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Smith AC, Draganich C, Thornton WA, Berliner JC, Lennarson PJ, Rejc E, Sevigny M, Charlifue S, Tefertiller C, Weber KA. Response to Letter to the Editor on "A Single Dermatome Clinical Prediction Rule for Independent Walking One Year After Spinal Cord Injury". Arch Phys Med Rehabil 2024:S0003-9993(24)00939-0. [PMID: 38582334 DOI: 10.1016/j.apmr.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 04/01/2024] [Accepted: 04/02/2024] [Indexed: 04/08/2024]
Affiliation(s)
- Andrew C Smith
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado, Aurora, CO.
| | - Christina Draganich
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado, Aurora, CO; Craig Hospital, Englewood, CO
| | - Wesley A Thornton
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado, Aurora, CO
| | - Jeffrey C Berliner
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado, Aurora, CO
| | - Peter J Lennarson
- Department of Neurosurgery, School of Medicine, University of Colorado, Aurora, CO
| | - Enrico Rejc
- University of Udine, Department of Medicine, Udine, Italy; Kessler Foundation, West Orange, NJ, USA
| | | | | | | | - Kenneth A Weber
- Department of Anesthesiology, Perioperative and Pain Medicine, School of Medicine, Stanford University, Palo Alto, CA
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Rejc E, Bowersock C, Pisolkar T, Omofuma I, Luna T, Khan M, Santamaria V, Ugiliweneza B, Angeli CA, Forrest GF, Stein J, Agrawal S, Harkema SJ. Robotic Postural Training With Epidural Stimulation for the Recovery of Upright Postural Control in Individuals With Motor Complete Spinal Cord Injury: A Pilot Study. Neurotrauma Rep 2024; 5:277-292. [PMID: 38515546 PMCID: PMC10956531 DOI: 10.1089/neur.2024.0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024] Open
Abstract
Activity-based training and lumbosacral spinal cord epidural stimulation (scES) have the potential to restore standing and walking with self-balance assistance after motor complete spinal cord injury (SCI). However, improvements in upright postural control have not previously been addressed in this population. Here, we implemented a novel robotic postural training with scES, performed with free hands, to restore upright postural control in individuals with chronic, cervical (n = 5) or high-thoracic (n = 1) motor complete SCI, who had previously undergone stand training with scES using a walker or a standing frame for self-balance assistance. Robotic postural training re-enabled and/or largely improved the participants' ability to control steady standing, self-initiated trunk movements and upper limb reaching movements while standing with free hands, receiving only external assistance for pelvic control. These improvements were associated with neuromuscular activation pattern adaptations above and below the lesion. These findings suggest that the human spinal cord below the level of injury can generate meaningful postural responses when its excitability is modulated by scES, and can learn to improve these responses. Upright postural control improvements can enhance functional motor recovery promoted by scES after severe SCI.
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Affiliation(s)
- Enrico Rejc
- Tim and Caroline Reynolds Center for Spinal Stimulation, Kessler Foundation, West Orange, New Jersey, USA
- Department of Medicine, University of Udine, Udine, Italy
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA
| | - Collin Bowersock
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA
- Department of Mechanical Engineering, Northern Arizona University, Flagstaff, Arizona, USA
| | - Tanvi Pisolkar
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA
| | - Isirame Omofuma
- Department of Mechanical Engineering, Columbia University, New York, New York, USA
| | - Tatiana Luna
- Department of Mechanical Engineering, Columbia University, New York, New York, USA
| | - Moiz Khan
- Department of Radiology at BWH, Harvard Medical School, Boston, Massachusetts, USA
| | - Victor Santamaria
- Department of Physical Therapy, New York Medical College, Valhalla, New York, USA
| | - Beatrice Ugiliweneza
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, USA
| | - Claudia A Angeli
- Tim and Caroline Reynolds Center for Spinal Stimulation, Kessler Foundation, West Orange, New Jersey, USA
| | - Gail F Forrest
- Tim and Caroline Reynolds Center for Spinal Stimulation, Kessler Foundation, West Orange, New Jersey, USA
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Joel Stein
- Department of Rehabilitation and Regenerative Medicine, Columbia University, New York, New York, USA
| | - Sunil Agrawal
- Department of Mechanical Engineering, Columbia University, New York, New York, USA
- Department of Rehabilitation and Regenerative Medicine, Columbia University, New York, New York, USA
| | - Susan J Harkema
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, USA
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Alazzam AM, Ballance WB, Smith AC, Rejc E, Weber KA, Trainer R, Gorgey AS. Peak Slope Ratio of the Recruitment Curves Compared to Muscle Evoked Potentials to Optimize Standing Configurations with Percutaneous Epidural Stimulation after Spinal Cord Injury. J Clin Med 2024; 13:1344. [PMID: 38592158 PMCID: PMC10932170 DOI: 10.3390/jcm13051344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Percutaneous spinal cord epidural stimulation (pSCES) has effectively restored varying levels of motor control in persons with motor complete spinal cord injury (SCI). Studying and standardizing the pSCES configurations may yield specific motor improvements. Previously, reliance on the amplitude of the SCES-evoked potentials (EPs) was used to determine the correct stimulation configurations. Methods: We, hereby, retrospectively examined the effects of wide and narrow-field configurations on establishing the motor recruitment curves of motor units of three different agonist-antagonist muscle groups. Magnetic resonance imaging was also used to individualize SCI participants (n = 4) according to their lesion characteristics. The slope of the recruitment curves using a six-degree polynomial function was calculated to derive the slope ratio for the agonist-antagonist muscle groups responsible for standing. Results: Axial damage ratios of the spinal cord ranged from 0.80 to 0.92, indicating at least some level of supraspinal connectivity for all participants. Despite the close range of these ratios, standing motor performance was enhanced using different stimulation configurations in the four persons with SCI. A slope ratio of ≥1 was considered for the recommended configurations necessary to achieve standing. The retrospectively identified configurations using the supine slope ratio of the recruitment curves of the motor units agreed with that visually inspected muscle EPs amplitude of the extensor relative to the flexor muscles in two of the four participants. Two participants managed to advance the selected configurations into independent standing performance after using tonic stimulation. The other two participants required different levels of assistance to attain standing performance. Conclusions: The findings suggest that the peak slope ratio of the muscle agonists-antagonists recruitment curves may potentially identify the pSCES configurations necessary to achieve standing in persons with SCI.
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Affiliation(s)
- Ahmad M. Alazzam
- Spinal Cord Injury and Disorders Center, Richmond VA Medical Center, Richmond, VA 23249, USA; (A.M.A.); (W.B.B.)
| | - William B. Ballance
- Spinal Cord Injury and Disorders Center, Richmond VA Medical Center, Richmond, VA 23249, USA; (A.M.A.); (W.B.B.)
| | - Andrew C. Smith
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO 80045, USA;
| | - Enrico Rejc
- Department of Medicine, University of Udine, 33100 Udine, Italy;
| | - Kenneth A. Weber
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA 94304, USA;
| | - Robert Trainer
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA 23284, USA;
- Physical Medicine and Rehabilitation, Richmond VA Medical Center, Richmond, VA 23249, USA
| | - Ashraf S. Gorgey
- Spinal Cord Injury and Disorders Center, Richmond VA Medical Center, Richmond, VA 23249, USA; (A.M.A.); (W.B.B.)
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA 23284, USA;
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Smith AC, Draganich C, Thornton WA, Berliner JC, Lennarson PJ, Rejc E, Sevigny M, Charlifue S, Tefertiller C, Weber KA. A Single Dermatome Clinical Prediction Rule for Independent Walking 1 Year After Spinal Cord Injury. Arch Phys Med Rehabil 2024; 105:10-19. [PMID: 37414239 PMCID: PMC10766862 DOI: 10.1016/j.apmr.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 04/24/2023] [Accepted: 06/22/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVE To derive and validate a simple, accurate CPR to predict future independent walking ability after SCI at the bedside that does not rely on motor scores and is predictive for those initially classified in the middle of the SCI severity spectrum. DESIGN Retrospective cohort study. Binary variables were derived, indicating degrees of sensation to evaluate predictive value of pinprick and light touch variables across dermatomes. The optimal single sensory modality and dermatome was used to derive our CPR, which was validated on an independent dataset. SETTING Analysis of SCI Model Systems dataset. PARTICIPANTS Individuals with traumatic SCI. The data of 3679 participants (N=3679) were included with 623 participants comprising the derivation dataset and 3056 comprising the validation dataset. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Self-reported ability to walk both indoors and outdoors. RESULTS Pinprick testing at S1 over lateral heels, within 31 days of SCI, accurately identified future independent walkers 1 year after SCI. Normal pinprick in both lateral heels provided good prognosis, any pinprick sensation in either lateral heel provided fair prognosis, and no sensation provided poor prognosis. This CPR performed satisfactorily in the middle SCI severity subgroup. CONCLUSIONS In this large multi-site study, we derived and validated a simple, accurate CPR using only pinprick sensory testing at lateral heels that predicts future independent walking after SCI.
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Affiliation(s)
- Andrew C Smith
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO.
| | - Christina Draganich
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO; Craig Hospital, Englewood, CO
| | - Wesley A Thornton
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO
| | - Jeffrey C Berliner
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO
| | - Peter J Lennarson
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO
| | - Enrico Rejc
- Department of Neurosurgery, University of Louisville School of Medicine, Louisville, KY; Department of Medicine, University of Udine, Udine, Italy
| | | | | | | | - Kenneth A Weber
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA
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Gorgey AS, Venigalla S, Rehman MU, George B, Rejc E, Gouda JJ. Interleaved configurations of percutaneous epidural stimulation enhanced overground stepping in a person with chronic paraplegia. Front Neurosci 2023; 17:1284581. [PMID: 38144208 PMCID: PMC10740173 DOI: 10.3389/fnins.2023.1284581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/13/2023] [Indexed: 12/26/2023] Open
Abstract
Descending motor signals are disrupted after complete spinal cord injury (SCI) resulting in loss of standing and walking. We previously restored standing and trunk control in a person with a T3 complete SCI following implantation of percutaneous spinal cord epidural stimulation (SCES). We, hereby, present a step-by-step procedure on configuring the SCES leads to initiate rhythmic lower limb activation (rhythmic-SCES) resulting in independent overground stepping in parallel bars and using a standard walker. Initially, SCES was examined in supine lying at 2 Hz before initiating stepping-like activity in parallel bars using 20 or 30 Hz; however, single lead configuration (+2, -5) resulted in lower limb adduction and crossing of limbs, impairing the initiation of overground stepping. After 6 months, interleaving the original rhythmic-SCES with an additional configuration (-12, +15) on the opposite lead, resulted in a decrease of the extensive adduction tone and allowed the participant to initiate overground stepping up to 16 consecutive steps. The current paradigm suggests that interleaving two rhythmic-SCES configurations may improve the excitability of the spinal circuitry to better interpret the residual descending supraspinal signals with the ascending proprioceptive inputs, resulting in a stepping-like motor behavior after complete SCI.
