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Hodgkiss DD, Bhangu GS, Lunny C, Jutzeler CR, Chiou SY, Walter M, Lucas SJE, Krassioukov AV, Nightingale TE. Exercise and aerobic capacity in individuals with spinal cord injury: A systematic review with meta-analysis and meta-regression. PLoS Med 2023; 20:e1004082. [PMID: 38011304 PMCID: PMC10712898 DOI: 10.1371/journal.pmed.1004082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 12/11/2023] [Accepted: 10/30/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND A low level of cardiorespiratory fitness [CRF; defined as peak oxygen uptake ([Formula: see text]O2peak) or peak power output (PPO)] is a widely reported consequence of spinal cord injury (SCI) and a major risk factor associated with chronic disease. However, CRF can be modified by exercise. This systematic review with meta-analysis and meta-regression aimed to assess whether certain SCI characteristics and/or specific exercise considerations are moderators of changes in CRF. METHODS AND FINDINGS Databases (MEDLINE, EMBASE, CENTRAL, and Web of Science) were searched from inception to March 2023. A primary meta-analysis was conducted including randomised controlled trials (RCTs; exercise interventions lasting >2 weeks relative to control groups). A secondary meta-analysis pooled independent exercise interventions >2 weeks from longitudinal pre-post and RCT studies to explore whether subgroup differences in injury characteristics and/or exercise intervention parameters explained CRF changes. Further analyses included cohort, cross-sectional, and observational study designs. Outcome measures of interest were absolute (A[Formula: see text]O2peak) or relative [Formula: see text]O2peak (R[Formula: see text]O2peak), and/or PPO. Bias/quality was assessed via The Cochrane Risk of Bias 2 and the National Institute of Health Quality Assessment Tools. Certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Random effects models were used in all meta-analyses and meta-regressions. Of 21,020 identified records, 120 studies comprising 29 RCTs, 67 pre-post studies, 11 cohort, 7 cross-sectional, and 6 observational studies were included. The primary meta-analysis revealed significant improvements in A[Formula: see text]O2peak [0.16 (0.07, 0.25) L/min], R[Formula: see text]O2peak [2.9 (1.8, 3.9) mL/kg/min], and PPO [9 (5, 14) W] with exercise, relative to controls (p < 0.001). Ninety-six studies (117 independent exercise interventions comprising 1,331 adults with SCI) were included in the secondary, pooled meta-analysis which demonstrated significant increases in A[Formula: see text]O2peak [0.22 (0.17, 0.26) L/min], R[Formula: see text]O2peak [2.8 (2.2, 3.3) mL/kg/min], and PPO [11 (9, 13) W] (p < 0.001) following exercise interventions. There were subgroup differences for R[Formula: see text]O2peak based on exercise modality (p = 0.002) and intervention length (p = 0.01), but there were no differences for A[Formula: see text]O2peak. There were subgroup differences (p ≤ 0.018) for PPO based on time since injury, neurological level of injury, exercise modality, and frequency. The meta-regression found that studies with a higher mean age of participants were associated with smaller changes in A[Formula: see text]O2peak and R[Formula: see text]O2peak (p < 0.10). GRADE indicated a moderate level of certainty in the estimated effect for R[Formula: see text]O2peak, but low levels for A[Formula: see text]O2peak and PPO. This review may be limited by the small number of RCTs, which prevented a subgroup analysis within this specific study design. CONCLUSIONS Our primary meta-analysis confirms that performing exercise >2 weeks results in significant improvements to A[Formula: see text]O2peak, R[Formula: see text]O2peak, and PPO in individuals with SCI. The pooled meta-analysis subgroup comparisons identified that exercise interventions lasting up to 12 weeks yield the greatest change in R[Formula: see text]O2peak. Upper-body aerobic exercise and resistance training also appear the most effective at improving R[Formula: see text]O2peak and PPO. Furthermore, acutely injured, individuals with paraplegia, exercising for ≥3 sessions/week will likely experience the greatest change in PPO. Ageing seemingly diminishes the adaptive CRF responses to exercise training in individuals with SCI. REGISTRATION PROSPERO: CRD42018104342.
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Affiliation(s)
- Daniel D. Hodgkiss
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Gurjeet S. Bhangu
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada
- MD Undergraduate Program, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Carole Lunny
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, and University of British Columbia, Vancouver, Canada
| | - Catherine R. Jutzeler
- Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- Schulthess Clinic, Zurich, Switzerland
| | - Shin-Yi Chiou
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
- Centre for Human Brain Health, University of Birmingham, Birmingham, United Kingdom
- MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, United Kingdom
- Centre for Trauma Science Research, University of Birmingham, Birmingham, United Kingdom
| | - Matthias Walter
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada
- Department of Urology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Samuel J. E. Lucas
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
- Centre for Human Brain Health, University of Birmingham, Birmingham, United Kingdom
| | - Andrei V. Krassioukov
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, Canada
- GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, Canada
| | - Tom E. Nightingale
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada
- Centre for Trauma Science Research, University of Birmingham, Birmingham, United Kingdom
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Gelman R, Berg M, Ilan Y. A Subject-Tailored Variability-Based Platform for Overcoming the Plateau Effect in Sports Training: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:1722. [PMID: 35162745 PMCID: PMC8834821 DOI: 10.3390/ijerph19031722] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 01/29/2022] [Accepted: 01/30/2022] [Indexed: 12/16/2022]
Abstract
The plateau effect in training is a significant obstacle for professional athletes and average subjects. It evolves from both the muscle-nerve-axis-associated performance and various cardiorespiratory parameters. Compensatory adaptation mechanisms contribute to a lack of continuous improvement with most exercise regimens. Attempts to overcome this plateau in exercise have been only partially successful, and it remains a significant unmet need in both healthy subjects and those suffering from chronic neuromuscular, cardiopulmonary, and metabolic diseases. Variability patterns characterize many biological processes, from cellular to organ levels. The present review discusses the significant obstacles in overcoming the plateau in training and establishes a platform to implement subject-tailored variability patterns to prevent and overcome this plateau in muscle and cardiorespiratory performance.
