Stimulation parameters ranged from 200-1000 μs for pulse duration, 2-60 Hz for the frequency, and 10-200 mA in amplitude. Finally, increase in weekly training volumes after NMES loading exercise resulted in a remarkable increase in percentage changes in LM or muscle CSA. CONCLUSIONS NMES/FES is an effective rehabilitation strategy for muscle hypertrophy and increasing LM. Weekly training volumes are associated with muscle hypertrophy after NMES loading exercise. Furthermore, positive muscle adaptations occur despite the applied stimulation parameters. Finally, the included studies reported wide range of stimulation parameters without reporting rationale for such selection.
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Affiliation(s)
| | - Alhadi M Jahan
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, Canada
| | - Vanesa Bochkezanian
- Department of Exercise and Health Sciences, School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD, Australia
| | - Kristin E Musselman
- KITE, Toronto Rehabilitation Institute-University Health Network, Toronto, Canada; Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada; Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Amr A Elsareih
- Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Ashraf S Gorgey
- Faculty of Physical Therapy, Cairo University, Giza, Egypt; Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire VAMC, 1201 Broad Rock Boulevard, Richmond, VA; Virginia Commonwealth University, Department of Physical Medicine & Rehabilitation, Richmond, VA.
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14
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Yacyshyn AF, McNeil CJ. Intrinsic Neuromuscular Fatigability in Humans: The Critical Role of Stimulus Frequency. Exerc Sport Sci Rev 2022; 50:97-103. [PMID: 35025843 DOI: 10.1249/jes.0000000000000283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Electrically evoked contractions provide insight into intrinsic neuromuscular fatigability and also represent a valuable technique to maintain muscle mass in a clinical setting. To appropriately investigate intrinsic fatigability and design optimal stimulation protocols, it would seem to be crucial to stimulate the muscle at a frequency equivalent to the mean motor unit discharge rate expected at the target force level.
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Affiliation(s)
- Alexandra F Yacyshyn
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada
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15
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Vieira DCL, Vieira A, Dos Santos MA, Da Cunha RR, Lage V, Blazevich AJ, Bottaro M. Concurrent Achilles tendon vibration and tibial nerve stimulation to estimate persistent inward current strength in motoneurons. Eur J Transl Myol 2021; 31. [PMID: 34897294 PMCID: PMC8758954 DOI: 10.4081/ejtm.2021.10045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 10/22/2021] [Indexed: 11/23/2022] Open
Abstract
Vibratory (Tvib) and sustained (Tsust) torque responses to concurrent Achilles tendon vibration and neuromuscular electrical stimulation applied over the muscle belly (vib+stim) are used as indicators of motoneuron facilitation and, theoretically, persistent inward current strength. However, neuromuscular electrical stimulation (NMES) applied to the nerve trunk may potentiate motoneuronal excitability more than muscle belly NMES, yet it remains unclear whether NMES applied over the nerve evokes robust Tvib and Tsust responses when used during the vib+stim protocol. This study tested whether a nerve-targeted vib+stim protocol elicits Tvib and Tsust responses in the ankle plantar flexors with acceptable intra- and inter-session reliability. Fifteen men performed the vib+stim protocol with NMES applied over the tibial nerve three times across two sessions; twice in a single session (5-min apart) to test intrasession reliability and then again after 48 h to test intersession reliability. Intraclass correlation coefficients (ICC3,1), within-participant coefficients of variation (CV) and pairwise comparisons were used to verify relative and absolute reliability as well as systematic bias. Thirteen men presented Tvib and Tsust responses (response rate of 87%). Intrasession Tvib and Tsust ICCs were >0.73 but inter-session ICCs were <0.5. Although no systematic bias was detected (p>0.05), both intra- and inter-session CVs were large (>10%) for Tvib and Tsust. The Vib+stim protocol with NMES applied over the nerve evoked Tvib and Tsust in almost all participants, but presented a large intra- and inter-session variability. The method does not appear to be effective for assessing motoneuron facilitation in the plantar flexors.
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Affiliation(s)
| | - Amilton Vieira
- College of Physical Education, University of Brasilia, Federal District.
| | | | | | - Victor Lage
- College of Physical Education, University of Brasilia, Federal District.
| | - Anthony J Blazevich
- Centre for Exercise and Sports Science Research, School of Medical and Health Sciences, Edith Cowan University, Joondalup.
| | - Martim Bottaro
- College of Physical Education, University of Brasilia, Federal District.
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16
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Ibáñez J, Angeli CA, Harkema SJ, Farina D, Rejc E. Recruitment order of motor neurons promoted by epidural stimulation in individuals with spinal cord injury. J Appl Physiol (1985) 2021; 131:1100-1110. [PMID: 34382840 PMCID: PMC8461808 DOI: 10.1152/japplphysiol.00293.2021] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Spinal cord epidural stimulation (scES) combined with activity-based training can promote motor function recovery in individuals with motor complete spinal cord injury (SCI). The characteristics of motor neuron recruitment, which influence different aspects of motor control, are still unknown when motor function is promoted by scES. Here, we enrolled five individuals with chronic motor complete SCI implanted with a scES unit to study the recruitment order of motor neurons during standing enabled by scES. We recorded high-density electromyography (HD-EMG) signals on the vastus lateralis muscle, and inferred the order of recruitment of motor neurons from the relation between amplitude and conduction velocity of the scES-evoked EMG responses along the muscle fibers. Conduction velocity of scES-evoked responses was modulated over time, while stimulation parameters and standing condition remained constant, with average values ranging between 3.0±0.1 and 4.4±0.3 m/s. We found that the human spinal circuitry receiving epidural stimulation can promote both orderly (according to motor neuron size) and inverse trends of motor neuron recruitment, and that the engagement of spinal networks promoting rhythmic activity may favor orderly recruitment trends. Conversely, the different recruitment trends did not appear to be related with time since injury or scES implant, nor to the ability to achieve independent knees extension, nor to the conduction velocity values. The proposed approach can be implemented to investigate the effects of stimulation parameters and training-induced neural plasticity on the characteristics of motor neuron recruitment order, contributing to improve mechanistic understanding and effectiveness of epidural stimulation-promoted motor recovery after SCI.
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Affiliation(s)
- Jaime Ibáñez
- Department of Bioengineering, Imperial College London, London, United Kingdom.,Department of Clinical and Movement Disorders, Institute of Neurology, University College London, London, United Kingdom
| | - Claudia A Angeli
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, United States.,Department of Bioengineering, University of Louisville, Louisville, Kentucky, United States.,Frazier Rehabilitation Institute, University of Louisville Health, Louisville, Kentucky, United States
| | - Susan J Harkema
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, United States.,Department of Bioengineering, University of Louisville, Louisville, Kentucky, United States.,Frazier Rehabilitation Institute, University of Louisville Health, Louisville, Kentucky, United States.,Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, United States
| | - Dario Farina
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Enrico Rejc
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, United States.,Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, United States
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17
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Shin H, Hawari MA, Hu X. Activation of Superficial and Deep Finger Flexors Through Transcutaneous Nerve Stimulation. IEEE J Biomed Health Inform 2021; 25:2575-2582. [PMID: 33259310 DOI: 10.1109/jbhi.2020.3041669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Functional electrical stimulation (FES) is a common technique to elicit muscle contraction and help improve muscle strength. Traditional FES over the muscle belly typically only activates superficial muscle regions. In the case of hand FES, this prevents the activation of the deeper flexor muscles which control the distal finger joints. Here, we evaluated whether an alternative transcutaneous nerve-bundle stimulation approach can activate both superficial and deep extrinsic finger flexors using a high-density stimulation grid. METHODS Transverse ultrasound of the forearm muscles was used to obtain cross-sectional images of the underlying finger flexors during stimulated finger flexions and kinematically-matched voluntary motions. Finger kinematics were recorded, and an image registration method was used to capture the large deformation of the muscle regions during each flexion. This deformation was used as a surrogate measure of the contraction of muscle tissue, and the regions of expanding tissue can identify activated muscles. RESULTS The nerve-bundle stimulation elicited contractions in the superficial and deep finger flexors. Both separate and concurrent activation of these two muscles were observed. Joint kinematics of the fingers also matched the expected regions of muscle contractions. CONCLUSIONS Our results showed that the nerve-bundle stimulation technique can activate the deep extrinsic finger flexors, which are typically not accessible via traditional surface FES. SIGNIFICANCE Our nerve-bundle stimulation method enables us to produce the full range of motion of different joints necessary for various functional grasps, which could benefit future neuroprosthetic applications.
