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Rigoli A, Francis L, Nicholson M, Weber G, Redhead J, Iyer P. A systematic review of the effects of robotic exoskeleton training on energy expenditure and body composition in adults with spinal cord injury. Int J Rehabil Res 2024; 47:64-74. [PMID: 38616768 DOI: 10.1097/mrr.0000000000000626] [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: 04/16/2024]
Abstract
Metabolic diseases disproportionately affect people with spinal cord injury (SCI). Increasing energy expenditure and remodeling body composition may offset deleterious consequences of SCI to improve cardiometabolic health. Evidence is emerging that robotic exoskeleton use increases physical activity in SCI, but little is known about its effects on energy expenditure and body composition. This study therefore aimed to evaluate the impact of robotic exoskeleton training on body composition and energy expenditure in adults with SCI. A systematic literature review was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Five databases were searched to retrieve studies meeting pre-set eligibility criteria: adults with SCI, interventions evaluating the effects of robotic exoskeleton devices on body composition or energy expenditure. The PEDro scale guided quality assessments with findings described narratively. Of 2163 records, 10 studies were included. Robotic exoskeleton training does not significantly improve energy expenditure compared to other exercise interventions. Significant changes ( P < 0.05) in body composition, particularly reduced fat mass, however, were reported. High variability seen with the interventions was coupled with poor quality of the studies. While robotic exoskeleton interventions may propose modest cardiometabolic benefits in adults with SCI, further robust trials in larger samples are needed to strengthen these findings.
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Affiliation(s)
- Alessandra Rigoli
- The University of Sydney, Nutrition and Dietetics Group, Susan Wakil School of Nursing and Midwifery, The Charles Perkins Centre
| | - Lucinda Francis
- The University of Sydney, Nutrition and Dietetics Group, Susan Wakil School of Nursing and Midwifery, The Charles Perkins Centre
| | - Margaret Nicholson
- The University of Sydney, Nutrition and Dietetics Group, Susan Wakil School of Nursing and Midwifery, The Charles Perkins Centre
| | | | | | - Priya Iyer
- The University of Sydney, Nutrition and Dietetics Group, Susan Wakil School of Nursing and Midwifery, The Charles Perkins Centre
- Royal Rehab, Sydney, New South Wales, Australia
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Løve US, Kasch H, Severinsen KE, Abrahamsen J, Høyer C, Forman A, Thomsen HH. The Laparoscopic Implantation of Neuroprosthesis Procedure Increases Leg Lean Mass in Individuals With Paraplegia Due To Traumatic Spinal Cord Injury. Neuromodulation 2023; 26:1802-1807. [PMID: 35690509 DOI: 10.1016/j.neurom.2022.04.044] [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: 12/20/2021] [Revised: 04/09/2022] [Accepted: 04/12/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES We hypothesized that the laparoscopic implantation of neuroprosthesis (LION) procedure would significantly alter the body composition of patients with chronic traumatic spinal cord injury (SCI). The objectives were to determine the effect of the LION procedure on lean mass (LM), fatty mass (FM), and bone mineral content (BMC) in patients with SCI. MATERIALS AND METHODS Five consecutive patients underwent dual-energy x-ray absorptiometry scans before the LION procedure and at the one-year postoperative follow-up to determine changes in LM, FM, and BMC. Student paired t-test was used to determine significance. RESULTS The patients gained 2506 ± 565 g of LM in the legs (p < 0.001), which was an 18% total increase in leg LM. Total body LM was significantly increased by 3523 ± 1048 g (p < 0.003). FM was unaffected, whereas total BMC showed a small but significant increase of 99 ± 42 g (p = 0.009). CONCLUSIONS The LION procedure and subsequent neurostimulation procedures resulted in substantial increases in leg LM in patients with chronic traumatic SCI and paraplegia. A possible incremental effect on total BMC also was observed. Further studies are needed to confirm and expand these promising results.
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Affiliation(s)
- Uffe Schou Løve
- Department of Surgery, Regional Hospital of Viborg, Viborg, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Helge Kasch
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Spinal Cord Injury Center of Western Denmark, Department of Neurology, Regional Hospital of Viborg, Viborg, Denmark
| | - Kåre Eg Severinsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Spinal Cord Injury Center of Western Denmark, Department of Neurology, Regional Hospital of Viborg, Viborg, Denmark
| | - Jan Abrahamsen
- Department of Clinical Physiology, Regional Hospital of Viborg, Viborg, Denmark
| | - Christian Høyer
- Department of Clinical Physiology, Regional Hospital of Viborg, Viborg, Denmark
| | - Axel Forman
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Holm Thomsen
- Research Unit of Multimorbidity, Regional Hospital of Viborg, Viborg, Denmark; Department of Internal Medicine, Clinic for Diabetes and Hormonal Diseases, Regional Hospital of Viborg, Viborg, Denmark
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Basiratzadeh S, Hakimjavadi R, Baddour N, Michalowski W, Viktor H, Wai E, Stratton A, Kingwell S, Mac-Thiong JM, Tsai EC, Wang Z, Phan P. A data-driven approach to categorize patients with traumatic spinal cord injury: cluster analysis of a multicentre database. Front Neurol 2023; 14:1263291. [PMID: 37900603 PMCID: PMC10602788 DOI: 10.3389/fneur.2023.1263291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/05/2023] [Indexed: 10/31/2023] Open
Abstract
Background Conducting clinical trials for traumatic spinal cord injury (tSCI) presents challenges due to patient heterogeneity. Identifying clinically similar subgroups using patient demographics and baseline injury characteristics could lead to better patient-centered care and integrated care delivery. Purpose We sought to (1) apply an unsupervised machine learning approach of cluster analysis to identify subgroups of tSCI patients using patient demographics and injury characteristics at baseline, (2) to find clinical similarity within subgroups using etiological variables and outcome variables, and (3) to create multi-dimensional labels for categorizing patients. Study design Retrospective analysis using prospectively collected data from a large national multicenter SCI registry. Methods A method of spectral clustering was used to identify patient subgroups based on the following baseline variables collected since admission until rehabilitation: location of the injury, severity of the injury, Functional Independence Measure (FIM) motor, and demographic data (age, and body mass index). The FIM motor score, the FIM motor score change, and the total length of stay were assessed on the subgroups as outcome variables at discharge to establish the clinical similarity of the patients within derived subgroups. Furthermore, we discussed the relevance of the identified subgroups based on the etiological variables (energy and mechanism of injury) and compared them with the literature. Our study also employed a qualitative approach to systematically describe the identified subgroups, crafting multi-dimensional labels to highlight distinguishing factors and patient-focused insights. Results Data on 334 tSCI patients from the Rick Hansen Spinal Cord Injury Registry was analyzed. Five significantly different subgroups were identified (p-value ≤0.05) based on baseline variables. Outcome variables at discharge superimposed on these subgroups had statistically different values between them (p-value ≤0.05) and supported the notion of clinical similarity of patients within each subgroup. Conclusion Utilizing cluster analysis, we identified five clinically similar subgroups of tSCI patients at baseline, yielding statistically significant inter-group differences in clinical outcomes. These subgroups offer a novel, data-driven categorization of tSCI patients which aligns with their demographics and injury characteristics. As it also correlates with traditional tSCI classifications, this categorization could lead to improved personalized patient-centered care.
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Affiliation(s)
| | | | - Natalie Baddour
- Department of Mechanical Engineering, Faculty of Engineering, University of Ottawa, Ottawa, ON, Canada
| | | | - Herna Viktor
- School of Electrical Engineering and Computer Science, Faculty of Engineering, University of Ottawa, Ottawa, ON, Canada
| | - Eugene Wai
- Division of Orthopedic Surgery, Ottawa Hospital Research Institute (OHRI), Ottawa, ON, Canada
- Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Alexandra Stratton
- Division of Orthopedic Surgery, Ottawa Hospital Research Institute (OHRI), Ottawa, ON, Canada
- Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Stephen Kingwell
- Division of Orthopedic Surgery, Ottawa Hospital Research Institute (OHRI), Ottawa, ON, Canada
- Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Jean-Marc Mac-Thiong
- Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada
- Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Eve C. Tsai
- Division of Neurosurgery, The Ottawa Hospital, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Zhi Wang
- Department of Orthopedic Surgery, University of Montreal Health Center, Montreal, QC, Canada
| | - Philippe Phan
- Division of Orthopedic Surgery, Ottawa Hospital Research Institute (OHRI), Ottawa, ON, Canada
- Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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Ma Y, de Groot S, Vink A, Harmsen W, Smit CA, Stolwijk-Swuste JM, Weijs PJ, Janssen TW. Optimization of Protocols Using Neuromuscular Electrical Stimulation for Paralyzed Lower-Limb Muscles to Increase Energy Expenditure in People With Spinal Cord Injury. Am J Phys Med Rehabil 2023; 102:489-497. [PMID: 36228281 PMCID: PMC10184805 DOI: 10.1097/phm.0000000000002120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate whether using surface neuromuscular electrical stimulation (NMES) for paralyzed lower-limb muscles results in an increase in energy expenditure and whether the number of activated muscles and duty cycle affect the potential increase. DESIGN This was a cross-sectional study. RESULTS Energy expenditure during all NMES protocols was significantly higher than the condition without NMES (1.2 ± 0.2 kcal/min), with the highest increase (+51%; +0.7 kcal/min, 95% confidence interval, 0.3-1.2) for the protocol with more muscles activated and the duty cycle with a shorter rest period. A significant decrease in muscle contraction size during NMES was found with a longer stimulation time, more muscles activated, or the duty cycle with a shorter rest period. CONCLUSION Using NMES for paralyzed lower-limb muscles can significantly increase energy expenditure compared with sitting without NMES, with the highest increase for the protocol with more muscles activated and the duty cycle with a shorter rest period. Muscle fatigue occurred significantly with the more intense NMES protocols, which might cause a lower energy expenditure in a longer protocol. Future studies should further optimize the NMES parameters and investigate the long-term effects of NMES on weight management in people with SCI.
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Dolbow DR, Gorgey AS, Sutor TW, Musselman K, Bochkezanian V, Davis GM. Electrical Stimulation Exercise Recommendations for Individuals With Spinal Cord Injury. Arch Phys Med Rehabil 2023; 104:847-851. [PMID: 36708856 DOI: 10.1016/j.apmr.2022.11.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 11/28/2022] [Indexed: 01/27/2023]
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Dolbow DR, Gorgey AS, Johnston TE, Bersch I. Electrical Stimulation Exercise for People with Spinal Cord Injury: A Healthcare Provider Perspective. J Clin Med 2023; 12:jcm12093150. [PMID: 37176591 PMCID: PMC10179213 DOI: 10.3390/jcm12093150] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/05/2023] [Accepted: 04/15/2023] [Indexed: 05/15/2023] Open
Abstract
Electrical stimulation exercise has become an important modality to help improve the mobility and health of individuals with spinal cord injury (SCI). Electrical stimulation is used to stimulate peripheral nerves in the extremities to assist with muscle strengthening or functional activities such as cycling, rowing, and walking. Electrical stimulation of the peripheral nerves in the upper extremities has become a valuable tool for predicting the risk of hand deformities and rehabilitating functional grasping activities. The purpose of this paper is to provide healthcare providers perspective regarding the many rehabilitation uses of electrical stimulation in diagnosing and treating individuals with SCI. Electrical stimulation has been shown to improve functional mobility and overall health, decrease spasticity, decrease the risk of cardiometabolic conditions associated with inactivity, and assist in the diagnosis/prognosis of hand deformities in those with tetraplegia. Studies involving non-invasive stimulation of the spinal nerves via external electrodes aligned with the spinal cord and more invasive stimulation of electrodes implanted in the epidural lining of the spinal cord have demonstrated improvements in the ability to stand and enhanced the stepping pattern during ambulation. Evidence is also available to educate healthcare professionals in using functional electrical stimulation to reduce muscle spasticity and to recognize limitations and barriers to exercise compliance in those with SCI. Further investigation is required to optimize the dose-response relationship between electrical stimulation activities and the mobility and healthcare goals of those with SCI and their healthcare providers.
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Affiliation(s)
- David R Dolbow
- Department of Physical Therapy, College of Osteopathic Medicine, William Carey University, Hattiesburg, MS 39401, USA
| | - Ashraf S Gorgey
- Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire VA Medical Center, Richmond, VA 23249, USA
- College of Medicine, Virginia Commonwealth University, Richmond, VA 23298, USA
| | - Therese E Johnston
- Department of Physical Therapy, Arcadia University, Glenside, PA 19038, USA
| | - Ines Bersch
- International FES Centre®, Swiss Paraplegic Center, CH-6207 Nottwil, Switzerland
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Iwanaga S, Matsuse H, Hashida R, Bekki M, Kawaguchi T, Shiba N. The Effect of Walking Combined with Neuromuscular Electrical Stimulation on Liver Stiffness and Insulin Resistance in Patients with Non-alcoholic Fatty Liver Disease: An Exploratory Randomized Controlled Trial. Kurume Med J 2023; 67:137-146. [PMID: 36450482 DOI: 10.2739/kurumemedj.ms674001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Increased liver stiffness and insulin resistance are important therapeutic targets in patients with nonalcoholic fatty liver disease (NAFLD). A hybrid training system (HTS) has been developed which combines application of electrical stimulation and volitional contractions. We compared the effect of walking exercise (5.6 km/h) both with and without simultaneous HTS on liver stiffness and insulin resistance. In a single-blind, controlled trial, 32 subjects with NAFLD were randomized to 12 weeks of triweekly 30 minute walking exercise with either HTS (HTS group) or without HTS (control group). Transient elastography for the assessment of liver stiffness, body weight, visceral fat, the homeostasis model assessment of insulin resistance, fasting blood glucose, serum aspartate aminotransferase, alanine aminotransferase, and gamma-glutamyl transpeptidase were evaluated. Data were evaluated using the linear model after adjusting the baseline value. In the subjects with BMI of 27 kg/m2 or more, the decrement of transient elastography in the HTS group was significantly larger than in the control group (mean ± standard error: Δ2.13 ± 0.64 kPa vs. Δ-0.67 ± 0.42 kPa, p=0.0009). There were no significant differences between groups in other endpoints. These results showed that simultaneously combining electrical stimulation with walking exercise could potentially improve liver stiffness in people who have NAFLD. In fact, because the exercise effect was increased by HTS without increasing the walking speed, this HTS could be especially useful for obese or overweight subjects, in whom NAFLD and joint problems often coexist. However, its effects on insulin resistance and body composition were not clear.