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Affiliation(s)
- Ashraf S. Gorgey
- Spinal Cord Injury and Disorders, Richmond VA Medical Center, Richmond, VA, United States
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, United States
| | - Siddharth Venigalla
- Spinal Cord Injury and Disorders, Richmond VA Medical Center, Richmond, VA, United States
| | - Muhammad Uzair Rehman
- Spinal Cord Injury and Disorders, Richmond VA Medical Center, Richmond, VA, United States
| | - Botros George
- ELAGI Center for Physical Therapy and Rehabilitation, Giza, Egypt
| | - Enrico Rejc
- Department of Medicine, University of Udine, Udine, Italy
| | - Jan J. Gouda
- Neurosurgery Department, Louran Hospital, Alexandria, Egypt
- Department of Surgery, Wright State University, Dayton, OH, United States
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Bowersock CD, Pisolkar T, Ai X, Zhu C, Angeli C, Harkema SJ, Forrest GF, Agrawal S, Rejc E. Standing reactive postural responses of lower limbs with and without self-balance assistance in individuals with spinal cord injury receiving epidural stimulation. J Neurotrauma 2023. [PMID: 38009201 DOI: 10.1089/neu.2023.0403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2023] Open
Abstract
Spinal cord epidural stimulation can promote the recovery of motor function in individuals with severe spinal cord injury (SCI) by enabling the spinal circuitry to interpret sensory information and generate related neuromuscular responses. This approach enables the spinal cord to generate lower limb extension patterns during weight bearing, allowing individuals with SCI to achieve upright standing. We have shown that the human spinal cord can generate some standing postural responses during self-initiated body weight shifting. In this study, we investigated the ability of individuals with motor complete SCI receiving epidural stimulation to generate standing reactive postural responses after external perturbations were applied at the trunk. A cable-driven robotic device was used to provide constant assistance for pelvic control and to deliver precise trunk perturbations while participants used their hands to grasp onto handlebars for self-balance support (hands-on) as well as without support (free-hands). Five individuals with motor complete SCI receiving lumbosacral spinal cord epidural stimulation parameters specific for standing (Stand-scES) participated in this study. Trunk perturbations (average magnitude: 17 ± 3% bodyweight) were delivered randomly in the four cardinal directions. Participants attempted to control each perturbation such that upright standing was maintained and no additional external assistance was needed. Lower limb postural responses were generally more frequent, larger in magnitude, and appropriately modulated during the free-hands condition. This was associated with trunk displacement and lower limb loading modulation that were larger during free-hands. Further, we observed discernible lower limb muscle synergies that were similar between the two perturbed standing conditions. These findings suggest that the human spinal circuitry involved in postural control retains the ability to generate meaningful lower limb postural responses after SCI when its excitability is properly modulated. Moreover, lower limb postural responses appear enhanced by a standing environment without upper limb stabilization that promotes afferent inputs associated with a larger modulation of ground reaction forces and trunk kinematic. These findings should be considered when developing future experimental frameworks aimed at studying upright postural control and activity-based recovery training protocols aimed at promoting neural plasticity and sensory-motor recovery.
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Affiliation(s)
- Collin D Bowersock
- Kentucky Spinal Cord Injury Research Center, 466950, Louisville, Kentucky, United States
- University of Louisville, 5170, Department of Neurological Surgery, Louisville, Kentucky, United States
- Northern Arizona University, 3356, Flagstaff, Arizona, United States;
| | - Tanvi Pisolkar
- Kentucky Spinal Cord Injury Research Center, 466950, Louisville, Kentucky, United States;
| | - Xupeng Ai
- Columbia University, 5798, Department of Mechanical Engineering, New York, New York, United States;
| | - Chenfei Zhu
- Columbia University, 5798, Mechanical Engineering, New York, New York, United States;
| | - Claudia Angeli
- University of Louisville, 5170, Bioengineering, 220 Abraham Flexner Way, Louisville, Louisville, Kentucky, United States, 40292;
| | - Susan J Harkema
- University of Louisville, 5170, Louisville, Kentucky, United States;
| | - Gail F Forrest
- Kessler Foundation, Human Performance and Engineering Research, 1120 pleasant vallley way, West Orange, New Jersey, United States, 3625;
| | - Sunil Agrawal
- Columbia University, 5798, Mechanical Engineering, New York, New York, United States;
| | - Enrico Rejc
- Universita degli Studi di Udine, 9316, Medicine, Udine, UD, Italy
- Kessler Foundation West Orange Campus, 8525, West Orange, New Jersey, United States
- Kentucky Spinal Cord Injury Research Center, 466950, Louisville, Kentucky, United States
- University of Louisville, 5170, Department of Neurological Surgery, Louisville, Kentucky, United States;
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Bowersock CD, Pisolkar T, Omofuma I, Luna T, Khan M, Santamaria V, Stein J, Agrawal S, Harkema SJ, Rejc E. Robotic upright stand trainer (RobUST) and postural control in individuals with spinal cord injury. J Spinal Cord Med 2023; 46:889-899. [PMID: 35532324 PMCID: PMC10653750 DOI: 10.1080/10790268.2022.2069532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
CONTEXT/OBJECTIVE Assessed feasibility and potential effectiveness of using a novel robotic upright stand trainer (RobUST) to deliver postural perturbations or provide assistance-as-needed at the trunk while individuals with spinal cord injury (SCI) performed stable standing and self-initiated trunk movements. These tasks were assessed with research participants' hands on handlebars for self-balance assistance (hands on) and with hands off (free hands). DESIGN Proof of concept study. PARTICIPANTS Four individuals with motor complete (n = 3) or incomplete (n = 1) SCI who were not able to achieve independent standing and presented a neurological lesion level ranging from cervical 4 to thoracic 2. OUTCOME MEASURES Ground reaction forces, trunk displacement, and electromyography activity of trunk and lower limb muscles. RESULTS Research participants received continuous pelvic assistance via RobUST, and manual trainer assistance at the knees to maintain standing. Participants were able to attempt all tasks. Free hands trunk perturbations resulted in greater load bearing-related sensory information (73% ipsilateral vertical loading), trunk displacement (57%), and muscle activation compared to hands on. Similarly, free hands stable standing with RobUST assistance-as-needed resulted in 8.5% larger bodyweight bearing, 112% larger trunk movement velocity, and higher trunk muscles activation compared to standing with hands on. Self-initiated trunk movements controlled by hands on showed 116% greater trunk displacement, 10% greater vertical ground reaction force, and greater ankle muscle activation compared to free hands. CONCLUSION RobUST established a safe and challenging standing environment for individuals with SCI and has the potential to improve training paradigms and assessments of standing postural control.
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Affiliation(s)
- Collin D. Bowersock
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA
| | - Tanvi Pisolkar
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA
| | - Isirame Omofuma
- Department of Mechanical Engineering, Columbia University, New York, New York, USA
| | - Tatiana Luna
- Department of Mechanical Engineering, Columbia University, New York, New York, USA
| | - Moiz Khan
- Department of Mechanical Engineering, Columbia University, New York, New York, USA
| | - Victor Santamaria
- Department of Mechanical Engineering, Columbia University, New York, New York, USA
| | - Joel Stein
- Department of Rehabilitation and Regenerative Medicine, Columbia University, New York, New York, USA
| | - Sunil Agrawal
- Department of Mechanical Engineering, Columbia University, New York, New York, USA
- Department of Rehabilitation and Regenerative Medicine, Columbia University, New York, New York, USA
| | - Susan J. Harkema
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, USA
- Frazier Rehabilitation Institute, University of Louisville Health, Louisville, Kentucky, USA
- Department of Bioengineering, University of Louisville, Louisville, Kentucky, USA
| | - Enrico Rejc
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, USA
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Angeli C, Wagers S, Harkema S, Rejc E. Sensory Information Modulates Voluntary Movement in an Individual with a Clinically Motor- and Sensory-Complete Spinal Cord Injury: A Case Report. J Clin Med 2023; 12:6875. [PMID: 37959340 PMCID: PMC10647542 DOI: 10.3390/jcm12216875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023] Open
Abstract
Motor recovery following a complete spinal cord injury is not likely. This is partially due to insurance limitations. Rehabilitation strategies for individuals with this type of severe injury focus on the compensation for the activities of daily living in the home and community and not on the restoration of function. With limited time in therapies, the initial goals must focus on getting the patient home safely without the expectation of recovery of voluntary movement below the level of injury. In this study, we report a case of an individual with a chronic, cervical (C3)-level clinically motor- and sensory-complete injury who was able to perform voluntary movements with both upper and lower extremities when positioned in a sensory-rich environment conducive to the specific motor task. We show how he is able to intentionally perform push-ups, trunk extensions and leg presses only when appropriate sensory information is available to the spinal circuitry. These data show that the human spinal circuitry, even in the absence of clinically detectable supraspinal input, can generate motor patterns effective for the execution of various upper and lower extremity tasks, only when appropriate sensory information is present. Neurorehabilitation in the right sensory-motor environment that can promote partial recovery of voluntary movements below the level of injury, even in individuals diagnosed with a clinically motor-complete spinal cord injury.
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Affiliation(s)
- Claudia Angeli
- Tim and Caroline Reynolds Center for Spinal Stimulation, Kessler Foundation, West Orange, NJ 07052, USA;
- Department of Bioengineering, University of Louisville, Louisville, KY 40292, USA
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY 40202, USA; (S.W.); (S.H.)
| | - Sarah Wagers
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY 40202, USA; (S.W.); (S.H.)
- Division of Physical Medicine and Rehabilitation, University of Louisville, Louisville, KY 40292, USA
| | - Susan Harkema
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY 40202, USA; (S.W.); (S.H.)
| | - Enrico Rejc
- Tim and Caroline Reynolds Center for Spinal Stimulation, Kessler Foundation, West Orange, NJ 07052, USA;
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY 40202, USA; (S.W.); (S.H.)
- Department of Medicine, University of Udine, 33100 Udine, Italy
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Joshi K, Rejc E, Ugiliweneza B, Harkema SJ, Angeli CA. Spinal Cord Epidural Stimulation Improves Lower Spine Sitting Posture Following Severe Cervical Spinal Cord Injury. Bioengineering (Basel) 2023; 10:1065. [PMID: 37760167 PMCID: PMC10525621 DOI: 10.3390/bioengineering10091065] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/02/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
Cervical spinal cord injury (SCI) leads to impaired trunk motor control, negatively impacting the performance of activities of daily living in the affected individuals. Improved trunk control with better sitting posture has been previously observed due to neuromuscular electrical stimulation and transcutaneous spinal stimulation, while improved postural stability has been observed with spinal cord epidural stimulation (scES). Hence, we studied how trunk-specific scES impacts sitting independence and posture. Fourteen individuals with chronic, severe cervical SCI with an implanted neurostimulator performed a 5-min tall-sit task without and with trunk-specific scES. Spine posture was assessed by placing markers on five spine levels and evaluating vertical spine inclination angles. Duration of trunk manual assistance was used to assess independence along with the number of independence changes and average independence score across those changes. With scES, the sacrum-L1 inclination and number of independence changes tended to decrease by 1.64 ± 3.16° (p = 0.07; Cohen's d = 0.53) and 9.86 ± 16.8 (p = 0.047; Cohen's d = 0.59), respectively. Additionally, for the participants who had poor sitting independence without scES, level of independence tended to increase by 12.91% [0%, 31.52%] (p = 0.38; Cohen's d = 0.96) when scES was present. Hence, trunk-specific scES promoted improvements in lower spine posture and lower levels of trunk assistance.
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Affiliation(s)
- Kundan Joshi
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY 40202, USA; (K.J.); (E.R.); (B.U.); (S.J.H.)
- Department of Bioengineering, University of Louisville, Louisville, KY 40292, USA
| | - Enrico Rejc
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY 40202, USA; (K.J.); (E.R.); (B.U.); (S.J.H.)
- Department of Neurological Surgery, University of Louisville, Louisville, KY 40202, USA
- Department of Medicine, University of Udine, 33100 Udine, Italy
| | - Beatrice Ugiliweneza
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY 40202, USA; (K.J.); (E.R.); (B.U.); (S.J.H.)
- Department of Neurological Surgery, University of Louisville, Louisville, KY 40202, USA
| | - Susan J. Harkema
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY 40202, USA; (K.J.); (E.R.); (B.U.); (S.J.H.)
- Department of Neurological Surgery, University of Louisville, Louisville, KY 40202, USA
- Frazier Rehabilitation Institute, University of Louisville Health, Louisville, KY 40202, USA
| | - Claudia A. Angeli
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY 40202, USA; (K.J.); (E.R.); (B.U.); (S.J.H.)
