1
|
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.
Collapse
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
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Akagi R, Miyokawa Y, Shiozaki D, Yajima Y, Yamada K, Kano K, Hashimoto Y, Okamoto T, Ando S. Eight-week neuromuscular electrical stimulation training produces muscle strength gains and hypertrophy, and partial muscle quality improvement in the knee extensors. J Sports Sci 2023; 41:2209-2228. [PMID: 38390833 DOI: 10.1080/02640414.2024.2318540] [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: 07/30/2023] [Accepted: 02/07/2024] [Indexed: 02/24/2024]
Abstract
This study investigated the effect of an 8-week neuromuscular electrical stimulation (NMES) training programme (3 days/week) on muscle quantity and quality and single-joint performance in the knee extensors. Thirty-nine untrained young male participants were randomly assigned to NMES training (n = 21) and control (n = 18) groups. The 8-week NMES training induced significant increase in the isometric maximal voluntary contraction (MVC) torque of the knee extensors (≈9.3%), muscle volume of the individual and entire quadriceps muscles determined by magnetic resonance imaging (≈3.3%-6.4%), and a significant decrease in the ultrasound echo intensity of the vastus lateralis (≈-4.0%); however, hypertrophy of the vastus intermedius (i.e., the deep muscle) was limited (≈3.3%). In the NMES training group, the repeated measures correlations of the isometric MVC torque with the muscle volume of the entire quadriceps muscle and each quadriceps muscle were significant (rrm (20) = 0.551-0.776), whereas that of the isometric MVC torque with the ultrasound echo intensity of the vastus lateralis was not significant. These findings suggest that NMES training produces muscle strength gains, muscle hypertrophy, and partial muscle quality improvement and that the NMES training-induced muscle strength gains is caused by muscle hypertrophy in the knee extensors.
Collapse
Affiliation(s)
- Ryota Akagi
- College of Systems Engineering and Science, Shibaura Institute of Technology, Saitama, Japan
- Graduate School of Engineering and Science, Shibaura Institute of Technology, Saitama, Japan
| | - Yusuke Miyokawa
- College of Systems Engineering and Science, Shibaura Institute of Technology, Saitama, Japan
| | - Daigo Shiozaki
- Graduate School of Engineering and Science, Shibaura Institute of Technology, Saitama, Japan
| | - Yoshinari Yajima
- College of Systems Engineering and Science, Shibaura Institute of Technology, Saitama, Japan
| | - Koki Yamada
- Graduate School of Engineering and Science, Shibaura Institute of Technology, Saitama, Japan
| | - Kosuke Kano
- Graduate School of Informatics and Engineering, The University of Electro-Communications, Tokyo, Japan
| | - Yuto Hashimoto
- Department of Exercise Physiology, Nippon Sport Science University, Tokyo, Japan
| | - Takanobu Okamoto
- Department of Exercise Physiology, Nippon Sport Science University, Tokyo, Japan
| | - Soichi Ando
- Graduate School of Informatics and Engineering, The University of Electro-Communications, Tokyo, Japan
| |
Collapse
|
4
|
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.
Collapse
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.
| |
Collapse
|
5
|
Fenton JM, King JA, Hoekstra SP, Valentino SE, Phillips SM, Goosey-Tolfrey VL. Protocols aiming to increase muscle mass in persons with motor complete spinal cord injury: a systematic review. Disabil Rehabil 2022; 45:1433-1443. [PMID: 35465798 DOI: 10.1080/09638288.2022.2063420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE The purpose of this review was to compare all intervention modalities aimed at increasing skeletal muscle mass (SMM) in the paralysed limbs of persons with chronic (>1-year post-injury), motor complete spinal cord injury (SCI). MATERIALS AND METHODS A systematic review of EMBASE, MEDLINE, Scopus, and SPORTDiscus databases was conducted from inception until December 2021. Published intervention studies aimed to increase SMM (measured by magnetic resonance imaging, computed tomography, ultrasound, muscle biopsy, or lean soft tissue mass by dual X-ray absorptiometry) in the paralysed limbs of adults (>18 years) with SCI were included. RESULTS Fifty articles were included that, overall, demonstrated a high risk of bias. Studies were categorised into six groups: neuromuscular electrical stimulation (NMES) with and without external resistance, functional electrical stimulation cycling, walking- and standing-based interventions, pharmacological treatments, and studies that compared or combined intervention modalities. Resistance training (RT) using NMES on the quadriceps produced the largest and most consistent increases in SMM of all intervention modalities. CONCLUSIONS Current evidence suggests that clinical practise aiming to increase SMM in the paralysed limbs of persons with motor complete SCI should perform NMES-RT. However, more high-quality randomised control trials are needed to determine how training variables, such as exercise volume and intensity, can be optimised for increasing SMM. Implications for rehabilitationPersons with spinal cord injury (SCI) experience severe reductions in skeletal muscle mass (SMM) post-injury, which may exacerbate their risk of obesity and metabolic disease.Out of all exercise and non-exercise-based interventions, this systematic review shows that neuromuscular electrical stimulation-based resistance training demonstrates the most robust and consistent evidence for increasing skeletal muscle mass in the paralysed limbs of adults with motor complete spinal cord injury.The findings from this review can be used to inform evidence-based practise for exercise practitioners, as well as direct future research focused on increasing muscle mass in this population.