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Affiliation(s)
- Ram Gelman
- Department of Medicine, Hebrew University-Hadassah Medical Center, Jerusalem 9103401, Israel;
| | - Marc Berg
- Department of Pediatrics, Lucile Packard Children’s Hospital, Stanford University, Palo Alto, CA 94304, USA;
| | - Yaron Ilan
- Department of Medicine, Hebrew University-Hadassah Medical Center, Jerusalem 9103401, Israel;
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Figoni SF, Dolbow DR, Crawford EC, White ML, Pattanaik S. Does aerobic exercise benefit persons with tetraplegia from spinal cord injury? A systematic review. J Spinal Cord Med 2021; 44:690-703. [PMID: 32043944 PMCID: PMC8477928 DOI: 10.1080/10790268.2020.1722935] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
CONTEXT This review synthesizes the findings of previous research studies on the cardiovascular and metabolic benefits of aerobic exercise for individuals with tetraplegia secondary to spinal cord injury. They are often less active due to muscular paralysis, sensory loss, and sympathetic nervous system dysfunction that result from injury. Consequently, these persons are at higher risk for exercise intolerance and secondary health conditions. OBJECTIVE To evaluate the evidence concerning efficacy of aerobic exercise training for improving health and exercise performance in persons with tetraplegia from cervical injury. METHODS The search engines PubMed and Google Scholar were used to locate published research. The final 75 papers were selected on the basis of inclusion criteria. The studies were then rank-ordered using Physiotherapy Evidence Database. RESULTS Studies combining individuals with tetraplegia and paraplegia show that voluntary arm-crank training can increase mean peak power output by 33%. Functional electrical stimulation leg cycling was shown to induce higher peak cardiac output and stroke volume than arm-crank exercise. A range of peak oxygen uptake (VO2peak) values have been reported (0.57-1.32 L/min). Both VO2peak and cardiac output may be enhanced via increased muscle pump in the legs and venous return to the heart. Hybrid exercise (arm-crank and functional electrical stimulation leg cycling) can result in greater peak oxygen uptake and cardiovascular responses. CONCLUSION Evidence gathered from this systematic review of literature is inconclusive due to the lack of research focusing on those with tetraplegia. Higher power studies (level 1-3) are needed with the focus on those with tetraplegia.
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Affiliation(s)
- Stephen F Figoni
- Spinal Cord Injury/Disorders Healthcare Group (128), Tibor Rubin VA Medical Center, Long Beach, California, USA
| | - David R Dolbow
- Physical Therapy Program, William Carey University, Hattiesburg, Mississippi, USA
| | - Edwin C Crawford
- Physical Therapy Program, William Carey University, Hattiesburg, Mississippi, USA
| | - Margaret L White
- Physical Therapy Program, William Carey University, Hattiesburg, Mississippi, USA
| | - Sambit Pattanaik
- College of Osteopathic Medicine, William Carey University, Hattiesburg, Mississippi, USA
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A Novel Framework for Quantifying Accuracy and Precision of Event Detection Algorithms in FES-Cycling. SENSORS 2021; 21:s21134571. [PMID: 34283104 PMCID: PMC8272114 DOI: 10.3390/s21134571] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/21/2021] [Accepted: 06/23/2021] [Indexed: 02/06/2023]
Abstract
Functional electrical stimulation (FES) is a technique used in rehabilitation, allowing the recreation or facilitation of a movement or function, by electrically inducing the activation of targeted muscles. FES during cycling often uses activation patterns which are based on the crank angle of the pedals. Dynamic changes in their underlying predefined geometrical models (e.g., change in seating position) can lead to desynchronised contractions. Adaptive algorithms with a real-time interpretation of anatomical segments can avoid this and open new possibilities for the automatic design of stimulation patterns. However, their ability to accurately and precisely detect stimulation triggering events has to be evaluated in order to ensure their adaptability to real-case applications in various conditions. In this study, three algorithms (Hilbert, BSgonio, and Gait Cycle Index (GCI) Observer) were evaluated on passive cycling inertial data of six participants with spinal cord injury (SCI). For standardised comparison, a linear phase reference baseline was used to define target events (i.e., 10%, 40%, 60%, and 90% of the cycle’s progress). Limits of agreement (LoA) of ±10% of the cycle’s duration and Lin’s concordance correlation coefficient (CCC) were used to evaluate the accuracy and precision of the algorithm’s event detections. The delays in the detection were determined for each algorithm over 780 events. Analysis showed that the Hilbert and BSgonio algorithms validated the selected criteria (LoA: +5.17/−6.34% and +2.25/−2.51%, respectively), while the GCI Observer did not (LoA: +8.59/−27.89%). When evaluating control algorithms, it is paramount to define appropriate criteria in the context of the targeted practical application. To this end, normalising delays in event detection to the cycle’s duration enables the use of a criterion that stays invariable to changes in cadence. Lin’s CCC, comparing both linear correlation and strength of agreement between methods, also provides a reliable way of confirming comparisons between new control methods and an existing reference.