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18
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Inns TB, McCormick D, Greig CA, Atherton PJ, Phillips BE, Piasecki M. Factors associated with electrical stimulation-induced performance fatigability are dependent upon stimulation location. Exp Physiol 2021; 106:828-836. [PMID: 33638246 DOI: 10.1113/ep089204] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 02/23/2021] [Indexed: 12/14/2022]
Abstract
NEW FINDINGS What is the central question of this study? How does peripheral nerve stimulation (PNS) compare with neuromuscular electrical stimulation (NMES) used clinically to reduce muscle atrophy? What is the main finding and its importance? NMES resulted in progressive increases in M-wave duration and delay of muscle relaxation throughout a single stimulation protocol, findings not observed with PNS. This suggests PNS recruits from a wider pool of muscle fibres/motor units, providing a more favourable alternative to NMES for rehabilitation intervention. ABSTRACT Neuromuscular electrical stimulation (NMES) is increasingly viewed as a central tenet to minimise muscle loss during periods of disuse/illness - typically applied directly over a muscle belly. Peripheral nerve stimulation (PNS) is afforded less attention, despite providing a more global contractile stimulus to muscles. We investigated NMES versus PNS in relation to performance fatigability and peripheral contributions to voluntary force capacity. Two fatigue protocols were assessed separately: (1) over-quadriceps NMES and (2) peripheral (femoral) nerve stimulation (PNS). Before and after each session, a maximal voluntary contraction (MVC) was performed to assess force loss. Knee-extensor force was measured throughout to assess contractile function in response to submaximal electrical stimulation, and M-wave features quantified myoelectrical activity. NMES and PNS induced similar voluntary (MVC, NMES: -12 ± 9%, PNS: -10 ± 8%, both P < 0.001) and stimulated (NMES: -45 ± 12%, PNS -27 ± 27%, both P < 0.001) force reductions. Although distinct between protocols, myoelectrical indicators of muscle recruitment (M-wave area and amplitude) and nerve conduction time did not change throughout either protocol. Myoelectrical propagation speed, represented as M-wave duration, and the delay before muscle relaxation began both progressively increased during NMES only (P < 0.05 and P < 0.001, respectively). NMES myoelectrical changes suggested performance fatigability, indicating activation of superficial fibres only, which was not observed with PNS. This suggests PNS recruits a wider pool of muscle fibres and motor units and is a favourable alternative for rehabilitation. Future work should focus on implementing PNS interventions in clinically relevant scenarios such as immobilisation, care homes and critical illness.
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Affiliation(s)
- Thomas B Inns
- Clinical, Metabolic and Molecular Physiology, MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Daniel McCormick
- Clinical, Metabolic and Molecular Physiology, MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Carolyn A Greig
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK.,MRC-Versus Arthritis Research UK Centre for Musculoskeletal Ageing Research, NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Philip J Atherton
- Clinical, Metabolic and Molecular Physiology, MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Bethan E Phillips
- Clinical, Metabolic and Molecular Physiology, MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Mathew Piasecki
- Clinical, Metabolic and Molecular Physiology, MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
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19
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Gonnelli F, Rejc E, Giovanelli N, Floreani M, Porcelli S, Harkema S, Willhite A, Stills S, Richardson T, Lazzer S. Effects of NMES pulse width and intensity on muscle mechanical output and oxygen extraction in able-bodied and paraplegic individuals. Eur J Appl Physiol 2021; 121:1653-1664. [PMID: 33656575 DOI: 10.1007/s00421-021-04647-y] [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: 09/17/2020] [Accepted: 02/15/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE Neuromuscular Electrical Stimulation (NMES) is commonly used in neuromuscular rehabilitation protocols, and its parameters selection substantially affects the characteristics of muscle activation. Here, we investigated the effects of short pulse width (200 µs) and higher intensity (short-high) NMES or long pulse width (1000 µs) and lower intensity (long-low) NMES on muscle mechanical output and fractional oxygen extraction. Muscle contractions were elicited with 100 Hz stimulation frequency, and the initial torque output was matched by adjusting stimulation intensity. METHODS Fourteen able-bodied and six spinal cord-injured (SCI) individuals participated in the study. The NMES protocol (75 isometric contractions, 1-s on-3-s off) targeting the knee extensors was performed with long-low or short-high NMES applied over the midline between anterior superior iliac spine and patella protrusion in two different days. Muscle work was estimated by torque-time integral, contractile properties by rate of torque development and half-relaxation time, and vastus lateralis fractional oxygen extraction was assessed by Near-Infrared Spectroscopy (NIRS). RESULTS Torque-time integral elicited by the two NMES paradigms was similar throughout the stimulation protocol, with differences ranging between 1.4% (p = 0.877; able-bodied, mid-part of the protocol) and 9.9% (p = 0.147; SCI, mid-part of the protocol). Contractile properties were also comparable in the two NMES paradigms. However, long-low NMES resulted in higher fractional oxygen extraction in able-bodied (+ 36%; p = 0.006). CONCLUSION Long-low and short-high NMES recruited quadriceps femoris motor units that demonstrated similar contractile and fatigability properties. However, long-low NMES conceivably resulted in the preferential recruitment of vastus lateralis muscle fibers as detected by NIRS.
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Affiliation(s)
- Federica Gonnelli
- Department of Medicine, University of Udine, Udine, Italy.,School of Sport Sciences, University of Udine, Udine, Italy.,Kentucky Spinal Cord Injury Research Center, University of Louisville, 220 Abraham Flexner Way, Louisville, KY, 40202, USA
| | - Enrico Rejc
- Kentucky Spinal Cord Injury Research Center, University of Louisville, 220 Abraham Flexner Way, Louisville, KY, 40202, USA. .,Department of Neurosurgery, University of Louisville, Louisville, KY, USA.
| | - Nicola Giovanelli
- Department of Medicine, University of Udine, Udine, Italy.,School of Sport Sciences, University of Udine, Udine, Italy
| | - Mirco Floreani
- Department of Medicine, University of Udine, Udine, Italy.,School of Sport Sciences, University of Udine, Udine, Italy
| | - Simone Porcelli
- Department of Molecular Medicine, University of Pavia, Pavia, Italy.,Institute of Biomedical Technologies, National Research Council, Segrate, Italy
| | - Susan Harkema
- Kentucky Spinal Cord Injury Research Center, University of Louisville, 220 Abraham Flexner Way, Louisville, KY, 40202, USA.,Department of Neurosurgery, University of Louisville, Louisville, KY, USA.,Department of Bioengineering, University of Louisville, Louisville, KY, USA
| | - Andrea Willhite
- Kentucky Spinal Cord Injury Research Center, University of Louisville, 220 Abraham Flexner Way, Louisville, KY, 40202, USA
| | - Sean Stills
- Kentucky Spinal Cord Injury Research Center, University of Louisville, 220 Abraham Flexner Way, Louisville, KY, 40202, USA
| | - Tine Richardson
- Kentucky Spinal Cord Injury Research Center, University of Louisville, 220 Abraham Flexner Way, Louisville, KY, 40202, USA
| | - Stefano Lazzer
- Department of Medicine, University of Udine, Udine, Italy.,School of Sport Sciences, University of Udine, Udine, Italy
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20
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Petraş A, Drăgoi RG, Pupazan V, Drăgoi M, Popa D, Neagu A. Using Portable Ultrasound to Monitor the Neuromuscular Reactivity to Low-Frequency Electrical Stimulation. Diagnostics (Basel) 2021; 11:diagnostics11010065. [PMID: 33401607 PMCID: PMC7824493 DOI: 10.3390/diagnostics11010065] [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: 11/11/2020] [Revised: 12/26/2020] [Accepted: 12/28/2020] [Indexed: 01/19/2023] Open
Abstract
Neuromuscular electrical stimulation (NMES) is useful for muscle strengthening and for motor restoration of stroke patients. Using a portable ultrasound instrument, we developed an M-mode imaging protocol to visualize contractions elicited by NMES in the quadriceps muscle group. To quantify muscle activation, we performed digital image processing based on the Teager–Kaiser energy operator. The proposed method was applied for 35 voluntary patients (18 women and 17 men), of 63.8 ± 14.1 years and body mass index (BMI) 30.2 ± 6.70 kg/m2 (mean ± standard deviation). Biphasic, rectangular electric pulses of 350 µs duration were applied at two frequencies (60 Hz and 120 Hz), and ultrasound was used to assess the sensory threshold (ST) and motor threshold (MT) amplitude of the NMES signal. The MT was 23.4 ± 4.94 mA, whereas the MT to ST ratio was 2.69 ± 0.57. Linear regression analysis revealed that MT correlates poorly with body mass index (R2 = 0.004) or with the thickness of the subcutaneous adipose tissue layer that covers the treated muscle (R2 = 0.013). Our work suggests that ultrasound is suitable to visualize neuromuscular reactivity during electrotherapy. The proposed method can be used in the clinic, enabling the physiotherapist to establish personalized treatment parameters.