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Affiliation(s)
- Sohei Iwanaga
- Division of Rehabilitation, Kurume University Hospital
| | - Hiroo Matsuse
- Division of Rehabilitation, Kurume University Hospital
| | - Ryuki Hashida
- Division of Rehabilitation, Kurume University Hospital
| | | | - Takumi Kawaguchi
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine
| | - Naoto Shiba
- Division of Rehabilitation, Kurume University Hospital
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Maher JL, Whitmarsh C, Smith P, Taylor H, Fard A, Bilzon J. Feasibility study of high-intensity interval training to reduce cardiometabolic disease risks in individuals with acute spinal cord injury. BMJ Open 2023; 13:e068507. [PMID: 36737096 PMCID: PMC9900054 DOI: 10.1136/bmjopen-2022-068507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Individuals ageing with spinal cord injury (SCI) experience an accelerated trajectory of diseases and disorders, such as cardiovascular disease and diabetes, that resemble those experienced with ageing alone. Currently, an evidence-based approach toward managing this problem does not exist and therefore the purpose of this study is to determine the feasibility of conducting a high-intensity exercise intervention in individuals with acute (<6 months postinjury) SCI to improve cardiometabolic health. METHODS AND ANALYSIS We will conduct a single-centre, two parallel-arm, randomised feasibility study of a high-intensity interval training (HIIT) intervention in individuals with acute SCI. We will enrol 40 individuals (20 intervention, 20 control) with acute SCI attending inpatient rehabilitation at Salisbury District Hospital. Participants will be randomly allocated to the intervention group (HIIT) or control group for 18 weeks. Both groups will participate in standard care throughout the duration of the study. The HIIT group only will also perform supervised HIIT exercise on an arm cycle ergometer three times per week. Over the course of the intervention, most participants will be discharged from the hospital, and at this time, an arm cycle ergometer will be installed in their home and the intervention will transition into outpatient care. We will assess cardiorespiratory fitness, glycaemic control, lipid profile and body habitus as well as qualitative assessments of acceptability at weeks 0, 9 and 18 with the primary outcome being the feasibility of a full Randomised Controlled Trial (RCT). ETHICS AND DISSEMINATION This study will inform a longer-term, definitive, multicentre RCT to establish the impact of this exercise intervention in maintaining the cardiometabolic health of patients during the acute phase following SCI. Results will be disseminated in different formats including peer-reviewed journal articles, conference presentations and internet media, to a wide audience including clinicians, researchers and individuals with SCI. TRIAL REGISTRATION NUMBER ISRCTN57514022.
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Affiliation(s)
| | - Catherine Whitmarsh
- Duke of Cornwall Spinal Treatment Centre, Salisbury NHS Foundation Trust, Salisbury, UK
| | - Paula Smith
- Department of Psychology, University of Bath, Bath, UK
| | - Hazel Taylor
- Research Design Service, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Aram Fard
- Duke of Cornwall Spinal Treatment Centre, Salisbury NHS Foundation Trust, Salisbury, UK
| | - James Bilzon
- Department for Health, University of Bath, Bath, UK
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Effect of electromyostimulation training on intramuscular fat accumulation determined by ultrasonography in older adults. Eur J Appl Physiol 2023; 123:271-282. [PMID: 36260185 PMCID: PMC9580431 DOI: 10.1007/s00421-022-05074-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 10/11/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE Electromyostimulation (EMS) induces a short-term change in muscle metabolism, and EMS training induces long-term improvements of muscle atrophy and function. However, the effects of EMS training on intramuscular fat in older adults are still poorly known. The purpose of this study was to examine whether the intramuscular fat index and biochemical parameters change with EMS training of the quadriceps femoris muscles in older adults. METHODS Nineteen non-obese older men and women performed EMS training of the quadriceps femoris for 12 weeks (3 times/week; single session for 30 min). The intramuscular fat content index was estimated by echo intensity of the vastus lateralis and rectus femoris muscles on ultrasonography, and muscle thickness was also measured. Muscle strength was assessed as the maximal voluntary contraction during isometric knee extension. Echo intensity, muscle thickness, and muscle strength were measured before and after EMS training. A rested/fasting blood samples were collected before and after EMS training for measuring plasma glucose, insulin, free fatty acid, triglyceride, and interleukin-6 concentrations. To examine the acute effect of a single-EMS session on biochemical parameters, blood samples were taken before and after the EMS session. RESULTS EMS training did not significantly change echo intensity in muscles, muscle thickness, muscle strength, or biochemical parameters. Regarding the acute effect on blood lipid concentrations, a single-EMS session increased free fatty acid and glucose concentrations. CONCLUSION EMS sessions had an acute effect of increasing free fatty acid and glucose concentrations, but EMS training intervention did not improve intramuscular fat content.
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Coelho-Magalhães T, Azevedo Coste C, Resende-Martins H. A Novel Functional Electrical Stimulation-Induced Cycling Controller Using Reinforcement Learning to Optimize Online Muscle Activation Pattern. SENSORS (BASEL, SWITZERLAND) 2022; 22:9126. [PMID: 36501826 PMCID: PMC9741342 DOI: 10.3390/s22239126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/02/2022] [Accepted: 11/08/2022] [Indexed: 06/17/2023]
Abstract
This study introduces a novel controller based on a Reinforcement Learning (RL) algorithm for real-time adaptation of the stimulation pattern during FES-cycling. Core to our approach is the introduction of an RL agent that interacts with the cycling environment and learns through trial and error how to modulate the electrical charge applied to the stimulated muscle groups according to a predefined policy and while tracking a reference cadence. Instead of a static stimulation pattern to be modified by a control law, we hypothesized that a non-stationary baseline set of parameters would better adjust the amount of injected electrical charge to the time-varying characteristics of the musculature. Overground FES-assisted cycling sessions were performed by a subject with spinal cord injury (SCI AIS-A, T8). For tracking a predefined pedaling cadence, two closed-loop control laws were simultaneously used to modulate the pulse intensity of the stimulation channels responsible for evoking the muscle contractions. First, a Proportional-Integral (PI) controller was used to control the current amplitude of the stimulation channels over an initial parameter setting with predefined pulse amplitude, width and fixed frequency parameters. In parallel, an RL algorithm with a decayed-epsilon-greedy strategy was implemented to randomly explore nine different variations of pulse amplitude and width parameters over the same stimulation setting, aiming to adjust the injected electrical charge according to a predefined policy. The performance of this global control strategy was evaluated in two different RL settings and explored in two different cycling scenarios. The participant was able to pedal overground for distances over 3.5 km, and the results evidenced the RL agent learned to modify the stimulation pattern according to the predefined policy and was simultaneously able to track a predefined pedaling cadence. Despite the simplicity of our approach and the existence of more sophisticated RL algorithms, our method can be used to reduce the time needed to define stimulation patterns. Our results suggest interesting research possibilities to be explored in the future to improve cycling performance since more efficient stimulation cost dynamics can be explored and implemented for the agent to learn.
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Affiliation(s)
- Tiago Coelho-Magalhães
- Graduate Program in Electrical Engineering, Universidade Federal de Minas Gerais, Av, Antônio Carlos 6627, Belo Horizonte 31270-901, MG, Brazil
| | - Christine Azevedo Coste
- National Institute for Research in Computer Science and Automation (Inria), Camin Team, 34090 Montpellier, France
| | - Henrique Resende-Martins
- Graduate Program in Electrical Engineering, Universidade Federal de Minas Gerais, Av, Antônio Carlos 6627, Belo Horizonte 31270-901, MG, Brazil
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The Effects of Physical Exercise on Depression for Individuals with Spinal Cord Injury: a Systematic Review. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2022. [DOI: 10.1007/s40141-022-00370-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2022]
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Alajam RA, Alqahtani AS, Moon S, Sarmento CVM, Frederick J, Smirnova IV, Liu W. Effects of walking training on risk markers of cardiovascular disease in individuals with chronic spinal cord injury. J Spinal Cord Med 2022; 45:622-630. [PMID: 33443465 PMCID: PMC9246252 DOI: 10.1080/10790268.2020.1853332] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE To investigate the effects of an 8-week walking training program on glycemic control, lipid profile, and inflammatory markers in individuals with chronic spinal cord injury (SCI). DESIGN A pilot, single-group, pretest-posttest study. SETTING A neuromuscular research laboratory. PARTICIPANTS Eleven participants with chronic SCI. INTERVENTION An 8-week walking training program using a treadmill, a body weight-supported system, and an assistive gait training device. OUTCOME MEASURES Levels of glycated hemoglobin (HbA1c), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), C-reactive protein (CRP), and interleukin-6 were assessed before and after the walking training. RESULTS Following the walking training, there was a statistically significant decrease in HbA1c level (P<0.01) of uncertain clinical significance. The lipid profile improved after training, as shown by a statistically and clinically significant increase in HDL-C level (P<0.01) and a statistically significant decrease in LDL-C level (P<0.1) of no clinical significance. The ratio of LDL-C to HDL-C was significantly reduced (P<0.01). In regard to inflammatory markers, concentrations of IL-6 showed a significant reduction after training (P=0.05) of unknown clinical significance, while those of CRP trended to decrease (P=0.13). CONCLUSION The findings of this pilot study suggest that an 8-week walking training program may produce favorable changes in risk markers of cardiovascular disease in individuals with chronic SCI as shown by clinically meaningful improvements in HDL-C, and small changes in the right direction, but uncertain clinical significance, in HbA1c, LDL-C and IL-6. A randomized controlled trial is needed to compare the effects of walking training on these outcome measures with those of other exercise modalities suitable for this population, and to see if more prolonged exercise exposure leads to favorable parameters of significant size to justify the exercise modality.
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Affiliation(s)
- Ramzi A. Alajam
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, Kansas, United States,Department of Physical Therapy, Jazan University, Jazan, Saudi Arabia,Corresponding author: Ramzi Alajam, Department of Physical Therapy, Faculty of Applied Medical Science, Jazan University, Jazan, Saudi Arabia;
| | - Abdulfattah S. Alqahtani
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, Kansas, United States,Department of Health Rehabilitation Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Sanghee Moon
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, Kansas, United States
| | - Caio V. M. Sarmento
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, Kansas, United States,Department of Physical Therapy, California State University, Fresno, California, United States
| | - Jason Frederick
- Department of Physical Medicine and Rehabilitation, University of Kansas Medical Center, Kansas City, Kansas, United States
| | - Irina V. Smirnova
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, Kansas, United States
| | - Wen Liu
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, Kansas, United States
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Farkas GJ, Burton AM, McMillan DW, Sneij A, Gater DR. The Diagnosis and Management of Cardiometabolic Risk and Cardiometabolic Syndrome after Spinal Cord Injury. J Pers Med 2022; 12:1088. [PMID: 35887592 PMCID: PMC9320035 DOI: 10.3390/jpm12071088] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/19/2022] [Accepted: 06/21/2022] [Indexed: 11/23/2022] Open
Abstract
Individuals with spinal cord injuries (SCI) commonly present with component risk factors for cardiometabolic risk and combined risk factors for cardiometabolic syndrome (CMS). These primary risk factors include obesity, dyslipidemia, dysglycemia/insulin resistance, and hypertension. Commonly referred to as "silent killers", cardiometabolic risk and CMS increase the threat of cardiovascular disease, a leading cause of death after SCI. This narrative review will examine current data and the etiopathogenesis of cardiometabolic risk, CMS, and cardiovascular disease associated with SCI, focusing on pivotal research on cardiometabolic sequelae from the last five years. The review will also provide current diagnosis and surveillance criteria for cardiometabolic disorders after SCI, a novel obesity classification system based on percent total body fat, and lifestyle management strategies to improve cardiometabolic health.
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Affiliation(s)
- Gary J. Farkas
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Miami Miller, Miami, FL 33136, USA; (A.S.); (D.R.G.J.)
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, Miami, FL 33136, USA;
| | - Adam M. Burton
- School of Medicine, University of Miami Miller, Miami, FL 33136, USA;
| | - David W. McMillan
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, Miami, FL 33136, USA;
- The Miami Project to Cure Paralysis, School of Medicine, University of Miami Miller, Miami, FL 33136, USA
| | - Alicia Sneij
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Miami Miller, Miami, FL 33136, USA; (A.S.); (D.R.G.J.)
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, Miami, FL 33136, USA;
| | - David R. Gater
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Miami Miller, Miami, FL 33136, USA; (A.S.); (D.R.G.J.)
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, Miami, FL 33136, USA;
- School of Medicine, University of Miami Miller, Miami, FL 33136, USA;
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14
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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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15
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Dolbow DR, Davis GM, Welsch M, Gorgey AS. Benefits and interval training in individuals with spinal cord injury: A thematic review. J Spinal Cord Med 2022; 45:327-338. [PMID: 34855568 PMCID: PMC9135438 DOI: 10.1080/10790268.2021.2002020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Arm crank ergometry (ACE), functional electrical stimulation leg cycling exercise (FES-LCE), and the combination of the two (FES hybrid exercise) have all been used as activities to help improve the fitness-related health of individuals with spinal cord injury (SCI). More recently, high-intensity interval training (HIIT) has become popular in the non-disabled community due to its ability to produce greater aerobic fitness benefits or equivalent benefits with reduced time commitment. OBJECTIVE This thematic review of the literature sought to determine the potential benefits and practicality of using ACE, FES-LCE, and FES hybrid exercise in an interval training format for individuals with SCI. METHODS Systematic literature searches were conducted in May 2020 and March 2021 focusing on interval training in individuals with SCI. Pre-defined nested search terms were used to narrow the available literature from 4273 citations to 1362 articles. The titles and abstracts were then reviewed to determine the appropriateness of the articles ending with fifteen articles. RESULTS The literature was limited to fifteen articles with low participant numbers (n = 1-20). However, in each article, HIIT protocols either demonstrated a greater improvement in cardiovascular, metabolic, or practicality scores compared to moderate intensity continuous training (MICT) protocols, or improvement during relatively brief time commitments. CONCLUSION The available literature lacked sufficient numbers of randomized control trials. However, the available evidence is encouraging concerning the potential benefits and practicality of using HIIT (ACE, FES-LCE, or FES hybrid exercise) to improve aerobic and anaerobic capacity and decrease cardiometabolic risk after SCI.
