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Zheng H, Tian F, Sun W, Zheng L, Xiao W. Neuromuscular Electrical Stimulation Improves Frontal Ankle Motor Control in Individuals With Chronic Ankle Instability During Drop Landing. Am J Phys Med Rehabil 2024; 103:890-896. [PMID: 38466194 DOI: 10.1097/phm.0000000000002468] [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: 03/12/2024]
Abstract
OBJECTIVE This study investigated the effect of neuromuscular electrical stimulation on the frontal ankle motor control in individuals with chronic ankle instability during drop landing. DESIGN This was a randomized, controlled, double-blind trial. Thirty-six individuals with chronic ankle instability were randomly assigned to each group. Participants received 6-wk neuromuscular electrical stimulation intervention and sham stimulation in the neuromuscular electrical stimulation and control groups, respectively. Data were collected at week 0 and week 6 . A mixed-effects model and analysis of covariance were employed to investigate the between-group differences in continuous and discrete outcome variables at week 6 , with the outcome variables at week 0 as covariates. RESULTS Compared to control group, neuromuscular electrical stimulation group exhibited a 2.66° (2.45, 2.86) reduction in frontal ankle inversion angle, a 47.41°/sec (-16.05, -78.77) decrease in peak ankle inversion angular velocity, and a 0.43 Nm/kg (0.18, 0.68) increase in peak ankle eversion moment during drop landing at week 6 . CONCLUSIONS Applying 6-wk neuromuscular electrical stimulation to the fibularis longus resulted in decreased ankle inversion angle and ankle inversion angular velocity and increased peak ankle eversion moment during drop landing. Consequently, neuromuscular electrical stimulation could be considered an effective modality for individuals with chronic ankle instability to enhance the frontal ankle movement patterns and overall ankle motor control.
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Affiliation(s)
- Huifen Zheng
- From the School of Exercise and Health, Shanghai University of Sport, Shanghai, China (HZ); Changzhi Medical College, Changzhi, China (FT); College of Sport and Health, Shandong Sport University, Jinan, China (WS); Department of Orthopedics, Shanghai Tenth People's hospital, Tongji University School of Medicine, Shanghai, China (LZ); Shanghai Trauma Emergency Center, Shanghai, China (LZ); Orthopedic Intelligent Minimally Invasive Diagnosis & Treatment Center, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China (LZ); Shanghai Key Lab of Human Performance, Shanghai University of Sport, Shanghai, China (WX); and The Key Lab of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai, China (WX)
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Dar G, Shenhar M, Finestone AS, Witchalls J, Waddington G, Paulman O, Nemet D, Steinberg N. Is Achilles tendon structure associated with functional ability and chronic ankle instability in military recruits? Musculoskelet Sci Pract 2024; 74:103197. [PMID: 39366311 DOI: 10.1016/j.msksp.2024.103197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 09/17/2024] [Accepted: 09/27/2024] [Indexed: 10/06/2024]
Abstract
OBJECTIVE To determine the relationship between Achilles tendon (AT) structure, functional ability and chronic ankle instability (CAI) in military recruits. METHODS Three hundred and sixty newly recruited infantry male soldiers recruited in April 2022 were assessed for AT structure by Ultrasound Tissue Characterization (UTC), for functional abilities (included proprioception ability, heel-raise test, dynamic postural balance, and hopping agility ability) and for CAI (recurrent sprains and a positive perceived instability). RESULTS Soldiers that were identified with disorganized tendon had significantly lower heel-raise and agility scores compared to those with organized tendon structures (33.6 ± 18.1(n) vs. 49.9 ± 28.9(n), p < 0.001; and 5.39 ± 2.12(n) vs. 6.16 ± 1.90(n), p = 0.002, respectively). The best discriminator between soldiers with organized vs. disorganized structure, was heel-raise test (AUC = 0.741). Moreover, soldiers with disorganized AT structure had a higher prevalence of CAI compared with those with organized tendon structures (p < 0.05). CONCLUSION Recruits with disorganized tendon structures displayed reduced heel-raise score, agility ability and dynamic postural-balance and greater ankle instability. Inferior tendon quality at the onset of military service is an important physical indicator to consider when seeking to manage future injuries and potential for physical performance. Pre-recruitment screening of the AT structure, CAI, and functional abilities, especially in high-intensity infantry programs, needs to be considered.
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Affiliation(s)
- Gali Dar
- Department of Physical Therapy, Faculty of Social Welfare and Health Studies, University of Haifa, Israel.
| | - Michal Shenhar
- The Academic College Levinsky-WIngate, Wingate Campus, Netanya, Israel.
| | - Aharon S Finestone
- Department of Orthopaedic Surgery, Shamir Medical Center, Israel; Affiliated to the Faculty of Medicine, Tel Aviv University, Israel.
| | - Jeremy Witchalls
- Research Institute for Sport and Exercise, University of Canberra, Australia.
| | | | - Omer Paulman
- Military Medical Corps, Israel Defense Forces, Israel.
| | - Dan Nemet
- Child Health and Sport Center, Pediatrics, Meir Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Nili Steinberg
- The Academic College Levinsky-WIngate, Wingate Campus, Netanya, Israel.
