1
|
Korupolu R, Stampas A, Singh M, Zhou P, Francisco G. Electrophysiological Outcome Measures in Spinal Cord Injury Clinical Trials: A Systematic Review. Top Spinal Cord Inj Rehabil 2020; 25:340-354. [PMID: 31844386 DOI: 10.1310/sci2504-340] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: Electrophysiological measures are being increasingly utilized due to their ability to provide objective measurements with minimal bias and to detect subtle changes with quantitative data on neural function. Heterogeneous reporting of trial outcomes limits effective interstudy comparison and optimization of treatment. Objective: The objective of this systematic review is to describe the reporting of electrophysiological outcome measures in spinal cord injury (SCI) clinical trials in order to inform a subsequent consensus study. Methods: A systematic search of PubMed and EMBASE databases was conducted according to PRISMA guidelines. Adult human SCI clinical trials published in English between January 1, 2008 and September 15, 2018 with at least one electrophysiological outcome measure were eligible. Findings were reviewed by all authors to create a synthesis narrative describing each outcome measure. Results: Sixty-four SCI clinical trials were included in this review. Identified electrophysiological outcomes included electromyography activity (44%), motor evoked potentials (33%), somatosensory evoked potentials (33%), H-reflex (20%), reflex electromyography activity (11%), nerve conduction studies (9%), silent period (3%), contact heat evoked potentials (2%), and sympathetic skin response (2%). Heterogeneity was present in regard to both methods of measurement and reporting of electrophysiological outcome measures. Conclusion: This review demonstrates need for the development of a standardized reporting set for electrophysiological outcome measures. Limitations of this review include exclusion of non-English publications, studies more than 10 years old, and an inability to assess methodological quality of primary studies due to a lack of guidelines on reporting of systematic reviews of outcome measures.
Collapse
Affiliation(s)
- Radha Korupolu
- Department of Physical Medicine and Rehabilitation, University of Texas John P and Katherine G McGovern Medical School, Houston, Texas
| | - Argyrios Stampas
- Department of Physical Medicine and Rehabilitation, University of Texas John P and Katherine G McGovern Medical School, Houston, Texas
| | - Mani Singh
- Department of Physical Medicine and Rehabilitation, University of Texas John P and Katherine G McGovern Medical School, Houston, Texas
| | - Ping Zhou
- Department of Physical Medicine and Rehabilitation, University of Texas John P and Katherine G McGovern Medical School, Houston, Texas
| | - Gerard Francisco
- Department of Physical Medicine and Rehabilitation, University of Texas John P and Katherine G McGovern Medical School, Houston, Texas
| |
Collapse
|
2
|
Berenpas F, Weerdesteyn V, Geurts AC, van Alfen N. Long-term use of implanted peroneal functional electrical stimulation for stroke-affected gait: the effects on muscle and motor nerve. J Neuroeng Rehabil 2019; 16:86. [PMID: 31292003 PMCID: PMC6621964 DOI: 10.1186/s12984-019-0556-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 06/21/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Peripheral changes to muscle and motor nerves occur following stroke, which may further impair functional capacity. We investigated whether a year-long use of an implanted peroneal FES system reverses stroke-related changes in muscles and motor nerves in people with foot drop in the chronic phase after supratentorial stroke. METHODS Thirteen persons with a chronic stroke (mean age 56.1 years, median Fugl-Meyer Assessment leg score 71%) were included and received an implanted peroneal FES system (ActiGait®). Quantitative muscle ultrasound (QMUS) images were obtained bilaterally from three leg muscles (i.e. tibialis anterior, rectus femoris, gastrocnemius). Echogenicity (muscle ultrasound gray value) and muscle thickness were assessed over a one-year follow-up and compared to age-, sex-, height- and weight-corrected reference values. Compound motor action potentials (CMAPs) and motor evoked potentials (MEPs) were obtained from the tibialis anterior muscle. Generalized estimated equation modeling was used to assess changes in QMUS, CMAPs and MEPs outcomes over the follow-up period. RESULTS Echogenicity of the tibialis anterior decreased significantly during the follow-up on the paretic side. Z-scores changed from 0.88 at baseline to - 0.15 after 52 weeks. This was accompanied by a significant increase in muscle thickness on the paretic side, where z-scores changed from - 0.32 at baseline to 0.48 after 52 weeks. Echogenicity of the rectus femoris normalized on both the paretic and non-paretic side (z-scores changed from - 1.09 and - 1.51 to 0.14 and - 0.49, respectively). Amplitudes of CMAP and MEP (normalized to CMAP) were reduced during follow-up, particularly on the paretic side (ΔCMAP = 20% and ΔMEP = 14%). CONCLUSIONS We show that the structural changes to muscles following stroke are reversible with FES and that these changes might not be limited to electrically stimulated muscles. No evidence for improvement of the motor nerves was found.