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Affiliation(s)
- David R. Dolbow
- Department of Physical Therapy and College of Osteopathic Medicine, William Carey University, Hattiesburg, Mississippi, USA,Correspondence to: David R. Dolbow, Department of Physical Therapy and College of Osteopathic Medicine, William Carey University, 710 William Carey Parkway, Hattiesburg, Mississippi39401, USA.
| | - Glen M. Davis
- Clinical Exercise and Rehabilitation Unit, Discipline of Exercise and Sports Science, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Michael Welsch
- School of Population Health, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Ashraf S. Gorgey
- Spinal Cord Injury & Disorders Center, Hunter Holmes McGuire VAMC and Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, USA
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16
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Wheelchair-modified ergometer rowing exercise in individuals with spinal cord injury: a feasibility, acceptability, and preliminary efficacy study. Spinal Cord Ser Cases 2022; 8:48. [PMID: 35487894 PMCID: PMC9054742 DOI: 10.1038/s41394-022-00518-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/19/2022] [Accepted: 04/19/2022] [Indexed: 11/08/2022] Open
Abstract
STUDY DESIGN Exploratory clinical investigation. OBJECTIVES To assess the feasibility, acceptability, and preliminary efficacy of upper-body rowing exercise adapted to wheelchair users with spinal cord injury (SCI). SETTING University exercise laboratory. METHODS Eight individuals with SCI exercised on a rowing ergometer modified for wheelchair users (REMW), three times weekly, for up to 30 min per session. Participants completed feasibility and acceptability questionnaire (1-5 Likert scale), and the Wheelchair Users Shoulder Pain Index (WUSPI) before and after six weeks of exercise. Average power output (POAVG), distance rowed, percent peak heart rate (%HRpeak), and rating of perceived exertion (RPE) (6-20 scale) were monitored throughout the 18 exercise sessions and analyzed to evaluate preliminary efficacy of the exercise modality. RESULTS All eight participants completed the study (97% adherence). Participants rated the exercise high on the feasibility and acceptability scale; median (interquartile range) = 5.0 (4.0-5.0), where higher numbers indicated greater feasibility. Shoulder pain was reduced by 21% yet not significantly different from baseline (p = 0.899). Physiological measures (%HRpeak = 80-83%; RPE = 15.0-16.0) indicated a high cardiovascular training load. From week 1 to week 6, POAVG and distance rowed increased by 37 and 36%, respectively (both p ≤ 0.001). CONCLUSIONS Data from six weeks of exercise on the REMW suggests that upper-body rowing is a feasible and acceptable exercise modality for wheelchair users with SCI. Session data on %HRpeak, RPE, and shoulder pain indicate that REMW evoked moderate to vigorous intensity exercise without exacerbation of shoulder pain. Future research is required to quantify potential training-induced changes in cardiorespiratory fitness.
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17
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Sheikh N, Phillips AA, Ranada S, Lloyd M, Kogut K, Bourne K, Jorge JG, Lei LY, Sheldon RS, Exner DV, Runte M, Raj SR. Mitigating Initial Orthostatic Hypotension: Mechanistic Roles of Muscle Contraction Versus Sympathetic Activation. Hypertension 2022; 79:638-647. [PMID: 34990207 PMCID: PMC8828707 DOI: 10.1161/hypertensionaha.121.18580] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Initial orthostatic hypotension (IOH) is defined by a large drop in blood pressure (BP) within 15 s of standing. IOH often presents during an active stand, but not with a passive tilt, suggesting that a muscle activation reflex involving lower body muscles plays an important role. To our knowledge, there is no literature exploring how sympathetic activation affects IOH. We hypothesized involuntary muscle contractions before standing would significantly reduce the drop in BP seen in IOH while increasing sympathetic activity would not. METHODS Study participants performed 4 sit-to-stand maneuvers including a mental stress test (serial 7 mental arithmetic stress test), cold pressor test, electrical stimulation, and no intervention. Continuous heart rate and beat-to-beat BP were measured. Cardiac output and systemic vascular resistance were estimated from these waveforms. Data are presented as mean±SD. RESULTS A total of 23 female IOH participants (31±8 years) completed the study. The drops in systolic BP following the serial 7 mental arithmetic stress test (-26±12 mm Hg; P=0.004), cold pressor test (-20±15 mm Hg; P<0.001), and electrical stimulation (-28±12 mm Hg; P=0.01) were significantly reduced compared with no intervention (-34±11 mm Hg). The drops in systemic vascular resistance following the serial 7 mental arithmetic stress test (-391±206 dyne×s/cm5; P=0.006) and cold pressor test (-386±179 dyne×s/cm5; P=0.011) were significantly reduced compared with no intervention (-488±173 dyne×s/cm5). Cardiac output was significantly increased upon standing (7±2 L/min) compared with during the sit (6±1 L/min; P<0.001) for electrical stimulation. CONCLUSION Sympathetic activation mitigates the BP response in IOH, while involuntary muscle contraction mitigates the BP response and reduces symptoms. Active muscle contractions may induce both of these mechanisms of action in their pretreatment of IOH. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03970551.
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Affiliation(s)
- Nasia Sheikh
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Aaron A Phillips
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Departments of Physiology and Pharmacology and Clinical Neuroscience, University of Calgary, Calgary, AB, Canada
| | - Shaun Ranada
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Matthew Lloyd
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Karolina Kogut
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Kate Bourne
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Juliana G Jorge
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Lucy Y Lei
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Robert S. Sheldon
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Derek V. Exner
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Mary Runte
- Department of Management, University of Lethbridge, 4401 University Dr W, Lethbridge, Alberta, Canada T1K 3M4
| | - Satish R. Raj
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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18
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Coelho-Magalhães T, Fachin-Martins E, Silva A, Azevedo Coste C, Resende-Martins H. Development of a High-Power Capacity Open Source Electrical Stimulation System to Enhance Research into FES-Assisted Devices: Validation of FES Cycling. SENSORS 2022; 22:s22020531. [PMID: 35062492 PMCID: PMC8778229 DOI: 10.3390/s22020531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/06/2022] [Accepted: 01/09/2022] [Indexed: 02/04/2023]
Abstract
Since the first Cybathlon 2016, when twelve teams competed in the FES bike race, we have witnessed a global effort towards the development of stimulation and control strategies to improve FES-assisted devices, particularly for cycling, as a means to practice a recreational physical activity. As a result, a set of technical notes and research paved the way for many other studies and the potential behind FES-assisted cycling has been consolidated. However, engineering research needs instrumented devices to support novel developments and enable precise assessment. Therefore, some researchers struggle to develop their own FES-assisted devices or find it challenging to implement their instrumentation using commercial devices, which often limits the implementation of advanced control strategies and the possibility to connect different types of sensor. In this regard, we hypothesize that it would be advantageous for some researchers in our community to enjoy access to an entire open-source FES platform that allows different control strategies to be implemented, offers greater adaptability and power capacity than commercial devices, and can be used to assist different functional activities in addition to cycling. Hence, it appears to be of interest to make our proprietary electrical stimulation system an open-source device and to prove its capabilities by addressing all the aspects necessary to implement a FES cycling system. The high-power capacity stimulation device is based on a constant current topology that allows the creation of biphasic electrical pulses with amplitude, width, and frequency up to 150 mA, 1000 µs, and 100 Hz, respectively. A mobile application (Android) was developed to set and modify the stimulation parameters of up to eight stimulation channels. A proportional-integral controller was implemented for cadence tracking with the aim to improve the overall cycling performance. A volunteer with complete paraplegia participated in the functional testing of the system. He was able to cycle indoors for 45 min, accomplish distances of more than 5 km using a passive cycling trainer, and pedal 2400 m overground in 32 min. The results evidenced the capacity of our FES cycling system to be employed as a cycling tool for individuals with spinal cord injury. The methodological strategies used to improve FES efficiency suggest the possibility of maximizing pedaling duration through more advanced control techniques.
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Affiliation(s)
- Tiago Coelho-Magalhães
- Graduate Program in Electrical Engineering, Universidade Federal de Minas Gerais, Av. Antônio Carlos 6627, Belo Horizonte 31270-901, Brazil;
- Correspondence:
| | - Emerson Fachin-Martins
- Plataforma de Serviços Tecnológicos BEMTEVI, Parque Científico e Tecnológico, Universidade de Brasília, Brasília 70910-900, Brazil;
| | - Andressa Silva
- Centro de Treinamento Esportivo da Escola de Educação Física, Fisioterapia e Terapia Ocupacional, Universidade Federal de Minas Gerais, Belo Horizonte 31310-000, Brazil;
| | - Christine Azevedo Coste
- National Institute for Research in Computer Science and Automation (Inria), Camin Team, 34090 Montpellier, France;
| | - Henrique Resende-Martins
- Graduate Program in Electrical Engineering, Universidade Federal de Minas Gerais, Av. Antônio Carlos 6627, Belo Horizonte 31270-901, Brazil;
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19
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Invasive and Non-Invasive Approaches of Electrical Stimulation to Improve Physical Functioning after Spinal Cord Injury. J Clin Med 2021; 10:jcm10225356. [PMID: 34830637 PMCID: PMC8625266 DOI: 10.3390/jcm10225356] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/09/2021] [Accepted: 11/12/2021] [Indexed: 12/13/2022] Open
Abstract
This review of literature provides the latest evidence involving invasive and non-invasive uses of electrical stimulation therapies that assist in restoring functional abilities and the enhancement of quality of life in those with spinal cord injuries. The review includes neuromuscular electrical stimulation and functional electrical stimulation activities that promote improved body composition changes and increased muscular strength, which have been shown to improve abilities in activities of daily living. Recommendations for optimizing electrical stimulation parameters are also reported. Electrical stimulation is also used to enhance the skills of reaching, grasping, standing, and walking, among other activities of daily living. Additionally, we report on the use of invasive and non-invasive neuromodulation techniques targeting improved mobility, including standing, postural control, and assisted walking. We attempt to summarize the effects of epidural stimulation on cardiovascular performance and provide a mechanistic explanation to the current research findings. Future trends such as the combination of epidural stimulation and exoskeletal-assisted walking are also discussed.
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20
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Burkhart L, Pellegrini CA, Jones K, LaVela SL. Strategies used by providers to support individuals with spinal cord injury in weight management: a qualitative study of provider perspectives. Spinal Cord Ser Cases 2021; 7:65. [PMID: 34326307 DOI: 10.1038/s41394-021-00426-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 07/12/2021] [Accepted: 07/12/2021] [Indexed: 01/18/2023] Open
Abstract
STUDY DESIGN This is a descriptive qualitative study. OBJECTIVES To explore recommended strategies employed by healthcare providers to support individuals with SCI in weight management. SETTING Fourteen veteran administration hospitals in the United States and the Shirley Ryan AbilityLab (SRALab) SCI Model Systems in Illinois. METHODS Semi-structured interviews were conducted with interprofessional SCI providers involved in weight management with individuals living with SCI. Thematic analysis methods were used. RESULTS A total of 25 interprofessional providers were interviewed. Providing clinical expertise to assist in weight management included (1) checking progress or status of weight over time, (2) monitoring and tracking other health-related indicators, (3) stressing weight-related health risks, (4) providing education, (5) encouraging healthy behaviors, and (6) identifying and accessing resources. Fostering provider-patient relationships included (1) establishing and maintaining rapport and (2) tailoring/individualizing weight management treatment. Coordinating a team approach included (1) involving a dietitian or nutritionist, (2) communicating the same message, and (3) involving the informal caregiver/family. CONCLUSION Weight management strategies should incorporate patient preferences and goals, informed through provider expert and personalized clinical advice, and supported within the context of interprofessional team collaboration that includes caregivers and family.
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Affiliation(s)
- Lisa Burkhart
- Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare (CINCCH), Edward Hines Jr. VA Hospital, Hines, IL, USA. .,Marcella Niehoff School of Nursing, Loyola University Chicago, Chicago, IL, USA.
| | - Christine A Pellegrini
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Kayla Jones
- Midwest Regional SCI Care System (MRSCICS), Shirley Ryan AbilityLab (SRAlab), Chicago, IL, USA
| | - Sherri L LaVela
- Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare (CINCCH), Edward Hines Jr. VA Hospital, Hines, IL, USA.,Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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21
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Waldauf P, Hrušková N, Blahutova B, Gojda J, Urban T, Krajčová A, Fric M, Jiroutková K, Řasová K, Duška F. Functional electrical stimulation-assisted cycle ergometry-based progressive mobility programme for mechanically ventilated patients: randomised controlled trial with 6 months follow-up. Thorax 2021; 76:664-671. [PMID: 33931570 PMCID: PMC8223653 DOI: 10.1136/thoraxjnl-2020-215755] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 03/15/2021] [Accepted: 04/06/2021] [Indexed: 12/30/2022]
Abstract
PURPOSE Functional electrical stimulation-assisted cycle ergometry (FESCE) enables in-bed leg exercise independently of patients' volition. We hypothesised that early use of FESCE-based progressive mobility programme improves physical function in survivors of critical care after 6 months. METHODS We enrolled mechanically ventilated adults estimated to need >7 days of intensive care unit (ICU) stay into an assessor-blinded single centre randomised controlled trial to receive either FESCE-based protocolised or standard rehabilitation that continued up to day 28 or ICU discharge. RESULTS We randomised in 1:1 ratio 150 patients (age 61±15 years, Acute Physiology and Chronic Health Evaluation II 21±7) at a median of 21 (IQR 19-43) hours after admission to ICU. Mean rehabilitation duration of rehabilitation delivered to intervention versus control group was 82 (IQR 66-97) versus 53 (IQR 50-57) min per treatment day, p<0.001. At 6 months 42 (56%) and 46 (61%) patients in interventional and control groups, respectively, were alive and available to follow-up (81.5% of prespecified sample size). Their Physical Component Summary of SF-36 (primary outcome) was not different at 6 months (50 (IQR 21-69) vs 49 (IQR 26-77); p=0.26). At ICU discharge, there were no differences in the ICU length of stay, functional performance, rectus femoris cross-sectional diameter or muscle power despite the daily nitrogen balance was being 0.6 (95% CI 0.2 to 1.0; p=0.004) gN/m2 less negative in the intervention group. CONCLUSION Early delivery of FESCE-based protocolised rehabilitation to ICU patients does not improve physical functioning at 6 months in survivors. TRIAL REGISTRATION NUMBER NCT02864745.