Collapse
Affiliation(s)
- Jordan M. Fenton
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- Peter Harrison Centre for Disability Sport, Loughborough University, Loughborough, UK
| | - James A. King
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester, UK
| | - Sven P. Hoekstra
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- Peter Harrison Centre for Disability Sport, Loughborough University, Loughborough, UK
| | | | - Stuart M. Phillips
- Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
| | - Victoria L. Goosey-Tolfrey
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- Peter Harrison Centre for Disability Sport, Loughborough University, Loughborough, UK
| |
Collapse
|
6
|
Gorgey AS, Sutor TW, Goldsmith JA, Ennasr AN, Lavis TD, Cifu DX, Trainer R. Epidural stimulation with locomotor training ameliorates unstable blood pressure after tetraplegia. A case report. Ann Clin Transl Neurol 2022; 9:232-238. [PMID: 35068086 PMCID: PMC8862417 DOI: 10.1002/acn3.51508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 01/03/2022] [Accepted: 01/04/2022] [Indexed: 12/13/2022] Open
Abstract
A male with C7 complete tetraplegia participated in 14 weeks of body weight supported treadmill training (BWSTT) combined with spinal cord epidural stimulation (SCES), 4 weeks of no intervention, and two more weeks of BWSTT + SCES. The participant presented with unstable resting seated blood pressure (BP; 131/66 mmHg). After retrospective analysis, resting systolic BP decreased and diastolic BP increased, yielding a safe mean arterial BP. There was a fivefold increase in BWSTT bouts per session, and percentage of body weight support decreased to 69%. BWSTT + SCES safely and effectively regulated resting BP and mitigated symptoms of orthostatic intolerance. These effects were not maintained after 4 weeks without training.
Collapse
Affiliation(s)
- Ashraf S. Gorgey
- Spinal Cord Injury and Disorders Center Hunter Holmes McGuire VAMC 1201 Broad Rock Boulevard Richmond Virginia 23249 USA
- Department of Physical Medicine & Rehabilitation Virginia Commonwealth University Richmond Virginia 23298 USA
| | - Tommy W. Sutor
- Spinal Cord Injury and Disorders Center Hunter Holmes McGuire VAMC 1201 Broad Rock Boulevard Richmond Virginia 23249 USA
| | - Jacob A. Goldsmith
- Spinal Cord Injury and Disorders Center Hunter Holmes McGuire VAMC 1201 Broad Rock Boulevard Richmond Virginia 23249 USA
| | - Areej N. Ennasr
- Spinal Cord Injury and Disorders Center Hunter Holmes McGuire VAMC 1201 Broad Rock Boulevard Richmond Virginia 23249 USA
| | - Timothy D. Lavis
- Spinal Cord Injury and Disorders Center Hunter Holmes McGuire VAMC 1201 Broad Rock Boulevard Richmond Virginia 23249 USA
- Department of Physical Medicine & Rehabilitation Virginia Commonwealth University Richmond Virginia 23298 USA
| | - David X. Cifu
- Department of Physical Medicine & Rehabilitation Virginia Commonwealth University Richmond Virginia 23298 USA
| | - Robert Trainer
- Physical Medicine and Rehabilitation Hunter Holmes McGuire VAMC 1201 Broad Rock Boulevard Richmond Virginia 23249 USA
| |
Collapse
|
7
|
Gorgey AS, Khalil RE, Gill R, Khan R, Adler RA. Effects of dose de-escalation following testosterone treatment and evoked resistance exercise on body composition, metabolic profile, and neuromuscular parameters in persons with spinal cord injury. Physiol Rep 2021; 9:e15089. [PMID: 34713983 PMCID: PMC8554770 DOI: 10.14814/phy2.15089] [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] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/29/2021] [Accepted: 10/06/2021] [Indexed: 11/24/2022] Open
Abstract
The dose de-escalation (DD) effects of testosterone and evoked resistance training (RT) on body composition, cardiometabolic, and neuromuscular variables were investigated. Thirteen men with chronic complete spinal cord injury (SCI) were followed for additional 16 weeks after receiving either testosterone treatment only (TT) or TT+RT. During the 16-week DD period, the TT+RT group underwent a program of once weekly electrical stimulation with gradually decreasing ankle weights and testosterone patches of 2 mg day-1 (TT+RT group). The TT only group did not receive any intervention throughout the detraining period (no-TT group). 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, inflammatory biomarkers, glucose effectiveness, and insulin sensitivity were measured. Finally, peak isometric and isokinetic torques were measured only in the TT+RT group. All measurements were conducted at the beginning and at the end of DD. Absolute thigh muscle cross-sectional areas (CSAs) demonstrated interaction effects (p < 0.05) between the TT+RT (-8.15%, -6.5%) and no-TT (2.3%, 4.4%) groups. Similarly, absolute knee extensor muscle CSA demonstrated interaction effects (p < 0.05) between the TT+RT (-11%, -7.0%) and no-TT (2.6%, 3.8%) groups. There was a trend (p = 0.07) of increasing visceral adipose tissue (VAT) CSAs in the TT+RT (18%) and in the no-TT (16% cm2 ) groups. There was an interaction (p = 0.005) between TT+RT (decreased by 3.7%) and no-TT groups (increased by 9.0%) in BMR. No interactions were evident between groups over time for biomarkers related to carbohydrate, lipid metabolism, or inflammation. Finally, there were no changes (p > 0.05) in peak isometric or isokinetic torques and rise time following 16 weeks of the DD period in the TT+RT group. TT+RT during 16 weeks of DD was minimally effective at preventing detraining relative to no-TT on muscle size, BMR, and VAT. However, neuromuscular gains were successfully maintained.
