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Chandrasekaran S, Bhagat NA, Ramdeo R, Ebrahimi S, Sharma PD, Griffin DG, Stein A, Harkema SJ, Bouton CE. Targeted transcutaneous spinal cord stimulation promotes persistent recovery of upper limb strength and tactile sensation in spinal cord injury: a pilot study. Front Neurosci 2023; 17:1210328. [PMID: 37483349 PMCID: PMC10360050 DOI: 10.3389/fnins.2023.1210328] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 06/15/2023] [Indexed: 07/25/2023] Open
Abstract
Long-term recovery of limb function is a significant unmet need in people with paralysis. Neuromodulation of the spinal cord through epidural stimulation, when paired with intense activity-based training, has shown promising results toward restoring volitional limb control in people with spinal cord injury. Non-invasive neuromodulation of the cervical spinal cord using transcutaneous spinal cord stimulation (tSCS) has shown similar improvements in upper-limb motor control rehabilitation. However, the motor and sensory rehabilitative effects of activating specific cervical spinal segments using tSCS have largely remained unexplored. We show in two individuals with motor-complete SCI that targeted stimulation of the cervical spinal cord resulted in up to a 1,136% increase in exerted force, with weekly activity-based training. Furthermore, this is the first study to document up to a 2-point improvement in clinical assessment of tactile sensation in SCI after receiving tSCS. Lastly, participant gains persisted after a one-month period void of stimulation, suggesting that targeted tSCS may lead to persistent recovery of motor and sensory function.
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Affiliation(s)
- Santosh Chandrasekaran
- Neural Bypass and Brain Computer Interface Laboratory, Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Nikunj A. Bhagat
- Neural Bypass and Brain Computer Interface Laboratory, Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center, Houston, TX, United States
| | - Richard Ramdeo
- Neural Bypass and Brain Computer Interface Laboratory, Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Sadegh Ebrahimi
- Neural Bypass and Brain Computer Interface Laboratory, Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Pawan D. Sharma
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States
| | - Doug G. Griffin
- Northwell Health STARS Rehabilitation, East Meadow, NY, United States
| | - Adam Stein
- Department of Physical Medicine and Rehabilitation, Donald and Barbara Zucker School of Medicine at Hofstra, Northwell Health, Manhasset, NY, United States
| | - Susan J. Harkema
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States
- Department of Bioengineering, University of Louisville, Louisville, KY, United States
- Frazier Rehabilitation Institute, University of Louisville Health, Louisville, KY, United States
- Department of Neurological Surgery, University of Louisville, Louisville, KY, United States
| | - Chad E. Bouton
- Neural Bypass and Brain Computer Interface Laboratory, Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, United States
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Cvetic D, Janicijevic D, Knezevic OM, García-Ramos A, Mirkov DM. Methodological considerations for assessing whole-body strength capacity through isometric dynamometry. Sports Biomech 2022:1-15. [PMID: 35287552 DOI: 10.1080/14763141.2022.2048063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 02/24/2022] [Indexed: 10/18/2022]
Abstract
The present study aimed to explore the possibility of comprehensively assessing whole-body muscle strength by testing as few muscle groups as possible, using a single testing method (isometric or isokinetic dynamometry) and a single variable (maximal force or rate of force development). Knee, hip, shoulder and elbow extensors and flexors were evaluated in males with high (n = 26) and low strength levels (n = 32). The principal component analysis revealed three factors that explained 62.5% of the total variance, while the main factors were loaded by the different testing methods and strength variables for the muscles acting on the knee (first component), hip (second component) and arm joints (third component). These results were confirmed by a three-way ANOVA which revealed a significant factor of group (P < 0.001) and the interaction test type × group (P = 0.002), but not of test type (P = 0.644), muscle group (P = 0.999), or their interactions (P > 0.205). The correlations of strength outcomes across the muscles ranged from trivial to very large (r range = -0.17, 0.84), being generally higher for the antagonistic muscles. Overall, a comprehensive assessment of whole-body muscle strength can be obtained using isometric dynamometry and maximal force, but it should consider at least one muscle group from the antagonistic pair.