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van der Scheer JW, Goosey-Tolfrey VL, Valentino SE, Davis GM, Ho CH. Functional electrical stimulation cycling exercise after spinal cord injury: a systematic review of health and fitness-related outcomes. J Neuroeng Rehabil 2021; 18:99. [PMID: 34118958 PMCID: PMC8196442 DOI: 10.1186/s12984-021-00882-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 05/19/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES The objective of this review was to summarize and appraise evidence on functional electrical stimulation (FES) cycling exercise after spinal cord injury (SCI), in order to inform the development of evidence-based clinical practice guidelines. METHODS PubMed, the Cochrane Central Register of Controlled Trials, EMBASE, SPORTDiscus, and CINAHL were searched up to April 2021 to identify FES cycling exercise intervention studies including adults with SCI. In order to capture the widest array of evidence available, any outcome measure employed in such studies was considered eligible. Two independent reviewers conducted study eligibility screening, data extraction, and quality appraisal using Cochranes' Risk of Bias or Downs and Black tools. Each study was designated as a Level 1, 2, 3 or 4 study, dependent on study design and quality appraisal scores. The certainty of the evidence for each outcome was assessed using GRADE ratings ('High', 'Moderate', 'Low', or 'Very low'). RESULTS Ninety-two studies met the eligibility criteria, comprising 999 adults with SCI representing all age, sex, time since injury, lesion level and lesion completeness strata. For muscle health (e.g., muscle mass, fiber type composition), significant improvements were found in 3 out of 4 Level 1-2 studies, and 27 out of 32 Level 3-4 studies (GRADE rating: 'High'). Although lacking Level 1-2 studies, significant improvements were also found in nearly all of 35 Level 3-4 studies on power output and aerobic fitness (e.g., peak power and oxygen uptake during an FES cycling test) (GRADE ratings: 'Low'). CONCLUSION Current evidence indicates that FES cycling exercise improves lower-body muscle health of adults with SCI, and may increase power output and aerobic fitness. The evidence summarized and appraised in this review can inform the development of the first international, evidence-based clinical practice guidelines for the use of FES cycling exercise in clinical and community settings of adults with SCI. Registration review protocol: CRD42018108940 (PROSPERO).
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Affiliation(s)
- Jan W van der Scheer
- Peter Harrison Centre for Disability Sport, School for Sport, Exercise and Health Sciences, Loughborough University, Epinal Way, Loughborough, LE11 3TU, UK
- The Healthcare Improvement Studies (THIS) Institute, Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt Building, Cambridge, CB2 OAH, UK
| | - Victoria L Goosey-Tolfrey
- Peter Harrison Centre for Disability Sport, School for Sport, Exercise and Health Sciences, Loughborough University, Epinal Way, Loughborough, LE11 3TU, UK
| | - Sydney E Valentino
- Department of Kinesiology, McMaster University, Room IWC EG115, 1280 Main St. W., Hamilton, ON, L8S 4K1, Canada
| | - Glen M Davis
- Discipline of Exercise and Sport Sciences, Faculty of Medicine and Health, Sydney School of Health Sciences, University of Sydney, Sydney, NSW, 2006, Australia
| | - Chester H Ho
- Division of Physical Medicine & Rehabilitation, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, T6G 2R3, Canada.
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Abstract
For individuals with movement impairments due to neurological injuries, rehabilitative therapies such as functional electrical stimulation (FES) and rehabilitation robots hold vast potential to improve their mobility and activities of daily living. Combining FES with rehabilitation robots results in intimately coordinated human–robot interaction. An example of such interaction is FES cycling, where motorized assistance can provide high-intensity and repetitive practice of coordinated limb motion, resulting in physiological and functional benefits. In this paper, the development of multiple FES cycling testbeds and safeguards is described, along with the switched nonlinear dynamics of the cycle–rider system. Closed-loop FES cycling control designs are described for cadence and torque tracking. For each tracking objective, the authors’ past work on robust and adaptive controllers used to compute muscle stimulation and motor current inputs is presented and discussed. Experimental results involving both able-bodied individuals and participants with neurological injuries are provided for each combination of controller and tracking objective. Trade-offs for the control algorithms are discussed based on the requirements for implementation, desired rehabilitation outcomes and resulting rider performance. Lastly, future works and the applicability of the developed methods to additional technologies including teleoperated robotics are outlined.
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Vivodtzev I, Taylor JA. Cardiac, Autonomic, and Cardiometabolic Impact of Exercise Training in Spinal Cord Injury: A QUALITATIVE REVIEW. J Cardiopulm Rehabil Prev 2021; 41:6-12. [PMID: 33351539 PMCID: PMC7768813 DOI: 10.1097/hcr.0000000000000564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Direct and indirect effects of spinal cord injury lead to important cardiovascular (CV) complications that are further increased by years of injury and the process of "accelerated aging." The present review examines the current evidence in the literature for the potential cardioprotective effect of exercise training in spinal cord injury. REVIEW METHODS PubMed and Web of Science databases were screened for original studies investigating the effect of exercise-based interventions on aerobic capacity, cardiac structure/function, autonomic function, CV function, and/or cardiometabolic markers. We compared the effects in individuals <40 yr with time since injury <10 yr with those in older individuals (≥40 yr) with longer time since injury (≥10 yr), reasoning that the two can be considered individuals with low versus high CV risk factors. SUMMARY Studies showed similar exercise effects in both groups (n = 31 in low CV risk factors vs n = 15 in high CV risk factors). The evidence does not support any effect of exercise training on autonomic function but does support an increased peripheral blood flow, improved left ventricular mass, higher peak cardiac output, greater lean body mass, better antioxidant capacity, and improved endothelial function. In addition, some evidence suggests that it can result in lower blood lipids, systemic inflammation (interleukin-6, tumor necrosis factor α, and C-reactive protein), and arterial stiffness. Training intensity, volume, and frequency were key factors determining CV gains. Future studies with larger sample sizes, well-matched groups of subjects, and randomized controlled designs will be needed to determine whether high-intensity hybrid forms of training result in greater CV gains.