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Biswas P, Dodakian L, Wang PT, Johnson CA, See J, Chan V, Chou C, Lazouras W, McKenzie AL, Reinkensmeyer DJ, Nguyen DV, Cramer SC, Do AH, Nenadic Z. A single-center, assessor-blinded, randomized controlled clinical trial to test the safety and efficacy of a novel brain-computer interface controlled functional electrical stimulation (BCI-FES) intervention for gait rehabilitation in the chronic stroke population. BMC Neurol 2024; 24:200. [PMID: 38872109 PMCID: PMC11170800 DOI: 10.1186/s12883-024-03710-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Accepted: 06/04/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND In the United States, there are over seven million stroke survivors, with many facing gait impairments due to foot drop. This restricts their community ambulation and hinders functional independence, leading to several long-term health complications. Despite the best available physical therapy, gait function is incompletely recovered, and this occurs mainly during the acute phase post-stroke. Therapeutic options are limited currently. Novel therapies based on neurobiological principles have the potential to lead to long-term functional improvements. The Brain-Computer Interface (BCI) controlled Functional Electrical Stimulation (FES) system is one such strategy. It is based on Hebbian principles and has shown promise in early feasibility studies. The current study describes the BCI-FES clinical trial, which examines the safety and efficacy of this system, compared to conventional physical therapy (PT), to improve gait velocity for those with chronic gait impairment post-stroke. The trial also aims to find other secondary factors that may impact or accompany these improvements and establish the potential of Hebbian-based rehabilitation therapies. METHODS This Phase II clinical trial is a two-arm, randomized, controlled, longitudinal study with 66 stroke participants in the chronic (> 6 months) stage of gait impairment. The participants undergo either BCI-FES paired with PT or dose-matched PT sessions (three times weekly for four weeks). The primary outcome is gait velocity (10-meter walk test), and secondary outcomes include gait endurance, range of motion, strength, sensation, quality of life, and neurophysiological biomarkers. These measures are acquired longitudinally. DISCUSSION BCI-FES holds promise for gait velocity improvements in stroke patients. This clinical trial will evaluate the safety and efficacy of BCI-FES therapy when compared to dose-matched conventional therapy. The success of this trial will inform the potential utility of a Phase III efficacy trial. TRIAL REGISTRATION The trial was registered as "BCI-FES Therapy for Stroke Rehabilitation" on February 19, 2020, at clinicaltrials.gov with the identifier NCT04279067.
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Affiliation(s)
- Piyashi Biswas
- Department of Biomedical Engineering, University of California, Irvine, USA
| | - Lucy Dodakian
- Department of Rehabilitation Services, University of California at Irvine Medical Center, Orange, USA
| | - Po T Wang
- Department of Biomedical Engineering, University of California, Irvine, USA
| | | | - Jill See
- Department of Rehabilitation Services, University of California at Irvine Medical Center, Orange, USA
| | - Vicky Chan
- Department of Rehabilitation Services, University of California at Irvine Medical Center, Orange, USA
| | - Cathy Chou
- Department of Rehabilitation Services, University of California at Irvine Medical Center, Orange, USA
| | - Wendy Lazouras
- Department of Rehabilitation Services, University of California at Irvine Medical Center, Orange, USA
- Department of Epidemiology and Biostatistics, University of California, Irvine, USA
| | - Alison L McKenzie
- Department of Neurology, University of California, Irvine, USA
- Department of Physical Therapy, Chapman University, Orange, USA
| | - David J Reinkensmeyer
- Department of Anatomy and Neurobiology, University of California, Irvine, USA
- Department of Mechanical and Aerospace Engineering, University of California, Irvine, USA
| | - Danh V Nguyen
- Department of General Internal Medicine, University of California, Irvine, USA
| | - Steven C Cramer
- Department of Neurology, University of California, Los Angeles, USA
- California Rehabilitation Institute, Los Angeles, USA
| | - An H Do
- Department of Neurology, University of California, Irvine, USA.
| | - Zoran Nenadic
- Department of Biomedical Engineering, University of California, Irvine, USA.
- Department of Electrical Engineering and Computer Science, University of California, Irvine, USA.