- Department of Bioengineering, University of Louisville, Louisville, KY 40292, USA
- Frazier Rehabilitation Institute, University of Louisville Health, Louisville, KY 40202, USA
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Angeli C, Rejc E, Boakye M, Herrity A, Mesbah S, Hubscher C, Forrest G, Harkema S. Targeted Selection of Stimulation Parameters for Restoration of Motor and Autonomic Function in Individuals With Spinal Cord Injury. Neuromodulation 2023:S1094-7159(23)00148-4. [PMID: 37140522 PMCID: PMC10624649 DOI: 10.1016/j.neurom.2023.03.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 03/24/2023] [Accepted: 03/29/2023] [Indexed: 05/05/2023]
Abstract
STUDY DESIGN This is a report of methods and tools for selection of task and individual configurations targeted for voluntary movement, standing, stepping, blood pressure stabilization, and facilitation of bladder storage and emptying using tonic-interleaved excitation of the lumbosacral spinal cord. OBJECTIVES This study aimed to present strategies used for selection of stimulation parameters for various motor and autonomic functions. CONCLUSIONS Tonic-interleaved functionally focused neuromodulation targets a myriad of consequences from spinal cord injury with surgical implantation of the epidural electrode at a single location. This approach indicates the sophistication of the human spinal cord circuitry and its important role in the regulation of motor and autonomic functions in humans.
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Affiliation(s)
- Claudia Angeli
- Department of Bioengineering, University of Louisville, Louisville, KY, USA; Kentucky Spinal Cord Injury Center, University of Louisville, Louisville, KY, USA; Frazier Rehabilitation Institute, University of Louisville Health, Louisville, KY, USA.
| | - Enrico Rejc
- Kentucky Spinal Cord Injury Center, University of Louisville, Louisville, KY, USA; Department of Neurological Surgery, University of Louisville, Louisville, KY, USA
| | - Maxwell Boakye
- Kentucky Spinal Cord Injury Center, University of Louisville, Louisville, KY, USA; Department of Neurological Surgery, University of Louisville, Louisville, KY, USA
| | - April Herrity
- Kentucky Spinal Cord Injury Center, University of Louisville, Louisville, KY, USA; Department of Neurological Surgery, University of Louisville, Louisville, KY, USA; Department of Physiology, University of Louisville, Louisville, KY, USA
| | - Samineh Mesbah
- Kentucky Spinal Cord Injury Center, University of Louisville, Louisville, KY, USA
| | - Charles Hubscher
- Kentucky Spinal Cord Injury Center, University of Louisville, Louisville, KY, USA; Department of Anatomical Sciences and Neurobiology, University of Louisville, Louisville, KY, USA
| | - Gail Forrest
- Human Performance and Engineering Research, Kessler Foundation, West Orange, NJ, USA; Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Susan Harkema
- Kentucky Spinal Cord Injury Center, University of Louisville, Louisville, KY, USA; Frazier Rehabilitation Institute, University of Louisville Health, Louisville, KY, USA; Department of Neurological Surgery, University of Louisville, Louisville, KY, USA
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11
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Boakye M, Ball T, Dietz N, Sharma M, Angeli C, Rejc E, Kirshblum S, Forrest G, Arnold FW, Harkema S. Spinal cord epidural stimulation for motor and autonomic function recovery after chronic spinal cord injury: A case series and technical note. Surg Neurol Int 2023; 14:87. [PMID: 37025529 PMCID: PMC10070319 DOI: 10.25259/sni_1074_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/14/2023] [Indexed: 03/19/2023] Open
Abstract
Background:
Traumatic spinal cord injury (tSCI) is a debilitating condition, leading to chronic morbidity and mortality. In recent peer-reviewed studies, spinal cord epidural stimulation (scES) enabled voluntary movement and return of over-ground walking in a small number of patients with motor complete SCI. Using the most extensive case series (n = 25) for chronic SCI, the present report describes our motor and cardiovascular and functional outcomes, surgical and training complication rates, quality of life (QOL) improvements, and patient satisfaction results after scES.
Methods:
This prospective study occurred at the University of Louisville from 2009 to 2020. scES interventions began 2–3 weeks after surgical implantation of the scES device. Perioperative complications were recorded as well as long-term complications during training and device related events. QOL outcomes and patient satisfaction were evaluated using the impairment domains model and a global patient satisfaction scale, respectively.
Results:
Twenty-five patients (80% male, mean age of 30.9 ± 9.4 years) with chronic motor complete tSCI underwent scES using an epidural paddle electrode and internal pulse generator. The interval from SCI to scES implantation was 5.9 ± 3.4 years. Two participants (8%) developed infections, and three additional patients required washouts (12%). All participants achieved voluntary movement after implantation. A total of 17 research participants (85%) reported that the procedure either met (n = 9) or exceeded (n = 8) their expectations, and 100% would undergo the operation again.
Conclusion:
scES in this series was safe and achieved numerous benefits on motor and cardiovascular regulation and improved patient-reported QOL in multiple domains, with a high degree of patient satisfaction. The multiple previously unreported benefits beyond improvements in motor function render scES a promising option for improving QOL after motor complete SCI. Further studies may quantify these other benefits and clarify scES’s role in SCI patients.
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Affiliation(s)
- Maxwell Boakye
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky,
| | - Tyler Ball
- Department of Neurosurgery, Vanderbilt University, Nashville,
| | - Nicholas Dietz
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky,
| | - Mayur Sharma
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky,
| | - Claudia Angeli
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky,
| | - Enrico Rejc
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky,
| | - Steven Kirshblum
- Department of Physical Medicine Rehabilitation, Rutgers, Newark, New Jersey,
| | - Gail Forrest
- Department of Physical Medicine Rehabilitation, Rutgers, Newark, New Jersey,
| | - Forest W. Arnold
- Department of Infectious Diseases, University of Louisville, Louisville, United States
| | - Susan Harkema
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky,
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12
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Rejc E, Angeli CA, Ichiyama RM. Editorial: Advances in Spinal Cord Epidural Stimulation for Motor and Autonomic Functions Recovery After Severe Spinal Cord Injury. Front Syst Neurosci 2022; 15:820913. [PMID: 35069134 PMCID: PMC8770738 DOI: 10.3389/fnsys.2021.820913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 12/15/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
- Enrico Rejc
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States
- Department of Neurological Surgery, University of Louisville, Louisville, KY, United States
- *Correspondence: Enrico Rejc
| | - Claudia A. Angeli
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States
- Frazier Rehabilitation Institute, University of Louisville Health, Louisville, KY, United States
- Department of Bioengineering, University of Louisville, Louisville, KY, United States
| | - Ronaldo M. Ichiyama
- Faculty of Biological Sciences, School of Biomedical Sciences, University of Leeds, Leeds, United Kingdom
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13
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Gonnelli F, Rejc E, Floreani M, Lazzer S. Effects of NMES-elicited versus voluntary low-level conditioning contractions on explosive knee extensions. J Musculoskelet Neuronal Interact 2022; 22:465-473. [PMID: 36458384 PMCID: PMC9716298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Electrically-induced or voluntary conditioning-contractions (CC) can be used to affect contractile properties of a subsequent explosive contraction (EC). Here, we aimed at comparing the effect of neuromuscular-electrical-stimulation (NMES) vs voluntary CC performed prior to explosive contractions of the knee extensors. METHODS A 10 sec NMES CC (100Hz, 1000μs, 10% MVC), or a voluntary contraction (VOL CC) mimicking the NMES CC, preceded an isometric EC of the knee extensors. Explosive contraction was performed with the goal to reach the target (70% MVC) as quickly as possible. RESULTS All the parameters related with the explosive contractions' muscle-output were similar between protocols (difference ranging from 0.23%, Mean Torque; to 5.8%, Time to Target), except for the Time to Peak Torque, which was lower when preceded by NMES (11.1%, p=0.019). Interestingly, the RTD 0-50 ms_EC was 37.3% higher after the NMES compared with the VOL CC protocol. CONCLUSION Explosive contraction was potentiated by an NMES CC as compared with a voluntary CC. This may be due to a reduction in descending drive following VOL CC, which has been shown to occur even with low-level voluntary efforts. These findings could be used to improve rehabilitation or training protocols that include conditioning contractions.
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Affiliation(s)
- Federica Gonnelli
- Department of Medicine, University of Udine, Udine, Italy,School of Sport Sciences, University of Udine, Udine, Italy,Corresponding author: Dr Federica Gonnelli, Department of Medicine, University of Udine, P.le M. Kolbe 4, 33100 Udine, Italy E-mail:
| | - Enrico Rejc
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA,Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | - Mirco Floreani
- Department of Medicine, University of Udine, Udine, Italy,School of Sport Sciences, University of Udine, Udine, Italy
| | - Stefano Lazzer
- Department of Medicine, University of Udine, Udine, Italy,School of Sport Sciences, University of Udine, Udine, Italy
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14
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Floreani M, Rejc E, Gambin S, Vavassori L, Lazzer S. Effects of gravitational and iso-inertial resistance trainings using rating of perceived exertion on lower limbs muscle force and power abilities and metabolic cost of walking in healthy older adults. J Sports Med Phys Fitness 2021; 62:910-920. [PMID: 34498822 DOI: 10.23736/s0022-4707.21.12649-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The purpose was to compare the effects of 8-weeks resistance training programs (Flywheel Iso-inertial, FW vs Traditional Gravity-Dependent Resistance Training, GD) performed twice a week at the same rate of perceived exertion (RPE), on muscle force and power capacities and physical performance in healthy older participants. METHODS Twenty-four participants were randomly assigned to either FW (male/female: 7/5, age: 67.1±3.8 yr) or GD (male/female: 6/6, age 68.3±3.0 yr) group. Knee extension maximal isometric voluntary contractions (MVC), lower limb maximal explosive power (MEP), six-minute walking distance (6MWT), timed "Up & Go" scores (TUG), metabolic cost of walking (CW) and agonist-antagonist co-contraction time (CCT) during walking were evaluated before and after training. RESULTS absolute MEP and MEP normalized for body mass increased only in FW than GD group (+10.8% vs +0.31%, p: 0.056, respectively; +14.8% vs +13.9%, p<0.001, respectively). Both training modalities improved MVC to a similar extent (+11.1% in FW vs +13.4% in GD, p<0.001). Analogously, 6MWT distance increased in FW and GD (+5.2 and +5.5%, p<0.041, respectively). No effects of time and training modality were observed on the other parameters. CONCLUSIONS The study suggests that when FW and GD are administered at the same RPE with FW performed at higher movement speed in the concentric phase, both the trainings generate similar improvements in muscle strength but only the former can promote greater muscle power enhancements than GD in healthy older adults.
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Affiliation(s)
- Mirco Floreani
- Department of Medicine, University of Udine, Udine, Italy - .,School of Sport Science, University of Udine, Udine, Italy -
| | - Enrico Rejc
- Department of Medicine, University of Udine, Udine, Italy.,School of Sport Science, University of Udine, Udine, Italy.,Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA
| | - Simone Gambin
- Department of Medicine, University of Udine, Udine, Italy.,School of Sport Science, University of Udine, Udine, Italy
| | - Luca Vavassori
- Department of Medicine, University of Udine, Udine, Italy.,School of Sport Science, University of Udine, Udine, Italy
| | - Stefano Lazzer
- Department of Medicine, University of Udine, Udine, Italy.,School of Sport Science, University of Udine, Udine, Italy
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15
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Ibáñez J, Angeli CA, Harkema SJ, Farina D, Rejc E. Recruitment order of motor neurons promoted by epidural stimulation in individuals with spinal cord injury. J Appl Physiol (1985) 2021; 131:1100-1110. [PMID: 34382840 PMCID: PMC8461808 DOI: 10.1152/japplphysiol.00293.2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Spinal cord epidural stimulation (scES) combined with activity-based training can promote motor function recovery in individuals with motor complete spinal cord injury (SCI). The characteristics of motor neuron recruitment, which influence different aspects of motor control, are still unknown when motor function is promoted by scES. Here, we enrolled five individuals with chronic motor complete SCI implanted with a scES unit to study the recruitment order of motor neurons during standing enabled by scES. We recorded high-density electromyography (HD-EMG) signals on the vastus lateralis muscle, and inferred the order of recruitment of motor neurons from the relation between amplitude and conduction velocity of the scES-evoked EMG responses along the muscle fibers. Conduction velocity of scES-evoked responses was modulated over time, while stimulation parameters and standing condition remained constant, with average values ranging between 3.0±0.1 and 4.4±0.3 m/s. We found that the human spinal circuitry receiving epidural stimulation can promote both orderly (according to motor neuron size) and inverse trends of motor neuron recruitment, and that the engagement of spinal networks promoting rhythmic activity may favor orderly recruitment trends. Conversely, the different recruitment trends did not appear to be related with time since injury or scES implant, nor to the ability to achieve independent knees extension, nor to the conduction velocity values. The proposed approach can be implemented to investigate the effects of stimulation parameters and training-induced neural plasticity on the characteristics of motor neuron recruitment order, contributing to improve mechanistic understanding and effectiveness of epidural stimulation-promoted motor recovery after SCI.