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Affiliation(s)
- Isabelle Vivodtzev
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts (Drs Vivodtzev and Taylor); Cardiovascular Research Laboratory, Spaulding Rehabilitation Hospital, Cambridge, Massachusetts (Drs Vivodtzev and Taylor); and Sorbonne Université, INSERM, UMRS1158, Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France (Dr Vivodtzev)
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Taylor MJ, Schils S, Ruys AJ. Home FES: An Exploratory Review. Eur J Transl Myol 2019; 29:8285. [PMID: 31969976 PMCID: PMC6974778 DOI: 10.4081/ejtm.2019.8285] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 10/31/2019] [Indexed: 12/28/2022] Open
Abstract
This review of literature focuses on the multiple uses of Functional Electrical Stimulation (FES) and how this modality may be a valuable home-based therapy. Papers pertaining to home FES exercise were collected using the Web of Science, Google Scholar databases and collegial hints. In our opinion, the following statements summarize the results. FES may be used to induce health benefits in populations with paralysis, and in persons with musculoskeletal, cardiorespiratory and renal pathology. The EU Project Rise showed how FES could have a variety of encouraging outcomes for patients with denervated muscles following traumatic injuries. As suggested by recent literature, FES has proven to be a viable form of exercise for elderly individuals. Thus, Home FES may be an option for patients looking for an additional form of muscle and cardiopulmonary physical therapy.
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Affiliation(s)
- Matthew J. Taylor
- Faculty of Engineering and IT, The University of Sydney, Camperdown, Australia
- Charles Perkins Centre, The University of Sydney, Camperdown, Australia
- Discipline of Anatomy and Histology, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Sheila Schils
- EquiNew, River Falls, Wisconsin, United States of America
| | - Andrew J. Ruys
- Faculty of Engineering and IT, The University of Sydney, Camperdown, Australia
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Sijobert B, Le Guillou R, Fattal C, Azevedo Coste C. FES-Induced Cycling in Complete SCI: A Simpler Control Method Based on Inertial Sensors. SENSORS (BASEL, SWITZERLAND) 2019; 19:E4268. [PMID: 31581489 PMCID: PMC6806329 DOI: 10.3390/s19194268] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 08/29/2019] [Accepted: 09/26/2019] [Indexed: 12/13/2022]
Abstract
This article introduces a novel approach for a functional electrical stimulation (FES) controller intended for FES-induced cycling based on inertial measurement units (IMUs). This study aims at simplifying the design of electrical stimulation timing patterns while providing a method that can be adapted to different users and devices. In most of studies and commercial devices, the crank angle is used as an input to trigger stimulation onset. We propose instead to use thigh inclination as the reference information to build stimulation timing patterns. The tilting angles of both thighs are estimated from one inertial sensor located above each knee. An IF-THEN rule algorithm detects, online and automatically, the thigh peak angles in order to start and stop the stimulation of quadriceps muscles, depending on these events. One participant with complete paraplegia was included and was able to propel a recumbent trike using the proposed approach after a very short setting time. This new modality opens the way for a simpler and user-friendly method to automatically design FES-induced cycling stimulation patterns, adapted to clinical use, for multiple bike geometries and user morphologies.
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Affiliation(s)
- Benoît Sijobert
- Institut National de Recherche en Informatique et en Automatique (INRIA), Université de Montpellier, 34095 Montpellier, France.
| | - Ronan Le Guillou
- Institut National de Recherche en Informatique et en Automatique (INRIA), Université de Montpellier, 34095 Montpellier, France.
| | | | - Christine Azevedo Coste
- Institut National de Recherche en Informatique et en Automatique (INRIA), Université de Montpellier, 34095 Montpellier, France.