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Affiliation(s)
- Petr Waldauf
- Department of Anaesthesiology and Intensive Care Medicine, 3rd Faculty of Medicine and FNKV University Hospital, Charles University, Prague, Czech Republic
| | - Natália Hrušková
- Department of Rehabilitation, 3rd Faculty of Medicine and FNKV University Hospital, Charles University, Prague, Czech Republic
| | - Barbora Blahutova
- Department of Anaesthesiology and Intensive Care Medicine, 3rd Faculty of Medicine and FNKV University Hospital, Charles University, Prague, Czech Republic
| | - Jan Gojda
- Department of Internal Medicine, 3rd Faculty of Medicine and FNKV University Hospital, Charles University, Prague, Czech Republic
| | - Tomáš Urban
- Department of Anaesthesiology and Intensive Care Medicine, 3rd Faculty of Medicine and FNKV University Hospital, Charles University, Prague, Czech Republic
| | - Adéla Krajčová
- Department of Anaesthesiology and Intensive Care Medicine, 3rd Faculty of Medicine and FNKV University Hospital, Charles University, Prague, Czech Republic
| | - Michal Fric
- Department of Anaesthesiology and Intensive Care Medicine, 3rd Faculty of Medicine and FNKV University Hospital, Charles University, Prague, Czech Republic
| | - Kateřina Jiroutková
- Department of Anaesthesiology and Intensive Care Medicine, 3rd Faculty of Medicine and FNKV University Hospital, Charles University, Prague, Czech Republic
| | - Kamila Řasová
- Department of Rehabilitation, 3rd Faculty of Medicine and FNKV University Hospital, Charles University, Prague, Czech Republic
| | - František Duška
- Department of Anaesthesiology and Intensive Care Medicine, 3rd Faculty of Medicine and FNKV University Hospital, Charles University, Prague, Czech Republic
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22
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Corbin GN, Weaver K, Dolbow DR, Credeur D, Pattanaik S, Stokic DS. Safety and preliminary efficacy of functional electrical stimulation cycling in an individual with cervical cord injury, autonomic dysreflexia, and a pacemaker: Case report. J Spinal Cord Med 2021; 44:613-616. [PMID: 31809247 PMCID: PMC8288131 DOI: 10.1080/10790268.2019.1692180] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Context: Functional electric stimulation (FES) cycling is a commonly used therapeutic exercise modality after spinal cord injury (SCI); however, additional precautions must be taken in certain situations. The purpose of this study was to develop and apply a safety monitoring protocol for autonomic dysreflexia (AD) during FES cycling and to determine if an interval-FES cycling program can be safe and beneficial to an individual with cervical SCI, a history of AD, and a non-dependent cardiac pacemaker.The participant was a 36-year-old male with C6 AIS-C SCI sustained 9 years earlier, intermittent AD, and implanted cardiac pacemaker. Ten sessions of interval-FES cycling were performed twice weekly for 5 weeks. Rating of perceived exertion (RPE), blood pressure (BP), oxygen saturation (O2sat), and heart rate (HR) were monitored before, after, and every 5 min during cycling. ECG and cardiac pacemaker were evaluated by a cardiologist after ending the program.Findings: The participant reported self-limited chills 27 times over 10 sessions (19 "light", 3 "moderate", 5 "sharp"). Chills coincided with BP increases 59% of the time and their magnitudes moderately correlated (r = 0.32). The ECG was determined to be normal and the pacemaker fully functional at the end of the study, while blood glucose decreased (111-105 mg/dl), HbA1c levels increased (5.5-5.9%), and resting BP decreased (118/84-108/66 mmHg).Conclusion/Clinical Relevance: A person with cervical SCI, symptomatic AD, and a non-dependent pacemaker can safely participate and benefit from the interval-FES cycling program provided adequate monitoring of symptoms and vital signs.
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Affiliation(s)
- Gevork N. Corbin
- School of Physical Therapy, Department of Biomedical Sciences, and College of Osteopathic Medicine, William Carey University, Hattiesburg, Mississippi, USA
| | - Kelsi Weaver
- School of Physical Therapy, Department of Biomedical Sciences, and College of Osteopathic Medicine, William Carey University, Hattiesburg, Mississippi, USA
| | - David R. Dolbow
- School of Physical Therapy, Department of Biomedical Sciences, and College of Osteopathic Medicine, William Carey University, Hattiesburg, Mississippi, USA,Correspondence to: David R. Dolbow, PT, DPT, PhD, RKT, Associate Professor, Physical Therapy Program, William Carey University, 710 William Carey Parkway, Hattiesburg, MS 39401, USA; Ph: 601-318-6274.
| | - Daniel Credeur
- School of Kinesiology, University of Southern Mississippi, Hattiesburg, Mississippi, USA
| | - Sambit Pattanaik
- School of Physical Therapy, Department of Biomedical Sciences, and College of Osteopathic Medicine, William Carey University, Hattiesburg, Mississippi, USA
| | - Dobrivoje S. Stokic
- Center for Neuroscience and Neurological Recovery, Methodist Rehabilitation Center, Jackson, Mississippi, USA
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23
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Dolbow DR, Credeur DP, Lemacks JL, Stokic DS, Pattanaik S, Corbin GN, Courtner AS. Electrically induced cycling and nutritional counseling for counteracting obesity after spinal cord injury: A pilot study. J Spinal Cord Med 2021; 44:533-540. [PMID: 31971487 PMCID: PMC8288120 DOI: 10.1080/10790268.2019.1710939] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Objective: The purpose of this pilot study was to determine the preliminary efficacy of interval functional electrical stimulation (FES) cycling combined with nutritional counseling in obese adults with SCI.Setting: Community-based individuals with chronic SCI.Participants: Ten participants with chronic SCI.Interventions: Participants were divided into 2 groups (1) FES cycling and nutritional counseling (FES & Nutri) and (2) nutritional counseling only (Nutri Only). The FES & Nutri group performed high intensity interval FES cycling for 30 min 3 times per week for 8 weeks and received nutritional counseling for 30 min once per week for 8 weeks. The Nutri Only group received the nutritional counseling only.Outcome Measures: Body composition (fat mass, lean mass, body fat percentage), blood glucose levels.Results: Participants in the FES & Nutri group had a statistically significant greater decrease in body fat percentage (M = -1.14) compared to those in the Nutri Only group (M = +0.28) and gained more lean mass in their legs (M = +0.66 kg) compared to the Nutri Only group (M = -1.05 kg).Discussion/Conclusion: The statistically significant decrease in body fat percentage for the FES & Nutri group provides evidence that further study is merited. Future studies should include larger numbers of participants and the possible introduction of a preliminary strengthening program before initiating interval FES cycling. In addition, an increase in exercise volume and a greater role for nutritional counseling should be considered in order to optimize the treatment for obesity.
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Affiliation(s)
- David R. Dolbow
- School of Physical Therapy, William Carey University, Hattiesburg, Mississippi, USA,Correspondence to: David R. Dolbow, Physical Therapy Program, William Carey University, 710 William Carey Parkway, Hattiesburg, MS39401, USA.
| | - Daniel P. Credeur
- School of Kinesiology and Nutrition, University of Southern Mississippi, Hattiesburg, Mississippi, USA
| | - Jennifer L. Lemacks
- School of Kinesiology and Nutrition, University of Southern Mississippi, Hattiesburg, Mississippi, USA
| | - Dobrivoje S. Stokic
- Center for Neuroscience and Neurological Recovery, Methodist Rehabilitation Center, Jackson, Mississippi, USA
| | - Sambit Pattanaik
- College of Osteopathic Medicine, William Carey University, Hattiesburg, Mississippi, USA
| | - Gevork N. Corbin
- College of Osteopathic Medicine, William Carey University, Hattiesburg, Mississippi, USA
| | - Andrew S. Courtner
- Educational Research and Higher Education Administration, Lincoln Memorial University, Knoxville, Tennessee, USA
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24
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Gorgey AS, Lai RE, Khalil RE, Rivers J, Cardozo C, Chen Q, Lesnefsky EJ. Neuromuscular electrical stimulation resistance training enhances oxygen uptake and ventilatory efficiency independent of mitochondrial complexes after spinal cord injury: a randomized clinical trial. J Appl Physiol (1985) 2021; 131:265-276. [PMID: 33982590 DOI: 10.1152/japplphysiol.01029.2020] [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] [Indexed: 11/22/2022] Open
Abstract
The purpose of the study was to determine whether neuromuscular electrical stimulation resistance training (NMES-RT)-evoked muscle hypertrophy is accompanied by increased V̇o2 peak, ventilatory efficiency, and mitochondrial respiration in individuals with chronic spinal cord injury (SCI). Thirty-three men and women with chronic, predominantly traumatic SCI were randomized to either NMES-RT (n = 20) or passive movement training (PMT; n = 13). Functional electrical stimulation-lower extremity cycling (FES-LEC) was used to test the leg V̇o2 peak, V̇E/V̇co2 ratio, and substrate utilization pre- and postintervention. Magnetic resonance imaging was used to measure muscle cross-sectional area (CSA). Finally, muscle biopsy was performed to measure mitochondrial complexes and respiration. The NMES-RT group showed a significant increase in postintervention V̇o2 peak compared with baseline (ΔV̇o2 = 14%, P < 0.01) with no changes in the PMT group (ΔV̇o2 = 1.6%, P = 0.47). Similarly, thigh (ΔCSAthigh = 19%) and knee extensor (ΔCSAknee = 30.4%, P < 0.01) CSAs increased following NMES-RT but not after PMT. The changes in thigh and knee extensor muscle CSAs were positively related with the change in V̇o2 peak. Neither NMES-RT nor PMT changed mitochondrial complex tissue levels; however, changes in peak V̇o2 were related to complex I. In conclusion, in persons with SCI, NMES-RT-induced skeletal muscle hypertrophy was accompanied by increased peak V̇o2 consumption which may partially be explained by enhanced activity of mitochondrial complex I.NEW & NOTEWORTHY Leg oxygen uptake (V̇o2) and ventilatory efficiency (V̇E/V̇co2 ratio) were measured during functional electrical stimulation cycling testing following 12-16 wk of either electrically evoked resistance training or passive movement training, and the respiration of mitochondrial complexes. Resistance training increased thigh muscle area and leg V̇o2 peak but decreased V̇E/V̇co2 ratio without changes in mitochondrial complex levels. Leg V̇o2 peak was associated with muscle hypertrophy and mitochondrial respiration of complex I following training.
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Affiliation(s)
- Ashraf S Gorgey
- Spinal Cord Injury and Disorders Hunter Holmes McGuire VA Medical Center, Richmond, Virginia.,Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia
| | - Raymond E Lai
- Spinal Cord Injury and Disorders Hunter Holmes McGuire VA Medical Center, Richmond, Virginia.,Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia
| | - Refka E Khalil
- Spinal Cord Injury and Disorders Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
| | - Jeannie Rivers
- Surgical Service, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
| | - Christopher Cardozo
- National Center for the Medical Consequences of Spinal Cord Injury and Medical and Surgical Service, James J Peters VA Medical Center, Bronx, New York.,Department of Medicine, Icahn School of Medicine, New York City, New York.,Department Rehabilitation Medicine, Icahn School of Medicine, New York City, New York
| | - Qun Chen
- Medical Service, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia.,Division of Cardiology, Pauley Heart Center, Department of Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Edward J Lesnefsky
- Medical Service, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia.,Division of Cardiology, Pauley Heart Center, Department of Medicine, Virginia Commonwealth University, Richmond, Virginia
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Skiba GH, Andrade SF, Rodacki AF. Effects of functional electro-stimulation combined with blood flow restriction in affected muscles by spinal cord injury. Neurol Sci 2021; 43:603-613. [PMID: 33978870 DOI: 10.1007/s10072-021-05307-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/05/2021] [Indexed: 11/27/2022]
Abstract
Muscle atrophy is a great consequence of spinal cord injuries (SCI) due to immobility. SCI's detrimental effects on large muscle groups may lead to secondary effects such as glucose intolerance, increased risk of metabolic syndrome, and diabetes. Exercising with blood flow restriction (BFR) has been proposed as an effective method to induce hypertrophy using low training loads, with little or no muscle damage. This study investigated acute and chronic effects of low-intensity functional electrical stimulation (FES) combined with BFR on muscles affected by spinal cord injury. The acute effects of one bout of FES with (FES + BFR group) and without BFR (FES group) on muscle thickness (MT) and edema formation were compared. The chronic effects on MT and edema following 8 weeks of twice weekly training with and without BFR were also compared. The FES + BFR group showed MT and edema increases compared to the FES only group (p< 0.05). The FES + BFR showed a chronic MT increase after 4 weeks of training (p <0.05), with no further MT increases from the 4th to the 8th week (p>0.05). Following 3 weeks of detraining, MT decreased to baseline. No MT changes were observed in the FES (p>0.05). The FES + BF stimuli induced MT increases on the paralyzed skeletal muscles of SCI. The acute effects suggest that FES causes a greater metabolite accumulation and edema when combined with BFR. The early increases in MT can be attributed to edema, whereas after the 4th week, it is likely to be related to muscle hypertrophy. Register Clinical Trial Number on ReBeC: RBR-386rm8.
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Affiliation(s)
- Gabriel H Skiba
- Motor Behavior Studies Center/Physiology Education Post Graduation Program, Federal University of Paraná, Curitiba, Brazil.
| | - Sérgio F Andrade
- Motor Behavior Studies Center/Physiology Education Post Graduation Program, Federal University of Paraná, Curitiba, Brazil
| | - André F Rodacki
- Motor Behavior Studies Center/Physiology Education Post Graduation Program, Federal University of Paraná, Curitiba, Brazil
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26
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Farkas GJ, Swartz AM, Gorgey AS, Berg AS, Gater DR. Acute exercise improves glucose effectiveness but not insulin sensitivity in paraplegia. Disabil Rehabil 2021; 44:4656-4662. [PMID: 33905292 DOI: 10.1080/09638288.2021.1913517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To determine the effect of a single session of arm crank ergometry (ACE) exercise on carbohydrate metabolism immediately and 24 h after the exercise bout in paraplegia and able-bodied controls (ABC). METHODS Paraplegia (n = 11; 91% male; age 34.8 ± 11.4 years) and ABC (n = 6; 67% male; age 28.7 ± 11.9 years) underwent 45 min of ACE exercise at 75% VO2Peak. Glucose effectiveness (Sg) and insulin sensitivity (Si) were assessed. Data were analyzed with two-way mixed analysis of variance and Wilcoxon rank-sum or signed-rank post hoc test. RESULTS VO2Peak was lower in paraplegia versus ABC (22.3 ± 3.99 vs. 30.8 ± 2.9 ml/kg/min, p = 0.003). Si was lower paraplegia vs. ABC immediately following exercise (3.28 ± 1.6 vs. 5.30 ± 1.2 min-1/[µU/mL-1]x10-4, p = 0.023). In paraplegia, Sg was higher immediately after exercise than baseline (B: 0.021 ± 0.01 vs. I: 0.026 ± 0.01 min-1, p = 0.037). Twenty-four hours after exercise, Sg was lower than immediately following exercise (I: 0.026 ± 0.01 vs. 24: 0.017 ± 0.01 min-1, p = 0.001), but not different than baseline in paraplegia (B: 0.021 ± 0.01 vs. 24: 0.017 ± 0.01 min-1, p = 0.216). In the ABC group, Sg was not different at all timepoints (p > 0.05). Si did not differ at all timepoints (p > 0.05). CONCLUSION A single bout of ACE at 75% VO2Peak helped to acutely control glucose metabolism in those with paraplegia by increasing Sg by nearly 27%; however, this was not sustained past 24-hours. These data provide support for regular exercise engagement.Implications for RehabilitationDisorders of glucose metabolism have been reported at a greater prevalence in persons with spinal cord injury.A single bout of arm crank ergometry exercise at 75% VO2Peak helped to acutely control glucose metabolism persons with paraplegia; however, this was not sustained past 24 h.These data provide support for regular exercise engagement in persons with paraplegia.