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Affiliation(s)
- Alin Petraş
- Department of Medical Rehabilitation, Balneology and Rheumatology, Victor Babeş University of Medicine and Pharmacy Timişoara, 300041 Timişoara, Romania; (A.P.); (M.D.); (D.P.)
| | - Răzvan Gabriel Drăgoi
- Department of Medical Rehabilitation, Balneology and Rheumatology, Victor Babeş University of Medicine and Pharmacy Timişoara, 300041 Timişoara, Romania; (A.P.); (M.D.); (D.P.)
- Correspondence:
| | - Vasile Pupazan
- Department of Functional Sciences, Victor Babeş University of Medicine and Pharmacy Timişoara, 300041Timişoara, Romania; (V.P.); (A.N.)
| | - Mihai Drăgoi
- Department of Medical Rehabilitation, Balneology and Rheumatology, Victor Babeş University of Medicine and Pharmacy Timişoara, 300041 Timişoara, Romania; (A.P.); (M.D.); (D.P.)
| | - Daniel Popa
- Department of Medical Rehabilitation, Balneology and Rheumatology, Victor Babeş University of Medicine and Pharmacy Timişoara, 300041 Timişoara, Romania; (A.P.); (M.D.); (D.P.)
| | - Adrian Neagu
- Department of Functional Sciences, Victor Babeş University of Medicine and Pharmacy Timişoara, 300041Timişoara, Romania; (V.P.); (A.N.)
- Department of Physics and Astronomy, University of Missouri, Columbia, MO 65211, USA
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21
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Milosevic M, Marquez-Chin C, Masani K, Hirata M, Nomura T, Popovic MR, Nakazawa K. Why brain-controlled neuroprosthetics matter: mechanisms underlying electrical stimulation of muscles and nerves in rehabilitation. Biomed Eng Online 2020; 19:81. [PMID: 33148270 PMCID: PMC7641791 DOI: 10.1186/s12938-020-00824-w] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 10/10/2020] [Indexed: 12/11/2022] Open
Abstract
Delivering short trains of electric pulses to the muscles and nerves can elicit action potentials resulting in muscle contractions. When the stimulations are sequenced to generate functional movements, such as grasping or walking, the application is referred to as functional electrical stimulation (FES). Implications of the motor and sensory recruitment of muscles using FES go beyond simple contraction of muscles. Evidence suggests that FES can induce short- and long-term neurophysiological changes in the central nervous system by varying the stimulation parameters and delivery methods. By taking advantage of this, FES has been used to restore voluntary movement in individuals with neurological injuries with a technique called FES therapy (FEST). However, long-lasting cortical re-organization (neuroplasticity) depends on the ability to synchronize the descending (voluntary) commands and the successful execution of the intended task using a FES. Brain-computer interface (BCI) technologies offer a way to synchronize cortical commands and movements generated by FES, which can be advantageous for inducing neuroplasticity. Therefore, the aim of this review paper is to discuss the neurophysiological mechanisms of electrical stimulation of muscles and nerves and how BCI-controlled FES can be used in rehabilitation to improve motor function.
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Affiliation(s)
- Matija Milosevic
- Graduate School of Engineering Science, Department of Mechanical Science and Bioengineering, Osaka University, 1-3 Machikaneyama-cho, Toyonaka, Osaka, 560-8531, Japan.
| | - Cesar Marquez-Chin
- Institute of Biomedical Engineering, University of Toronto, 164 College Street, Toronto, ON, M5S 3G9, Canada
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, 520 Sutherland Drive, Toronto, ON, M4G 3V9, Canada
- CRANIA, University Health Network & University of Toronto, 550 University Avenue, Toronto, ON, M5G 2A2, Canada
| | - Kei Masani
- Institute of Biomedical Engineering, University of Toronto, 164 College Street, Toronto, ON, M5S 3G9, Canada
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, 520 Sutherland Drive, Toronto, ON, M4G 3V9, Canada
- CRANIA, University Health Network & University of Toronto, 550 University Avenue, Toronto, ON, M5G 2A2, Canada
| | - Masayuki Hirata
- Department of Neurological Diagnosis and Restoration, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Taishin Nomura
- Graduate School of Engineering Science, Department of Mechanical Science and Bioengineering, Osaka University, 1-3 Machikaneyama-cho, Toyonaka, Osaka, 560-8531, Japan
| | - Milos R Popovic
- Institute of Biomedical Engineering, University of Toronto, 164 College Street, Toronto, ON, M5S 3G9, Canada
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, 520 Sutherland Drive, Toronto, ON, M4G 3V9, Canada
- CRANIA, University Health Network & University of Toronto, 550 University Avenue, Toronto, ON, M5G 2A2, Canada
| | - Kimitaka Nakazawa
- Department of Life Sciences, Graduate School of Arts and Sciences, University of Tokyo, 3-8-1 Komaba, Meguro, Tokyo, 153-8902, Japan
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Yacyshyn AF, McNeil CJ. Electrically evoked force loss of the knee extensors is equivalent for young and old females and males. Appl Physiol Nutr Metab 2020; 45:1270-1276. [DOI: 10.1139/apnm-2020-0199] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Data are scant on sex-related differences for electrically evoked contractions, which assess intrinsic contractile properties while limiting spinal and supraspinal adaptations to mitigate fatigue. Furthermore, the few studies that exist use stimulus frequencies considerably higher than the natural motor unit discharge rate for the target force. The purpose of this study was to compare force loss to electrically evoked contractions at a physiological stimulus frequency among young females (n = 12), young males (n = 12), old females (n = 11), and old males (n = 11). The quadriceps of the dominant leg were fatigued by 3 min of intermittent transcutaneous muscle belly stimulation (15 Hz stimulus train to initially evoke 25% of maximal voluntary force). Impairment of tetanic contractile impulse (area under the curve) did not differ between sexes for young or old adults or between age groups, with a pooled value of 55.2% ± 12.4% control at the end of fatigue. These data contrast with previous findings at 30 Hz, when the quadriceps of females had greater fatigue resistance than males for young and old adults. The present results highlight the impact stimulus frequency has on intrinsic fatigability of muscle; the findings have implications for future fatigue paradigms and treatment approaches when utilizing electrical stimulation for rehabilitation. Novelty Fatigue was not different between sexes with a stimulation frequency comparable to discharge rates during voluntary contractions. These results highlight that stimulus frequency not only influences fatigue development but also between-group differences.
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Affiliation(s)
- Alexandra F. Yacyshyn
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, The University of British Columbia – Okanagan Campus, 1147 Research Road, Kelowna, BC V1V 1V7, Canada
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, The University of British Columbia – Okanagan Campus, 1147 Research Road, Kelowna, BC V1V 1V7, Canada
| | - Chris J. McNeil
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, The University of British Columbia – Okanagan Campus, 1147 Research Road, Kelowna, BC V1V 1V7, Canada
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, The University of British Columbia – Okanagan Campus, 1147 Research Road, Kelowna, BC V1V 1V7, Canada
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Monjo F, Zory R, Forestier N. Fatiguing Neuromuscular Electrical Stimulation Decreases the Sense of Effort During Subsequent Voluntary Contractions in Men. Neuroscience 2020; 446:113-123. [PMID: 32891703 DOI: 10.1016/j.neuroscience.2020.08.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 08/26/2020] [Accepted: 08/27/2020] [Indexed: 12/14/2022]
Abstract
As voluntary muscle fatigue increases, the perception of the effort required to produce a particular level of force also increases. This occurs because we produce greater neural outputs from the brain to compensate for the fatigue-induced loss of force. Muscle fatigue can also be generated following bouts of neuromuscular electrical stimulation (NMES), a technique widely used for rehabilitation and training purposes. Yet the effects of NMES-induced fatigue on the perception of effort have never been tested. In this study, we thus evaluated how electrically evoked fatigue would affect the sense of effort. For this purpose, we used two psychophysical tasks intended to assess effort perception: (i) a bilateral matching task in which subjects were asked to contract the elbow flexors of their reference and indicator arms with similar amounts of effort and (ii) a unilateral matching task in which they produced controlled levels of isometric force with their indicator arm and rated their perceived effort using the Borg CR10 scale. These tasks were performed before and after the biceps brachii of the indicator arm was submitted to a fatiguing NMES program that generated maximal force losses of 10-15%. Contrary to voluntary muscle fatigue, the sense of effort decreased post-NMES in both tasks despite increased neural outputs to the elbow flexors of the fatigued indicator arm. This shows that the relationship between motor command magnitude and effort perception was completely modified by NMES. It is proposed that NMES alters the sensory structures responsible for effort signal integration.