Collapse
Affiliation(s)
- Ashraf S. Gorgey
- Spinal Cord Injury and Disorders CenterHunter Holmes McGuire VAMCRichmondVirginiaUSA
- Department of Physical Medicine & RehabilitationVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Refka E. Khalil
- Spinal Cord Injury and Disorders CenterHunter Holmes McGuire VAMCRichmondVirginiaUSA
| | - Ranjodh Gill
- Endocrinology ServiceHunter Holmes McGuire VA Medical CenterRichmondVirginiaUSA
- Endocrine DivisionVirginia Commonwealth University School of MedicineRichmondVirginiaUSA
| | - Rehan Khan
- Radiology ServiceHunter Holmes McGuire VA Medical CenterRichmondVirginiaUSA
| | - Robert A. Adler
- Endocrinology ServiceHunter Holmes McGuire VA Medical CenterRichmondVirginiaUSA
- Endocrine DivisionVirginia Commonwealth University School of MedicineRichmondVirginiaUSA
| |
Collapse
|
8
|
Morse LR, Biering-Soerensen F, Carbone LD, Cervinka T, Cirnigliaro CM, Johnston TE, Liu N, Troy KL, Weaver FM, Shuhart C, Craven BC. Bone Mineral Density Testing in Spinal Cord Injury: 2019 ISCD Official Position. J Clin Densitom 2019; 22:554-566. [PMID: 31501005 DOI: 10.1016/j.jocd.2019.07.012] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 07/29/2019] [Indexed: 02/06/2023]
Abstract
Spinal cord injury (SCI) causes rapid osteoporosis that is most severe below the level of injury. More than half of those with motor complete SCI will experience an osteoporotic fracture at some point following their injury, with most fractures occurring at the distal femur and proximal tibia. These fractures have devastating consequences, including delayed union or nonunion, cellulitis, skin breakdown, lower extremity amputation, and premature death. Maintaining skeletal integrity and preventing fractures is imperative following SCI to fully benefit from future advances in paralysis cure research and robotic-exoskeletons, brain computer interfaces and other evolving technologies. Clinical care has been previously limited by the lack of consensus derived guidelines or standards regarding dual-energy X-ray absorptiometry-based diagnosis of osteoporosis, fracture risk prediction, or monitoring response to therapies. The International Society of Clinical Densitometry convened a task force to establish Official Positions for bone density assessment by dual-energy X-ray absorptiometry in individuals with SCI of traumatic or nontraumatic etiology. This task force conducted a series of systematic reviews to guide the development of evidence-based position statements that were reviewed by an expert panel at the 2019 Position Development Conference in Kuala Lumpur, Malaysia. The resulting the International Society of Clinical Densitometry Official Positions are intended to inform clinical care and guide the diagnosis of osteoporosis as well as fracture risk management of osteoporosis following SCI.
Collapse
Affiliation(s)
- Leslie R Morse
- Department of Rehabilitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA.