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Affiliation(s)
- Gary J Farkas
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ann M Swartz
- Department of Kinesiology, University of Wisconsin Milwaukee, Milwaukee, WI, USA
| | - Ashraf S Gorgey
- Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
| | - Arthur S Berg
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - David R Gater
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL, USA
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27
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Goldsmith JA, Ennasr AN, Farkas GJ, Gater DR, Gorgey AS. Role of exercise on visceral adiposity after spinal cord injury: a cardiometabolic risk factor. Eur J Appl Physiol 2021; 121:2143-2163. [PMID: 33891156 DOI: 10.1007/s00421-021-04688-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/10/2021] [Indexed: 12/30/2022]
Abstract
PURPOSE Visceral adipose tissue (VAT) is associated with cardiometabolic disease risk in able-bodied (AB) populations. However, the underlying mechanisms of VAT-induced disease risk are unknown in persons with spinal cord injury (SCI). Potential mechanisms of VAT-induced cardiometabolic dysfunction in persons with SCI include systemic inflammation, liver adiposity, mitochondrial dysfunction, and anabolic deficiency. Moreover, how exercise interventions impact these mechanisms associated with VAT-induced cardiometabolic dysfunction are still being explored. METHODS A search for relevant scientific literature about the effects of exercise on VAT and cardiometabolic health was conducted on the PubMed database. Literature from reference lists was also included when appropriate. RESULTS Both aerobic and resistance exercise training beneficially impact health and VAT mass via improving mitochondrial function, glucose effectiveness, and inflammatory signaling in SCI and AB populations. Specifically, aerobic exercise appears to also modulate cellular senescence in AB populations and animal models, while resistance exercise seems to augment anabolic signaling in persons with SCI. CONCLUSIONS The current evidence supports regular engagement in exercise to reduce VAT mass and the adverse effects on cardiometabolic health in persons with SCI. Future research is needed to further elucidate the precise mechanisms by which VAT negatively impacts health following SCI. This will likely facilitate the development of rehabilitation protocols that target VAT reduction in persons with SCI.
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Affiliation(s)
- Jacob A Goldsmith
- Spinal Cord Injury and Disorders Center, Central Virginia VA Health Care System, 1201 Broad Rock Boulevard, Richmond, VA, 23249, USA
| | - Areej N Ennasr
- Spinal Cord Injury and Disorders Center, Central Virginia VA Health Care System, 1201 Broad Rock Boulevard, Richmond, VA, 23249, USA
| | - Gary J Farkas
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - David R Gater
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Ashraf S Gorgey
- Spinal Cord Injury and Disorders Center, Central Virginia VA Health Care System, 1201 Broad Rock Boulevard, Richmond, VA, 23249, USA. .,Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, 23298, USA.
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Gordon PS, Farkas GJ, Gater DR. Neurogenic Obesity-Induced Insulin Resistance and Type 2 Diabetes Mellitus in Chronic Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2021; 27:36-56. [PMID: 33814882 DOI: 10.46292/sci20-00063] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The population with SCI is at a significant risk for both insulin resistance and type 2 diabetes mellitus (T2DM) secondary to neurogenic obesity. The prevalence of insulin resistance and T2DM in persons with SCI suggests that disorders of carbohydrate metabolism are at epidemic proportions within the population. However, the true frequency of such disorders may be underestimated because biomarkers of insulin resistance and T2DM used from the population without SCI remain nonspecific and may in fact fail to identify true cases that would benefit from intervention. Furthermore, diet and exercise have been used to help mitigate neurogenic obesity, but results on disorders of carbohydrate metabolism remain inconsistent, likely because of the various ways carbohydrate metabolism is assessed. The objective of this article is to review current literature on the prevalence and likely mechanisms driving insulin resistance and T2DM in persons with SCI. This article also explores the various assessments and diagnostic criteria used for insulin resistance and T2DM and briefly discusses the effects of exercise and/or diet to mitigate disorders of carbohydrate metabolism brought on by neurogenic obesity.
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Affiliation(s)
- Phillip S Gordon
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida
| | - Gary J Farkas
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida
| | - David R Gater
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida
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29
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SHIN Y, LEE JW, HONG SM, LEE JH. Exercise improves glucose and insulin response to oral glucose tolerance test in people with spinal cord injury. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2021. [DOI: 10.23736/s0393-3660.19.04137-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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30
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Farkas GJ, Gorgey AS, Dolbow DR, Berg AS, Gater DR. Energy Expenditure, Cardiorespiratory Fitness, and Body Composition Following Arm Cycling or Functional Electrical Stimulation Exercises in Spinal Cord Injury: A 16-Week Randomized Controlled Trial. Top Spinal Cord Inj Rehabil 2021; 27:121-134. [PMID: 33814890 PMCID: PMC7983642 DOI: 10.46292/sci20-00065] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: Physical deconditioning and inactivity following spinal cord injury (SCI) are associated with multiple cardiometabolic risks. To mitigate cardiometabolic risk, exercise is recommended, but it is poorly established whether arm cycling exercise (ACE) or functional electrical stimulation (FES) leg cycling yields superior benefits. Objectives: To determine the adaptations of 16 weeks of FES cycling and ACE on exercise energy expenditure (EEE), cardiorespiratory fitness (CRF), and obesity after SCI. Methods: Thirteen physically untrained individuals were randomly assigned to FES (n = 6) or ACE (n = 7) exercise 5 days/week for 16 weeks. Pre- and post-intervention EEE, peak oxygen consumption (absolute and relative VO2Peak), and work were assessed using indirect calorimetry, while body composition was measured by dual-energy x-ray absorptiometry. Results: Main effects were found for peak power (p < .001), absolute (p = .046) and relative (p = .042) VO2Peak, and peak work (p = .013). Compared to baseline, the ACE group increased in EEE (+85%, p = .002), peak power (+307%, p < .001), VO2Peak (absolute +21%, relative +22%, p ≤ .024), peak work (19% increase, p = .003), and total body fat decreased (-6%, p = .05). The FES group showed a decrease in percentage body fat mass (-5%, p = .008). The ACE group had higher EEE (p = .008), peak power (p < .001), and relative VO2Peak (p = .025) compared to postintervention values in the FES group. Conclusion: In the current study, ACE induced greater increases in EEE and CRF, whereas ACE and FES showed similar results on body fat. Exercise promotional efforts targeting persons with SCI should use both FES and ACE to reduce sedentary behavior and to optimize different health parameters after SCI.
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Affiliation(s)
- Gary J. Farkas
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida
| | - Ashraf S. Gorgey
- Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
| | - David R. Dolbow
- Department of Physical Therapy, William Carey University, Hattiesburg, Mississippi
| | - Arthur S. Berg
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - David R. Gater
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida
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31
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Farkas GJ, Gordon PS, Swartz AM, Berg AS, Gater DR. Influence of mid and low paraplegia on cardiorespiratory fitness and energy expenditure. Spinal Cord Ser Cases 2020; 6:110. [PMID: 33328437 DOI: 10.1038/s41394-020-00363-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/11/2020] [Accepted: 11/13/2020] [Indexed: 11/09/2022] Open
Abstract
STUDY DESIGN Observational, Cross-sectional. OBJECTIVE Examine the influence of mid (MP) and low (LP) paraplegia on cardiorespiratory fitness (CRF), energy expenditure (EE), and physical activity levels (PAL), and compare these data to able-bodied (AB) individuals. SETTING Academic medical center. METHODS Persons with MP (n = 6, T6-T8, 83% male, age: 31 ± 11 y, BMI: 24 ± 7 kg/m2) and LP (n = 5; T10-L1, 100% male, age: 39 ± 11 y, BMI: 26 ± 5 kg/m2) and AB controls (n = 6; 67% male, age: 29 ± 12 y, BMI: 26 ± 5 kg/m2) participated. All participants underwent 45-min of arm-crank exercise where CRF and exercise EE were measured. Basal metabolic rate (BMR) was measured, and total daily EE (TDEE) and PAL were estimated. RESULTS Absolute VO2Peak (MP: 1.6 ± 0.2, LP: 1.9 ± 0.1, AB: 2.5 ± 0.7 l/min), peak metabolic equivalents (MP: 6.8 ± 1.3, LP: 5.7 ± 0.7, AB: 8.8 ± 0.8 METs), peak power output (MP: 72.9 ± 11.5, LP: 86.8 ± 6.1, AB: 121.0 ± 34.8 Watts), and maximal heart rate (MP: 177.7 ± 9.8, LP: 157 ± 13.6, AB: 185.2 ± 8.5 bpm) were significantly different between the three groups (p < 0.05). BMR and TDEE did not significantly differ between the three groups (p > 0.05), whereas exercise EE (MP: 7.8 ± 1.2, LP: 9.5 ± 0.7, AB: 12.4 ± 3.5 kcal/min) and PAL (MP: 1.30 ± 0.04, LP: 1.32 ± 0.04, AB: 1.43 ± 0.06) significantly differed (p < 0.05). In the AB group, 33.3% and 66.7% were classified as sedentary or having low activity levels, respectively, while all persons with paraplegia were classified as sedentary according to PAL classifications. CONCLUSION Individuals with MP and LP have lower CRF, exercise EE, and PALs compared to AB individuals.
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Affiliation(s)
- Gary J Farkas
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Phillip S Gordon
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ann M Swartz
- Department of Kinesiology, University of Wisconsin Milwaukee, Milwaukee, WI, USA
| | - Arthur S Berg
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - David R Gater
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL, USA
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Momeni K, Ramanujam A, Ravi M, Garbarini E, Forrest GF. Effects of Multi-Muscle Electrical Stimulation and Stand Training on Stepping for an Individual With SCI. Front Hum Neurosci 2020; 14:549965. [PMID: 33100994 PMCID: PMC7546792 DOI: 10.3389/fnhum.2020.549965] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 08/28/2020] [Indexed: 11/13/2022] Open
Abstract
The objective of this study was to evaluate the biomechanical, neural, and functional outcomes during a 10-min treadmill stepping trial before and after two independent interventions with neuromuscular electrical stimulation (ES) in an individual with spinal cord injury (SCI). In this longitudinal study, a 34-year-old male with sensory- and motor-complete SCI (C5/C6) underwent two consecutive interventions: 61 h of supine lower limb ES (ES-alone) followed by 51 h of ES combined with stand training (ST) using an overhead body-weight support (BWS) system (ST + ES). In post ES-alone (unloaded), compared to baseline, the majority (∼60%) of lower extremity muscles decreased their peak surface electromyography (sEMG) amplitude, while in post ST + ES (loaded), compared to post ES-alone, there was a restoration in muscle activation that endured the continuous 10-min stepping. Temporal α-motor neuron activity patterns were observed for the SCI participant. In post ST + ES, there were increases in spinal activity patterns during mid-stance at spinal levels L5–S2 for the right and left limbs. Moreover, in post ES-alone, trunk stability increased with excursions from the midline of the base-of-support (50%) to the left (44.2%; Baseline: 54.2%) and right (66.4%; baseline: 77.5%). The least amount of trunk excursion observed post ST + ES, from midline to left (43%; AB: 22%) and right (64%; AB: 64%). Overall, in post ES-alone, there were gains in trunk independence with a decrease in lower limb muscle activation, whereas in post ST + ES, there were gains in trunk independence and increased muscle activation in both bilateral trunk muscles as well as lower limb muscles during the treadmill stepping paradigm. The results of the study illustrate the importance of loading during the stimulation for neural and mechanical gains.
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Affiliation(s)
- Kamyar Momeni
- Tim and Caroline Reynolds Center for Spinal Stimulation, Kessler Foundation, West Orange, NJ, United States.,Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, United States
| | - Arvind Ramanujam
- Tim and Caroline Reynolds Center for Spinal Stimulation, Kessler Foundation, West Orange, NJ, United States
| | - Manikandan Ravi
- Tim and Caroline Reynolds Center for Spinal Stimulation, Kessler Foundation, West Orange, NJ, United States
| | - Erica Garbarini
- Tim and Caroline Reynolds Center for Spinal Stimulation, Kessler Foundation, West Orange, NJ, United States
| | - Gail F Forrest
- Tim and Caroline Reynolds Center for Spinal Stimulation, Kessler Foundation, West Orange, NJ, United States.,Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, United States
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Bass A, Aubertin-Leheudre M, Vincent C, Karelis AD, Morin SN, McKerral M, Duclos C, Gagnon DH. Effects of an Overground Walking Program With a Robotic Exoskeleton on Long-Term Manual Wheelchair Users With a Chronic Spinal Cord Injury: Protocol for a Self-Controlled Interventional Study. JMIR Res Protoc 2020; 9:e19251. [PMID: 32663160 PMCID: PMC7545333 DOI: 10.2196/19251] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/30/2020] [Accepted: 07/07/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND In wheelchair users with a chronic spinal cord injury (WUSCI), prolonged nonactive sitting time and reduced physical activity-typically linked to this mode of mobility-contribute to the development or exacerbation of cardiorespiratory, musculoskeletal, and endocrine-metabolic health complications that are often linked to increased risks of chronic pain or psychological morbidity. Limited evidence suggests that engaging in a walking program with a wearable robotic exoskeleton may be a promising physical activity intervention to counter these detrimental health effects. OBJECTIVE This study's overall goals are as follows: (1) to determine the effects of a 16-week wearable robotic exoskeleton-assisted walking program on organic systems, functional capacities, and multifaceted psychosocial factors and (2) to determine self-reported satisfaction and perspectives with regard to the intervention and the device. METHODS A total of 20 WUSCI, who have had their injuries for more than 18 months, will complete an overground wearable robotic exoskeleton-assisted walking program (34 sessions; 60 min/session) supervised by a physiotherapist over a 16-week period (one to three sessions/week). Data will be collected 1 month prior to the program, at the beginning, and at the end as well as 2 months after completing the program. Assessments will characterize sociodemographic characteristics; anthropometric parameters; sensorimotor impairments; pain; lower extremity range of motion and spasticity; wheelchair abilities; cardiorespiratory fitness; upper extremity strength; bone architecture and mineral density at the femur, tibia, and radius; total and regional body composition; health-related quality of life; and psychological health. Interviews and an online questionnaire will be conducted to measure users' satisfaction levels and perspectives at the end of the program. Differences across measurement times will be verified using appropriate parametric or nonparametric analyses of variance for repeated measures. RESULTS This study is currently underway with active recruitment in Montréal, Québec, Canada. Results are expected in the spring of 2021. CONCLUSIONS The results from this study will be essential to guide the development, implementation, and evaluation of future evidence-based wearable robotic exoskeleton-assisted walking programs offered in the community, and to initiate a reflection regarding the use of wearable robotic exoskeletons during initial rehabilitation following a spinal cord injury. TRIAL REGISTRATION ClinicalTrials.gov NCT03989752; https://clinicaltrials.gov/ct2/show/NCT03989752. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/19251.