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Aksöz EA, Laubacher M, Riener R, Hunt KJ. Design of an isokinetic knee dynamometer for evaluation of functional electrical stimulation strategies. Med Eng Phys 2019; 73:100-106. [PMID: 31421979 DOI: 10.1016/j.medengphy.2019.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 07/09/2019] [Accepted: 07/18/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND The limitations of functional electrical stimulation (FES) cycling directly affect the health benefits acquired from this technology and prevents its' full potential to be realised. Experiments should be done on a test bed which can isolate and focus only on one muscle group, namely the quadriceps. The aim of this work was to design and develop an isokinetic robotic leg extension/flexion dynamometer which can mimic knee joint motion during actual cycling to be used for evaluation of novel functional electrical stimulation strategies. Although the main motivation for development of the dynamometer was for application in FES studies, it has the potential to be used for various different muscle physiology studies. METHODS A feedback control system with integrated electrical stimulation for isokinetic knee joint torque measurement has been developed and tested for safety and functionality. The leg extension/flexion device was modified and equipped with a DC motor drive system to imitate isokinetic knee joint motion during cycling when the hip joint remains fixed. Real-time bi-directional effective torque on the lever arm was measured by a magnetostrictive torque sensor and a load cell. Closed-loop motor control system was also designed to mimic the cyclical motion at desired angular velocity. RESULTS A functional model of the robotic dynamometer was developed and evaluated. The dynamometer is capable of simulating the knee angle during cycling at a cadence of up to 70 rpm with range of motion of 72∘. The magnetostrictive torque sensor can measure torque values up to 75 Nm. The lever arm can be adjusted and the target knee angle was controlled with RMSE tracking error of less than 2.1∘ in tests with and without a test person, and with and without muscle stimulation. CONCLUSIONS The isokinetic knee joint torque measurement system was designed and validated in this work, and subsequently used to develop and evaluate novel muscle activation strategies. This is important for fundamental research on effective stimulation patterns and novel activation strategies. This will, in turn, enhance the efficiency of FES cycling exercise and has the potential to improve the health-beneficial effects.
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Affiliation(s)
- Efe Anil Aksöz
- Institute for Rehabilitation and Performance Technology, Division of Mechanical Engineering, Department of Engineering and Information Technology, Bern University of Applied Sciences, BurgdorfCH-3400, Switzerland; Sensory Motor Systems Lab, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zürich, CH-8000 Zürich, Switzerland
| | - Marco Laubacher
- Institute for Rehabilitation and Performance Technology, Division of Mechanical Engineering, Department of Engineering and Information Technology, Bern University of Applied Sciences, BurgdorfCH-3400, Switzerland; Sensory Motor Systems Lab, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zürich, CH-8000 Zürich, Switzerland
| | - Robert Riener
- Sensory Motor Systems Lab, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zürich, CH-8000 Zürich, Switzerland
| | - Kenneth J Hunt
- Institute for Rehabilitation and Performance Technology, Division of Mechanical Engineering, Department of Engineering and Information Technology, Bern University of Applied Sciences, BurgdorfCH-3400, Switzerland.
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Alam M, Li S, Ahmed RU, Yam YM, Thakur S, Wang XY, Tang D, Ng S, Zheng YP. Development of a battery-free ultrasonically powered functional electrical stimulator for movement restoration after paralyzing spinal cord injury. J Neuroeng Rehabil 2019; 16:36. [PMID: 30850027 PMCID: PMC6408863 DOI: 10.1186/s12984-019-0501-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 02/22/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Functional electrical stimulation (FES) is used to restore movements in paretic limbs after severe paralyses resulting from neurological injuries such as spinal cord injury (SCI). Most chronic FES systems utilize an implantable electrical stimulator to deliver a small electric current to the targeted muscle or nerve to stimulate muscle contractions. These implanted stimulators are generally bulky, mainly due to the size of the batteries. Furthermore, these battery-powered stimulators are required to be explanted every few years for battery replacement which may result in surgical failures or infections. Hence, a wireless power transfer technique is desirable to power these implantable stimulators. METHODS Conventional wireless power transduction faces significant challenges for safe and efficient energy transfer through the skin and deep into the body. Inductive and electromagnetic power transduction is generally used for very short distances and may also interfere with other medical measurements such as X-ray and MRI. To address these issues, we have developed a wireless, ultrasonically powered, implantable piezoelectric stimulator. The stimulator is encapsulated with biocompatible materials. RESULTS The stimulator is capable of harvesting a maximum of 5.95 mW electric power at an 8-mm depth under the skin from an ultrasound beam with about 380 mW/cm2 of acoustic intensity. The stimulator was implanted in several paraplegic rats with SCI. Our implanted stimulator successfully induced several hindlimb muscle contractions and restored leg movement. CONCLUSIONS A battery-free miniature (10 mm diameter × 4 mm thickness) implantable stimulator, developed in the current study is capable of directly stimulating paretic muscles through external ultrasound signals. The required cost to develop the stimulator is relatively low as all the components are off the shelf.
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Affiliation(s)
- Monzurul Alam
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China
| | - Shuai Li
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China
| | - Rakib Uddin Ahmed
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China
| | - Yat Man Yam
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China
| | - Suman Thakur
- Department of Chemical Sciences, Tezpur University, Tezpur, 784028 India
| | - Xiao-Yun Wang
- Guangdong Work Injury Rehabilitation Center, Guangzhou, China
| | - Dan Tang
- Guangdong Work Injury Rehabilitation Center, Guangzhou, China
| | - Serena Ng
- Community Rehabilitation Service Support Centre, Hospital Authority, Hong Kong SAR, China
| | - Yong-Ping Zheng
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China
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Azevedo Coste C, Wolf P. FES-Cycling at Cybathlon 2016: Overview on Teams and Results. Artif Organs 2018. [PMID: 29516578 DOI: 10.1111/aor.13139] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | - Peter Wolf
- Sensory-Motor Systems Lab, ETH Zurich, Zurich, Switzerland
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13
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Aksöz EA, Luder MA, Laubacher M, Riener R, Binder-Macleod SA, Hunt KJ. Stochastically modulated inter-pulse intervals to increase the efficiency of functional electrical stimulation cycling. J Rehabil Assist Technol Eng 2018; 5:2055668318767364. [PMID: 31191935 PMCID: PMC6453100 DOI: 10.1177/2055668318767364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 03/07/2018] [Indexed: 11/30/2022] Open
Abstract
Introduction Functional electrical stimulation cycling has various health benefits, but
the mechanical power output and efficiency are very low compared to
volitional muscle activation. Stimulation with variable frequency showed
significantly higher power output values in experiments with a knee
dynamometer. The aim of the present work was to compare stochastic
modulation of inter-pulse interval to constant inter-pulse interval
stimulation during functional electrical stimulation cycling. Methods Seventeen able-bodied subjects participated (n = 17).