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Affiliation(s)
| | | | - Nicolas Forestier
- Université Savoie Mont Blanc, Laboratoire Interuniversitaire de Biologie de la Motricité, Chambéry, France
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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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Shin H, Hu X. Multichannel Nerve Stimulation for Diverse Activation of Finger Flexors. IEEE Trans Neural Syst Rehabil Eng 2019; 27:2361-2368. [PMID: 31634137 DOI: 10.1109/tnsre.2019.2947785] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Neuromuscular electrical stimulation (NMES) is a common approach to restore muscle strength of individuals with a neurological injury but restoring hand dexterity is still a challenge. This study sought to quantify the diversity of finger movements elicited by a multichannel nerve stimulation technique. METHODS A 2 × 8 stimulation grid, placed on the upper arm along the ulnar and median nerves, was used to activate different finger flexors by automatically switching between randomized bipolar electrodes. The forces from each individual finger as well as the high-density electromyogram (HDEMG) of the intrinsic and extrinsic flexors were recorded. The elicited finger forces were categorized using hierarchical clustering, and the 2D correlation of the spatial patterns of muscle activation was also calculated. RESULTS A wide range of movement patterns were identified, including multi-finger and single-digit movements. Additionally, a number of electrode pairs elicited similar finger movements. The muscle activation patterns showed similar and distinct spatial patterns, signifying activation redundancy. CONCLUSION These results revealed the diversity of elicitable finger movements and muscle activations. The system redundancy can be explored to compensate for system instability due to fatigue or electrode shift. The outcomes can also enable the development of an automatic calibration of the stimulation.
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Ruggiero L, Hoiland RL, Hansen AB, Ainslie PN, McNeil CJ. High-Altitude Acclimatization Improves Recovery from Muscle Fatigue. Med Sci Sports Exerc 2019; 52:161-169. [PMID: 31343519 DOI: 10.1249/mss.0000000000002100] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE We investigated the effect of high-altitude acclimatization on peripheral fatigue compared with sea level and acute hypoxia. METHODS At sea level (350 m), acute hypoxia (environmental chamber), and chronic hypoxia (5050 m, 5-9 d) (partial pressure of inspired oxygen = 140, 74 and 76 mm Hg, respectively), 12 participants (11 in chronic hypoxia) had the quadriceps of their dominant leg fatigued by three bouts of 75 intermittent electrically evoked contractions (12 pulses at 15 Hz, 1.6 s between train onsets, and 15 s between bouts). The initial peak force was ~30% of maximal voluntary force. Recovery was assessed by single trains at 1, 2, and 3 min postprotocol. Tissue oxygenation of rectus femoris was recorded by near-infrared spectroscopy. RESULTS At the end of the fatigue protocol, the impairments of peak force and peak rates of force development and relaxation were greater (all P < 0.05) in acute hypoxia (~51%, 53%, and 64%, respectively) than sea level (~43%, 43%, and 52%) and chronic hypoxia (~38%, 35%, and 48%). Peak force and rate of force development recovered faster (P < 0.05) in chronic hypoxia (pooled data for 1-3 min: ~84% and 74% baseline, respectively) compared with sea level (~73% and 63% baseline) and acute hypoxia (~70% and 55% baseline). Tissue oxygenation did not differ among conditions for fatigue or recovery (P > 0.05). CONCLUSIONS Muscle adaptations occurring with chronic hypoxia, independent of other adaptations, positively influence muscle contractility during and after repeated contractions at high altitude.
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Affiliation(s)
- Luca Ruggiero
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, CANADA
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Johnson M, Baudin P, Ley AL, Collins DF. A Warm-Up Routine That Incorporates a Plyometric Protocol Potentiates the Force-Generating Capacity of the Quadriceps Muscles. J Strength Cond Res 2019; 33:380-389. [PMID: 28595235 DOI: 10.1519/jsc.0000000000002054] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Mariska Johnson
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Pierre Baudin
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Alejandro L Ley
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Alberta, Canada
- Human Neurophysiology Laboratory, Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada
| | - David F Collins
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Alberta, Canada
- Human Neurophysiology Laboratory, Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada
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Effectiveness of Intra-anal Biofeedback and Electrical Stimulation in the Treatment of Children With Refractory Monosymptomatic Nocturnal Enuresis: A Comparative Randomized Controlled Trial. Int Neurourol J 2018; 22:295-304. [PMID: 30599501 PMCID: PMC6312976 DOI: 10.5213/inj.1836142.071] [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: 06/23/2018] [Accepted: 08/25/2018] [Indexed: 11/08/2022] Open
Abstract
Purpose To compare the effects of intra-anal biofeedback (BF) and intra-anal electrical stimulation (ES) on pelvic floor muscles (PFMs) activity, nocturnal bladder capacity, and frequency of wet night episodes in children with refractory primary monosymptomatic nocturnal enuresis (PMNE). Methods Ninety children of both sexes aged 8–12 years with refractory PMNE participated in this study. They were randomly assigned to 3 groups of equal number: control group (CON) that underwent behavioral therapy and PFM training, and 2 study groups (BF and ES) that underwent the same program in addition to intra-anal BF training and intra-anal ES, respectively. PFMs activity was assessed using electromyography, nocturnal bladder capacity was evaluated by measuring the first morning voided volume, and a nocturnal enuresis diary was used for documenting wet night episodes before treatment and after 3 months of treatment. Results After training, all groups showed statistically significant improvements in all measured outcomes compared to their pretreatment findings. The ES group showed significantly greater improvements in all measured outcomes than the CON and BF groups. Conclusions Both intra-anal BF training and ES combined with behavioral therapy and PFMs training were effective in the treatment of PMNE, with intra-anal ES being superior to BF training.
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Crago PE. Neuromodulation by combined sensory and motor stimulation in the peripheral nerve: tendon organ afferent activity. J Neural Eng 2018; 16:016015. [PMID: 30523807 DOI: 10.1088/1741-2552/aaeaa9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Neuromuscular stimulation is a therapeutic approach to treat impairments such as stroke or pain, although the resulting inputs to the nervous system due to the stimulation are not well quantified. Stimulation activates both afferents and efferents, and the resulting neural activity is a mix of the effects of both: the changes in afferent activity due to efferent physiological actions plus the alterations due to afferent stimulation. This study quantitatively describes the resulting Golgi tendon organ Ib afferent activity in response to mixed afferent and efferent stimulation. APPROACH Neural and stimulated action potentials interact by means of collision, neural resetting, and refractory block. We simulated the action potential patterns of Ib afferents in the human first dorsal interosseous during constant voluntary, stimulated, and combined contractions, varying both stimulation rate and location, and both with and without simultaneous Ib stimulation. MAIN RESULTS Efferent stimulation affects the firing rate versus force relationships of individual tendon organs, but the effects on the population mean are very small. In contrast, afferent stimulation changes the firing rate versus force relationship of individual afferents by increasing the firing rate, decreasing the force resolution, broadening the distribution of action potential rates, and temporally phase locking a portion of the action potentials. Force resolution is retained in the population mean. The effects of afferent stimulation change with the stimulation rate and location, and with receptor firing rates. SIGNIFICANCE This is the first quantitative description of the changes in afferent feedback during combined efferent and afferent nerve stimulation. The small effects of efferent stimulation on the population response implies that tendon organs could provide accurate force feedback during stimulated contractions. The effects of afferent stimulation can be altered by choice of stimulus rate and site and are generalizable to other afferents.