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Affiliation(s)
- Alec Bass
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Centre Intégré Universitaire de Santé et Services Sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, QC, Canada
| | | | - Claude Vincent
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Québec, QC, Canada
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Québec, QC, Canada
| | - Antony D Karelis
- Department of Exercise Science, Université du Québec à Montréal, Montréal, QC, Canada
| | - Suzanne N Morin
- Department of Medicine, McGill University, Montréal, QC, Canada
| | - Michelle McKerral
- Departement of Psychology, Faculty of Arts and Sciences, Université de Montréal, Montréal, QC, Canada
| | - Cyril Duclos
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Centre Intégré Universitaire de Santé et Services Sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, QC, Canada
| | - Dany H Gagnon
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Centre Intégré Universitaire de Santé et Services Sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, QC, Canada
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Nash MS, Gater DR. Cardiometabolic Disease and Dysfunction Following Spinal Cord Injury. Phys Med Rehabil Clin N Am 2020; 31:415-436. [DOI: 10.1016/j.pmr.2020.04.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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35
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A therapeutic effect for males with spinal cord injury using abdominal functional electrical stimulation for sexual functioning. Spinal Cord Ser Cases 2020; 6:24. [PMID: 32317626 DOI: 10.1038/s41394-020-0273-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 03/16/2020] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Sexual functioning is a high priority for people with a spinal cord injury (SCI) yet this area has received little attention. Two SCI case reports are presented which suggests there may be greater potential for the recovery of sexual functioning than previously recognised. CASE PRESENTATION A 74-year-old SCI male (AIS D, C5/C6) and a 36-year-old SCI male (AIS A, T4/T5) were treated for neurogenic bowel using 6 weeks of abdominal FES (ABFES) (40 Hz, 300 µ pulse width (current typically 30-60 MA) simultaneously delivered (8 s contraction with 2 s ramps and 3 s off period) from both channels). The 74-year-old AIS D, C5/C6 participant reported improved strength and duration of erectile function after using ABFES for 3 weeks. The 36-year-old AIS A, T4/T5 participant reported improvements in ejaculatory function and urine flow. Both reported a reduction in time required for bowel management. DISCUSSION The findings could be attributed to an improved vascularisation of the abdominal area, an improved body image and self-esteem, direct innervation of nerves involved in parasympathetic pathways or innervation of the T11/T1 area implicated in the alternative psychogenic pathway. Both participants reported they had not used ABFES during sexual activity suggesting a therapeutic effect from the treatment.
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Attenuation of autonomic dysreflexia during functional electrical stimulation cycling by neuromuscular electrical stimulation training: case reports. Spinal Cord Ser Cases 2020; 6:12. [PMID: 32127515 DOI: 10.1038/s41394-020-0262-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 02/12/2020] [Accepted: 02/15/2020] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Spinal cord injury (SCI) may cause impairments of the motor, sensory, and autonomic nervous systems, which result in adverse changes in body composition and cardiovascular health. Functional electrical stimulation (FES) cycling may provide an effective alternative approach to perform exercise and improve cardiovascular health after SCI. Persons with an injury at or above T6 level are at high risk of developing a life-threatening complication of autonomic dysreflexia (AD). CASE PRESENTATION Two participants with motor-complete C6 SCI completed either 12 weeks of passive range of motion or surface neuromuscular electrical stimulation (NMES) resistance training, followed by 12 weeks of functional electrical stimulation (FES) lower extremity cycling for both participants. Systolic and diastolic blood pressure (BP) were measured to determine the effects of NMES-resistance training and FES-lower extremity cycling during rest and exercise. DISCUSSION The difference between mean value of BP during FES-lower extremity cycling exercise and resting BP averaged for 24 sessions was smaller for participant A (31.25 mmHg for systolic BP and 10.44 mmHg for diastolic BP), who received NMES-resistance training, as compared with participant B (58.62 mmHg for systolic BP and 35.07 mmHg for diastolic BP). The results of these case reports suggest that 12 weeks of NMES-resistance training preceding FES-lower extremity cycling may attenuate the development of AD after SCI. Risk of AD, triggered by noxious stimuli, may be dampened with FES-lower extremity cycling training in persons with SCI.
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Waldauf P, Gojda J, Urban T, Hrušková N, Blahutová B, Hejnová M, Jiroutková K, Fric M, Jánský P, Kukulová J, Stephens F, Řasová K, Duška F. Functional electrical stimulation-assisted cycle ergometry in the critically ill: protocol for a randomized controlled trial. Trials 2019; 20:724. [PMID: 31842936 PMCID: PMC6915865 DOI: 10.1186/s13063-019-3745-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 09/23/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Intensive care unit (ICU)-acquired weakness is the most important cause of failed functional outcome in survivors of critical care. Most damage occurs during the first week when patients are not cooperative enough with conventional rehabilitation. Functional electrical stimulation-assisted cycle ergometry (FES-CE) applied within 48 h of ICU admission may improve muscle function and long-term outcome. METHODS An assessor-blinded, pragmatic, single-centre randomized controlled trial will be performed. Adults (n = 150) mechanically ventilated for < 48 h from four ICUs who are estimated to need > 7 days of critical care will be randomized (1:1) to receive either standard of care or FES-CE-based intensified rehabilitation, which will continue until ICU discharge. PRIMARY OUTCOME quality of life measured by 36-Item Short Form Health Survey score at 6 months. SECONDARY OUTCOMES functional performance at ICU discharge, muscle mass (vastus ultrasound, N-balance) and function (Medical Research Council score, insulin sensitivity). In a subgroup (n = 30) we will assess insulin sensitivity and perform skeletal muscle biopsies to look at mitochondrial function, fibre typing and regulatory protein expression. TRIAL REGISTRATION ClinicalTrials.gov, NCT02864745. Registered on 12 August 2016.
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Affiliation(s)
- Petr Waldauf
- Department of Anaesthesiology and Intensive Care Medicine, Charles University, 3rd Faculty of Medicine and KAR FNKV University Hospital, Fac Med 3, Srobarova 50, 10034, Prague, Czech Republic
| | - Jan Gojda
- Department of Internal Medicine II, Charles University, 3rd Faculty of Medicine and FNKV University Hospital, Prague, Czech Republic
| | - Tomáš Urban
- Department of Anaesthesiology and Intensive Care Medicine, Charles University, 3rd Faculty of Medicine and KAR FNKV University Hospital, Fac Med 3, Srobarova 50, 10034, Prague, Czech Republic
| | - Natália Hrušková
- Department of Rehabilitation, Charles University, 3rd Faculty of Medicine and FNKV University Hospital, Prague, Czech Republic
| | - Barbora Blahutová
- Department of Anaesthesiology and Intensive Care Medicine, Charles University, 3rd Faculty of Medicine and KAR FNKV University Hospital, Fac Med 3, Srobarova 50, 10034, Prague, Czech Republic
- Department of Rehabilitation, Charles University, 3rd Faculty of Medicine and FNKV University Hospital, Prague, Czech Republic
| | - Marie Hejnová
- Department of Anaesthesiology and Intensive Care Medicine, Charles University, 3rd Faculty of Medicine and KAR FNKV University Hospital, Fac Med 3, Srobarova 50, 10034, Prague, Czech Republic
- Department of Rehabilitation, Charles University, 3rd Faculty of Medicine and FNKV University Hospital, Prague, Czech Republic
| | - Kateřina Jiroutková
- Department of Anaesthesiology and Intensive Care Medicine, Charles University, 3rd Faculty of Medicine and KAR FNKV University Hospital, Fac Med 3, Srobarova 50, 10034, Prague, Czech Republic
| | - Michal Fric
- Department of Anaesthesiology and Intensive Care Medicine, Charles University, 3rd Faculty of Medicine and KAR FNKV University Hospital, Fac Med 3, Srobarova 50, 10034, Prague, Czech Republic
| | - Pavel Jánský
- Department of Anaesthesiology and Intensive Care Medicine, Charles University, 3rd Faculty of Medicine and KAR FNKV University Hospital, Fac Med 3, Srobarova 50, 10034, Prague, Czech Republic
| | - Jana Kukulová
- Department of Anaesthesiology and Intensive Care Medicine, Charles University, 3rd Faculty of Medicine and KAR FNKV University Hospital, Fac Med 3, Srobarova 50, 10034, Prague, Czech Republic
| | - Francis Stephens
- College of Life and Environmental Sciences, Sport and Health Sciences, University of Exeter, Exeter, UK
| | - Kamila Řasová
- Department of Rehabilitation, Charles University, 3rd Faculty of Medicine and FNKV University Hospital, Prague, Czech Republic
| | - František Duška
- Department of Anaesthesiology and Intensive Care Medicine, Charles University, 3rd Faculty of Medicine and KAR FNKV University Hospital, Fac Med 3, Srobarova 50, 10034, Prague, Czech Republic.
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Gorgey AS, Khalil RE, Gill R, Gater DR, Lavis TD, Cardozo CP, Adler RA. Low-Dose Testosterone and Evoked Resistance Exercise after Spinal Cord Injury on Cardio-Metabolic Risk Factors: An Open-Label Randomized Clinical Trial. J Neurotrauma 2019; 36:2631-2645. [PMID: 30794084 DOI: 10.1089/neu.2018.6136] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The purpose of the work is to investigate the effects of low-dose testosterone replacement therapy (TRT) and evoked resistance training (RT) on body composition and metabolic variables after spinal cord injury (SCI). Twenty-two individuals with chronic motor complete SCI (ages 18-50 years) were randomly assigned to either TRT+RT (n = 11) or TRT (n = 11) for 16 weeks following a 4 -week delayed entry period. TRT+RT men underwent twice weekly progressive RT using electrical stimulation with ankle weights. TRT was administered via testosterone patches (2-6 mg/day). Body composition was tested using anthropometrics, dual energy x-ray absorptiometry, and magnetic resonance imaging. After an overnight fast, basal metabolic rate (BMR), lipid panel, serum testosterone, adiponectin, inflammatory and anabolic biomarkers (insulin-like growth factor-1 and insulin-like growth factor-binding protein 3 [IGFBP-3]), glucose effectiveness (Sg), and insulin sensitivity (Si) were measured. Total body lean mass (LM; 2.7 kg, p < 0.0001), whole muscle (p < 0.0001), and whole muscle knee extensor cross-sectional areas (CSAs; p < 0.0001) increased in the TRT+RT group, with no changes in the TRT group. Visceral adiposity decreased (p = 0.049) in the TRT group, with a trend in the TRT+RT (p = 0.07) group. There was a trend (p = 0.050) of a 14-17% increase in BMR following TRT+RT. Sg showed a trend (p = 0.07) to improvement by 28.5-31.5% following both interventions. IGFBP-3 increased (p = 0.0001) while IL-6 decreased (p = 0.039) following both interventions, and TRT+RT suppressed adiponectin (p = 0.024). TRT+RT resulted in an increase in LM and whole thigh and knee extensor muscle CSAs, with an increase in BMR and suppressed adiponectin. Low-dose TRT may mediate modest effects on visceral adipose tissue, Sg, IGFBP-3, and IL-6, independent of changes in LM.
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Affiliation(s)
- Ashraf S Gorgey
- Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia
| | - Refka E Khalil
- Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
| | - Ranjodh Gill
- Endocrinology Service, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
- Endocrine Division, Virginia Commonwealth University, Richmond, Virginia
| | - David R Gater
- Department of Physical Medicine and Rehabilitation, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Timothy D Lavis
- Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia
| | - Christopher P Cardozo
- National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, New York
- Icahn School of Medicine at Mt. Sinai, New York, New York
| | - Robert A Adler
- Endocrinology Service, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
- Endocrine Division, Virginia Commonwealth University, Richmond, Virginia
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Gorgey AS, Khalil RE, Davis JC, Carter W, Gill R, Rivers J, Khan R, Goetz LL, Castillo T, Lavis T, Sima AP, Lesnefsky EJ, Cardozo CC, Adler RA. Skeletal muscle hypertrophy and attenuation of cardio-metabolic risk factors (SHARC) using functional electrical stimulation-lower extremity cycling in persons with spinal cord injury: study protocol for a randomized clinical trial. Trials 2019; 20:526. [PMID: 31443727 PMCID: PMC6708188 DOI: 10.1186/s13063-019-3560-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 07/06/2019] [Indexed: 12/16/2022] Open
Abstract
Background Persons with spinal cord injury (SCI) are at heightened risks of developing unfavorable cardiometabolic consequences due to physical inactivity. Functional electrical stimulation (FES) and surface neuromuscular electrical stimulation (NMES)-resistance training (RT) have emerged as effective rehabilitation methods that can exercise muscles below the level of injury and attenuate cardio-metabolic risk factors. Our aims are to determine the impact of 12 weeks of NMES + 12 weeks of FES-lower extremity cycling (LEC) compared to 12 weeks of passive movement + 12 weeks of FES-LEC on: (1) oxygen uptake (VO2), insulin sensitivity, and glucose disposal in adults with SCI; (2) skeletal muscle size, intramuscular fat (IMF), and visceral adipose tissue (VAT); and (3) protein expression of energy metabolism, protein molecules involved in insulin signaling, muscle hypertrophy, and oxygen uptake and electron transport chain (ETC) activities. Methods/Design Forty-eight persons aged 18–65 years with chronic (> 1 year) SCI/D (AIS A-C) at the C5-L2 levels, equally sub-grouped by cervical or sub-cervical injury levels and time since injury, will be randomized into either the NMES + FES group or Passive + FES (control group). The NMES + FES group will undergo 12 weeks of evoked RT using twice-weekly NMES and ankle weights followed by twice-weekly progressive FES-LEC for an additional 12 weeks. The control group will undergo 12 weeks of passive movement followed by 12 weeks of progressive FES-LEC. Measurements will be performed at baseline (B; week 0), post-intervention 1 (P1; week 13), and post-intervention 2 (P2; week 25), and will include: VO2 measurements, insulin sensitivity, and glucose effectiveness using intravenous glucose tolerance test; magnetic resonance imaging to measure muscle, IMF, and VAT areas; muscle biopsy to measure protein expression and intracellular signaling; and mitochondrial ETC function. Discussion Training through NMES + RT may evoke muscle hypertrophy and positively impact oxygen uptake, insulin sensitivity, and glucose effectiveness. This may result in beneficial outcomes on metabolic activity, body composition profile, mitochondrial ETC, and intracellular signaling related to insulin action and muscle hypertrophy. In the future, NMES-RT may be added to FES-LEC to improve the workloads achieved in the rehabilitation of persons with SCI and further decrease muscle wasting and cardio-metabolic risks. Trial registration ClinicalTrials.gov, NCT02660073. Registered on 21 Jan 2016.