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Affiliation(s)
- Danilo Cvetic
- University of Belgrade, Faculty of Sport and Physical Education, The Research Centre, Belgrade, Serbia
| | - Danica Janicijevic
- University of Belgrade, Faculty of Sport and Physical Education, The Research Centre, Belgrade, Serbia
| | - Olivera M Knezevic
- University of Belgrade, Faculty of Sport and Physical Education, The Research Centre, Belgrade, Serbia
| | - Amador García-Ramos
- Faculty of Sport Sciences, Department of Physical Education and Sport, University of Granada, Granada, Spain
- Faculty of Education, Department of Sports Sciences and Physical Conditioning, Universidad Católica de la Santísima Concepción, Concepción, Chile
| | - Dragan M Mirkov
- University of Belgrade, Faculty of Sport and Physical Education, The Research Centre, Belgrade, Serbia
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Meijering D, Welsink CL, Boerboom AL, Bulstra SK, Vegter RJK, Stevens M, Eygendaal D, van den Bekerom MPJ. Triceps Insufficiency After Total Elbow Arthroplasty: A Systematic Review. JBJS Rev 2021; 9:01874474-202107000-00008. [PMID: 34270508 DOI: 10.2106/jbjs.rvw.20.00281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND The incidence of triceps insufficiency after total elbow arthroplasty (TEA) varies in the literature, and a consensus on treatment strategy is lacking. We review the incidence, the risk factors, the clinical presentation, and the diagnosis and treatment of triceps insufficiency after TEA. Based on this information, we have formulated recommendations for clinical practice. METHODS We performed a systematic review of the literature from January 2003 to April 2020 to identify studies that investigated triceps function following TEA by searching the PubMed, Cochrane, and Embase databases. Eligible studies (1) reported on triceps function following primary or revision TEA for every indication, regardless of technique (e.g., bone grafts), (2) included ≥6 adult patients, (3) had the full-text article available, and (4) had a minimum follow-up of 1 year. RESULTS Eighty studies with a total of 4,825 TEAs were included. The quality was low in 15 studies, moderate in 64 studies, and high in 1 study. The mean incidence of triceps insufficiency was 4.5%. The rates were highest in patients after revision TEA (22%), in those with posttraumatic arthritis as an indication for surgery (10.2%), and after a triceps-reflecting approach (4.9%). Most studies used the Medical Research Council scale to score triceps function, although cutoff points and the definition of triceps insufficiency differed among studies. Surgical treatment showed favorable results with anconeus tendon transfer and Achilles allograft repair when compared with direct repair. CONCLUSIONS The incidence of triceps insufficiency varies greatly, probably due to a lack of consensus on the definition of the term. Therefore, we recommend the guidelines for clinical practice that are presented in this article. These guidelines assist clinicians in providing the best possible treatment strategy for their patients and help researchers optimize their future study designs in order to compare outcomes. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Daniëlle Meijering
- Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Chantal L Welsink
- Department of Orthopedic Surgery, Isala Klinieken, Zwolle, the Netherlands
| | - Alexander L Boerboom
- Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Sjoerd K Bulstra
- Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Riemer J K Vegter
- Department of Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Martin Stevens
- Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Denise Eygendaal
- Department of Orthopedic Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands.,Department of Orthopedic Surgery, Amphia Hospital, Breda, the Netherlands
| | - Michel P J van den Bekerom
- Department of Orthopedic Surgery, OLVG, Amsterdam, the Netherlands.,Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
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Meijering D, Boerboom AL, Gerritsma CLE, The B, van den Bekerom MPJ, van der Pluijm M, Vegter RJK, Bulstra SK, Eygendaal D, Stevens M. Prospective cohort study comparing a triceps-sparing and triceps-detaching approach in total elbow arthroplasty: a protocol. BMJ Open 2021; 11:e046098. [PMID: 33952551 PMCID: PMC8103376 DOI: 10.1136/bmjopen-2020-046098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND New surgical approaches have been developed to optimise elbow function after total elbow arthroplasty (TEA). Currently, there is no consensus on the best surgical approach. This study aims to investigate the functional outcomes, prosthetic component position and complication rates after a triceps-sparing and a triceps-detaching approach in TEA. METHODS AND ANALYSIS A multicentre prospective comparative cohort study will be conducted. All patients with an indication for primary TEA will enrol in either the triceps-sparing or the triceps-detaching cohort. Primary outcome measure is elbow function, specified as fixed flexion deformity. Secondary outcome parameters are self-reported and objectively measured physical functioning, including triceps force, prosthetic component position in standard radiographs and complications. DISCUSSION The successful completion of this study will clarify which surgical approach yields better functional outcomes, better prosthetic component position and lower complication rates in patients with a TEA. ETHICS AND DISSEMINATION The Medical Ethics Review Board of University Medical Center Groningen reviewed the study and concluded that it is not clinical research with human subjects as meant in the Medical Research Involving Human Subjects Act (WMO), therefore WMO approval is not needed (METc2019/544). TRIAL REGISTRATION NUMBER NTR NL8488.
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Affiliation(s)
- Danielle Meijering
- Department of Orthopedic Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Alexander L Boerboom
- Department of Orthopedic Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Bertram The
- Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands
| | - Michel P J van den Bekerom
- Department of Orthopedic Surgery, OLVG, Amsterdam, The Netherlands
- Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marco van der Pluijm
- Department of Orthopedic Surgery, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Riemer J K Vegter
- Department of Human Movement Sciences, University of Groningen, Groningen, The Netherlands
| | - Sjoerd K Bulstra
- Department of Orthopedic Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Denise Eygendaal
- Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands
- Department of Orthopedic Surgery, Amsterdam Universitair Medische Centra, Amsterdam, The Netherlands
| | - Martin Stevens
- Department of Orthopedic Surgery, University Medical Center Groningen, Groningen, The Netherlands
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