| | - Fin Biering-Soerensen
- Clinic for Spinal Cord Injuries, Neuroscience Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Laura D Carbone
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA; Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Tomas Cervinka
- Department of Physiotherapy and Rehabilitation, Faculty of Health and Welfare, Satakunta University of Applied Sciences, Pori, Finland
| | - Christopher M Cirnigliaro
- Department of Veterans Affairs Rehabilitation Research & Development Service National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - Therese E Johnston
- Department of Physical Therapy, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA
| | - Nan Liu
- Department of Rehabilitation Medicine and Osteoporosis and Metabolic Bone Disease Center, Peking University Third Hospital, Beijing, China
| | - Karen L Troy
- Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Frances M Weaver
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, Hines, IL, USA; Department of Public Health Sciences, Stritch School of Medicine, Loyola University, Maywood, IL, USA
| | - Christopher Shuhart
- Swedish Bone Health and Osteoporosis Center, Swedish Medical Group, Seattle WA, USA
| | - Beverley C Craven
- Neural Engineering and Therapeutics Team, KITE Research Institute - University Health Network, Department of Medicine, University of Toronto, Toronto, Ontario Canada
| |
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
Stone WJ, Stevens SL, Fuller DK, Caputo JL. Ambulation and physical function after eccentric resistance training in adults with incomplete spinal cord injury: A feasibility study. J Spinal Cord Med 2019; 42:526-533. [PMID: 29360000 PMCID: PMC6718937 DOI: 10.1080/10790268.2017.1417804] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Background: Strengthening the lower extremities has shown to positively influence walking mechanics in those with neurological deficiencies. Eccentric resistance training (ERT) is a potent stimulus for the development of muscular strength with low metabolic demand. Thereby, ERT may benefit those with incomplete spinal cord injuries (iSCI) seeking to improve ambulatory capacity. Design: This study was aimed to determine the effect of ERT on walking speed, mobility, independence, and at home function following iSCI. Methods: Individuals with longstanding iSCI trained twice a week for 12 weeks on an eccentrically biased recumbent stepper. Outcome measures: Walking speed (10 meter walk test; 10MWT), mobility (timed up and go), independence (Walking Index for Spinal Cord Injury; WISCI), and at home function (Spinal Cord Independence Measure; SCIM) were assessed at baseline, after 6 weeks, and after 12 weeks of ERT. Results: There were improvements in walking mobility (158.36 + 165.84 seconds to 56.31 + 42.42 seconds, P = .034, d = 0.62), speed (0.34 + 0.42 m/s to 0.43 + 0.50 m/s, P = .005, d = .23), and independence (8 + 7 to 13 + 7, P = .004, d = .73) after 12 weeks of ERT. At home function remained unchanged (22 + 10 to 24 + 10, P = .10, d = .12). Conclusions: Improving lower extremity strength translated to walking performance and independence in those with iSCI. Additionally, ERT may diminish therapist burden in programs designed to improve ambulatory capacity or strength in those with iSCI.
Collapse
Affiliation(s)
- Whitley J. Stone
- Nutrition and Kinesiology, University of Central Missouri, Warrensburg, Missouri, USA
| | - Sandra L. Stevens
- Health and Human Performance, Middle Tennessee State University, Murfreesboro, Tennessee, USA
| | - Dana K. Fuller
- Psychology, Middle Tennessee State University, Murfreesboro, Tennessee, USA
| | - Jennifer L. Caputo
- Health and Human Performance, Middle Tennessee State University, Murfreesboro, Tennessee, USA
| |
Collapse
|
11
|
Gorgey AS, Cirnigliaro CM, Bauman WA, Adler RA. Estimates of the precision of regional and whole body composition by dual-energy x-ray absorptiometry in persons with chronic spinal cord injury. Spinal Cord 2018; 56:987-995. [PMID: 29511310 PMCID: PMC6127003 DOI: 10.1038/s41393-018-0079-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 01/27/2018] [Accepted: 02/02/2018] [Indexed: 12/22/2022]
Abstract
Study Design Longitudinal design Objectives To determine the reproducibility of total- and regional-body composition assessments from a total-body scan using dual-energy x-ray absorptiometry (DXA) in persons with spinal cord injury (SCI). Methods Twenty-four individuals with SCI completed within-day short-term precision testing by repositioning study participants between scans. An additional and separate cohort of 22 individuals with SCI were scanned twice on a GE-Lunar DXA scanner separated by a 4-week interval to assess the long-term precision assessment. The root mean square coefficient of variation percent (RMS-CV%) values for the regional and total body composition was calculated. Results For the same day, short-term precision assessment, the RMS-CV% for each region did not exceed 5.6%, 2.7%, 3.8%, 6.5%, 5.8% and 2.3% for arms, legs, trunk, android and gynoid regions and total body mass, respectively. In the long-term precision assessment, the RMS-CV% for each region did not exceed 6.0%, 3.0%, 4.4%, 8.2%, 3.4% and 2.0% for arms, legs, trunk, android, gynoid and total body mass. Moreover, the interclass-correlation coefficient in the long-term precision group demonstrated excellent linear agreement between repeat scans for all regions (r> 0.97). Conclusion The precision error of the total body composition variables in our SCI cohort was similar to those reported in the literature for nondisabled individuals, and the precision errors of the regional body composition compartments were notably higher, but similar to the regional precision errors reported in the general population.
Collapse
Affiliation(s)
- Ashraf S Gorgey
- Spinal Cord Injury and Disorders, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA. .,Physical Medicine and Rehabilitation Virginia Commonwealth University, Richmond, VA, USA.