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Affiliation(s)
- Ashraf S Gorgey
- Spinal Cord Injury & Disorders Service, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA. .,Department of Physical Medicine & Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA.
| | - Refka E Khalil
- Spinal Cord Injury & Disorders Service, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
| | - John C Davis
- Spinal Cord Injury & Disorders Service, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
| | - William Carter
- Department of Physical Medicine & Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
| | - Ranjodh Gill
- Endocrinology Service, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA.,Endocrine Division, School of Medicine Virginia Commonwealth University, Richmond, VA, USA
| | - Jeannie Rivers
- Endocrine Division, School of Medicine Virginia Commonwealth University, Richmond, VA, USA
| | - Rehan Khan
- Radiology Service, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
| | - Lance L Goetz
- Spinal Cord Injury & Disorders Service, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA.,Department of Physical Medicine & Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
| | - Teodoro Castillo
- Spinal Cord Injury & Disorders Service, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA.,Department of Physical Medicine & Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
| | - Timothy Lavis
- Spinal Cord Injury & Disorders Service, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA.,Department of Physical Medicine & Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
| | - Adam P Sima
- Department of Biostatistics, School of Medicine Virginia Commonwealth University, Richmond, VA, USA
| | - Edward J Lesnefsky
- Cardiology Service, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA.,Division of Cardiology, Department of Internal Medicine, Pauley Heart Center Virginia Commonwealth University, Richmond, VA, USA
| | - Christopher C Cardozo
- Center for the Medical Consequences of Spinal Cord Injury, James J Peters VA Medical Center, Bronx, NY, USA.,Departments of Medicine and Rehabilitation Medicine, Icahn School of Medicine, New York, NY, USA
| | - Robert A Adler
- Endocrinology Service, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA.,Endocrine Division, School of Medicine Virginia Commonwealth University, Richmond, VA, USA
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Novel stochastic framework for automatic segmentation of human thigh MRI volumes and its applications in spinal cord injured individuals. PLoS One 2019; 14:e0216487. [PMID: 31071158 PMCID: PMC6508923 DOI: 10.1371/journal.pone.0216487] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 04/22/2019] [Indexed: 11/19/2022] Open
Abstract
Severe spinal cord injury (SCI) leads to skeletal muscle atrophy and adipose tissue infiltration in the skeletal muscle, which can result in compromised muscle mechanical output and lead to health-related complications. In this study, we developed a novel automatic 3-D approach for volumetric segmentation and quantitative assessment of thigh Magnetic Resonance Imaging (MRI) volumes in individuals with chronic SCI as well as non-disabled individuals. In this framework, subcutaneous adipose tissue, inter-muscular adipose tissue and total muscle tissue are segmented using linear combination of discrete Gaussians algorithm. Also, three thigh muscle groups were segmented utilizing the proposed 3-D Joint Markov Gibbs Random Field model that integrates first order appearance model, spatial information, and shape model to localize the muscle groups. The accuracy of the automatic segmentation method was tested both on SCI (N = 16) and on non-disabled (N = 14) individuals, showing an overall 0.93±0.06 accuracy for adipose tissue and muscle compartments segmentation based on Dice Similarity Coefficient. The proposed framework for muscle compartment segmentation showed an overall higher accuracy compared to ANTs and STAPLE, two previously validated atlas-based segmentation methods. Also, the framework proposed in this study showed similar Dice accuracy and better Hausdorff distance measure to that obtained using DeepMedic Convolutional Neural Network structure, a well-known deep learning network for 3-D medical image segmentation. The automatic segmentation method proposed in this study can provide fast and accurate quantification of adipose and muscle tissues, which have important health and functional implications in the SCI population.
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Momeni K, Ramanujam A, Garbarini EL, Forrest GF. Multi-muscle electrical stimulation and stand training: Effects on standing. J Spinal Cord Med 2019; 42:378-386. [PMID: 29447105 PMCID: PMC6522918 DOI: 10.1080/10790268.2018.1432311] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE To examine the biomechanical and neuromuscular effects of a longitudinal multi-muscle electrical stimulation (submaximal intensities) training of the lower limbs combined with/without activity-based stand training, on the recovery of stability and function for one individual with spinal cord injury (SCI). DESIGN Single-subject, longitudinal study. SETTING Neuroplasticity laboratory. PARTICIPANT A 34-year-old male, with sensory- and motor-complete SCI (C5/C6). INTERVENTIONS Two consecutive interventions: 61 hours of supine, lower-limb ES (ES-alone) and 51 hours of ES combined with stand training using an overhead body-weight support system (ST + ES). OUTCOME MEASURES Clinical measures, trunk stability, and muscle activity were assessed and compared across time points. Trunk Stability Limit (TSL) determined improvements in trunk independence. RESULTS Functional clinical values increased after both interventions, with further increases post ST + ES. Post ES-alone, trunk stability was maintained at 81% body-weight (BW) loading before failure; post ST + ES, BW loading increased to 95%. TSL values decreased post ST + ES (TSLA/P=54.0 kg.cm, TSLM/L=14.5 kg.cm), compared to ES-alone (TSLA/P=8.5 kg.cm, TSLM/L=3.9 kg.cm). Trunk muscle activity decreased post ST + ES training, compared to ES-alone. CONCLUSION Neuromuscular and postural trunk control dramatically improved following the multi-muscle ES of the lower limbs with stand training. Multi-muscle ES training paradigm of the lower limb, using traditional parameters, may contribute to the functional recovery of the trunk.
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Affiliation(s)
- Kamyar Momeni
- Human Performance and Engineering Research, Kessler Foundation, New Jersey, USA,Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, New Jersey, USA
| | - Arvind Ramanujam
- Human Performance and Engineering Research, Kessler Foundation, New Jersey, USA
| | - Erica L. Garbarini
- Human Performance and Engineering Research, Kessler Foundation, New Jersey, USA
| | - Gail F. Forrest
- Human Performance and Engineering Research, Kessler Foundation, New Jersey, USA,Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, New Jersey, USA,Correspondence to: Gail F. Forrest, Ph.D., Human Performance and Engineering Research, Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ07052, USA.
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Bresnahan JJ, Farkas GJ, Clasey JL, Yates JW, Gater DR. Arm crank ergometry improves cardiovascular disease risk factors and community mobility independent of body composition in high motor complete spinal cord injury. J Spinal Cord Med 2019; 42:272-280. [PMID: 29334345 PMCID: PMC6522950 DOI: 10.1080/10790268.2017.1412562] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE Evaluate the effect of aerobic exercise using arm crank ergometry (ACE) in high motor complete (ISNCSCI A/B) spinal cord injury (SCI) as primarily related to cardiovascular disease (CVD) risk factors and functional mobility and secondarily to body composition and metabolic profiles. DESIGN Longitudinal interventional study at an academic medical center. METHODS Ten previously untrained participants (M8/F2, Age 36.7 y ± 10.1, BMI 24.5 ± 6.0) with high motor complete SCI (C7-T5) underwent ACE exercise training 30 minutes/day × 3 days/week for 10 weeks at 70% VO2Peak. OUTCOME MEASURES Primary outcome measures were pre- and post-intervention changes in markers of cardiovascular fitness (graded exercise testing (GXT): VO2, VO2Peak, respiratory quotient [RQ], GXT time, peak power, and energy expenditure [EE]) and community mobility (time to traverse a 100ft-5° ramp, and 12-minute WC propulsion test). Secondary outcome measures were changes in body composition and metabolic profiles (fasting and area under the curve for glucose and insulin, homeostasis model assessment [HOMA] for %β-cell activity [%β], %insulin sensitivity [%S], and insulin resistance [IR], and Matsuda Index [ISIMatsuda]). RESULTS Resting VO2, relative VO2Peak, absolute VO2Peak, peak power, RQ, 12-minute WC propulsion, fasting insulin, fasting G:I ratio, HOMA-%S, and HOMA-IR all significantly improved following intervention (P < 0.05). There were no changes in body composition (P>0.05). CONCLUSIONS Ten weeks of ACE at 70% VO2Peak in high motor complete SCI improves aerobic capacity, community mobility, and metabolic profiles independent of changes in body composition.
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Affiliation(s)
- James J. Bresnahan
- Department of Medicine, Abington Hospital – Jefferson Health, Abington, Pennsylvania
- Department of Physical Medicine and Rehabilitation, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Gary J. Farkas
- Department of Physical Medicine and Rehabilitation, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Jody L. Clasey
- Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, Kentucky
- Department of Physical Medicine and Rehabilitation, University of Kentucky, Lexington, Kentucky
| | - James W. Yates
- Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, Kentucky
- Department of Physical Medicine and Rehabilitation, University of Kentucky, Lexington, Kentucky
| | - David R. Gater
- Department of Physical Medicine and Rehabilitation, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
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Dolbow DR, Credeur DP, Lemacks JL, Rahimi M, Stokic DS. The Effect of Electrically Induced Cycling and Nutritional Counseling on Cardiometabolic Health in Upper and Lower Motor Neuron Chronic Spinal Cord Injury: Dual Case Report. ACTA ACUST UNITED AC 2019; 6. [PMID: 32149189 PMCID: PMC7059704 DOI: 10.4172/2376-0281.1000336] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Introduction: Various therapies have been utilized to improve cardiometabolic health after spinal cord injury (SCI), including Functional Electrical Stimulation (FES) cycling. Typically, FES is used in SCI cases resulting from Upper Motor Neuron Injury (UMN-SCI). However, it has been reported that FES may improve muscle torque and functional mobility in individuals with Lower Motor Neuron Injuries (LMN-SCI) but potential effects on cardiometabolic health have not been studied before. Thus, this study examined the cardiometabolic health response to FES cycling combined with nutritional counseling in two individuals with chronic SCI; one person with LMN-SCI and one with UMN-SCI. Case Presentation: Body composition, vascular stiffness, and glucose deposition were assessed before and after participation in the FES cycling and nutritional counseling program. Despite the decrease in body mass in the case of LMN-SCI but not UMN-SCI, the fat mass-to-lean mass ratio in the lower limbs and trunk increased +4% and +8% respectively, in the former and decreased −10% and −8% respectively in the latter. Both subjects decreased markers of central vascular stiffness (AIx@75, reflection magnitude) as well as blood glucose and HbA1c levels, however, the changes were greater in the case of UMN-SCI. Discussion: This dual case study provides only a partial support for the use of FES cycling alone or in combination with nutritional counseling for improving cardio metabolic health in LMN-SCI, however modest decreases in glucose and vascular stiffness warrant further investigations.
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Affiliation(s)
- David R Dolbow
- Physical Therapy Program, William Carey University, Hattiesburg, MS, USA
| | - Daniel P Credeur
- School of Kinesiology and Nutrition, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Jennifer L Lemacks
- School of Kinesiology and Nutrition, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Mujtaba Rahimi
- Biomedical Sciences, William Carey University, Hattiesburg, MS, USA
| | - Dobrivoje S Stokic
- Center for Neuroscience and Neurological Recovery, Methodist Rehabilitation Center, Jackson, MS, USA
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Terson de Paleville DG, Harkema SJ, Angeli CA. Epidural stimulation with locomotor training improves body composition in individuals with cervical or upper thoracic motor complete spinal cord injury: A series of case studies. J Spinal Cord Med 2019; 42. [PMID: 29537940 PMCID: PMC6340278 DOI: 10.1080/10790268.2018.1449373] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
CONTEXT Four individuals with motor complete SCI with an implanted epidural stimulator who were enrolled in another study were assessed for cardiovascular fitness, metabolic function and body composition at four time points before, during, and after task specific training. Following 80 locomotor training sessions, a 16-electrode array was surgically placed on the dura (L1-S1 cord segments) to allow for electrical stimulation. After implantation individuals received 160 sessions of task specific training with epidural stimulation (stand and step). OUTCOME MEASURES Dual-energy X-ray absorptiometry (DXA), resting metabolic rate and peak oxygen consumption (VO2peak) were measured before locomotor training, after locomotor training but before epidural stimulator implant, at mid-locomotor training with spinal cord epidural stimulation (scES) and after locomotor training with scES. FINDINGS Participants showed increases in lean body mass with decreases on percentage of body fat, particularly android body fat, and android/gynoid ratio from baseline to post training; resting metabolic rate and VO2peak also show increases that are of clinical relevance in this population. CONCLUSIONS Task specific training combined with epidural stimulation has the potential to show improvements in cardiovascular fitness and body composition in individuals with cervical or upper thoracic motor complete SCI.
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Affiliation(s)
| | - Susan J. Harkema
- Kentucky Spinal Cord Injury Center, University of Louisville, Louisville, Kentucky,Department of Neurological Surgery, University of Louisville, Louisville, Kentucky,Human Locomotion Research Center, Frazier Rehab Institute, Louisville, Kentucky
| | - Claudia A. Angeli
- Kentucky Spinal Cord Injury Center, University of Louisville, Louisville, Kentucky,Human Locomotion Research Center, Frazier Rehab Institute, Louisville, Kentucky,Correspondence to: Claudia A. Angeli, PhD, University of Louisville Neuroscience Collaborative Center, 220 Abraham Flexner, suite 1515, Louisville, KY, 40202; Ph: 502-582-7443, 502-582-7605.