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Affiliation(s)
- Jaime Ibáñez
- Department of Bioengineering, Imperial College London, London, United Kingdom.,Department of Clinical and Movement Disorders, Institute of Neurology, University College London, London, United Kingdom
| | - Claudia A Angeli
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, United States.,Department of Bioengineering, University of Louisville, Louisville, Kentucky, United States.,Frazier Rehabilitation Institute, University of Louisville Health, Louisville, Kentucky, United States
| | - Susan J Harkema
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, United States.,Department of Bioengineering, University of Louisville, Louisville, Kentucky, United States.,Frazier Rehabilitation Institute, University of Louisville Health, Louisville, Kentucky, United States.,Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, United States
| | - Dario Farina
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Enrico Rejc
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, United States.,Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, United States
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16
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Mesbah S, Ball T, Angeli C, Rejc E, Dietz N, Ugiliweneza B, Harkema S, Boakye M. Predictors of volitional motor recovery with epidural stimulation in individuals with chronic spinal cord injury. Brain 2021; 144:420-433. [PMID: 33367527 DOI: 10.1093/brain/awaa423] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/25/2020] [Accepted: 09/30/2020] [Indexed: 12/25/2022] Open
Abstract
Spinal cord epidural stimulation (scES) has enabled volitional lower extremity movements in individuals with chronic and clinically motor complete spinal cord injury and no clinically detectable brain influence. The aim of this study was to understand whether the individuals' neuroanatomical characteristics or positioning of the scES electrode were important factors influencing the extent of initial recovery of lower limb voluntary movements in those with clinically motor complete paralysis. We hypothesized that there would be significant correlations between the number of joints moved during attempts with scES prior to any training interventions and the amount of cervical cord atrophy above the injury, length of post-traumatic myelomalacia and the amount of volume coverage of lumbosacral enlargement by the stimulation electrode array. The clinical and imaging records of 20 individuals with chronic and clinically motor complete spinal cord injury who underwent scES implantation were reviewed and analysed using MRI and X-ray integration, image segmentation and spinal cord volumetric reconstruction techniques. All individuals that participated in the scES study (n = 20) achieved, to some extent, lower extremity voluntary movements post scES implant and prior to any locomotor, voluntary movement or cardiovascular training. The correlation results showed that neither the cross-section area of spinal cord at C3 (n = 19, r = 0.33, P = 0.16) nor the length of severe myelomalacia (n = 18, r = -0.02, P = 0.93) correlated significantly with volitional lower limb movement ability. However, there was a significant, moderate correlation (n = 20, r = 0.59, P = 0.006) between the estimated percentage of the lumbosacral enlargement coverage by the paddle electrode as well as the position of the paddle relative to the maximal lumbosacral enlargement and the conus tip (n = 20, r = 0.50, P = 0.026) with the number of joints moved volitionally. These results suggest that greater coverage of the lumbosacral enlargement by scES may improve motor recovery prior to any training, possibly because of direct modulatory effects on the spinal networks that control lower extremity movements indicating the significant role of motor control at the level of the spinal cord.
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Affiliation(s)
- Samineh Mesbah
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA
| | - Tyler Ball
- Department of Neurosurgery, University of Louisville, Louisville, KY, USA
| | - Claudia Angeli
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA.,Department of Bioengineering, University of Louisville, Louisville, KY, USA.,Frazier Rehab Institute, University of Louisville Health, Louisville, KY, USA
| | - Enrico Rejc
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA.,Department of Neurosurgery, University of Louisville, Louisville, KY, USA
| | - Nicholas Dietz
- Department of Neurosurgery, University of Louisville, Louisville, KY, USA
| | - Beatrice Ugiliweneza
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA.,Department of Neurosurgery, University of Louisville, Louisville, KY, USA
| | - Susan Harkema
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA.,Department of Neurosurgery, University of Louisville, Louisville, KY, USA.,Frazier Rehab Institute, University of Louisville Health, Louisville, KY, USA
| | - Maxwell Boakye
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA.,Department of Neurosurgery, University of Louisville, Louisville, KY, USA
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17
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Gonnelli F, Rejc E, Giovanelli N, Floreani M, Porcelli S, Harkema S, Willhite A, Stills S, Richardson T, Lazzer S. Effects of NMES pulse width and intensity on muscle mechanical output and oxygen extraction in able-bodied and paraplegic individuals. Eur J Appl Physiol 2021; 121:1653-1664. [PMID: 33656575 DOI: 10.1007/s00421-021-04647-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 02/15/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE Neuromuscular Electrical Stimulation (NMES) is commonly used in neuromuscular rehabilitation protocols, and its parameters selection substantially affects the characteristics of muscle activation. Here, we investigated the effects of short pulse width (200 µs) and higher intensity (short-high) NMES or long pulse width (1000 µs) and lower intensity (long-low) NMES on muscle mechanical output and fractional oxygen extraction. Muscle contractions were elicited with 100 Hz stimulation frequency, and the initial torque output was matched by adjusting stimulation intensity. METHODS Fourteen able-bodied and six spinal cord-injured (SCI) individuals participated in the study. The NMES protocol (75 isometric contractions, 1-s on-3-s off) targeting the knee extensors was performed with long-low or short-high NMES applied over the midline between anterior superior iliac spine and patella protrusion in two different days. Muscle work was estimated by torque-time integral, contractile properties by rate of torque development and half-relaxation time, and vastus lateralis fractional oxygen extraction was assessed by Near-Infrared Spectroscopy (NIRS). RESULTS Torque-time integral elicited by the two NMES paradigms was similar throughout the stimulation protocol, with differences ranging between 1.4% (p = 0.877; able-bodied, mid-part of the protocol) and 9.9% (p = 0.147; SCI, mid-part of the protocol). Contractile properties were also comparable in the two NMES paradigms. However, long-low NMES resulted in higher fractional oxygen extraction in able-bodied (+ 36%; p = 0.006). CONCLUSION Long-low and short-high NMES recruited quadriceps femoris motor units that demonstrated similar contractile and fatigability properties. However, long-low NMES conceivably resulted in the preferential recruitment of vastus lateralis muscle fibers as detected by NIRS.
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Affiliation(s)
- Federica Gonnelli
- Department of Medicine, University of Udine, Udine, Italy.,School of Sport Sciences, University of Udine, Udine, Italy.,Kentucky Spinal Cord Injury Research Center, University of Louisville, 220 Abraham Flexner Way, Louisville, KY, 40202, USA
| | - Enrico Rejc
- Kentucky Spinal Cord Injury Research Center, University of Louisville, 220 Abraham Flexner Way, Louisville, KY, 40202, USA. .,Department of Neurosurgery, University of Louisville, Louisville, KY, USA.
| | - Nicola Giovanelli
- Department of Medicine, University of Udine, Udine, Italy.,School of Sport Sciences, University of Udine, Udine, Italy
| | - Mirco Floreani
- Department of Medicine, University of Udine, Udine, Italy.,School of Sport Sciences, University of Udine, Udine, Italy
| | - Simone Porcelli
- Department of Molecular Medicine, University of Pavia, Pavia, Italy.,Institute of Biomedical Technologies, National Research Council, Segrate, Italy
| | - Susan Harkema
- Kentucky Spinal Cord Injury Research Center, University of Louisville, 220 Abraham Flexner Way, Louisville, KY, 40202, USA.,Department of Neurosurgery, University of Louisville, Louisville, KY, USA.,Department of Bioengineering, University of Louisville, Louisville, KY, USA
| | - Andrea Willhite
- Kentucky Spinal Cord Injury Research Center, University of Louisville, 220 Abraham Flexner Way, Louisville, KY, 40202, USA
| | - Sean Stills
- Kentucky Spinal Cord Injury Research Center, University of Louisville, 220 Abraham Flexner Way, Louisville, KY, 40202, USA
| | - Tine Richardson
- Kentucky Spinal Cord Injury Research Center, University of Louisville, 220 Abraham Flexner Way, Louisville, KY, 40202, USA
| | - Stefano Lazzer
- Department of Medicine, University of Udine, Udine, Italy.,School of Sport Sciences, University of Udine, Udine, Italy
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18
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Rejc E, Smith AC, Weber KA, Ugiliweneza B, Bert RJ, Negahdar M, Boakye M, Harkema SJ, Angeli CA. Spinal Cord Imaging Markers and Recovery of Volitional Leg Movement With Spinal Cord Epidural Stimulation in Individuals With Clinically Motor Complete Spinal Cord Injury. Front Syst Neurosci 2020; 14:559313. [PMID: 33192348 PMCID: PMC7654217 DOI: 10.3389/fnsys.2020.559313] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 09/28/2020] [Indexed: 01/07/2023] Open
Abstract
Previous studies have shown that epidural stimulation of the lumbosacral spinal cord (scES) can re-enable lower limb volitional motor control in individuals with chronic, clinically motor complete spinal cord injury (SCI). This observation entails that residual supraspinal connectivity to the lumbosacral spinal circuitry still persisted after SCI, although it was non-detectable when scES was not provided. In the present study, we aimed at exploring further the mechanisms underlying scES-promoted recovery of volitional lower limb motor control by investigating neuroimaging markers at the spinal cord lesion site via magnetic resonance imaging (MRI). Spinal cord MRI was collected prior to epidural stimulator implantation in 13 individuals with chronic, clinically motor complete SCI, and the spared tissue of specific regions of the spinal cord (anterior, posterior, right, left, and total cord) was assessed. After epidural stimulator implantation, and prior to any training, volitional motor control was evaluated during left and right lower limb flexion and ankle dorsiflexion attempts. The ability to generate force exertion and movement was not correlated to any neuroimaging marker. On the other hand, spared tissue of specific cord regions significantly and importantly correlated with some aspects of motor control that include activation amplitude of antagonist (negative correlation) muscles during left ankle dorsiflexion, and electromyographic coordination patterns during right lower limb flexion. The fact that amount and location of spared spinal cord tissue at the lesion site were not related to the ability to generate volitional lower limb movements may suggest that supraspinal inputs through spared spinal cord regions that differ across individuals can result in the generation of lower limb volitional motor output prior to any training when epidural stimulation is provided.