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Affiliation(s)
- Patrick E Crago
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, United States of America. Louis Stokes Department of Veterans Affairs Medical Center, Cleveland Functional Electrical Stimulation (FES) Center, Cleveland, OH 44106, United States of America. MetroHealth Rehabilitation Institute, MetroHealth Medical Center, Cleveland, OH 44109, United States of America
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Shin H, Zheng Y, Hu X. Variation of Finger Activation Patterns Post-stroke Through Non-invasive Nerve Stimulation. Front Neurol 2018; 9:1101. [PMID: 30619058 PMCID: PMC6301189 DOI: 10.3389/fneur.2018.01101] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 12/03/2018] [Indexed: 11/18/2022] Open
Abstract
Purpose: A transcutaneous proximal nerve stimulation technique utilizing an electrode grid along the nerve bundles has previously shown flexible activation of multiple fingers. This case study aimed to further demonstrate the ability of this novel stimulation technique to induce various finger grasp patterns in a stroke survivor. Methods: An individual with chronic hemiplegia and severe hand impairment was recruited. Electrical stimulation was delivered to different pairs of an electrode grid along the ulnar and median nerves to selectively activate different finger flexor muscles, with an automated electrode switching method. The resultant individual isometric flexion forces and forearm flexor high-density electromyography (HDEMG) were acquired to evaluate the finger activation patterns. A medium and low level of overall activation were chosen to gauge the available finger patterns for both the contralateral and paretic hands. All the flexion forces were then clustered to categorize the different types of grasp patterns. Results: Both the contralateral and paretic sides demonstrated various force clusters including single and multi-finger activation patterns. The contralateral hand showed finger activation patterns mainly centered on median nerve activation of the index, middle, and ring fingers. The paretic hand exhibited fewer total activation patterns, but still showed activation of all four fingers in some combination. Conclusion: Our results show that electrical stimulation at multiple positions along the proximal nerve bundles can elicit a select variety of finger activation patterns even in a stroke survivor with minimal hand function. This system could be further implemented for better rehabilitative training to help induce functional grasp patterns or to help regain muscle mass.
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Affiliation(s)
- Henry Shin
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh, NC, United States
| | - Yang Zheng
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh, NC, United States
| | - Xiaogang Hu
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh, NC, United States
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Mani D, Almuklass AM, Amiridis IG, Enoka RM. Neuromuscular electrical stimulation can improve mobility in older adults but the time course varies across tasks: Double-blind, randomized trial. Exp Gerontol 2018; 108:269-275. [PMID: 29738790 DOI: 10.1016/j.exger.2018.04.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 04/17/2018] [Accepted: 04/23/2018] [Indexed: 10/17/2022]
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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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James DC, Solan MC, Mileva KN. Wide-pulse, high-frequency, low-intensity neuromuscular electrical stimulation has potential for targeted strengthening of an intrinsic foot muscle: a feasibility study. J Foot Ankle Res 2018; 11:16. [PMID: 29755590 PMCID: PMC5934883 DOI: 10.1186/s13047-018-0258-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 04/19/2018] [Indexed: 11/10/2022] Open
Abstract
Background Strengthening the intrinsic foot muscles is a poorly understood and largely overlooked area. In this study, we explore the feasibility of strengthening m. abductor hallucis (AH) with a specific paradigm of neuromuscular electrical stimulation; one which is low-intensity in nature and designed to interleave physiologically-relevant low frequency stimulation with high-frequencies to enhance effective current delivery to spinal motoneurones, and enable a proportion of force produced by the target muscle to be generated from a central origin. We use standard neurophysiological measurements to evaluate the acute (~ 30 min) peripheral and central adaptations in healthy individuals. Methods The AH in the dominant foot of nine healthy participants was stimulated with 24 × 15 s trains of square wave (1 ms), constant current (150% of motor threshold), alternating (20 Hz–100 Hz) neuromuscular electrical stimulation interspersed with 45 s rest. Prior to the intervention, peripheral variables were evoked from the AH compound muscle action potential (Mwave) and corresponding twitch force in response to supramaximal (130%) medial plantar nerve stimulation. Central variables were evoked from the motor evoked potential (MEP) in response to suprathreshold (150%) transcranial magnetic stimulation of the motor cortex corresponding to the AH pathway. Follow-up testing occurred immediately, and 30 min after the intervention. In addition, the force-time-integrals (FTI) from the 1st and 24th WPHF trains were analysed as an index of muscle fatigue. All variables except FTI (T-test) were entered for statistical analysis using a single factor repeated measures ANOVA with alpha set at 0.05. Results FTI was significantly lower at the end of the electrical intervention compared to that evoked by the first train (p < 0.01). Only significant peripheral nervous system adaptations were observed, consistent with the onset of low-frequency fatigue in the muscle. In most of these variables, the effects persisted for 30 min after the intervention. Conclusions An acute session of wide-pulse, high-frequency, low-intensity electrical stimulation delivered directly to abductor hallucis in healthy feet induces muscle fatigue via adaptations at the peripheral level of the neuromuscular system. Our findings would appear to represent the first step in muscle adaptation to training; therefore, there is potential for using WPHF for intrinsic foot muscle strengthening. Electronic supplementary material The online version of this article (10.1186/s13047-018-0258-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Darren C James
- 1Sport & Exercise Science Research Centre, School of Applied Sciences, London South Bank University, 103 Borough Road, London, SE1 0AA UK
| | - Matthew C Solan
- 2Department of Trauma and Orthopaedic Surgery, Royal Surrey County Hospital, Guildford, Surrey, GU2 5XX UK
| | - Katya N Mileva
- 1Sport & Exercise Science Research Centre, School of Applied Sciences, London South Bank University, 103 Borough Road, London, SE1 0AA UK
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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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Almuklass AM, Davis L, Hamilton LD, Hebert JR, Alvarez E, Enoka RM. Pulse Width Does Not Influence the Gains Achieved With Neuromuscular Electrical Stimulation in People With Multiple Sclerosis: Double-Blind, Randomized Trial. Neurorehabil Neural Repair 2018; 32:84-93. [PMID: 29366377 DOI: 10.1177/1545968317753681] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) eventually compromises the walking ability of most individuals burdened with the disease. Treatment with neuromuscular electrical stimulation (NMES) can restore some functional abilities in persons with MS, but its effectiveness may depend on stimulus-pulse duration. OBJECTIVE To compare the effects of a 6-week intervention with narrow- or wide-pulse NMES on walking performance, neuromuscular function, and disability status of persons with relapsing-remitting MS. METHODS Individuals with MS (52.6 ± 7.4 years) were randomly assigned to either the narrow-pulse (n = 13) or wide-pulse (n = 14) group. The NMES intervention was performed on the dorsiflexor and plantar flexor muscles of both legs (10 minutes each muscle, 4 s on and 12 s off) at a tolerable level for 18 sessions across 6 weeks. Outcomes were obtained before (week 0) and after (week 7) the intervention and 4 weeks later (week 11). RESULTS There was no influence of stimulus-pulse duration on the outcomes ( P > .05); thus, the data were collapsed across groups. The NMES intervention improved ( P < .05) gait speed and walking endurance, dorsiflexor strength in the more-affected leg, plantar flexor strength in the less-affected leg, force control for plantar flexors in the less-affected leg, and self-reported levels of fatigue and walking limitations. CONCLUSION There was no influence of stimulus-pulse duration on the primary outcomes (gait speed and walking endurance). The 6-week NMES intervention applied to the lower leg muscles of persons with mild to moderate levels of disability can improve their walking performance and provide some symptom relief.