| | - Christopher M Cirnigliaro
- Department of Veterans Affairs Rehabilitation Research & Development Service National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - William A Bauman
- Department of Veterans Affairs Rehabilitation Research & Development Service National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA.,Departments of Medicine and Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, NY, USA
| | - Robert A Adler
- Spinal Cord Injury and Disorders, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA.,Endocrinology Division, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
| |
Collapse
|
12
|
Abilmona SM, Gorgey AS. Associations of the trunk skeletal musculature and dietary intake to biomarkers of cardiometabolic health after spinal cord injury. Clin Physiol Funct Imaging 2018; 38:949-958. [PMID: 29405604 DOI: 10.1111/cpf.12505] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 01/03/2018] [Indexed: 12/30/2022]
Abstract
PURPOSE Skeletal muscle atrophy and poor dietary habits may contribute to increased adiposity and impaired metabolic health after spinal cord injury (SCI). The relative association of trunk muscle cross-sectional areas (CSA) versus dietary habits to central adiposity and impaired metabolic health after SCI remains unclear. METHODS Twenty-two men with motor complete SCI completed five-day dietary recalls for 4 weeks. Trunk muscle CSAs as well as visceral and subcutaneous adipose tissue (VAT and SAT, respectively) were quantified using magnetic resonance imaging. Basal metabolic rate (BMR), glucose effectiveness, insulin sensitivity and lipid profile were measured after overnight fast. RESULTS Antero-lateral trunk muscle (r = -0·79, P < 0·001) and posterior trunk muscle (r = -0·56, P = 0·008) CSAs normalized to total trunk CSA were negatively related to VAT. Antero-lateral trunk muscle ratio (TMR) was positively related to BMR (r = 0·54, P = 0·01), and posterior TMR was positively related to peak oxygen uptake (VO2 peak; r = 0·71, P = 0·003). After accounting for total TMR as a co-variate, total fat (r = 0·47, P = 0·04) and protein (r = 0·61, P = 0·004) intakes were positively related to fasting insulin levels. CONCLUSION Trunk muscle CSAs normalized to total trunk CSA were negatively associated with central adiposity. Both trunk muscles and dietary macro-nutrients are related to markers of metabolic health. The study highlights the significance of developing an exercise intervention with a healthy dietary regimen to attenuate the development of central adiposity associated metabolic disorders after SCI.
Collapse
Affiliation(s)
- Sally M Abilmona
- Spinal Cord Injury and Disorders, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
| | - Ashraf S Gorgey
- Spinal Cord Injury and Disorders, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
- Department of physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
| |
Collapse
|
13
|
Abstract
CONTEXT Individuals with chronic spinal cord injury (SCI) are susceptible to central and visceral obesity and it's metabolic consequences; consensus based guidelines for obesity management after SCI have not yet been stablished. OBJECTIVES To identify and compare effective means of obesity management among SCI individuals. METHODS This systematic review included English and non-English articles, published prior to April 2017 found in the PubMed/Medline, Embase, CINAHL Psychinfo and Cochrane databases. Studies evaluating any obesity management strategy, alone or in combination, including: diet therapy, voluntary and involuntary exercise such as neuro-muscular electric stimulation (NMES), pharmacotherapy, and surgery, among individuals with chronic SCI were included. Outcomes of interest were reductions in waist circumference, body weight (BW), body mass index (BMI) and total fat mass (TFM) and increases in total lean body mass (TLBM) from baseline. From 3,553 retrieved titles and abstracts, 34 articles underwent full text review and 23 articles were selected for data abstraction. Articles describing weight loss due to inflammation, cancer or B12 deficiency were excluded. The Downs and Black reported poor to moderate quality of the studies. RESULTS Bariatric surgery produced the greatest permanent weight reduction and BMI correction followed by combinations of physical exercise and diet therapy. Generally, NMES and pharmacotherapy improved TLBM and reduced TFM but not weight. CONCLUSIONS The greatest weight reduction and BMI correction was produced by bariatric surgery, followed by a combination of physical exercise and diet therapy. NMES and pharmacologic treatment did not reduce weight or TFM but increased in TLBM.
Collapse
Affiliation(s)
- Mir Hatef Shojaei
- Neural Engineering and Therapeutic Team, Lyndhurst Centre, UHN-Toronto Rehabilitation, Toronto, ON, Canada
| | - Seyed Mohammad Alavinia
- Neural Engineering and Therapeutic Team, Lyndhurst Centre, UHN-Toronto Rehabilitation, Toronto, ON, Canada
| | - B. Catharine Craven
- Neural Engineering and Therapeutic Team, Lyndhurst Centre, UHN-Toronto Rehabilitation, Toronto, ON, Canada
- Department of Physical Medicine and Rehabilitation, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
14
|
Woelfel JR, Kimball AL, Yen CL, Shields RK. Low-Force Muscle Activity Regulates Energy Expenditure after Spinal Cord Injury. Med Sci Sports Exerc 2017; 49:870-878. [PMID: 28009786 DOI: 10.1249/mss.0000000000001187] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Reduced physical activity is a primary risk factor for increased morbidity and mortality. People with spinal cord injury (SCI) have reduced activity for a lifetime, as they cannot volitionally activate affected skeletal muscles. We explored whether low-force and low-frequency stimulation is a viable strategy to enhance systemic energy expenditure in people with SCI. PURPOSE This study aimed to determine the effects of low stimulation frequency (1 and 3 Hz) and stimulation intensity (50 and 100 mA) on energy expenditure in people with SCI. We also examined the relationship between body mass index and visceral adipose tissue on energy expenditure during low-frequency stimulation. METHODS Ten individuals with complete SCI underwent oxygen consumption monitoring during electrical activation of the quadriceps and hamstrings at 1 and 3 Hz and at 50 and 100 mA. We calculated the difference in energy expenditure between stimulation and rest and estimated the number of days that would be necessary to burn 1 lb of body fat (3500 kcal) for each stimulation protocol (1 vs 3 Hz). RESULTS Both training frequencies induced a significant increase in oxygen consumption above a resting baseline level (P < 0.05). Energy expenditure positively correlated with stimulus intensity (muscle recruitment) and negatively correlated with adiposity (reflecting the insulating properties of adipose tissue). We estimated that 1 lb of body fat could be burned more quickly with 1 Hz training (58 d) as compared with 3 Hz training (87 d) if an identical number of pulses were delivered. CONCLUSION Low-frequency stimulation increased energy expenditure per pulse and may be a feasible option to subsidize physical activity to improve metabolic status after SCI.