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Affiliation(s)
- Enrico Rejc
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States.,Department of Neurological Surgery, University of Louisville, Louisville, KY, United States
| | - Andrew C Smith
- University of Colorado School of Medicine, Department of Physical Medicine and Rehabilitation, Physical Therapy Program, Aurora, CO, United States
| | - Kenneth A Weber
- Department of Anethesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Beatrice Ugiliweneza
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States.,Department of Neurological Surgery, University of Louisville, Louisville, KY, United States
| | - Robert J Bert
- Department of Radiology, University of Louisville, Louisville, KY, United States
| | | | - Maxwell Boakye
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States.,Department of Neurological Surgery, University of Louisville, Louisville, KY, United States
| | - Susan J Harkema
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States.,Department of Neurological Surgery, University of Louisville, Louisville, KY, United States.,Frazier Rehabilitation Institute, University of Louisville Health, Louisville, KY, United States.,Department of Bioengineering, University of Louisville, Louisville, KY, United States
| | - Claudia A Angeli
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States.,Frazier Rehabilitation Institute, University of Louisville Health, Louisville, KY, United States.,Department of Bioengineering, University of Louisville, Louisville, KY, United States
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19
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Legg Ditterline B, Harkema SJ, Willhite A, Stills S, Ugiliweneza B, Rejc E. Epidural stimulation for cardiovascular function increases lower limb lean mass in individuals with chronic motor complete spinal cord injury. Exp Physiol 2020; 105:1684-1691. [PMID: 32749719 DOI: 10.1113/ep088876] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 07/31/2020] [Indexed: 12/17/2022]
Abstract
NEW FINDINGS What is the central question of this study? Spinal cord injury results in paralysis and deleterious neuromuscular and autonomic adaptations. Lumbosacral epidural stimulation can modulate motor and/or autonomic functions. Does long-term epidural stimulation for normalizing cardiovascular function affect leg muscle properties? What is the main finding and its importance? Leg lean mass increased after long-term epidural stimulation for cardiovascular function, which was applied in the sitting position and did not activate the leg muscles. Leg muscle strength and fatigue resistance, assessed in a subgroup of individuals, also increased. These adaptations might support interventions for motor recovery and warrant further mechanistic investigation. ABSTRACT Chronic motor complete spinal cord injury (SCI) results in paralysis and deleterious neuromuscular and autonomic adaptations. Paralysed muscles demonstrate atrophy, loss of force and increased fatigability. Also, SCI-induced autonomic impairment results in persistently low resting blood pressure and heart rate, among other features. We previously reported that spinal cord epidural stimulation (scES) optimized for cardiovascular (CV) function (CV-scES), which is applied in sitting position and does not activate the leg muscles, can maintain systolic blood pressure within a normotensive range during quiet sitting and during orthostatic stress. In the present study, dual-energy X-ray absorptiometry collected from six individuals with chronic clinically motor complete SCI demonstrated that 88 ± 11 sessions of CV-scES (7 days week-1 ; 2 h day-1 in four individuals and 5 h day-1 in two individuals) over a period of ∼6 months significantly increased lower limb lean mass (by 0.67 ± 0.39 kg or 9.4 ± 8.1%; P < 0.001). Additionally, muscle strength and fatigability data elicited by neuromuscular electrical stimulation in three of these individuals demonstrated a general increase (57 ± 117%) in maximal torque output (between 2 and 44 N m in 14 of the 17 muscle groups tested overall) and torque-time integral during intermittent, fatiguing contractions (63 ± 71%; between 7 and 230% in 16 of the 17 muscle groups tested overall). In contrast, whole-body mass and composition did not change significantly. In conclusion, long-term use of CV-scES can have a significant impact on lower limb muscle properties after chronic motor complete SCI.
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Affiliation(s)
- Bonnie Legg Ditterline
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA.,Department of Neurological Surgery, University of Louisville, Louisville, KY, USA
| | - Susan J Harkema
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA.,Department of Neurological Surgery, University of Louisville, Louisville, KY, USA.,Frazier Rehabilitation Institute, University of Louisville Health, Louisville, KY, USA.,Department of Bioengineering, University of Louisville, Louisville, KY, USA
| | - Andrea Willhite
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA
| | - Sean Stills
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA
| | - Beatrice Ugiliweneza
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA.,Department of Neurological Surgery, University of Louisville, Louisville, KY, USA
| | - Enrico Rejc
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA.,Department of Neurological Surgery, University of Louisville, Louisville, KY, USA
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20
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Gonnelli F, Rejc E, Floreani M, Giovanelli N, Lazzer S. Neuromuscular Electrical Stimulation At Long Pulse Duration Is Associated With Higher Muscle Oxygen Utilization. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000685692.02145.67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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21
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Arpin DJ, Ugiliweneza B, Forrest G, Harkema SJ, Rejc E. Optimizing Neuromuscular Electrical Stimulation Pulse Width and Amplitude to Promote Central Activation in Individuals With Severe Spinal Cord Injury. Front Physiol 2019; 10:1310. [PMID: 31681016 PMCID: PMC6813182 DOI: 10.3389/fphys.2019.01310] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 09/30/2019] [Indexed: 12/28/2022] Open
Abstract
Neuromuscular electrical stimulation (NMES) is one of the most effective treatments for counteracting the deleterious skeletal muscle adaptations that occur after spinal cord injury (SCI). Additionally, previous findings suggest that NMES can activate motor units via both peripheral and central mechanisms; however, this NMES-promoted central activation is not well understood. In this study, we aimed at investigating the effects of NMES on central activation in 10 individuals with motor complete SCI, focusing on understanding how to optimize NMES pulse width and amplitude for promoting central activation in this population. To this end, we used NMES to generate isometric contractions of the knee extensors and ankle plantarflexors while electromyographic (EMG) activity was recorded from the vastus lateralis and gastrocnemius medialis, respectively. We used EMG activity that persisted after the termination of NMES delivery (post-NMES) as a neurophysiological marker to assess central activation and explored differences in post-NMES EMG activity promoted by 500 and 1,000 μs pulse width NMES. Additionally, we explored the relationships between post-NMES EMG amplitude, torque output, and stimulation amplitude. Our results show that the higher pulse width (1,000 μs) demonstrated a greater effect on central activation as quantified by more frequent occurrences of post-NMES EMG activity (p = 0.002) and a 3.551 μV higher EMG amplitude (p = 0.003) when controlling for the torque output generated by 500 and 1,000 μs pulse width NMES. Importantly, we also found that the interplay among central activation, stimulation amplitude, and muscle torque output differs across SCI individuals, conceivably because of the individual-specific characteristics of the cord lesion and following plasticity of the spinal circuitry. These results suggest that NMES can be optimized to promote central activation, which may lead to novel opportunities for motor function recovery after SCI.
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Affiliation(s)
- David J Arpin
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States.,Department of Neurological Surgery, University of Louisville, Louisville, KY, United States
| | - Beatrice Ugiliweneza
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States.,Department of Neurological Surgery, University of Louisville, Louisville, KY, United States
| | - Gail Forrest
- Human Performance and Engineering Research, Kessler Foundation, West Orange, NJ, United States.,Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, United States
| | - Susan J Harkema
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States.,Department of Neurological Surgery, University of Louisville, Louisville, KY, United States.,Frazier Rehab Institute, KentuckyOne Health, Louisville, KY, United States
| | - Enrico Rejc
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States.,Department of Neurological Surgery, University of Louisville, Louisville, KY, United States
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22
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Mesbah S, Gonnelli F, Angeli CA, El-Baz A, Harkema SJ, Rejc E. Neurophysiological markers predicting recovery of standing in humans with chronic motor complete spinal cord injury. Sci Rep 2019; 9:14474. [PMID: 31597924 PMCID: PMC6785550 DOI: 10.1038/s41598-019-50938-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 09/20/2019] [Indexed: 12/19/2022] Open
Abstract
The appropriate selection of individual-specific spinal cord epidural stimulation (scES) parameters is crucial to re-enable independent standing with self-assistance for balance in individuals with chronic, motor complete spinal cord injury, which is a key achievement toward the recovery of functional mobility. To date, there are no available algorithms that contribute to the selection of scES parameters for facilitating standing in this population. Here, we introduce a novel framework for EMG data processing that implements spectral analysis by continuous wavelet transform and machine learning methods for characterizing epidural stimulation-promoted EMG activity resulting in independent standing. Analysis of standing data collected from eleven motor complete research participants revealed that independent standing was promoted by EMG activity characterized by lower median frequency, lower variability of median frequency, lower variability of activation pattern, lower variability of instantaneous maximum power, and higher total power. Additionally, the high classification accuracy of assisted and independent standing allowed the development of a prediction algorithm that can provide feedback on the effectiveness of muscle-specific activation for standing promoted by the tested scES parameters. This framework can support researchers and clinicians during the process of selection of epidural stimulation parameters for standing motor rehabilitation.
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Affiliation(s)
- Samineh Mesbah
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA.,Department of Electrical and Computer Engineering, University of Louisville, Louisville, Kentucky, USA.,Department of Bioengineering, University of Louisville, Louisville, Kentucky, USA
| | - Federica Gonnelli
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA.,Department of Medicine, University of Udine, Udine, Italy.,School of Sport Sciences, University of Udine, Udine, Italy
| | - Claudia A Angeli
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA.,Frazier Rehab Institute, Kentucky One Health, Louisville, Kentucky, USA
| | - Ayman El-Baz
- Department of Bioengineering, University of Louisville, Louisville, Kentucky, USA
| | - Susan J Harkema
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA.,Frazier Rehab Institute, Kentucky One Health, Louisville, Kentucky, USA.,Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, USA
| | - Enrico Rejc
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA. .,Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, USA.
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Khan M, Luna T, Santamaria V, Omofuma I, Martelli D, Rejc E, Stein J, Harkema S, Agrawal S. Stand Trainer With Applied Forces at the Pelvis and Trunk: Response to Perturbations and Assist-As-Needed Support. IEEE Trans Neural Syst Rehabil Eng 2019; 27:1855-1864. [PMID: 31395551 DOI: 10.1109/tnsre.2019.2933381] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Functional rehabilitation of patients with spinal cord injury remains a current challenge. Training these patients to successfully stand is the first step towards restoring advanced skills such as walking. To address this need, we have developed a novel robotic stand trainer that can apply controlled forces on the trunk and the pelvis of a user, while controlling the knee angle. The stand trainer utilizes cables to apply assistive, resistive, or perturbation forces at the trunk, pelvis, and the knees, simultaneously. We have conducted a human study to validate the system. In this study, we applied multi-direction perturbation forces either at the pelvis or the trunk while assist-as-needed forces were applied to the other segment to keep balance. This study characterizes the human kinematics and measures of balance under the perturbations and assistive forces on the human body. Results shows that the level of force-field assistance (trunk or pelvis) directly affects the motion of the trunk, pelvis, and center of pressure. This provides a quantitative framework to restore balance in patients while providing assistance only when needed. This stand trainer can potentially free up therapists to attend to higher level rehabilitation goals and objectively assist patients to engage in interventions that challenge both their musculoskeletal and sensorimotor impairments.
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Mesbah S, Shalaby AM, Stills S, Soliman A, Willhite A, Harkema SJ, Rejc E, El-Baz AS. Correction: Novel stochastic framework for automatic segmentation of human thigh MRI volumes and its applications in spinal cord injured individuals. PLoS One 2019; 14:e0219810. [PMID: 31310609 PMCID: PMC6634392 DOI: 10.1371/journal.pone.0219810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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25
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Šimunič B, Koren K, Rittweger J, Lazzer S, Reggiani C, Rejc E, Pišot R, Narici M, Degens H. Tensiomyography detects early hallmarks of bed-rest-induced atrophy before changes in muscle architecture. J Appl Physiol (1985) 2019; 126:815-822. [PMID: 30676871 DOI: 10.1152/japplphysiol.00880.2018] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In young and older people, skeletal muscle mass is reduced after as little as 7 days of disuse. The declines in muscle mass after such short periods are of high clinical relevance, particularly in older people who show a higher atrophy rate and a slower or even a complete lack of muscle mass recovery after disuse. Ten men (24.3 yr; SD 2.6) underwent 35 days of 6° head-down tilt bed rest, followed by 30 days of recovery. During bed rest, a neutral energy balance was maintained, with three weekly passive physiotherapy sessions to minimize muscle soreness and joint stiffness. All measurements were performed in a hospital at days 1-10, 16, 28, and 35 of bed rest (BR1-BR10, BR16, BR28, and BR35, respectively) and days 1, 3, and 30 after reambulation (R + 1, R + 3, and R + 30, respectively). Vastus medialis obliquus (VMO), vastus medialis longus (VML), and biceps femoris (BF) thickness (d) and pennation angle (Θ) were assessed by ultrasonography, whereas twitch muscle belly displacement (Dm) and contraction time (Tc) were assessed with tensiomyography (TMG). After bed rest, d and Θ decreased by 13-17% in all muscles ( P < 0.001) and had recovered at R + 30. Dm was increased by 42.3-84.4% ( P < 0.001) at BR35 and preceded the decrease in d by 7, 5, and 3 days in VMO, VML, and BF, respectively. Tc increased only in BF (32.1%; P < 0.001) and was not recovered at R + 30. TMG can detect early bed-rest-induced changes in muscle with higher sensitivity before overt architectural changes, and atrophy can be detected. NEW & NOTEWORTHY Detection of early atrophic processes and irreversible adaptation to disuse are of high clinical relevance. With the use of tensiomyography (TMG), we detected early atrophic processes before overt architectural changes, and atrophy can be detected using imaging technique. Furthermore, TMG detected irreversible changes of biceps femoris contraction time.