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Phadke CP, Vierira L, Mathur S, Cipriano G, Ismail F, Boulias C. Impact of Passive Leg Cycling in Persons With Spinal Cord Injury: A Systematic Review. Top Spinal Cord Inj Rehabil 2018; 25:83-96. [PMID: 30774292 DOI: 10.1310/sci18-00020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background: Passive leg cycling is an important clinical tool available for rehabilitation after spinal cord injury (SCI). Passive cycling can be used to derive exercise-related benefits in patients with poor motor control. There have been a number of studies examining the effects of passive cycling on a variety of outcomes. There is need for a systematic assessment of the cycling parameters and the associated clinical changes in cardiovascular, neuromuscular, and musculoskeletal outcomes after passive cycling. Objectives: To assess the effectiveness of passive leg cycling interventions on cardiovascular, neuromuscular, and musculoskeletal outcomes post SCI, and to describe intensity, duration, and type of passive leg cycling post SCI. Methods: PRISMA guided systematic review of literature based on searches in the following databases: PubMed/MEDLINE, PEDro, EMBASE, Cochrane Library, and Google Scholar. Peer-reviewed publications that were written in English were included if they described the effects of a single session or multiple sessions of passive leg cycling in persons post SCI. Results: Eleven papers were included: two were randomized controlled trials (RCTs), one was a crossover trial, and the rest were pre-post single-group designs. Three studies (including two RCTs) reported statistically significant benefits of multiple sessions of passive cycling on leg blood flow velocity, spasticity, reflex excitability and joint range of motion, and markers of muscle hypertrophy. About half of the single session studies showed statistically significant improvement in acute responses. Conclusion: Multiple sessions of passive leg cycling showed benefits in three categories - cardiovascular, musculoskeletal, and neurological - with medium to large effect sizes.
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Affiliation(s)
- Chetan P Phadke
- Spasticity Research Program, West Park Healthcare Centre, Toronto, Ontario, Canada.,Faculty of Health, York University, Toronto, Ontario, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Luciana Vierira
- Health Sciences and Technologies PhD Program, University of Brasilia, Brasilia, Brazil
| | - Sunita Mathur
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Gerson Cipriano
- Division of Physical Therapy - Ceilandia College, University of Brasilia, Brasilia, Brazil
| | - Farooq Ismail
- Spasticity Research Program, West Park Healthcare Centre, Toronto, Ontario, Canada.,Division of Physiatry, University of Toronto, Toronto, Ontario, Canada
| | - Chris Boulias
- Spasticity Research Program, West Park Healthcare Centre, Toronto, Ontario, Canada.,Division of Physiatry, University of Toronto, Toronto, Ontario, Canada
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An altered Bioheat model for persons with cervical spinal cord injury. J Therm Biol 2018; 77:96-110. [PMID: 30196905 DOI: 10.1016/j.jtherbio.2018.08.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 08/17/2018] [Accepted: 08/17/2018] [Indexed: 11/22/2022]
Abstract
The objective of this work is to develop a Bioheat model to predict the thermal responses of people with tetraplegia (TP) under hot, cold and neutral ambient conditions as well as different physical activities suitable for their level of injury. The focus is on TP with impairment or loss of motor and/or sensory function in C1 to C7 segments of the spinal cord due to damage of neural elements within the spinal canal. Starting from transient multi-segmented Bioheat model of able-bodied (AB) people, specific modifications were performed reflecting the changes in physiology due to the injury affecting the blood circulation system, energy expenditure, and thermoregulatory functions in the body. The TP Bioheat model predicts the TP thermal responses under steady and transient thermal conditions, and different activity levels that are appropriate for the level of injury. The model was validated with published experimental data reporting physiological and thermal data measurements on cases of people with complete and incomplete tetraplegia under controlled environmental conditions and activity levels. In both transient and steady state environmental conditions, the predicted core and mean skin temperature values were compared against the experimental data with maximum error of 0.86 °C and 0.9 °C respectively. The TP Bioheat model can be used as a tool to propose appropriate personal cooling strategies for TP.
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Li J, Polston KFL, Eraslan M, Bickel CS, Windham ST, McLain AB, Oster RA, Bamman MM, Yarar‐Fisher C. A high-protein diet or combination exercise training to improve metabolic health in individuals with long-standing spinal cord injury: a pilot randomized study. Physiol Rep 2018; 6:e13813. [PMID: 30156033 PMCID: PMC6113133 DOI: 10.14814/phy2.13813] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 07/02/2018] [Indexed: 11/24/2022] Open
Abstract
We compared the effects of an 8-week iso-caloric high-protein (HP) diet versus a combined exercise regimen (Comb-Ex) in individuals with long-standing spinal cord injury (SCI). Effects on metabolic profiles, markers of inflammation, and signaling proteins associated with glucose transporter 4 (GLUT-4) translocation in muscles were evaluated. Eleven participants with SCI completed the study (HP diet: n = 5; Comb-Ex: n = 6; 46 ± 8 years; C5-T12 levels; American Spinal Injury Association Impairment Scale A or B). The Comb-Ex regimen included upper body resistance training (RT) and neuromuscular electrical stimulation-induced-RT for paralytic quadriceps muscles, interspersed with high-intensity (80-90% VO2 peak) arm cranking exercises 3 days/week. The HP diet included ~30% total energy as protein (carbohydrate to protein ratio <1.5, ~30% energy from fat). Oral glucose tolerance tests and muscle biopsies of the vastus lateralis (VL) and deltoid muscles were performed before and after the trial. Fasting plasma glucose levels decreased in the Comb-Ex (P < 0.05) group compared to the HP-diet group. A decrease in areas under the curve for insulin and TNF-α concentrations was observed for all participants regardless of group assignment (time effect, P < 0.05). Although both groups exhibited a quantitative increase in insulin sensitivity as measured by the Matsuda Index, the change was clinically meaningful only in the HP diet group (HP diet: pre, 4.6; post, 11.6 vs. Comb-Ex: pre, 3.3; post, 4.6). No changes were observed in proteins associated with GLUT-4 translocation in VL or deltoid muscles. Our results suggest that the HP-diet and Comb-Ex regimen may improve insulin sensitivity and decrease TNF-α concentrations in individuals with SCI.
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Affiliation(s)
- Jia Li
- Physical Medicine and RehabilitationUniversity of Alabama at BirminghamBirminghamAlabama
| | - Keith F. L. Polston
- University of Tennessee Health Science Center College of MedicineMemphisTennessee
| | - Mualla Eraslan
- Physical Medicine and RehabilitationUniversity of Alabama at BirminghamBirminghamAlabama
| | - C. Scott Bickel
- Physical Therapy and RehabilitationSamford UniversityBirminghamAlabama
| | - Samuel T. Windham
- Department of SurgeryUniversity of Alabama at BirminghamBirminghamAlabama
- UAB Center for Exercise MedicineUniversity of Alabama at BirminghamBirminghamAlabama
| | - Amie B. McLain
- Physical Medicine and RehabilitationUniversity of Alabama at BirminghamBirminghamAlabama
- UAB Center for Exercise MedicineUniversity of Alabama at BirminghamBirminghamAlabama
| | - Robert A. Oster
- Division of Preventive MedicineDepartment of MedicineUniversity of Alabama at BirminghamBirminghamAlabama
| | - Marcas M. Bamman
- UAB Center for Exercise MedicineUniversity of Alabama at BirminghamBirminghamAlabama
- Department of Cell, Developmental, and Integrative BiologyUniversity of Alabama at BirminghamBirminghamAlabama
- Geriatric Research, Education, and Clinical CenterBirmingham VA Medical CenterBirminghamAlabama
| | - Ceren Yarar‐Fisher
- Physical Medicine and RehabilitationUniversity of Alabama at BirminghamBirminghamAlabama
- UAB Center for Exercise MedicineUniversity of Alabama at BirminghamBirminghamAlabama
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Farkas GJ, Gorgey AS, Dolbow DR, Berg AS, Gater DR. The influence of level of spinal cord injury on adipose tissue and its relationship to inflammatory adipokines and cardiometabolic profiles. J Spinal Cord Med 2018; 41:407-415. [PMID: 28758566 PMCID: PMC6055972 DOI: 10.1080/10790268.2017.1357918] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Level of injury (LOI) and the role of adipose tissue and its proinflammatory adipokines in cardiometabolic dysfunction following spinal cord injury (SCI) remains poorly understood. We aim to examine the influence of LOI on adipose tissue and its relationship to proinflammatory adipokines and cardiometabolic profiles following SCI. DESIGN Cross sectional and correlational study. SETTING Clinical hospital and academic setting. PARTICIPANTS Forty-seven individuals with chronic motor complete SCI (age 43.8±11.5 y, BMI: 27.3±5.3) were classified as having tetraplegia (TSCI; n=12) or paraplegia (PSCI; n=35). INTERVENTION Non applicable. OUTCOME MEASURES Visceral (VAT) and subcutaneous (SAT) adipose tissue volumes were measured using magnetic resonance imaging. Proinflammatory adipokines (tumor neurosis factor-α, interleukin-6 (IL-6), plasminogen activatable inhibitor-1, thrombin-activatable fibrinolysis inhibitor, and high-sensitivity c-reactive protein) and cardiovascular, carbohydrate, and lipid profiles were assessed according to standard techniques. RESULTS VAT volume was greater in TSCI versus PSCI (p=0.042); however, after covarying for age this significance was lost (p>0.05). IL-6 was significantly elevated in TSCI (p<0.05), while other markers of inflammation generally were elevated, but did not reach statistical significance (p>0.05). Systolic blood pressure and total cholesterol were significantly lower in TSCI (p<0.05), while fasting glucose was significantly lower in PSCI (p<0.05). A number of proinflammatory adipokines and cardiometabolic markers significantly correlated with adipose tissue depots by LOI (p<0.05). CONCLUSION The results show that LOI does not influence the distribution of adipose tissue, but does influence proinflammatory adipokines and cardiometabolic profiles following SCI. Further research is needed to evaluate impact of lean body mass on these findings.
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Affiliation(s)
- Gary J. Farkas
- Department of Physical Medicine and Rehabilitation, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Ashraf S. Gorgey
- Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia, USA
| | - David R. Dolbow
- School of Kinesiology, University of Southern Mississippi, Hattiesburg, Mississippi, USA
| | - Arthur S. Berg
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - David R. Gater
- Department of Physical Medicine and Rehabilitation, Penn State College of Medicine, Hershey, Pennsylvania, USA
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Withers TM, Croft L, Goosey-Tolfrey VL, Dunstan DW, Leicht CA, Bailey DP. Cardiovascular disease risk marker responses to breaking up prolonged sedentary time in individuals with paraplegia: the Spinal Cord Injury Move More (SCIMM) randomised crossover laboratory trial protocol. BMJ Open 2018; 8:e021936. [PMID: 29934392 PMCID: PMC6020957 DOI: 10.1136/bmjopen-2018-021936] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 05/16/2018] [Accepted: 05/24/2018] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Sedentary behaviour is a distinct risk factor for cardiovascular disease (CVD) and could partly explain the increased prevalence of CVD in people with spinal cord injury (SCI). Interrupting prolonged sitting periods with regular short bouts of walking acutely suppresses postprandial glucose and lipids in able-bodied individuals. However, the acute CVD risk marker response to breaking up prolonged sedentary time in people with SCI has not been investigated. METHODS AND ANALYSIS A randomised two-condition laboratory crossover trial will compare: (1) breaking up prolonged sedentary time with 2 min moderate-intensity arm-crank activity every 20 min, with (2) uninterrupted prolonged sedentary time (control) in people with SCI. Outcomes will include acute effects on postprandial glucose, insulin, lipids and blood pressure. Blood samples will be collected and blood pressure measured at regular intervals during each 5½-hour condition. ETHICS AND DISSEMINATION This study was approved by the Cambridge South National Health Service Research Ethics Committee. This research will help determine if breaking up prolonged sedentary time could be effective in lowering CVD risk in people with SCI. The findings of the research will be published in a peer-reviewed journal and disseminated to relevant user groups. TRIAL REGISTRATION NUMBER ISRCTN51868437; Pre-results.
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Affiliation(s)
- Thomas M Withers
- Institute for Sport and Physical Activity Research, School of Sport Science and Physical Activity, University of Bedfordshire, Bedford, UK
| | - Louise Croft
- Institute for Sport and Physical Activity Research, School of Sport Science and Physical Activity, University of Bedfordshire, Bedford, UK
| | - Victoria L Goosey-Tolfrey
- School of Sport, Exercise and Health Sciences, The Peter Harrison Centre for Disability Sport, Loughborough University, Loughborough, UK
| | - David W Dunstan
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Christof A Leicht
- School of Sport, Exercise and Health Sciences, The Peter Harrison Centre for Disability Sport, Loughborough University, Loughborough, UK
| | - Daniel P Bailey
- Institute for Sport and Physical Activity Research, School of Sport Science and Physical Activity, University of Bedfordshire, Bedford, UK
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Street T, Singleton C. A clinically meaningful training effect in walking speed using functional electrical stimulation for motor-incomplete spinal cord injury. J Spinal Cord Med 2018; 41:361-366. [PMID: 29108487 PMCID: PMC6055946 DOI: 10.1080/10790268.2017.1392106] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
CONTEXT/OBJECTIVE The study aimed to investigate the presence of a training effect for rehabilitation of walking function in motor-incomplete spinal cord injury (SCI) through daily use of functional electrical stimulation (FES). SETTING A specialist FES outpatient centre. PARTICIPANTS Thirty-five participants (mean age 53, SD 15, range 18-80; mean years since diagnosis 9, range 5 months - 39 years) with drop foot and motor-incomplete SCI (T12 or higher, ASIA Impairment Scale C and D) able to ambulate 10 metres with the use of a walking stick or frame. INTERVENTIONS FES of the peroneal nerve, glutei and hamstrings as clinically indicated over six months in the community. OUTCOME MEASURES The data was analysed for a training effect (difference between unassisted ten metre walking speed at baseline and after six months) and orthotic effects (difference between walking speed with and without FES) initially on day one and after six months. The data was further analysed for a minimum clinically important difference (MCID) (>0.06 m/s). RESULTS A clinically meaningful, significant change was observed for initial orthotic effect (0.13m/s, CI: 0.04-0.17, P = 0.013), total orthotic effect (0.11m/s, CI: 0.04-0.18, P = 0.017) and training effect (0.09m/s, CI: 0.02-0.16, P = 0.025). CONCLUSION The results suggest that daily independent use of FES may produce clinically meaningful changes in walking speed which are significant for motor-incomplete SCI. Further research exploring the mechanism for the presence of a training effect may be beneficial in targeting therapies for future rehabilitation.
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Affiliation(s)
- Tamsyn Street
- Clinical Science and Engineering, Salisbury NHS Foundation Trust, Salisbury, UK
| | - Christine Singleton
- West Midlands Rehabilitation Centre, Birmingham Community Healthcare NHS, Birmingham, UK
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