Collapse
Affiliation(s)
- Frank Berenpas
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Vivian Weerdesteyn
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Alexander C Geurts
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands.
| | - Nens van Alfen
- Department of Neurology and Clinical Neurophysiology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands
| |
Collapse
|
3
|
Ruslee R, Miller J, Gollee H. Investigation of different stimulation patterns with doublet pulses to reduce muscle fatigue. J Rehabil Assist Technol Eng 2019; 6:2055668319825808. [PMID: 31245029 PMCID: PMC6582293 DOI: 10.1177/2055668319825808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 12/18/2018] [Indexed: 11/29/2022] Open
Abstract
Introduction: Functional electrical stimulation is a common
technique used in the rehabilitation of individuals with a spinal cord injury to
produce functional movement of paralysed muscles. However, it is often
associated with rapid muscle fatigue which limits its applications.
Methods: The objective of this study is to investigate the
effects on the onset of fatigue of different multi-electrode patterns of
stimulation via multiple pairs of electrodes using doublet pulses: Synchronous
stimulation is compared to asynchronous stimulation patterns which are activated
sequentially (AsynS) or randomly (AsynR), mimicking voluntary muscle activation
by targeting different motor units. We investigated these three different
approaches by applying stimulation to the gastrocnemius muscle repeatedly for
10 min (300 ms stimulation followed by 700 ms of no-stimulation) with 40 Hz
effective frequency for all protocols and doublet pulses with an
inter-pulse-interval of 6 ms. Eleven able-bodied volunteers (28 ± 3 years old)
participated in this study. Ultrasound videos were recorded during stimulation
to allow evaluation of changes in muscle morphology. The main fatigue indicators
we focused on were the normalised fatigue index, fatigue time interval and
pre-post twitch–tetanus ratio. Results: The results demonstrate
that asynchronous stimulation with doublet pulses gives a higher normalised
fatigue index (0.80 ± 0.08 and 0.87 ± 0.08) for AsynS and AsynR, respectively,
than synchronous stimulation (0.62 ± 0.06). Furthermore, a longer fatigue time
interval for AsynS (302.2 ± 230.9 s) and AsynR (384.4 ± 279.0 s) compared to
synchronous stimulation (68.0 ± 30.5 s) indicates that fatigue occurs later
during asynchronous stimulation; however, this was only found to be
statistically significant for one of two methods used to calculate the group
mean. Although no significant difference was found in pre-post twitch–tetanus
ratio, there was a trend towards these effects. Conclusion: In this
study, we proposed an asynchronous stimulation pattern for the application of
functional electrical stimulation and investigated its suitability for reducing
muscle fatigue compared to previous methods. The results show that asynchronous
multi-electrode stimulation patterns with doublet pulses may improve fatigue
resistance in functional electrical stimulation applications in some
conditions.