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Affiliation(s)
- Boštjan Šimunič
- University of Primorska , Koper , Slovenia.,Science and Research Centre Koper, Institute for Kinesiology Research , Koper , Slovenia
| | - Katja Koren
- Science and Research Centre Koper, Institute for Kinesiology Research , Koper , Slovenia
| | - Jörn Rittweger
- Institute of Aerospace Medicine, German Aerospace Center , Cologne , Germany.,Department of Pediatrics and Adolescent Medicine, University of Cologne , Cologne , Germany
| | - Stefano Lazzer
- Department of Medicine, University of Udine , Udine , Italy.,School of Sport Sciences, University of Udine , Udine , Italy
| | - Carlo Reggiani
- Science and Research Centre Koper, Institute for Kinesiology Research , Koper , Slovenia.,Department of Biomedical Sciences, University of Padova , Padova , Italy
| | - Enrico Rejc
- Kentucky Spinal Cord Injury Research Center, University of Louisville , Louisville, Kentucky
| | - Rado Pišot
- Science and Research Centre Koper, Institute for Kinesiology Research , Koper , Slovenia
| | - Marco Narici
- Science and Research Centre Koper, Institute for Kinesiology Research , Koper , Slovenia.,Department of Biomedical Sciences, University of Padova , Padova , Italy
| | - Hans Degens
- School of Healthcare Science, Manchester Metropolitan University , Manchester , United Kingdom.,Institute of Sport Science and Innovations, Lithuanian Sports University , Kaunas , Lithuania.,University of Medicine and Pharmacy of Targu Mures , Targu Mures , Romania
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26
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Arpin DJ, Forrest G, Harkema SJ, Rejc E. Submaximal Marker for Investigating Peak Muscle Torque Using Neuromuscular Electrical Stimulation after Paralysis. J Neurotrauma 2018; 36:930-936. [PMID: 30226407 DOI: 10.1089/neu.2018.5848] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Spinal cord injury (SCI) results in deleterious skeletal muscle adaptations, such as relevant atrophy and loss of force. In particular, the relevant loss of lower-limb force-generating capacity may limit functional mobility even if neuronal control was sufficient. Currently, methods of assessing maximal force-generating capacity using neuromuscular electrical stimulation (NMES) are limited in individuals who cannot tolerate higher stimulation amplitudes, such as those with residual sensation and those at risk of fracture. In this study, we examined the relationship between NMES amplitude and muscle torque exerted (recruitment curve) in order to determine whether maximal torque output can be characterized by a submaximal marker. Recruitment curves for knee extensors, knee flexors, and ankle plantarflexors were recorded from 30 individuals with motor complete SCI. NMES was delivered starting with an amplitude of 5 mA, and increasing by 5 mA for every subsequent stimulation until either the participant requested to stop the stimulation or the maximum stimulation amplitude (140 mA) was reached. Significant correlations between peak slope of the recruitment curve and peak torque for all muscle groups were found (knee extensors, r = 0.75; p < 0.0001; knee flexors, r = 0.68; p < 0.0001; ankle plantarflexors, r = 0.91; p < 0.0001), indicating that muscles that show greater peak slope of the recruitment curve tend to generate a greater peak torque. This suggests that peak slope, which was achieved at an average stimulation intensity (55.0 mA) that was 43% smaller than that corresponding to peak torque (97.4 mA), may be used as a submaximal marker for characterizing maximal torque output in individuals with SCI.
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Affiliation(s)
- David J Arpin
- 1 Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky.,2 Department of Neurological Surgery, University of Louisville, Louisville, Kentucky
| | - Gail Forrest
- 3 Human Performance and Engineering Research, Kessler Foundation, West Orange, New Jersey.,4 Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Susan J Harkema
- 1 Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky.,2 Department of Neurological Surgery, University of Louisville, Louisville, Kentucky.,5 Frazier Rehab Institute, Kentucky One Health, Louisville, Kentucky
| | - Enrico Rejc
- 1 Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky.,2 Department of Neurological Surgery, University of Louisville, Louisville, Kentucky
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27
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Aslan SC, Legg Ditterline BE, Park MC, Angeli CA, Rejc E, Chen Y, Ovechkin AV, Krassioukov A, Harkema SJ. Epidural Spinal Cord Stimulation of Lumbosacral Networks Modulates Arterial Blood Pressure in Individuals With Spinal Cord Injury-Induced Cardiovascular Deficits. Front Physiol 2018; 9:565. [PMID: 29867586 PMCID: PMC5968099 DOI: 10.3389/fphys.2018.00565] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 04/30/2018] [Indexed: 12/23/2022] Open
Abstract
Disruption of motor and autonomic pathways induced by spinal cord injury (SCI) often leads to persistent low arterial blood pressure and orthostatic intolerance. Spinal cord epidural stimulation (scES) has been shown to enable independent standing and voluntary movement in individuals with clinically motor complete SCI. In this study, we addressed whether scES configured to activate motor lumbosacral networks can also modulate arterial blood pressure by assessing continuous, beat-by-beat blood pressure and lower extremity electromyography during supine and standing in seven individuals with C5-T4 SCI. In three research participants with arterial hypotension, orthostatic intolerance, and low levels of circulating catecholamines (group 1), scES applied while supine and standing resulted in increased arterial blood pressure. In four research participants without evidence of arterial hypotension or orthostatic intolerance and normative circulating catecholamines (group 2), scES did not induce significant increases in arterial blood pressure. During scES, there were no significant differences in electromyographic (EMG) activity between group 1 and group 2. In group 1, during standing assisted by scES, blood pressure was maintained at 119/72 ± 7/14 mmHg (mean ± SD) compared with 70/45 ± 5/7 mmHg without scES. In group 2 there were no arterial blood pressure changes during standing with or without scES. These findings demonstrate that scES configured to facilitate motor function can acutely increase arterial blood pressure in individuals with SCI-induced cardiovascular deficits.
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Affiliation(s)
- Sevda C Aslan
- Department of Neurological Surgery, University of Louisville, Louisville, KY, United States.,Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States
| | - Bonnie E Legg Ditterline
- Department of Neurological Surgery, University of Louisville, Louisville, KY, United States.,Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States
| | - Michael C Park
- Department of Neurological Surgery, University of Louisville, Louisville, KY, United States.,Department of Neurosurgery and Neurology, University of Minnesota School of Medicine, Minneapolis, MN, United States
| | - Claudia A Angeli
- Department of Neurological Surgery, University of Louisville, Louisville, KY, United States.,Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States.,Frazier Rehab Institute, Louisville, KY, United States
| | - Enrico Rejc
- Department of Neurological Surgery, University of Louisville, Louisville, KY, United States.,Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States
| | - Yangsheng Chen
- Department of Neurological Surgery, University of Louisville, Louisville, KY, United States.,Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States
| | - Alexander V Ovechkin
- Department of Neurological Surgery, University of Louisville, Louisville, KY, United States.,Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States
| | - Andrei Krassioukov
- Experimental Medicine Program, University of British Columbia, Vancouver, BC, Canada.,International Collaboration on Repair Discoveries, Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.,GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, BC, Canada
| | - Susan J Harkema
- Department of Neurological Surgery, University of Louisville, Louisville, KY, United States.,Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States.,Frazier Rehab Institute, Louisville, KY, United States
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28
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Floreani M, Rejc E, Taboga P, Ganzini A, Pišot R, Šimunič B, Biolo G, Reggiani C, Passaro A, Narici M, Rittweger J, di Prampero PE, Lazzer S. Effects of 14 days of bed rest and following physical training on metabolic cost, mechanical work, and efficiency during walking in older and young healthy males. PLoS One 2018. [PMID: 29529070 PMCID: PMC5847238 DOI: 10.1371/journal.pone.0194291] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
In this study, we investigated: i) the effects of bed rest and a subsequent physical training program on metabolic cost (Cw), mechanical work and efficiency during walking in older and young men; ii) the mechanisms underlying the higher Cw observed in older than young men.Twenty-three healthy male subjects (N = 16 older adults, age 59.6±3.4 years; N = 7 young, age: 23.1±2.9 years) participated in this study. The subjects underwent 14 days of bed rest followed by two weeks of physical training (6 sessions). Cw, mechanical work, efficiency, and co-contraction time of proximal muscles (vastus lateralis and biceps femoris) and distal muscles (gastrocnemius medialis and tibialis anterior) were measured during walking at 0.83, 1.11, 1.39, 1.67 m·s-1 before bed rest (pre-BR), after bed rest (post-BR) and after physical training (post-PT).No effects of bed rest and physical training were observed on the analysed parameters in either group. Older men showed higher Cw and lower efficiency at each speed (average +25.1 and -20.5%, P<0.001, respectively) compared to young. Co-contraction time of proximal and distal muscles were higher in older than in young men across the different walking speeds (average +30.0 and +110.3%, P<0.05, respectively).The lack of bed rest and physical training effects on the parameters analyzed in this study may be explained by the healthy status of both young and older men, which could have mitigated the effects of these interventions on walking motor function. On the other hand, the fact that older adults showed greater Cw, overall higher co-contraction time of antagonist lower limb muscles, and lower efficiency compared to the young cohort throughout a wide range of walking speed may suggest that older adults sacrificed economy of walking to improve stability.
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Affiliation(s)
- Mirco Floreani
- Department of Medical Area, University of Udine, Udine, Italy
- School of Sport Sciences, University of Udine, Udine, Italy
| | - Enrico Rejc
- Department of Medical Area, University of Udine, Udine, Italy
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States of America
| | - Paolo Taboga
- Department of Medical Area, University of Udine, Udine, Italy
- Department of Kinesiology and Health Science, California State University, Sacramento, CA, United States of America
| | - Alessandro Ganzini
- Department of Medical Area, University of Udine, Udine, Italy
- School of Sport Sciences, University of Udine, Udine, Italy
| | - Rado Pišot
- Institute for Kinesiology Research, Science and Research Centre Koper, Koper, Slovenia
| | - Bostjan Šimunič
- Institute for Kinesiology Research, Science and Research Centre Koper, Koper, Slovenia
| | - Gianni Biolo
- Department of Medical, Surgical and Health Sciences, Division of Internal Medicine, University of Trieste, Trieste, Italy
| | - Carlo Reggiani
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Angelina Passaro
- Department of Medical Sciences, Section of Internal and Cardiorespiratory Medicine, University of Ferrara, Ferrara, Italy
| | - Marco Narici
- MRC/ARUK Centre for Musculoskeletal Ageing Research, University of Nottingham, Derby Royal Hospital, Derby, United Kingdom
| | - Joern Rittweger
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
- Department of Pediatrics and Adolescent Medicine, University of Cologne, Cologne, Germany
| | - Pietro Enrico di Prampero
- Department of Medical Area, University of Udine, Udine, Italy
- School of Sport Sciences, University of Udine, Udine, Italy
| | - Stefano Lazzer
- Department of Medical Area, University of Udine, Udine, Italy
- School of Sport Sciences, University of Udine, Udine, Italy
- * E-mail:
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29
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Rejc E, Floreani M, Taboga P, Botter A, Toniolo L, Cancellara L, Narici M, Šimunič B, Pišot R, Biolo G, Passaro A, Rittweger J, Reggiani C, Lazzer S. Loss of maximal explosive power of lower limbs after 2 weeks of disuse and incomplete recovery after retraining in older adults. J Physiol 2018; 596:647-665. [PMID: 29266264 DOI: 10.1113/jp274772] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 12/11/2017] [Indexed: 01/01/2023] Open
Abstract
KEY POINTS Disuse in older adults can critically decrease lower limb muscle power, leading to compromised mobility and overall quality of life. We studied how muscle power and its determinants (muscle mass, single muscle fibre properties and motor control) adapted to 2 weeks of disuse and subsequent 2 weeks of physical training in young and older people. Disuse decreased lower limb muscle power in both groups; however, different adaptations in single muscle fibre properties and co-contraction of leg muscles were observed between young and older individuals. Six physical training sessions performed after disuse promoted the recovery of muscle mass and power. However, they were not sufficient to restore muscle power to pre-disuse values in older individuals, suggesting that further countermeasures are required to counteract the disuse-induced loss of muscle power in older adults. ABSTRACT Disuse-induced loss of muscle power can be detrimental in older individuals, seriously impairing functional capacity. In this study, we examined the changes in maximal explosive power (MEP) of lower limbs induced by a 14-day disuse (bed-rest, BR) and a subsequent 14-day retraining, to assess whether the impact of disuse was greater in older than in young men, and to analyse the causes of such adaptations. Sixteen older adults (Old: 55-65 years) and seven Young (18-30 years) individuals participated in this study. In a subgroup of eight Old subjects, countermeasures based on cognitive training and protein supplementation were applied. MEP was measured with an explosive ergometer, muscle mass was determined by magnetic resonance, motor control was studied by EMG, and single muscle fibres were analysed in vastus lateralis biopsy samples. MEP was ∼33% lower in Old than in Young individuals, and remained significantly lower (-19%) when normalized by muscle volume. BR significantly affected MEP in Old (-15%) but not in Young. Retraining tended to increase MEP; however, this intervention was not sufficient to restore pre-BR values in Old. Ankle co-contraction increased after BR in Old only, and remained elevated after retraining (+30%). Significant atrophy occurred in slow fibres in Old, and in fast fibres in Young. After retraining, the recovery of muscle fibre thickness was partial. The proposed countermeasures were not sufficient to affect muscle mass and power. The greater impact of disuse and smaller retraining-induced recovery observed in Old highlight the importance of designing suitable rehabilitation protocols for older individuals.