Collapse
Affiliation(s)
- Jessica R Woelfel
- 1Carver College of Medicine, University of Iowa, Iowa City, IA; and 2Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, IA
| | | | | | | |
Collapse
|
15
|
Gorgey AS, Lester RM, Wade RC, Khalil RE, Khan RK, Anderson ML, Castillo T. A feasibility pilot using telehealth videoconference monitoring of home-based NMES resistance training in persons with spinal cord injury. Spinal Cord Ser Cases 2017; 3:17039. [PMID: 29021917 PMCID: PMC5633749 DOI: 10.1038/scsandc.2017.39] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 05/23/2017] [Accepted: 05/30/2017] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION The objective of the study was to investigate the feasibility and initial efficacy of telehealth communication in conjunction with surface neuromuscular electrical stimulation (NMES) resistance training (RT) to induce muscle hypertrophy. MATERIALS AND METHODS This was a home-based setting of within-subject control design of trained vs controlled limbs. Five men with chronic (>1 year postinjury) motor-complete spinal cord injury (SCI) participated in a twice-weekly telehealth videoconference program using home-based NMES-RT for 8 weeks. Stimulation was applied to the knee extensor muscle group of the trained leg, while the untrained leg served as a control. Participants received real-time feedback to ensure a proper setup of electrodes and stimulator to monitor subject safety throughout the entire training session. Magnetic resonance imaging was used to measure cross-sectional areas (CSAs) and intramuscular fat (IMF) of the whole thigh and individual muscle groups. Average two-way travel time, distance traveled in miles and total cost of gas per mile were calculated. RESULTS Participants had 100% compliance. Trained whole and absolute knee extensor muscle CSA increased by 13% (P=0.002) and 18% (P=0.0002), with no changes in the controlled limb. Absolute knee flexor and adductor CSAs increased by 3% (P=0.02) and 13% (P=0.0001), respectively. Absolute whole thigh and knee extensor IMF CSAs decreased significantly in the trained limb by 14% (P=0.01) and 36% (P=0.0005), respectively, with no changes in controlled limb. DISCUSSION The pilot work documented that using telehealth communication is a safe, feasible and potentially cost-reducing approach for monitoring home-based NMES-RT in persons with chronic SCI. All trained muscles showed detectable muscle hypertrophy with concomitant decrease in ectopic adipose tissue.
Collapse
Affiliation(s)
- Ashraf S Gorgey
- Spinal Cord Injury and Disorders Service, Department of Veterans Affairs, Hunter Holmes McGuire VAMC, Richmond, VA, USA
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
| | - Robert M Lester
- Spinal Cord Injury and Disorders Service, Department of Veterans Affairs, Hunter Holmes McGuire VAMC, Richmond, VA, USA
| | - Rodney C Wade
- Spinal Cord Injury and Disorders Service, Department of Veterans Affairs, Hunter Holmes McGuire VAMC, Richmond, VA, USA
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
- Radiology Service, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
| | - Refka E Khalil
- Spinal Cord Injury and Disorders Service, Department of Veterans Affairs, Hunter Holmes McGuire VAMC, Richmond, VA, USA
| | - Rehan K Khan
- Radiology Service, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
| | - Melodie L Anderson
- Spinal Cord Injury and Disorders Service, Department of Veterans Affairs, Hunter Holmes McGuire VAMC, Richmond, VA, USA
| | - Teodoro Castillo
- Spinal Cord Injury and Disorders Service, Department of Veterans Affairs, Hunter Holmes McGuire VAMC, Richmond, VA, USA
| |
Collapse
|
16
|
Gorgey AS, Wade R, Sumrell R, Villadelgado L, Khalil RE, Lavis T. Exoskeleton Training May Improve Level of Physical Activity After Spinal Cord Injury: A Case Series. Top Spinal Cord Inj Rehabil 2017; 23:245-255. [PMID: 29339900 PMCID: PMC5562032 DOI: 10.1310/sci16-00025] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Objectives: To determine whether the use of a powered exoskeleton can improve parameters of physical activity as determined by walking time, stand up time, and number of steps in persons with spinal cord injury (SCI). Methods: Three men with complete (1 C5 AIS A and 2 T4 AIS A) and one man with incomplete (C5 AIS D) SCI participated in a clinical rehabilitation program. In the training program, the participants walked once weekly using a powered exoskeleton (Ekso) for approximately 1 hour over the course of 10 to 15 weeks. Walking time, stand up time, ratio of walking to stand up time, and number of steps were determined. Oxygen uptake (L/min), energy expenditure, and body composition were measured in one participant after training. Results: Over the course of 10 to 15 weeks, the maximum walking time increased from 12 to 57 minutes and the number of steps increased from 59 to 2,284 steps. At the end of the training, the 4 participants were able to exercise for 26 to 59 minutes. For one participant, oxygen uptake increased from 0.27 L/min during rest to 0.55 L/min during walking. Maximum walking speed was 0.24 m/s, and delta energy expenditure increased by 1.4 kcal/min during walking. Body composition showed a modest decrease in absolute fat mass in one participant. Conclusion: Exoskeleton training may improve parameters of physical activity after SCI by increasing the number of steps and walking time. Other benefits may include increasing energy expenditure and improving the profile of body composition.