Quadriceps and hamstring muscle groups were stimulated with two activation
patterns: P1-constant frequency, P2-stochastic inter-pulse interval. Power
output was measured on functional electrical stimulation ergometer. Results Overall, mean power output with the stochastically modulated pattern P2 was
lower than with P1 (12.57 ± 3.74 W vs. 11.44 ± 3.81 W, P1 vs. P2,
p = 0.022), but no significant differences during the
first 30 s and the last 30 s were observed. Conclusions This study showed that stimulation strategies that use randomized modulation
of inter-pulse intervals can negatively affect power output generation
during functional electrical stimulation cycling. To minimise voluntary
contractions, power measurement and assessment should be focused on the
periods where only the quadriceps are stimulated.
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Affiliation(s)
- E A Aksöz
- Department of Engineering and Information Technology, Division of Mechanical Engineering, Institute for Rehabilitation and Performance Technology, Bern University of Applied Sciences, Burgdorf, Switzerland.,Department of Health Sciences and Technology, Sensory Motor Systems Lab, ETH Zürich, Zürich, Switzerland
| | - M A Luder
- Department of Engineering and Information Technology, Division of Mechanical Engineering, Institute for Rehabilitation and Performance Technology, Bern University of Applied Sciences, Burgdorf, Switzerland
| | - M Laubacher
- Department of Engineering and Information Technology, Division of Mechanical Engineering, Institute for Rehabilitation and Performance Technology, Bern University of Applied Sciences, Burgdorf, Switzerland.,Department of Health Sciences and Technology, Sensory Motor Systems Lab, ETH Zürich, Zürich, Switzerland
| | - R Riener
- Department of Health Sciences and Technology, Sensory Motor Systems Lab, ETH Zürich, Zürich, Switzerland
| | | | - K J Hunt
- Department of Engineering and Information Technology, Division of Mechanical Engineering, Institute for Rehabilitation and Performance Technology, Bern University of Applied Sciences, Burgdorf, Switzerland
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14
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Laubacher M, Aksöz AE, Riener R, Binder-Macleod S, Hunt KJ. Power output and fatigue properties using spatially distributed sequential stimulation in a dynamic knee extension task. Eur J Appl Physiol 2017; 117:1787-1798. [PMID: 28674921 PMCID: PMC5556133 DOI: 10.1007/s00421-017-3675-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 06/28/2017] [Indexed: 11/06/2022]
Abstract
PURPOSE The low power output and fatigue resistance during functional electrical stimulation (FES) limits its use for functional applications. The aim of this study was to compare the power output and fatigue properties of spatially distributed sequential stimulation (SDSS) against conventional single electrode stimulation (SES) in an isokinetic knee extension task simulating knee movement during recumbent cycling. METHODS M. vastus lateralis and m. vastus medialis of eight able-bodied subjects were stimulated for 6 min on both legs with both setups. In the SES setup, target muscles were each stimulated by a pair of electrodes. In SDSS, four small electrodes replaced the SES active electrodes, but reference electrodes were the same. Torque was measured during knee extension movement by a dynamometer at an angular velocity of 110°/s. Mean power (P mean) was calculated from stimulated extensions for the first 10 extensions, the final 20 extensions and overall. Fatigue is presented as an index, calculated as the decrease with respect to initial power. RESULTS P mean was significantly higher for SDSS than for SES in the final phase (9.9 ± 4.0 vs. 7.4 ± 4.3 W, p = 0.035) and overall (11.5 ± 4.0 vs. 9.2 ± 4.5 W, p = 0.037). With SDSS, the reduction in P mean was significantly smaller compared to SES (from 14.9 to 9.9 vs. 14.6 to 7.4 W, p = 0.024). The absolute mean pulse width was substantially lower with SDSS (62.5 vs. 90.0 µs). CONCLUSION Although less stimulation was applied, SDSS showed a significantly higher mean power output than SES. SDSS also had improved fatigue resistance when compared to conventional stimulation. The SDSS approach may provide substantial performance benefits for cyclical FES applications.
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Affiliation(s)
- Marco Laubacher
- Division of Mechanical Engineering, Department of Engineering and Information Technology, Institute for Rehabilitation and Performance Technology, Bern University of Applied Sciences, 3400, Burgdorf, Switzerland.