Collapse
Affiliation(s)
- Ruslinda Ruslee
- Centre for Rehabilitation Engineering, University of Glasgow, Glasgow, UK.,Department of Electronics Engineering, MARA Japan Industrial Institute (MJII), Beranang, Selangor, Malaysia
| | - Jennifer Miller
- Centre for Rehabilitation Engineering, University of Glasgow, Glasgow, UK
| | - Henrik Gollee
- Centre for Rehabilitation Engineering, University of Glasgow, Glasgow, UK
| |
Collapse
|
4
|
Islam MA, Hamzaid NA, Ibitoye MO, Hasnan N, Wahab AKA, Davis GM. Mechanomyography responses characterize altered muscle function during electrical stimulation-evoked cycling in individuals with spinal cord injury. Clin Biomech (Bristol, Avon) 2018; 58:21-27. [PMID: 30005423 DOI: 10.1016/j.clinbiomech.2018.06.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 05/16/2018] [Accepted: 06/27/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Investigation of muscle fatigue during functional electrical stimulation (FES)-evoked exercise in individuals with spinal cord injury using dynamometry has limited capability to characterize the fatigue state of individual muscles. Mechanomyography has the potential to represent the state of muscle function at the muscle level. This study sought to investigate surface mechanomyographic responses evoked from quadriceps muscles during FES-cycling, and to quantify its changes between pre- and post-fatiguing conditions in individuals with spinal cord injury. METHODS Six individuals with chronic motor-complete spinal cord injury performed 30-min of sustained FES-leg cycling exercise on two days to induce muscle fatigue. Each participant performed maximum FES-evoked isometric knee extensions before and after the 30-min cycling to determine pre- and post- extension peak torque concomitant with mechanomyography changes. FINDINGS Similar to extension peak torque, normalized root mean squared (RMS) and mean power frequency (MPF) of the mechanomyography signal significantly differed in muscle activities between pre- and post-FES-cycling for each quadriceps muscle (extension peak torque up to 69%; RMS up to 80%, and MPF up to 19%). Mechanomyographic-RMS showed significant reduction during cycling with acceptable between-days consistency (intra-class correlation coefficients, ICC = 0.51-0.91). The normalized MPF showed a weak association with FES-cycling duration (ICC = 0.08-0.23). During FES-cycling, the mechanomyographic-RMS revealed greater fatigue rate for rectus femoris and greater fatigue resistance for vastus medialis in spinal cord injured individuals. INTERPRETATION Mechanomyographic-RMS may be a useful tool for examining real time muscle function of specific muscles during FES-evoked cycling in individuals with spinal cord injury.
Collapse
Affiliation(s)
- Md Anamul Islam
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603 Kuala Lumpur, Malaysia; Department of Physical Therapy, College of Staten Island, City University of New York, New York 10314, USA
| | - Nur Azah Hamzaid
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603 Kuala Lumpur, Malaysia.
| | - Morufu Olusola Ibitoye
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Nazirah Hasnan
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603 Kuala Lumpur, Malaysia; Department of Rehabilitation Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Ahmad Khairi Abdul Wahab
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Glen M Davis
- Clinical Exercise and Rehabilitation Unit, Discipline of Exercise and Sport Science, Faculty of Health Sciences, University of Sydney, Sydney, 2006 NSW, Australia; Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603 Kuala Lumpur, Malaysia
| |
Collapse
|
5
|
Vromans M, Faghri P. Electrical Stimulation Frequency and Skeletal Muscle Characteristics: Effects on Force and Fatigue. Eur J Transl Myol 2017; 27:6816. [PMID: 29299218 PMCID: PMC5745385 DOI: 10.4081/ejtm.2017.6816] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 10/14/2017] [Accepted: 10/14/2017] [Indexed: 12/02/2022] Open
Abstract
This investigation aimed to determine the force and muscle surface electromyography (EMG) responses to different frequencies of electrical stimulation (ES) in two groups of muscles with different size and fiber composition (fast- and slow-twitch fiber proportions) during a fatigue-inducing protocol. Progression towards fatigue was evaluated in the abductor pollicis brevis (APB) and vastus lateralis (VL) when activated by ES at three frequencies (10, 35, and 50Hz). Ten healthy adults (mean age: 23.2 ± 3.0 years) were recruited; participants signed an IRB approved consent form prior to participation. Protocols were developed to 1) identify initial ES current intensity required to generate the 25% maximal voluntary contraction (MVC) at each ES frequency and 2) evaluate changes in force and EMG activity during ES-induced contraction at each frequency while progressing towards fatigue. For both muscles, stimulation at 10Hz required higher current intensity of ES to generate the initial force. There was a significant decline in force in response to ES-induced fatigue for all frequencies and for both muscles (p<0.05). However, the EMG response was not consistent between muscles. During the progression towards fatigue, the APB displayed an initial drop in force followed by an increase in EMG activity and the VL displayed a decrease in EMG activity for all frequencies. Overall, it appeared that there were some significant interactions between muscle size and fiber composition during progression towards fatigue for different ES frequencies. It could be postulated that muscle characteristics (size and fiber composition) should be considered when evaluating progression towards fatigue as EMG and force responses are not consistent between muscles.