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Affiliation(s)
- Enrico Rejc
- Department of Medicine, University of Udine, Udine, Italy.,Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA
| | - Mirco Floreani
- Department of Medicine, University of Udine, Udine, Italy.,School of Sport Sciences, University of Udine, Udine, Italy
| | - Paolo Taboga
- Department of Medicine, University of Udine, Udine, Italy.,Department of Kinesiology and Health Science, California State University, Sacramento, CA, USA
| | - Alberto Botter
- Department of Medicine, University of Udine, Udine, Italy.,School of Sport Sciences, University of Udine, Udine, Italy
| | - Luana Toniolo
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Lina Cancellara
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Marco Narici
- Department of Biomedical Sciences, University of Padova, Padova, Italy.,MRC/ARUK Centre for Musculoskeletal Ageing Research, University of Nottingham, Derby Royal Hospital, Derby, UK
| | - Boštjan Šimunič
- Institute for Kinesiology Research, Science and Research Center of Koper, Koper, Slovenia
| | - Rado Pišot
- Institute for Kinesiology Research, Science and Research Center of Koper, Koper, Slovenia
| | - Gianni Biolo
- Department of Medical Sciences, Surgical and Health Sciences, Clinica Medica AOUTS, University of Trieste, Italy
| | - Angelina Passaro
- Department of Medical Sciences, Section of Internal and Cardiorespiratory Medicine, University of Ferrara, Ferrara, Italy
| | - Joern Rittweger
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
| | - Carlo Reggiani
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Stefano Lazzer
- Department of Medicine, University of Udine, Udine, Italy.,School of Sport Sciences, University of Udine, Udine, Italy
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30
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Harkema SJ, Rejc E, Angeli CA. Neuromodulation of the Spinal Cord for Movement Restoration. Neuromodulation 2018. [DOI: 10.1016/b978-0-12-805353-9.00098-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Passaro A, Soavi C, Marusic U, Rejc E, Sanz JM, Morieri ML, Nora ED, Kavcic V, Narici MV, Reggiani C, Biolo G, Zuliani G, Lazzer S, Pišot R. Computerized cognitive training and brain derived neurotrophic factor during bed rest: mechanisms to protect individual during acute stress. Aging (Albany NY) 2017; 9:393-407. [PMID: 28161695 PMCID: PMC5361671 DOI: 10.18632/aging.101166] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 01/25/2017] [Indexed: 12/19/2022]
Abstract
Acute stress, as bed rest, was shown to increase plasma level of the neurotrophin brain-derived neurotrophic factor (BDNF) in older, but not in young adults. This increase might represent a protective mechanism towards acute insults in aging subjects. Since computerized cognitive training (CCT) is known to protect brain, herein we evaluated the effect of CCT during bed rest on BDNF, muscle mass, neuromuscular function and metabolic parameters. The subjects that underwent CCT did not show an increase of BDNF after bed rest, and showed an anti-insular modification pattern in metabolism. Neuromuscular function parameters, already shown to beneficiate from CCT, negatively correlated with BDNF in research participants undergoing CCT, while positively correlated in the control group. In conclusion, BDNF increase can be interpreted as a standardized protective mechanism taking place whenever an insult occurs; it gives low, but consistent preservation of neuromuscular function. CCT, acting as an external protective mechanism, seems to modify this standardized response, avoiding BDNF increase or possibly modifying its time course. Our results suggest the possibility of differential neuroprotective mechanisms among ill and healthy individuals, and the importance of timing in determining the effects of protective mechanisms.
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Affiliation(s)
- Angelina Passaro
- Medical Science Department, University of Ferrara, Ferrara 44121, Italy.,Co-first authors
| | - Cecilia Soavi
- Medical Science Department, University of Ferrara, Ferrara 44121, Italy.,Co-first authors
| | - Uros Marusic
- Science and Research Centre, University of Primorska, Koper 6000, Slovenia
| | - Enrico Rejc
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY 40202, USA
| | - Juana M Sanz
- Medical Science Department, University of Ferrara, Ferrara 44121, Italy
| | - Mario L Morieri
- Medical Science Department, University of Ferrara, Ferrara 44121, Italy
| | | | - Voyko Kavcic
- Institute of Gerontology, Wayne State University, Detroit, MI 48202, USA.,Biomedical Research and Innovative Society, Ljubljana 1000, Slovenia
| | - Marco V Narici
- School of Graduate Entry Medicine and Health, University of Nottingham, Derby DE22 3NE, UK
| | - Carlo Reggiani
- Department of Biomedical Sciences, University of Padua, Padua 35131 Italy
| | - Gianni Biolo
- Department of Medical, Surgical and Health Sciences, Division of Internal Medicine, University of Trieste, Trieste 34149, Italy
| | - Giovanni Zuliani
- Medical Science Department, University of Ferrara, Ferrara 44121, Italy
| | - Stefano Lazzer
- Department of Medical and Biological Sciences, University of Udine, Udine 33100, Italy.,School of Sport Sciences, University of Udine, Udine 33100, Italy
| | - Rado Pišot
- Science and Research Centre, University of Primorska, Koper 6000, Slovenia
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Rejc E, Angeli CA, Atkinson D, Harkema SJ. Motor recovery after activity-based training with spinal cord epidural stimulation in a chronic motor complete paraplegic. Sci Rep 2017; 7:13476. [PMID: 29074997 PMCID: PMC5658385 DOI: 10.1038/s41598-017-14003-w] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 10/05/2017] [Indexed: 11/17/2022] Open
Abstract
The prognosis for recovery of motor function in motor complete spinal cord injured (SCI) individuals is poor. Our research team has demonstrated that lumbosacral spinal cord epidural stimulation (scES) and activity-based training can progressively promote the recovery of volitional leg movements and standing in individuals with chronic clinically complete SCI. However, scES was required to perform these motor tasks. Herein, we show the progressive recovery of voluntary leg movement and standing without scES in an individual with chronic, motor complete SCI throughout 3.7 years of activity-based interventions utilizing scES configurations customized for the different motor tasks that were specifically trained (standing, stepping, volitional leg movement). In particular, this report details the ongoing neural adaptations that allowed a functional progression from no volitional muscle activation to a refined, task-specific activation pattern and movement generation during volitional attempts without scES. Similarly, we observed the re-emergence of muscle activation patterns sufficient for standing with independent knee and hip extension. These findings highlight the recovery potential of the human nervous system after chronic clinically motor complete SCI.
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Affiliation(s)
- Enrico Rejc
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA.,Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, USA
| | - Claudia A Angeli
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA.,Frazier Rehab Institute, Louisville, Kentucky, USA
| | - Darryn Atkinson
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA.,Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, USA
| | - Susan J Harkema
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA. .,Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, USA. .,Frazier Rehab Institute, Louisville, Kentucky, USA.
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Giovanelli N, Taboga P, Rejc E, Lazzer S. Effects of strength, explosive and plyometric training on energy cost of running in ultra-endurance athletes. Eur J Sport Sci 2017; 17:805-813. [PMID: 28394719 DOI: 10.1080/17461391.2017.1305454] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The aim of the present study was to evaluate the effects of a 12-week home-based strength, explosive and plyometric (SEP) training on the cost of running (Cr) in well-trained ultra-marathoners and to assess the main mechanical parameters affecting changes in Cr. Twenty-five male runners (38.2 ± 7.1 years; body mass index: 23.0 ± 1.1 kg·m-2; V˙O2max: 55.4 ± 4.0 mlO2·kg-1·min-1) were divided into an exercise (EG = 13) and control group (CG = 12). Before and after a 12-week SEP training, Cr, spring-mass model parameters at four speeds (8, 10, 12, 14 km·h-1) were calculated and maximal muscle power (MMP) of the lower limbs was measured. In EG, Cr decreased significantly (p < .05) at all tested running speeds (-6.4 ± 6.5% at 8 km·h-1; -3.5 ± 5.3% at 10 km·h-1; -4.0 ± 5.5% at 12 km·h-1; -3.2 ± 4.5% at 14 km·h-1), contact time (tc) increased at 8, 10 and 12 km·h-1 by mean +4.4 ± 0.1% and ta decreased by -25.6 ± 0.1% at 8 km·h-1 (p < .05). Further, inverse relationships between changes in Cr and MMP at 10 (p = .013; r = -0.67) and 12 km·h-1 (p < .001; r = -0.86) were shown. Conversely, no differences were detected in the CG in any of the studied parameters. Thus, 12-week SEP training programme lower the Cr in well-trained ultra-marathoners at submaximal speeds. Increased tc and an inverse relationship between changes in Cr and changes in MMP could be in part explain the decreased Cr. Thus, adding at least three sessions per week of SEP exercises in the normal endurance-training programme may decrease the Cr.
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Affiliation(s)
- Nicola Giovanelli
- a Department of Medical and Biological Sciences , University of Udine , Udine , Italy.,b School of Sport Sciences , University of Udine , Udine , Italy
| | - Paolo Taboga
- a Department of Medical and Biological Sciences , University of Udine , Udine , Italy.,b School of Sport Sciences , University of Udine , Udine , Italy.,c Integrative Physiology Department , University of Colorado Boulder , Boulder , CO , USA
| | - Enrico Rejc
- a Department of Medical and Biological Sciences , University of Udine , Udine , Italy.,b School of Sport Sciences , University of Udine , Udine , Italy.,d Kentucky Spinal Cord Injury Research Center , University of Louisville , Louisville , KY , USA
| | - Stefano Lazzer
- a Department of Medical and Biological Sciences , University of Udine , Udine , Italy.,b School of Sport Sciences , University of Udine , Udine , Italy
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Moreno C, Mattiussi G, Núñez FJ, Messina G, Rejc E. Intratissue percutaneous electolysis combined with active physical therapy for the treatment of adductor longus enthesopathy-related groin pain: a randomized trial. J Sports Med Phys Fitness 2017; 57:1318-1329. [PMID: 28116876 DOI: 10.23736/s0022-4707.16.06466-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Adductor longus enthesopathy-related groin pain (ALErGP) is the most common cause of groin pain in soccer players. The aim of this study was to evaluate the therapeutic utility of intratissue percutaneous electrolysis (EPI®) technique in combination with an active physical therapy (APT) program to treat ALErGP. METHODS Twenty-four non-professional male soccer players diagnosed with ALErGP were included in this study and randomly divided into two groups. Group A was treated with EPI® technique in combination with a standardized APT program. Group B only underwent the APT program. The Numeric Rating Scale (NRS) and the Patient Specific Functional Scale (PSFS) were used to assess the effectiveness of the two interventions. The follow-up covered a 6-month period. RESULTS Both groups significantly improved pain and functional scores after treatment and maintained this therapeutic result throughout the follow-up. The combined intervention of APT program and EPI® ensured a greater and faster reduction of pain in group A. In addition, functional recovery tended to be greater in group A than B after the treatment and throughout the follow-up by 7.8±3.8% (P=0.093). CONCLUSIONS EPI® treatment in association with APT ensured a greater and more rapid reduction of pain and tended to promote greater functional recovery in soccer players with ALErGP compared to APT only. This positive therapeutic result lasted for at least 6 months after the end of the treatment. These findings support the combined use of EPI® and APT to treat ALErGP.