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Gottlieb U, Hayek R, Hoffman JR, Springer S. Exercise combined with electrical stimulation for the treatment of chronic ankle instability - A randomized controlled trial. J Electromyogr Kinesiol 2024; 74:102856. [PMID: 38198892 DOI: 10.1016/j.jelekin.2023.102856] [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: 04/23/2023] [Revised: 12/03/2023] [Accepted: 12/26/2023] [Indexed: 01/12/2024] Open
Abstract
PURPOSE To compare the short, medium, and long-term effects of balance exercises combined with either peroneal neuromuscular electrical stimulation (NMES) or peroneal transcutaneous electrical nerve stimulation (TENS) on dynamic postural control and patient reported outcome measures (PROMs) in patients with chronic ankle instability (CAI). METHODS Thirty-four participants with CAI were randomly assigned to a 12-session home based exercise program combined with NMES (Ex-NMES) or TENS (Ex- TENS). Baseline postural control was tested with the modified Star Excursion Balance Test (mSEBT) and time to stabilization (TTS) after a single-leg drop-jump. The self-reported function was measured using the Cumberland Ankle Instability Tool (CAIT), the Identification of Functional Ankle Instability (IdFAI), and the Sports subscale of the Foot and Ankle Ability Measure (FAAMSport). RESULTS Both groups showed significant improvements in all self-reported outcome measures at the 12-month follow-up. Subjects in the Ex-NMES group had significantly better IdFAI (-4.2 [95% CI -8.1, -0.2]) and FAAMSport (13.7 [95% CI 2.2, 25.2]) scores at 6- and 12-month follow-up, respectively, compared to the Ex-TENS group. Medium to large between-group effect sizes were observed in self-reported functional outcomes and the mSEBT. CONCLUSION The consistent trend of improvement in self-reported functional outcomes when training is combined with NMES compared with training with TENS may indicate a potential benefit that should be further investigated as a treatment for patients with CAI.
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Affiliation(s)
- Uri Gottlieb
- Neuromuscular and Human Performance Laboratory, Department of Physiotherapy, Ariel University, Israel.
| | - Roee Hayek
- Neuromuscular and Human Performance Laboratory, Department of Physiotherapy, Ariel University, Israel
| | - Jay R Hoffman
- Neuromuscular and Human Performance Laboratory, Department of Physiotherapy, Ariel University, Israel
| | - Shmuel Springer
- Neuromuscular and Human Performance Laboratory, Department of Physiotherapy, Ariel University, Israel.
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Aout T, Begon M, Jegou B, Peyrot N, Caderby T. Effects of Functional Electrical Stimulation on Gait Characteristics in Healthy Individuals: A Systematic Review. SENSORS (BASEL, SWITZERLAND) 2023; 23:8684. [PMID: 37960383 PMCID: PMC10648660 DOI: 10.3390/s23218684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 10/09/2023] [Accepted: 10/17/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND This systematic review aimed to provide a comprehensive overview of the effects of functional electrical stimulation (FES) on gait characteristics in healthy individuals. METHODS Six electronic databases (PubMed, Embase, Epistemonikos, PEDro, COCHRANE Library, and Scopus) were searched for studies evaluating the effects of FES on spatiotemporal, kinematic, and kinetic gait parameters in healthy individuals. Two examiners evaluated the eligibility and quality of the included studies using the PEDro scale. RESULTS A total of 15 studies met the inclusion criteria. The findings from the literature reveal that FES can be used to modify lower-limb joint kinematics, i.e., to increase or reduce the range of motion of the hip, knee, and ankle joints. In addition, FES can be used to alter kinetics parameters, including ground reaction forces, center of pressure trajectory, or knee joint reaction force. As a consequence of these kinetics and kinematics changes, FES can lead to changes in spatiotemporal gait parameters, such as gait speed, step cadence, and stance duration. CONCLUSIONS The findings of this review improve our understanding of the effects of FES on gait biomechanics in healthy individuals and highlight the potential of this technology as a training or assistive solution for improving gait performance in this population.
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Affiliation(s)
- Thomas Aout
- Laboratoire IRISSE, EA4075, UFR des Sciences de l’Homme et de l’Environnement, Université de La Réunion, 97430 Le Tampon, France; (B.J.); (N.P.); (T.C.)
| | - Mickael Begon
- Laboratoire de Simulation et Modélisation du Mouvement, École de Kinésiologie et des Sciences de l’Activité Physique, Université de Montréal, Montreal, QC H3T 1J4, Canada;
- Centre de Recherche du CHU Sainte-Justine, Université de Montréal, Montreal, QC H3C 3J7, Canada
| | - Baptiste Jegou
- Laboratoire IRISSE, EA4075, UFR des Sciences de l’Homme et de l’Environnement, Université de La Réunion, 97430 Le Tampon, France; (B.J.); (N.P.); (T.C.)
| | - Nicolas Peyrot
- Laboratoire IRISSE, EA4075, UFR des Sciences de l’Homme et de l’Environnement, Université de La Réunion, 97430 Le Tampon, France; (B.J.); (N.P.); (T.C.)
- Mouvement-Interactions-Performance (MIP), Le Mans Université, EA 4334, 72000 Le Mans, France
| | - Teddy Caderby
- Laboratoire IRISSE, EA4075, UFR des Sciences de l’Homme et de l’Environnement, Université de La Réunion, 97430 Le Tampon, France; (B.J.); (N.P.); (T.C.)
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