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Affiliation(s)
- Awad M Almuklass
- 1 University of Colorado, Boulder, CO, USA.,2 King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Leah Davis
- 1 University of Colorado, Boulder, CO, USA
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Simoneau-Buessinger E, Leteneur S, Bisman A, Gabrielli F, Jakobi J. Ultrasonographic quantification of architectural response in tibialis anterior to neuromuscular electrical stimulation. J Electromyogr Kinesiol 2017; 36:90-95. [DOI: 10.1016/j.jelekin.2017.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 07/25/2017] [Accepted: 07/25/2017] [Indexed: 10/19/2022] Open
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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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Cheng AJ, Neyroud D, Kayser B, Westerblad H, Place N. Intramuscular Contributions to Low-Frequency Force Potentiation Induced by a High-Frequency Conditioning Stimulation. Front Physiol 2017; 8:712. [PMID: 28979214 PMCID: PMC5611669 DOI: 10.3389/fphys.2017.00712] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 09/04/2017] [Indexed: 11/13/2022] Open
Abstract
Electrically-evoked low-frequency (submaximal) force is increased immediately following high-frequency stimulation in human skeletal muscle. Although central mechanisms have been suggested to be the major cause of this low-frequency force potentiation, intramuscular factors might contribute. Thus, we hypothesized that two intramuscular Ca2+-dependent mechanisms can contribute to the low-frequency force potentiation: increased sarcoplasmic reticulum Ca2+ release and increased myofibrillar Ca2+ sensitivity. Experiments in humans were performed on the plantar flexor muscles at a shortened, intermediate, and long muscle length and electrically evoked contractile force and membrane excitability (i.e., M-wave amplitude) were recorded during a stimulation protocol. Low-frequency force potentiation was assessed by stimulating with a low-frequency tetanus (25 Hz, 2 s duration), followed by a high-frequency tetanus (100 Hz, 2 s duration), and finally followed by another low-frequency (25 Hz, 2 s duration) tetanus. Similar stimulation protocols were performed on intact mouse single fibers from flexor digitorum brevis muscle, whereby force and myoplasmic free [Ca2+] ([Ca2+]i) were assessed. Our data show a low-frequency force potentiation that was not muscle length-dependent in human muscle and it was not accompanied by any increase in M-wave amplitude. A length-independent low-frequency force potentiation could be replicated in mouse single fibers, supporting an intramuscular mechanism. We show that at physiological temperature (31°C) this low-frequency force potentiation in mouse fibers corresponded with an increase in sarcoplasmic reticulum (SR) Ca2+ release. When mimicking the slower contractile properties of human muscle by cooling mouse single fibers to 18°C, the low-frequency force potentiation was accompanied by minimally increased SR Ca2+ release and hence it could be explained by increased myofibrillar Ca2+ sensitivity. Finally, introducing a brief 200 ms pause between the high- and low-frequency tetanus in human and mouse muscle revealed that the low-frequency force potentiation is abolished, arguing that increased myofibrillar Ca2+ sensitivity is the main intramuscular mechanism underlying the low-frequency force potentiation in humans.
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Affiliation(s)
- Arthur J Cheng
- Department of Physiology and Pharmacology, Karolinska InstitutetStockholm, Sweden
| | - Daria Neyroud
- Faculty of Biology-Medicine, Institute of Sport Sciences, University of LausanneLausanne, Switzerland.,Department of Physical Therapy, University of Florida Health Science CenterGainesville, FL, United States
| | - Bengt Kayser
- Faculty of Biology-Medicine, Institute of Sport Sciences, University of LausanneLausanne, Switzerland
| | - Håkan Westerblad
- Department of Physiology and Pharmacology, Karolinska InstitutetStockholm, Sweden
| | - Nicolas Place
- Faculty of Biology-Medicine, Institute of Sport Sciences, University of LausanneLausanne, Switzerland
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Barss TS, Ainsley EN, Claveria-Gonzalez FC, Luu MJ, Miller DJ, Wiest MJ, Collins DF. Utilizing Physiological Principles of Motor Unit Recruitment to Reduce Fatigability of Electrically-Evoked Contractions: A Narrative Review. Arch Phys Med Rehabil 2017; 99:779-791. [PMID: 28935232 DOI: 10.1016/j.apmr.2017.08.478] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 08/08/2017] [Accepted: 08/16/2017] [Indexed: 10/18/2022]
Abstract
Neuromuscular electrical stimulation (NMES) is used to produce contractions to restore movement and reduce secondary complications for individuals experiencing motor impairment. NMES is conventionally delivered through a single pair of electrodes over a muscle belly or nerve trunk using short pulse durations and frequencies between 20 and 40Hz (conventional NMES). Unfortunately, the benefits and widespread use of conventional NMES are limited by contraction fatigability, which is in large part because of the nonphysiological way that contractions are generated. This review provides a summary of approaches designed to reduce fatigability during NMES, by using physiological principles that help minimize fatigability of voluntary contractions. First, relevant principles of the recruitment and discharge of motor units (MUs) inherent to voluntary contractions and conventional NMES are introduced, and the main mechanisms of fatigability for each contraction type are briefly discussed. A variety of NMES approaches are then described that were designed to reduce fatigability by generating contractions that more closely mimic voluntary contractions. These approaches include altering stimulation parameters, to recruit MUs in their physiological order, and stimulating through multiple electrodes, to reduce MU discharge rates. Although each approach has unique advantages and disadvantages, approaches that minimize MU discharge rates hold the most promise for imminent translation into rehabilitation practice. The way that NMES is currently delivered limits its utility as a rehabilitative tool. Reducing fatigability by delivering NMES in ways that better mimic voluntary contractions holds promise for optimizing the benefits and widespread use of NMES-based programs.
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Affiliation(s)
- Trevor S Barss
- Human Neurophysiology Laboratory, Faculty of Physical Education and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Emily N Ainsley
- Human Neurophysiology Laboratory, Faculty of Physical Education and Recreation, University of Alberta, Edmonton, AB, Canada; Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
| | - Francisca C Claveria-Gonzalez
- Human Neurophysiology Laboratory, Faculty of Physical Education and Recreation, University of Alberta, Edmonton, AB, Canada; Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - M John Luu
- Human Neurophysiology Laboratory, Faculty of Physical Education and Recreation, University of Alberta, Edmonton, AB, Canada; Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
| | - Dylan J Miller
- Human Neurophysiology Laboratory, Faculty of Physical Education and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Matheus J Wiest
- Human Neurophysiology Laboratory, Faculty of Physical Education and Recreation, University of Alberta, Edmonton, AB, Canada; Biomechanics Laboratory, Department of Physical Education, Federal University of Santa Catarina, Florianópolis, Brazil
| | - David F Collins
- Human Neurophysiology Laboratory, Faculty of Physical Education and Recreation, University of Alberta, Edmonton, AB, Canada; Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada.
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Kilohertz and Low-Frequency Electrical Stimulation With the Same Pulse Duration Have Similar Efficiency for Inducing Isometric Knee Extension Torque and Discomfort. Am J Phys Med Rehabil 2017; 96:388-394. [PMID: 27680427 DOI: 10.1097/phm.0000000000000631] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To test the hypotheses that, as compared with pulsed current with the same pulse duration, kilohertz frequency alternating current would not differ in terms of evoked-torque production and perceived discomfort, and as a result, it would show the same current efficiency. DESIGN A repeated-measures design with 4 stimuli presented in random order was used to test 25 women: (1) 500-microsecond pulse duration, (2) 250-microsecond pulse duration, (3) 500-microsecond pulse duration and low carrier frequency (1 kHz), (4) 250-microsecond pulse duration and high carrier frequency (4 kHz). Isometric peak torque of quadriceps muscle was measured using an isokinetic dynamometer. Discomfort was measured using a visual analog scale. RESULTS Currents with long pulse durations induced approximately 21% higher evoked torque than short pulse durations. In addition, currents with 500 microseconds delivered greater amounts of charge than stimulation patterns using 250-microsecond pulse durations (P < 0.05). All currents presented similar discomfort. There was no difference on stimulation efficiency with the same pulse duration. CONCLUSIONS Both kilohertz frequency alternating current and pulsed current, with the same pulse duration, have similar efficiency for inducing isometric knee extension torque and discomfort. However, neuromuscular electrical stimulation (NMES) with longer pulse duration induces higher NMES-evoked torque, regardless of the carrier frequency. Pulse duration is an important variable that should receive more attention for an optimal application of NMES in clinical settings.
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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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Dankel SJ, Mattocks KT, Jessee MB, Buckner SL, Mouser JG, Loenneke JP. Do metabolites that are produced during resistance exercise enhance muscle hypertrophy? Eur J Appl Physiol 2017; 117:2125-2135. [PMID: 28776271 DOI: 10.1007/s00421-017-3690-1] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 07/24/2017] [Indexed: 12/20/2022]
Abstract
Many reviews conclude that metabolites play an important role with respect to muscle hypertrophy during resistance exercise, but their actual physiologic contribution remains unknown. Some have suggested that metabolites may work independently of muscle contraction, while others have suggested that metabolites may play a secondary role in their ability to augment muscle activation via inducing fatigue. Interestingly, the studies used as support for an anabolic role of metabolites use protocols that are not actually designed to test the importance of metabolites independent of muscle contraction. While there is some evidence in vitro that metabolites may induce muscle hypertrophy, the only study attempting to answer this question in humans found no added benefit of pooling metabolites within the muscle post-exercise. As load-induced muscle hypertrophy is thought to work via mechanotransduction (as opposed to being metabolically driven), it seems likely that metabolites simply augment muscle activation and cause the mechanotransduction cascade in a larger proportion of muscle fibers, thereby producing greater muscle growth. A sufficient time under tension also appears necessary, as measurable muscle growth is not observed after repeated maximal testing. Based on current evidence, it is our opinion that metabolites produced during resistance exercise do not have anabolic properties per se, but may be anabolic in their ability to augment muscle activation. Future studies are needed to compare protocols which produce similar levels of muscle activation, but differ in the magnitude of metabolites produced, or duration in which the exercised muscles are exposed to metabolites.