Collapse
Affiliation(s)
- Maria Vromans
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT, USA
| | - Pouran Faghri
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT, USA.,Department of Allied Health Sciences, Storrs, CT, USA
| |
Collapse
|
6
|
Vromans M, Faghri PD. Functional electrical stimulation-induced muscular fatigue: Effect of fiber composition and stimulation frequency on rate of fatigue development. J Electromyogr Kinesiol 2017; 38:67-72. [PMID: 29169055 DOI: 10.1016/j.jelekin.2017.11.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 11/07/2017] [Accepted: 11/09/2017] [Indexed: 01/23/2023] Open
Abstract
This investigation evaluated the progression towards fatigue in two muscles of differing fast- and slow-twitch fiber proportions (abductor pollicis brevis (APB) and vastus lateralis (VL)) when activated by functional electrical stimulation (FES) at three frequencies (10, 35, and 50 Hz). Fatigue was defined as a 50% drop from the initial FES-induced force of 25% maximal voluntary contraction (MVC). Ten healthy adults (mean age: 23.2 ± 3.0 years) were recruited; participants signed an IRB approved consent form prior to participation. Protocols were developed to evaluate the effects of muscle size, fiber type and FES frequency on total time to fatigue. Results indicated that the predominantly fast-twitch VL fatigued more quickly than the slow-twitch APB at the higher frequencies (p < 0.05), but did not significantly differ with stimulation at 10 Hz. Overall, muscle size and FES frequencies showed some significant interactions when generating a defined force and during fatigue development. Furthermore, it appears that to reduce fatigue, FES treatments should not extend past ∼14-16 min for large and small muscle groups, respectively, when the muscle group's optimal stimulation frequency is applied.
Collapse
Affiliation(s)
- Maria Vromans
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT, USA
| | - Pouran D Faghri
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT, USA; Department of Allied Health Sciences, Storrs, CT, USA.
| |
Collapse
|
7
|
Mohamad NZ, Hamzaid NA, Davis GM, Abdul Wahab AK, Hasnan N. Mechanomyography and Torque during FES-Evoked Muscle Contractions to Fatigue in Individuals with Spinal Cord Injury. SENSORS (BASEL, SWITZERLAND) 2017; 17:E1627. [PMID: 28708068 PMCID: PMC5539548 DOI: 10.3390/s17071627] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 04/05/2017] [Accepted: 04/12/2017] [Indexed: 11/22/2022]
Abstract
A mechanomyography muscle contraction (MC) sensor, affixed to the skin surface, was used to quantify muscle tension during repetitive functional electrical stimulation (FES)-evoked isometric rectus femoris contractions to fatigue in individuals with spinal cord injury (SCI). Nine persons with motor complete SCI were seated on a commercial muscle dynamometer that quantified peak torque and average torque outputs, while measurements from the MC sensor were simultaneously recorded. MC-sensor-predicted measures of dynamometer torques, including the signal peak (SP) and signal average (SA), were highly associated with isometric knee extension peak torque (SP: r = 0.91, p < 0.0001), and average torque (SA: r = 0.89, p < 0.0001), respectively. Bland-Altman (BA) analyses with Lin's concordance (ρC) revealed good association between MC-sensor-predicted peak muscle torques (SP; ρC = 0.91) and average muscle torques (SA; ρC = 0.89) with the equivalent dynamometer measures, over a range of FES current amplitudes. The relationship of dynamometer torques and predicted MC torques during repetitive FES-evoked muscle contraction to fatigue were moderately associated (SP: r = 0.80, p < 0.0001; SA: r = 0.77; p < 0.0001), with BA associations between the two devices fair-moderate (SP; ρC = 0.70: SA; ρC = 0.30). These findings demonstrated that a skin-surface muscle mechanomyography sensor was an accurate proxy for electrically-evoked muscle contraction torques when directly measured during isometric dynamometry in individuals with SCI. The novel application of the MC sensor during FES-evoked muscle contractions suggested its possible application for real-world tasks (e.g., prolonged sit-to-stand, stepping,) where muscle forces during fatiguing activities cannot be directly measured.
Collapse
Affiliation(s)
- Nor Zainah Mohamad
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur 50603, Malaysia.
| | - Nur Azah Hamzaid
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur 50603, Malaysia.
| | - Glen M Davis
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur 50603, Malaysia.
- Clinical Exercise and Rehabilitation Unit, Discipline of Exercise and Sports Sciences, Faculty of Health Sciences, University of Sydney, Lidcombe, NSW 2141, Australia.
| | - Ahmad Khairi Abdul Wahab
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur 50603, Malaysia.
| | - Nazirah Hasnan
- Department of Rehabilitation Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia.
| |
Collapse
|