Collapse
Affiliation(s)
- Ashraf S. Gorgey
- Spinal Cord Injury Service and Disorders, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
- Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia
| | - Rodney Wade
- Spinal Cord Injury Service and Disorders, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
| | - Ryan Sumrell
- Spinal Cord Injury Service and Disorders, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
| | - Lynette Villadelgado
- Spinal Cord Injury Service and Disorders, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
| | - Refka E. Khalil
- Spinal Cord Injury Service and Disorders, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
| | - Timothy Lavis
- Spinal Cord Injury Service and Disorders, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
- Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia
| |
Collapse
|
17
|
Gorgey AS, Martin H, Metz A, Khalil RE, Dolbow DR, Gater DR. Longitudinal changes in body composition and metabolic profile between exercise clinical trials in men with chronic spinal cord injury. J Spinal Cord Med 2016; 39:699-712. [PMID: 27077574 PMCID: PMC5137575 DOI: 10.1080/10790268.2016.1157970] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
STUDY DESIGN Longitudinal design. OBJECTIVES The study was undertaken to determine the effects of cessation of exercise interventions on body composition and metabolic profiles in men with chronic SCI. SETTINGS Clinical trials within a Medical Center. METHODS Eleven men with motor complete SCI were followed on average over a period of 2.5 years. Six men were involved in two different exercise interventions (functional electrical stimulation cycling versus arm cycling ergometer), 5 days/week for 16 weeks (exercise group), and five men served as a control (control group). Anthropometrics and dual energy X-ray absorptiometry (DXA) were captured to measure changes in lean mass (LM), fat mass (FM), percentage FM before, immediately after exercise, and after a period of 2.5 years. Basal metabolic rate (BMR) and lipid panel were also measured. RESULTS Thigh circumference increased by 8.5% following exercise (P = 0.042) and remained 6.4% greater than baseline measurements (P = 0.012). Leg LM increased by 9% following the exercise intervention (P = 0.03) and decreased by 16% in the follow-up visit (P = 0.02). Percentage trunk and total body FM increased by 4.5% (P = 0.008) and 3.5% (P = 0.019) in the follow-up visit, respectively, and whole body LM increased by 8.4% and decreased back by 5.4% following a 2.5 year-period. BMR significantly decreased by 15.5% following the exercise (P = 0.029) interventions. CONCLUSION Exercise training is accompanied with positive changes in body composition as well as compensatory decrease in BMR, that regressed back following 2.5 years of exercise cessation. Participation in an exercise trial is unlikely to confound the measurements of a follow-up trial.
Collapse
Affiliation(s)
- Ashraf S. Gorgey
- Spinal Cord Injury Service and Disorders, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
| | - Heather Martin
- Spinal Cord Injury Service and Disorders, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
| | - Alyse Metz
- Spinal Cord Injury Service and Disorders, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
- College of Health and Human Performance, Virginia Commonwealth University, Richmond, VA, USA
| | - Refka E. Khalil
- Spinal Cord Injury Service and Disorders, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
| | - David R. Dolbow
- School of Kinesiology, College of Health, University of Southern Mississippi, Hattiesburg, MS, USA
| | - David R. Gater
- Department of Physical Medicine and Rehabilitation, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| |
Collapse
|
18
|
Moore PD, Gorgey AS, Wade RC, Khalil RE, Lavis TD, Khan R, Adler RA. Neuromuscular electrical stimulation and testosterone did not influence heterotopic ossification size after spinal cord injury: A case series. World J Clin Cases 2016; 4:172-176. [PMID: 27458592 PMCID: PMC4945587 DOI: 10.12998/wjcc.v4.i7.172] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 04/01/2016] [Accepted: 05/09/2016] [Indexed: 02/05/2023] Open
Abstract
Neuromuscular electrical stimulation (NMES) and testosterone replacement therapy (TRT) are effective rehabilitation strategies to attenuate muscle atrophy and evoke hypertrophy in persons with spinal cord injury (SCI). However both interventions might increase heterotopic ossification (HO) size in SCI patients. We present the results of two men with chronic traumatic motor complete SCI who also had pre-existing HO and participated in a study investigating the effects of TRT or TRT plus NMES resistance training (RT) on body composition. The 49-year-old male, Subject A, has unilateral HO in his right thigh. The 31-year-old male, Subject B, has bilateral HO in both thighs. Both participants wore transdermal testosterone patches (4-6 mg/d) daily for 16 wk. Subject A also underwent progressive NMES-RT twice weekly for 16 wk. Magnetic resonance imaging scans were acquired prior to and post intervention. Cross-sectional areas (CSA) of the whole thigh and knee extensor skeletal muscles, femoral bone, and HO were measured. In Subject A (NMES-RT + TRT), the whole thigh skeletal muscle CSA increased by 10%, the knee extensor CSA increased by 17%, and the HO + femoral bone CSA did not change. In Subject B (TRT), the whole thigh skeletal muscle CSA increased by 13% in the right thigh and 6% in the left thigh. The knee extensor CSA increased by 7% in the right thigh and did not change in the left thigh. The femoral bone and HO CSAs in both thighs did not change. Both the TRT and NMES-RT + TRT protocols evoked muscle hypertrophy without stimulating the growth of pre-existing HO.