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Affiliation(s)
- Scott J Dankel
- Kevser Ermin Applied Physiology Laboratory, Department of Health, Exercise Science, and Recreation Management, The University of Mississippi, P.O. Box 1848, University, MS, 38677, USA
| | - Kevin T Mattocks
- Kevser Ermin Applied Physiology Laboratory, Department of Health, Exercise Science, and Recreation Management, The University of Mississippi, P.O. Box 1848, University, MS, 38677, USA
| | - Matthew B Jessee
- Kevser Ermin Applied Physiology Laboratory, Department of Health, Exercise Science, and Recreation Management, The University of Mississippi, P.O. Box 1848, University, MS, 38677, USA
| | - Samuel L Buckner
- Kevser Ermin Applied Physiology Laboratory, Department of Health, Exercise Science, and Recreation Management, The University of Mississippi, P.O. Box 1848, University, MS, 38677, USA
| | - J Grant Mouser
- Kevser Ermin Applied Physiology Laboratory, Department of Health, Exercise Science, and Recreation Management, The University of Mississippi, P.O. Box 1848, University, MS, 38677, USA
| | - Jeremy P Loenneke
- Kevser Ermin Applied Physiology Laboratory, Department of Health, Exercise Science, and Recreation Management, The University of Mississippi, P.O. Box 1848, University, MS, 38677, USA.
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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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Wiewelhove T, Raeder C, de Paula Simola RA, Schneider C, Döweling A, Ferrauti A. Tensiomyographic Markers Are Not Sensitive for Monitoring Muscle Fatigue in Elite Youth Athletes: A Pilot Study. Front Physiol 2017; 8:406. [PMID: 28670284 PMCID: PMC5473413 DOI: 10.3389/fphys.2017.00406] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 05/29/2017] [Indexed: 11/13/2022] Open
Abstract
Objective: Tensiomyography (TMG) is an indirect measure of a muscle's contractile properties and has the potential as a technique for detecting exercise-induced skeletal muscle fatigue. Therefore, the aim of this study was to assess the sensitivity of tensiomyographic markers to identify reduced muscular performance in elite youth athletes. Methods: Fourteen male junior tennis players (age: 14.9 ± 1.2 years) with an international (International Tennis Federation) ranking position participated in this pre-post single group trial. They completed a 4-day high-intensity interval training (HIT) microcycle, which was composed of seven training sessions. TMG markers; countermovement jump (CMJ) performance (criterion measure of fatigue); delayed onset muscle soreness; and perceived recovery and stress were measured 24 h before and after the training program. The TMG measures included maximal radial deformation of the rectus femoris muscle belly (Dm), contraction time between 10 and 90% Dm (Tc) and the rate of deformation until 10% (V10) and 90% Dm (V90), respectively. Diagnostic characteristics were assessed with a receiver-operating curve (ROC) analysis and a contingency table, in which the area under the curve (AUC), Youden's index, sensitivity, specificity, and the diagnostic effectiveness (DE) of TMG measures were reported. A minimum AUC of 0.70 and a lower confidence interval (CI) >0.50 classified "good" diagnostic markers to assess performance changes. Results: Twenty-four hours after the microcycle, CMJ performance was observed to be significantly (p < 0.001) reduced (Effect Size [ES] = -0.68), and DOMS (ES = 3.62) as well as perceived stress were significantly (p < 0.001) increased. In contrast, Dm (ES = -0.35), Tc (ES = 0.04), V10 (ES = -0.32), and V90 (ES = -0.33) remained unchanged (p > 0.05) throughout the study. ROC analysis and the data derived from the contingency table revealed that none of the tensiomyographic markers were effective diagnostic tools for detecting impaired muscular performance in elite youth athletes (AUC, 95% CI, DE%; Dm: 0.46, 0.15-0.77, 35.7%; Tc: 0.29, 0.03-0.59, 35.7%; V10: 0.71, 0.27-1.00, 35.7%; V90: 0.37, 0.10-0.65, 35.7%). Conclusion: The tensiomyographic parameters that were assessed in this study were not sensitive enough to detect muscular performance changes in elite youth athletes.However, due to the preliminary nature of the study, further research is needed to investigate the sensitivity of TMG in this population.
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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 the decline and recovery of muscle force. BMC Neurol 2017; 17:82. [PMID: 28464800 PMCID: PMC5414318 DOI: 10.1186/s12883-017-0862-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 04/22/2017] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Neuromuscular electrical stimulation (NMES) is commonly used to activate skeletal muscles and reverse muscle atrophy in clinical populations. Clinical recommendations for NMES suggest the use of short pulse widths (100-200 μs) and low-to-moderate pulse frequencies (30-50 Hz). However, this type of NMES causes rapid muscle fatigue due to the (non-physiological) high stimulation intensities and non-orderly recruitment of motor units. The use of both wide pulse widths (1000 μs) and tendon vibration might optimize motor unit activation through spinal reflex pathways and thus delay the onset of muscle fatigue, increasing muscle force and mass. Thus, the objective of this study was to examine the acute effects of patellar tendon vibration superimposed onto wide-pulse width (1000 μs) knee extensor electrical stimulation (NMES, 30 Hz) on peak muscle force, total impulse before "muscle fatigue", and the post-exercise recovery of muscle function. METHODS Tendon vibration (Vib), NMES (STIM) or NMES superimposed onto vibration (STIM + Vib) were applied in separate sessions to 16 healthy adults. Total torque-time integral (TTI), maximal voluntary contraction torque (MVIC) and indirect measures of muscle damage were tested before, immediately after, 1 h and 48 h after each stimulus. RESULTS TTI increased (145.0 ± 127.7%) in STIM only for "positive responders" to the tendon vibration (8/16 subjects), but decreased in "negative responders" (-43.5 ± 25.7%). MVIC (-8.7%) and rectus femoris electromyography (RF EMG) (-16.7%) decreased after STIM (group effect) for at least 1 h, but not after STIM + Vib. No changes were detected in indirect markers of muscle damage in any condition. CONCLUSIONS Tendon vibration superimposed onto wide-pulse width NMES increased TTI only in 8 of 16 subjects, but reduced voluntary force loss (fatigue) ubiquitously. Negative responders to tendon vibration may derive greater benefit from wide-pulse width NMES alone.
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Affiliation(s)
- Vanesa Bochkezanian
- Exercise Medicine Research Institute, Edith Cowan University, Perth, Australia. .,Centre for Sports and Exercise Science, School of Medical and Health Sciences, Edith Cowan University, Joondalup 270 Joondalup Drive, Joondalup, WA, 6027, Australia.
| | - Robert U Newton
- Exercise Medicine Research Institute, Edith Cowan University, Perth, Australia.,Centre for Sports and Exercise Science, School of Medical and Health Sciences, Edith Cowan University, Joondalup 270 Joondalup Drive, Joondalup, WA, 6027, Australia.,UQ Centre for Clinical Research, University of Queensland, Brisbane, Australia
| | - Gabriel S Trajano
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Australia
| | | | - Timothy S Pulverenti
- Centre for Sports and Exercise Science, School of Medical and Health Sciences, Edith Cowan University, Joondalup 270 Joondalup Drive, Joondalup, WA, 6027, Australia
| | - Anthony J Blazevich
- Centre for Sports and Exercise Science, School of Medical and Health Sciences, Edith Cowan University, Joondalup 270 Joondalup Drive, Joondalup, WA, 6027, Australia
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Dideriksen JL, Laine CM, Dosen S, Muceli S, Rocon E, Pons JL, Benito-Leon J, Farina D. Electrical Stimulation of Afferent Pathways for the Suppression of Pathological Tremor. Front Neurosci 2017; 11:178. [PMID: 28420958 PMCID: PMC5378793 DOI: 10.3389/fnins.2017.00178] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 03/20/2017] [Indexed: 11/13/2022] Open
Abstract
Pathological tremors are involuntary oscillatory movements which cannot be fully attenuated using conventional treatments. For this reason, several studies have investigated the use of neuromuscular electrical stimulation for tremor suppression. In a recent study, however, we found that electrical stimulation below the motor threshold also suppressed tremor, indicating involvement of afferent pathways. In this study, we further explored this possibility by systematically investigating how tremor suppression by afferent stimulation depends on the stimulation settings. In this way, we aimed at identifying the optimal stimulation strategy, as well as to elucidate the underlying physiological mechanisms of tremor suppression. Stimulation strategies varying the stimulation intensity and pulse timing were tested in nine tremor patients using either intramuscular or surface stimulation. Significant tremor suppression was observed in six patients (tremor suppression > 75% was observed in three patients) and the average optimal suppression level observed across all subjects was 52%. The efficiency for each stimulation setting, however, varied substantially across patients and it was not possible to identify a single set of stimulation parameters that yielded positive results in all patients. For example, tremor suppression was achieved both with stimulation delivered in an out-of-phase pattern with respect to the tremor, and with random timing of the stimulation. Overall, these results indicate that low-current stimulation of afferent fibers is a promising approach for tremor suppression, but that further research is required to identify how the effect can be maximized in the individual patient.