- Sensory Motor Systems Laboratory, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.
| | - Anil Efe Aksöz
- Division of Mechanical Engineering, Department of Engineering and Information Technology, Institute for Rehabilitation and Performance Technology, Bern University of Applied Sciences, 3400, Burgdorf, Switzerland
- Sensory Motor Systems Laboratory, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Robert Riener
- Sensory Motor Systems Laboratory, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | | | - Kenneth J Hunt
- Division of Mechanical Engineering, Department of Engineering and Information Technology, Institute for Rehabilitation and Performance Technology, Bern University of Applied Sciences, 3400, Burgdorf, Switzerland
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Effects of Functional Electrical Stimulation Lower Extremity Training in Myotonic Dystrophy Type I: A Pilot Controlled Study. Am J Phys Med Rehabil 2017; 95:809-817. [PMID: 27088471 DOI: 10.1097/phm.0000000000000497] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Functional electrical stimulation (FES) is a new rehabilitative approach that combines electrical stimulation with a functional task. This pilot study evaluated the safety and effectiveness of FES lower extremity training in myotonic dystrophy type 1. DESIGN This is a controlled pilot study that enrolled 20 patients with myotonic dystrophy type 1 over 2 years. Eight patients (age, 39-67 years) fulfilled the inclusion criteria. Four participants performed FES cycling training for 15 days (one daily session of 30 minutes for 5 days a week). A control group, matched for clinical and genetic variables, who had contraindications to electrical stimulation, performed 6 weeks of conventional resistance and aerobic training. The modified Medical Research Council Scale and functional assessments were performed before and after treatment. Cohen d effect size was used for statistical analysis. RESULTS Functional electrical stimulation induced lower extremity training was well tolerated and resulted in a greater improvement of tibialis anterior muscle strength (d = 1,583), overall muscle strength (d = 1,723), and endurance (d = 0,626) than conventional training. CONCLUSIONS Functional electrical stimulation might be considered a safe and valid tool to improve muscle function, also in muscles severely compromised in which no other restorative options are available. Confirmation of FES efficacy through further clinical trials is strongly advised.
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16
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Aksöz EA, Laubacher M, Binder-Macleod S, Hunt KJ. Effect of Stochastic Modulation of Inter-Pulse Interval During Stimulated Isokinetic Leg Extension. Eur J Transl Myol 2016; 26:6160. [PMID: 27990242 PMCID: PMC5128975 DOI: 10.4081/ejtm.2016.6160] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Recumbent cycling exercise achieved by functional electrical stimulation (FES) of the paralyzed leg muscles is effective for cardiopulmonary and musculoskeletal conditioning after spinal cord injury, but its full potential has not yet been realized. Mechanical power output and efficiency is very low and endurance is limited due to early onset of muscle fatigue. The aim of this work was to compare stochastic modulation of the inter-pulse interval (IPI) to constant-frequency stimulation during an isokinetic leg extension task similar to FES-cycling. Seven able-bodied subjects participated: both quadriceps muscles were stimulated (n = 14) with two activation patterns (P1-constant frequency, P2-stochastic IPI). There was significantly higher power output with P2 during the first 30 s (p = 0.0092), the last 30 s (p = 0.018) and overall (p = 0.0057), but there was no overall effect on fatiguability when stimulation frequency was randomly modulated.
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Affiliation(s)
- Efe Anil Aksöz
- Institute for Rehabilitation and Performance Technology, Bern University of Applied Sciences, Burgdorf, Switzerland; Sensory Motor Systems Lab, ETH Zurich, Zürich, Switzerland
| | - Marco Laubacher
- Institute for Rehabilitation and Performance Technology, Bern University of Applied Sciences, Burgdorf, Switzerland; Sensory Motor Systems Lab, ETH Zurich, Zürich, Switzerland
| | | | - Kenneth J Hunt
- Institute for Rehabilitation and Performance Technology, Bern University of Applied Sciences , Burgdorf, Switzerland
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17
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Functional electrical stimulation: cardiorespiratory adaptations and applications for training in paraplegia. Sports Med 2015; 45:71-82. [PMID: 25205000 DOI: 10.1007/s40279-014-0250-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Regular exercise can be broadly beneficial to health and quality of life in humans with spinal cord injury (SCI). However, exercises must meet certain criteria, such as the intensity and muscle mass involved, to induce significant benefits. SCI patients can have difficulty achieving these exercise requirements since the paralysed muscles cannot contribute to overall oxygen consumption. One solution is functional electrical stimulation (FES) and, more importantly, hybrid training that combines volitional arm and electrically controlled contractions of the lower limb muscles. However, it might be rather complicated for therapists to use FES because of the wide variety of protocols that can be employed, such as stimulation parameters or movements induced. Moreover, although the short-term physiological and psychological responses during different types of FES exercises have been extensively reported, there are fewer data regarding the long-term effects of FES. Therefore, the purpose of this brief review is to provide a critical appraisal and synthesis of the literature on the use of FES for exercise in paraplegic individuals. After a short introduction underlying the importance of exercise for SCI patients, the main applications and effects of FES are reviewed and discussed. Major findings reveal an increased physiological demand during FES hybrid exercises as compared with arms only exercises. In addition, when repeated within a training period, FES exercises showed beneficial effects on muscle characteristics, force output, exercise capacity, bone mineral density and cardiovascular parameters. In conclusion, there appears to be promising evidence of beneficial effects of FES training, and particularly FES hybrid training, for paraplegic individuals.