Collapse
|
19
|
Ibitoye MO, Hamzaid NA, Hasnan N, Abdul Wahab AK, Davis GM. Strategies for Rapid Muscle Fatigue Reduction during FES Exercise in Individuals with Spinal Cord Injury: A Systematic Review. PLoS One 2016; 11:e0149024. [PMID: 26859296 PMCID: PMC4747522 DOI: 10.1371/journal.pone.0149024] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Background Rapid muscle fatigue during functional electrical stimulation (FES)-evoked muscle contractions in individuals with spinal cord injury (SCI) is a significant limitation to attaining health benefits of FES-exercise. Delaying the onset of muscle fatigue is often cited as an important goal linked to FES clinical efficacy. Although the basic concept of fatigue-resistance has a long history, recent advances in biomedical engineering, physiotherapy and clinical exercise science have achieved improved clinical benefits, especially for reducing muscle fatigue during FES-exercise. This review evaluated the methodological quality of strategies underlying muscle fatigue-resistance that have been used to optimize FES therapeutic approaches. The review also sought to synthesize the effectiveness of these strategies for persons with SCI in order to establish their functional impacts and clinical relevance. Methods Published scientific literature pertaining to the reduction of FES-induced muscle fatigue was identified through searches of the following databases: Science Direct, Medline, IEEE Xplore, SpringerLink, PubMed and Nature, from the earliest returned record until June 2015. Titles and abstracts were screened to obtain 35 studies that met the inclusion criteria for this systematic review. Results Following the evaluation of methodological quality (mean (SD), 50 (6) %) of the reviewed studies using the Downs and Black scale, the largest treatment effects reported to reduce muscle fatigue mainly investigated isometric contractions of limited functional and clinical relevance (n = 28). Some investigations (n = 13) lacked randomisation, while others were characterised by small sample sizes with low statistical power. Nevertheless, the clinical significance of emerging trends to improve fatigue-resistance during FES included (i) optimizing electrode positioning, (ii) fine-tuning of stimulation patterns and other FES parameters, (iii) adjustments to the mode and frequency of exercise training, and (iv) biofeedback-assisted FES-exercise to promote selective recruitment of fatigue-resistant motor units. Conclusion Although the need for further in-depth clinical trials (especially RCTs) was clearly warranted to establish external validity of outcomes, current evidence was sufficient to support the validity of certain techniques for rapid fatigue-reduction in order to promote FES therapy as an integral part of SCI rehabilitation. It is anticipated that this information will be valuable to clinicians and other allied health professionals administering FES as a treatment option in rehabilitation and aid the development of effective rehabilitation interventions.
Collapse
Affiliation(s)
- Morufu Olusola Ibitoye
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
- Department of Biomedical Engineering, Faculty of Engineering and Technology, University of Ilorin, Ilorin, Nigeria
| | - Nur Azah Hamzaid
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
- * E-mail:
| | - Nazirah Hasnan
- Department of Rehabilitation Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ahmad Khairi Abdul Wahab
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Glen M. Davis
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
- Clinical Exercise and Rehabilitation Unit, Discipline of Exercise and Sport Sciences, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| |
Collapse
|
20
|
Gorgey AS, Wells KM, Austin TL. Adiposity and spinal cord injury. World J Orthop 2015; 6:567-576. [PMID: 26396933 PMCID: PMC4573501 DOI: 10.5312/wjo.v6.i8.567] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 03/18/2015] [Accepted: 07/17/2015] [Indexed: 02/06/2023] Open
Abstract
The drastic changes in body composition following spinal cord injury (SCI) have been shown to play a significant role in cardiovascular and metabolic health. The pattern of storage and distribution of different types of adipose tissue may impact metabolic health variables similar to carbohydrate, lipid and bone metabolism. The use of magnetic resonance imaging provides insights on the interplay among different regional adipose tissue compartments and their role in developing chronic diseases. Regional adipose tissue can be either distributed centrally or peripherally into subcutaneous and ectopic sites. The primary ectopic adipose tissue sites are visceral, intramuscular and bone marrow. Dysfunction in the central nervous system following SCI impacts the pattern of distribution of adiposity especially between tetraplegia and paraplegia. The current editorial is focused primarily on introducing different types of adipose tissue and establishing scientific basis to develop appropriate dietary, rehabilitation or pharmaceutical interventions to manage the negative consequences of increasing adiposity after SCI. We have also summarized the clinical implications and future recommendations relevant to study adiposity after SCI.
Collapse
|