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Affiliation(s)
- Jakob L Dideriksen
- SMI, Department of Health Science and Technology, Aalborg UniversityAalborg, Denmark
| | - Christopher M Laine
- Brain-Body Dynamics Lab, University of Southern CaliforniaLos Angeles, CA, USA
| | - Strahinja Dosen
- Institute of Neurorehabilitation Systems, University Medical Center GöttingenGöttingen, Germany.,Clinic for Trauma Surgery, Orthopedics and Plastic Surgery, University Medical Center GöttingenGöttingen, Germany
| | - Silvia Muceli
- Institute of Neurorehabilitation Systems, University Medical Center GöttingenGöttingen, Germany.,Clinic for Trauma Surgery, Orthopedics and Plastic Surgery, University Medical Center GöttingenGöttingen, Germany
| | - Eduardo Rocon
- Center for Automation and Robotics, Consejo Superior de Investigaciones CientíficasArganda del Rey, Spain
| | - José L Pons
- Neural Rehabilitation Group, Instituto Cajal, Consejo Superior de Investigaciones CientíficasMadrid, Spain
| | | | - Dario Farina
- Department of Bioengineering, Imperial College LondonLondon, UK
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Bergquist AJ, Wiest MJ, Okuma Y, Collins DF. Interleaved neuromuscular electrical stimulation after spinal cord injury. Muscle Nerve 2017; 56:989-993. [PMID: 28245521 DOI: 10.1002/mus.25634] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2017] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Neuromuscular electrical stimulation (NMES) over a muscle belly (mNMES) recruits superficial motor units (MUs) preferentially, whereas NMES over a nerve trunk (nNMES) recruits MUs evenly throughout the muscle. We performed tests to determine whether "interleaving" pulses between the mNMES and nNMES sites (iNMES) reduces the fatigability of contractions for people experiencing paralysis because of chronic spinal cord injury. METHODS Plantar flexion torque and soleus electromyography (M-waves) were recorded from 8 participants. A fatigue protocol (75 contractions; 2 s on/2 s off for 5 min) was delivered by iNMES. The results were compared with previously published data collected with mNMES and nNMES in the same 8 participants. RESULTS Torque declined ∼40% more during mNMES than during nNMES or iNMES. M-waves declined during mNMES but not during nNMES or iNMES. DISCUSSION To reduce fatigability of electrically evoked contractions of paralyzed plantar flexors, iNMES is equivalent to nNMES, and both are superior to mNMES. Muscle Nerve 56: 989-993, 2017.
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Affiliation(s)
- Austin J Bergquist
- Rehabilitation Engineering Laboratory, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Matheus J Wiest
- Human Neurophysiology Laboratory, Faculty of Physical Education and Recreation, E-488 Van Vliet Centre, University of Alberta, Edmonton, Alberta, Canada, T6G 2H9
| | - Yoshino Okuma
- Human Neurophysiology Laboratory, Faculty of Physical Education and Recreation, E-488 Van Vliet Centre, University of Alberta, Edmonton, Alberta, Canada, T6G 2H9
| | - David F Collins
- Human Neurophysiology Laboratory, Faculty of Physical Education and Recreation, E-488 Van Vliet Centre, University of Alberta, Edmonton, Alberta, Canada, T6G 2H9
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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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Wiest MJ, Bergquist AJ, Schimidt HL, Jones KE, Collins DF. Interleaved neuromuscular electrical stimulation: Motor unit recruitment overlap. Muscle Nerve 2017; 55:490-499. [PMID: 27422814 DOI: 10.1002/mus.25249] [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] [Received: 11/10/2015] [Revised: 07/05/2016] [Accepted: 07/13/2016] [Indexed: 11/12/2022]
Abstract
INTRODUCTION In this study, we quantified the "overlap" between motor units recruited by single pulses of neuromuscular electrical stimulation (NMES) delivered over the tibialis anterior muscle (mNMES) and the common peroneal nerve (nNMES). We then quantified the torque produced when pulses were alternated between the mNMES and nNMES sites at 40 Hz ("interleaved" NMES; iNMES). METHODS Overlap was assessed by comparing torque produced by twitches evoked by mNMES, nNMES, and both delivered together, over a range of stimulus intensities. Trains of iNMES were delivered at the intensity that produced the lowest overlap. RESULTS Overlap was lowest (5%) when twitches evoked by both mNMES and nNMES produced 10% peak twitch torque. iNMES delivered at this intensity generated 25% of maximal voluntary dorsiflexion torque (11 Nm). DISCUSSION Low intensity iNMES leads to low overlap and produces torque that is functionally relevant to evoke dorsiflexion during walking. Muscle Nerve 55: 490-499, 2017.
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Affiliation(s)
- Matheus J Wiest
- Laboratory of Neurophysiology, Faculty of Physical Education and Recreation, 4-218 Van Vliet Complex, University of Alberta, Edmonton, Canada, T6G 2H9
| | - Austin J Bergquist
- Rehabilitation Engineering Laboratory, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Helen L Schimidt
- Laboratory of Neurophysiology, Faculty of Physical Education and Recreation, 4-218 Van Vliet Complex, University of Alberta, Edmonton, Canada, T6G 2H9.,Applied Neuromechanics Research Group, Neuromechanics Laboratory, Universidade Federal do Pampa, Uruguaiana, Brazil
| | - Kelvin E Jones
- Laboratory of Neurophysiology, Faculty of Physical Education and Recreation, 4-218 Van Vliet Complex, University of Alberta, Edmonton, Canada, T6G 2H9
| | - David F Collins
- Laboratory of Neurophysiology, Faculty of Physical Education and Recreation, 4-218 Van Vliet Complex, University of Alberta, Edmonton, Canada, T6G 2H9
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Bergquist AJ, Babbar V, Ali S, Popovic MR, Masani K. Fatigue reduction during aggregated and distributed sequential stimulation. Muscle Nerve 2016; 56:271-281. [PMID: 27862023 DOI: 10.1002/mus.25465] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2016] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Transcutaneous neuromuscular electrical stimulation (NMES) can generate muscle contractions for rehabilitation and exercise. However, NMES-evoked contractions are limited by fatigue when they are delivered "conventionally" (CONV) using a single active electrode. Researchers have developed "sequential" (SEQ) stimulation, involving rotation of pulses between multiple "aggregated" (AGGR-SEQ) or "distributed" (DISTR-SEQ) active electrodes, to reduce fatigue (torque-decline) by reducing motor unit discharge rates. The primary objective was to compare fatigue-related outcomes, "potentiation," "variability," and "efficiency" between CONV, AGGR-SEQ, and DISTR-SEQ stimulation of knee extensors in healthy participants. METHODS Torque and current were recorded during testing with fatiguing trains using each NMES type under isometric and isokinetic (180°/s) conditions. RESULTS Compared with CONV stimulation, SEQ techniques reduced fatigue-related outcomes, increased potentiation, did not affect variability, and reduced efficiency. CONCLUSIONS SEQ techniques hold promise for reducing fatigue during NMES-based rehabilitation and exercise; however, optimization is required to improve efficiency. Muscle Nerve 56: 271-281, 2017.
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Affiliation(s)
- Austin J Bergquist
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Vishvek Babbar
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Saima Ali
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Milos R Popovic
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Kei Masani
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
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