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Hunt KJ, Hosmann D, Grob M, Saengsuwan J. Metabolic efficiency of volitional and electrically stimulated cycling in able-bodied subjects. Med Eng Phys 2012; 35:919-25. [PMID: 23253953 DOI: 10.1016/j.medengphy.2012.08.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Revised: 08/28/2012] [Accepted: 08/29/2012] [Indexed: 11/15/2022]
Abstract
This study compared the metabolic efficiency of volitional cycling and functional-electrical-stimulation (FES) cycling within a subject group of able-bodied individuals, with a view to further elucidating the mechanisms underlying the low efficiency of FES cycling. Previous studies estimated the metabolic efficiency of volitional cycling and anaesthetised FES cycling in able-bodied subjects, and of FES cycling in subjects paralysed by spinal cord injury. The rationale for the experimental model chosen here, i.e. non-anaesthetised able-bodied subjects, was that this lies between normal cycling and paralysed cycling: while using FES, this group has artificial muscle activation and timing like the paralysed group; but it does not have disrupted sensory feedback and vasomotor control; this measurement therefore allows delineation of the magnitude of reduction in metabolic efficiency resulting from: (i) the FES itself and (ii) paralysis (where there is disrupted sensory feedback and vasomotor control). Furthermore, we used the same methods employed previously for estimation of metabolic efficiency in subjects with motor- and sensory-complete paraplegia. The mean metabolic efficiency of volitional cycling was found to be 29.8% and that of FES cycling was 16.4% (n=11). The low efficiency of FES cycling can be explained in large part by the crude timing of muscle activation and by non-physiological muscle fibre recruitment. In FES cycling with paralysed subjects, disrupted sensory feedback and vasomotor control may play a further, albeit smaller, role in the reduced efficiency.
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Affiliation(s)
- K J Hunt
- Institute for Rehabilitation and Performance Technology, Division of Mechanical Engineering, Department of Engineering and Information Technology, Bern University of Applied Sciences, CH-3400 Burgdorf, Switzerland.
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19
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Increased Aerobic Fitness After Neuromuscular Electrical Stimulation Training in Adults With Spinal Cord Injury. Arch Phys Med Rehabil 2012; 93:790-5. [DOI: 10.1016/j.apmr.2011.10.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Revised: 10/10/2011] [Accepted: 10/30/2011] [Indexed: 11/18/2022]
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Hakansson NA, Hull ML. Can the efficacy of electrically stimulated pedaling using a commercially available ergometer BE improved by minimizing the muscle stress-time integral? Muscle Nerve 2012; 45:393-402. [PMID: 22334174 DOI: 10.1002/mus.22302] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The cardiorespiratory and muscular strength benefits of functional electrical stimulation (FES) pedaling for spinal cord injury (SCI) subjects are limited because the endurance of electrically stimulated muscle is low. METHODS We tested new electrical stimulation timing patterns (Stim3, designed using a forward dynamic simulation to minimize the muscle stress-time integral) to determine whether SCI subjects could increase work and metabolic responses when pedaling a commercial FES ergometer. Work, rate of oxygen uptake (VO(2)), and blood lactate data were taken from 11 subjects (injury level T4-T12) on repeated trials. RESULTS Subjects performed 11% more work pedaling with Stim3 than with existing stimulation patterns (StimErg) (P = 0.043). Average (VO(2)) and blood lactate concentrations were not significantly different between Stim3 (442 ml/min, 5.9 mmol/L) and StimErg (417 ml/min, 5.9 mmol/L). CONCLUSION The increased mechanical work performed with Stim3 supports the use of patterns that minimize the muscle stress-time integral to prolong FES pedaling.
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Affiliation(s)
- Nils A Hakansson
- Mechanical Engineering Department, University of Delaware, 126 Spencer Laboratory, Newark, Delaware 19711, USA.
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Taylor JA, Picard G, Widrick JJ. Aerobic Capacity With Hybrid FES Rowing in Spinal Cord Injury: Comparison With Arms-Only Exercise and Preliminary Findings With Regular Training. PM R 2011; 3:817-24. [DOI: 10.1016/j.pmrj.2011.03.020] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Revised: 03/17/2011] [Accepted: 03/23/2011] [Indexed: 12/20/2022]
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Duffell LD, Rowlerson AM, Donaldson NDN, Harridge SDR, Newham DJ. Effects of endurance and strength-directed electrical stimulation training on the performance and histological properties of paralyzed human muscle: a pilot study. Muscle Nerve 2010; 42:756-63. [PMID: 20976779 DOI: 10.1002/mus.21746] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Electrical stimulation (ES) improves muscle properties after spinal cord injury (SCI), but cycling power output (PO) remains low. We investigated the effect of endurance and strength ES training on these parameters. Assessments of quadriceps strength and fatigue resistance, cycling PO, and muscle biopsies were made in four well-trained SCI subjects (three cyclists and one rower) before and after additional weight training in the cyclists and once in the rower. Weight training improved muscle strength, but cycling PO was low in all subjects. There was no effect of training type on biopsy data. Biopsies showed non-specific signs of pathology, predominance of type IIa fibers, and uniform metabolic activity. Oxidative activity was low, as were capillary:fiber ratios in the cyclists. Cycling PO is limited by factors other than muscle strength. Future ES training studies should attempt to improve muscle oxidative capacity to optimize the potential benefits of ES exercise.
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Affiliation(s)
- Lynsey D Duffell
- Division of Applied Biomedical Research, King's College London, London, UK
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Pennycott A, Hunt K. Cadence control system for paediatric functional electrical stimulation cycling. Biomed Signal Process Control 2010. [DOI: 10.1016/j.bspc.2010.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Duffell LD, Donaldson NDN, Newham DJ. Power Output During Functional Electrically Stimulated Cycling in Trained Spinal Cord Injured People. Neuromodulation 2009; 13:50-7. [DOI: 10.1111/j.1525-1403.2009.00245.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Duffell LD, Donaldson NDN, Perkins TA, Rushton DN, Hunt KJ, Kakebeeke TH, Newham DJ. Long-term intensive electrically stimulated cycling by spinal cord-injured people: Effect on muscle properties and their relation to power output. Muscle Nerve 2008; 38:1304-11. [DOI: 10.1002/mus.21060] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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