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Affiliation(s)
| | | | - Francisco J Núñez
- Department of Sports and Computing, Sport Faculty, Pablo de Olavide University of Sevilla, Sevilla, Spain
| | - Giovanni Messina
- Department of Medical and Biological Sciences, School of Motor Sciences, University of Udine, Udine, Italy
| | - Enrico Rejc
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA
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Rejc E, Angeli CA, Bryant N, Harkema SJ. Effects of Stand and Step Training with Epidural Stimulation on Motor Function for Standing in Chronic Complete Paraplegics. J Neurotrauma 2016; 34:1787-1802. [PMID: 27566051 DOI: 10.1089/neu.2016.4516] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Individuals affected by motor complete spinal cord injury are unable to stand, walk, or move their lower limbs voluntarily; this diagnosis normally implies severe limitations for functional recovery. We have recently shown that the appropriate selection of epidural stimulation parameters was critical to promoting full-body, weight-bearing standing with independent knee extension in four individuals with chronic clinically complete paralysis. In the current study, we examined the effects of stand training and subsequent step training with epidural stimulation on motor function for standing in the same four individuals. After stand training, the ability to stand improved to different extents in the four participants. Step training performed afterwards substantially impaired standing ability in three of the four individuals. Improved standing ability generally coincided with continuous electromyography (EMG) patterns with constant levels of ground reaction forces. Conversely, poorer standing ability was associated with more variable EMG patterns that alternated EMG bursts and longer periods of negligible activity in most of the muscles. Stand and step training also differentially affected the evoked potentials amplitude modulation induced by sitting-to-standing transition. Finally, stand and step training with epidural stimulation were not sufficient to improve motor function for standing without stimulation. These findings show that the spinal circuitry of motor complete paraplegics can generate motor patterns effective for standing in response to task-specific training with optimized stimulation parameters. Conversely, step training can lead to neural adaptations resulting in impaired motor function for standing.
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Affiliation(s)
- Enrico Rejc
- 1 Kentucky Spinal Cord Injury Research Center, University of Louisville , Louisville, Kentucky.,2 Department of Neurological Surgery, University of Louisville , Louisville, Kentucky
| | - Claudia A Angeli
- 1 Kentucky Spinal Cord Injury Research Center, University of Louisville , Louisville, Kentucky.,3 Frazier Rehab Institute , Kentucky One Health, Louisville, Kentucky
| | - Nicole Bryant
- 1 Kentucky Spinal Cord Injury Research Center, University of Louisville , Louisville, Kentucky
| | - Susan J Harkema
- 1 Kentucky Spinal Cord Injury Research Center, University of Louisville , Louisville, Kentucky.,2 Department of Neurological Surgery, University of Louisville , Louisville, Kentucky.,3 Frazier Rehab Institute , Kentucky One Health, Louisville, Kentucky
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Porcelli S, Pugliese L, Rejc E, Pavei G, Bonato M, Montorsi M, La Torre A, Rasica L, Marzorati M. Effects of a Short-Term High-Nitrate Diet on Exercise Performance. Nutrients 2016; 8:nu8090534. [PMID: 27589795 PMCID: PMC5037521 DOI: 10.3390/nu8090534] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 08/14/2016] [Accepted: 08/24/2016] [Indexed: 02/07/2023] Open
Abstract
It has been reported that nitrate supplementation can improve exercise performance. Most of the studies have used either beetroot juice or sodium nitrate as a supplement; there is lack of data on the potential ergogenic benefits of an increased dietary nitrate intake from a diet based on fruits and vegetables. Our aim was to assess whether a high-nitrate diet increases nitric oxide bioavailability and to evaluate the effects of this nutritional intervention on exercise performance. Seven healthy male subjects participated in a randomized cross-over study. They were tested before and after 6 days of a high (HND) or control (CD) nitrate diet (~8.2 mmol∙day(-1) or ~2.9 mmol∙day(-1), respectively). Plasma nitrate and nitrite concentrations were significantly higher in HND (127 ± 64 µM and 350 ± 120 nM, respectively) compared to CD (23 ± 10 µM and 240 ± 100 nM, respectively). In HND (vs. CD) were observed: (a) a significant reduction of oxygen consumption during moderate-intensity constant work-rate cycling exercise (1.178 ± 0.141 vs. 1.269 ± 0.136 L·min(-1)); (b) a significantly higher total muscle work during fatiguing, intermittent sub-maximal isometric knee extension (357.3 ± 176.1 vs. 253.6 ± 149.0 Nm·s·kg(-1)); (c) an improved performance in Repeated Sprint Ability test. These findings suggest that a high-nitrate diet could be a feasible and effective strategy to improve exercise performance.
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Affiliation(s)
- Simone Porcelli
- Institute of Molecular Bioimaging and Physiology, National Research Council, Segrate 20090, Italy.
| | - Lorenzo Pugliese
- Institute of Molecular Bioimaging and Physiology, National Research Council, Segrate 20090, Italy.
| | - Enrico Rejc
- Department of Neurological Surgery, Kentucky Spinal Cord Research Center, University of Louisville, Louisville, KY 40202, USA.
| | - Gaspare Pavei
- Department of Pathopysiology and Transplantation, Università degli Studi di Milano, Milano 20100, Italy.
| | - Matteo Bonato
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano 20100, Italy.
| | - Michela Montorsi
- Institute of Molecular Bioimaging and Physiology, National Research Council, Segrate 20090, Italy.
- Department of Human Sciences and Promotion of Quality of Life, Telematic University S. Raffaele, Roma 00166, Italy.
| | - Antonio La Torre
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano 20100, Italy.
| | - Letizia Rasica
- Institute of Molecular Bioimaging and Physiology, National Research Council, Segrate 20090, Italy.
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano 20100, Italy.
| | - Mauro Marzorati
- Institute of Molecular Bioimaging and Physiology, National Research Council, Segrate 20090, Italy.
- Department of Psychology, Exercise and Sport Science Degree Course, Catholic University of the Sacred Heart, Milan 20100, Italy.
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Abstract
Sensory and motor complete spinal cord injury (SCI) has been considered functionally complete resulting in permanent paralysis with no recovery of voluntary movement, standing or walking. Previous findings demonstrated that lumbosacral spinal cord epidural stimulation can activate the spinal neural networks in one individual with motor complete, but sensory incomplete SCI, who achieved full body weight-bearing standing with independent knee extension, minimal self-assistance for balance and minimal external assistance for facilitating hip extension. In this study, we showed that two clinically sensory and motor complete participants were able to stand over-ground bearing full body-weight without any external assistance, using their hands to assist balance. The two clinically motor complete, but sensory incomplete participants also used minimal external assistance for hip extension. Standing with the least amount of assistance was achieved with individual-specific stimulation parameters, which promoted overall continuous EMG patterns in the lower limbs’ muscles. Stimulation parameters optimized for one individual resulted in poor standing and additional need of external assistance for hip and knee extension in the other participants. During sitting, little or negligible EMG activity of lower limb muscles was induced by epidural stimulation, showing that the weight-bearing related sensory information was needed to generate sufficient EMG patterns to effectively support full weight-bearing standing. In general, electrode configurations with cathodes selected in the caudal region of the array at relatively higher frequencies (25–60 Hz) resulted in the more effective EMG patterns for standing. These results show that human spinal circuitry can generate motor patterns effective for standing in the absence of functional supraspinal connections; however the appropriate selection of stimulation parameters is critical.
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Affiliation(s)
- Enrico Rejc
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, United States of America
| | - Claudia Angeli
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, United States of America
- Frazier Rehab Institute, Kentucky One Health, Louisville, Kentucky, United States of America
| | - Susan Harkema
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, United States of America
- Frazier Rehab Institute, Kentucky One Health, Louisville, Kentucky, United States of America
- * E-mail:
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Rejc E, Botter A, Floreani M, Simunic B, Pisot R, di Prampero PE, Lazzer S. Functional Impact Of 14 Days Of Bed Rest In Healthy Older And Young Adults. Med Sci Sports Exerc 2015. [DOI: 10.1249/01.mss.0000465986.20909.da] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Rejc E, di Prampero PE, Lazzer S, Grassi B, Simunic B, Pisot R, Antonutto G, Narici M. Maximal explosive power of the lower limbs before and after 35 days of bed rest under different diet energy intake. Eur J Appl Physiol 2014; 115:429-36. [PMID: 25344798 DOI: 10.1007/s00421-014-3024-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 10/13/2014] [Indexed: 01/10/2023]
Abstract
PURPOSE Microgravity leads to a decline of muscle power especially in the postural muscles of the lower limb. Muscle atrophy primarily contributes to this negative adaptation. Nutritional countermeasures during unloading were shown to possibly mitigate the loss of muscle mass and strength. The aim of this study was to investigate the effects of different diet energy intakes during prolonged inactivity on body composition and lower limbs power output. METHODS The effects of lower or higher diet energy intake on the decline of maximal explosive power of the lower limbs, as determined on a sledge ergometer before and after 35 days of bed rest, were investigated on two matched groups of young healthy volunteers. Body composition and lean volume of the lower limb were also measured. RESULTS After bed rest, fat mass increased (+20.5 %) in the higher energy intake group (N = 9), while it decreased (-4.8 %) in the lower energy intake group (N = 10). Also, the loss of body fat-free mass and lean volume of the lower limb was significantly greater in the higher (-4.6 and -10.8 %, respectively) as compared to the lower (-2.4 and -3.7 %, respectively) diet energy intake group. However, the loss of maximal explosive power was similar between the two groups (-25.2 and -29.5 % in the higher and lower energy intake group, respectively; P = 0.440). CONCLUSIONS The mitigation of loss of muscle mass by means of a moderate caloric diet restriction during prolonged inactivity was not sufficient for reducing the loss of maximal explosive power of the lower limbs.
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Affiliation(s)
- Enrico Rejc
- Department of Medical and Biological Sciences, University of Udine, P.le Kolbe 4, 33100, Udine, Italy,
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Lazzer S, Taboga P, Salvadego D, Rejc E, Simunic B, Narici MV, Buglione A, Giovanelli N, Antonutto G, Grassi B, Pisot R, di Prampero PE. Factors Affecting Energy Cost Of Running During An Ultra-endurance Race. Med Sci Sports Exerc 2014. [DOI: 10.1249/01.mss.0000496348.77814.b2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Samozino P, Rejc E, di Prampero PE, Belli A, Morin JB. Force–Velocity Properties’ Contribution to Bilateral Deficit during Ballistic Push-off. Med Sci Sports Exerc 2014; 46:107-14. [DOI: 10.1249/mss.0b013e3182a124fb] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Lazzer S, Salvadego D, Porcelli S, Rejc E, Agosti F, Sartorio A, Grassi B. Skeletal muscle oxygen uptake in obese patients: functional evaluation by knee-extension exercise. Eur J Appl Physiol 2013; 113:2125-32. [DOI: 10.1007/s00421-013-2647-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 04/08/2013] [Indexed: 01/27/2023]
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Lazzer S, Taboga P, Salvadego D, Rejc E, Simunic B, Narici M, Buglione A, Giovanelli N, Antonutto G, Grassi B, Pisot R, di Prampero PE. Factors affecting energy cost of running during an ultra-endurance race. J Exp Biol 2013; 217:787-95. [DOI: 10.1242/jeb.091645] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Summary
Purpose: to investigate: 1) the role of V'O2max, fraction of it (F) and metabolic cost of transport (CoT) in determining performance during an ultra-endurance competition and 2) the effects of the race on several biomechanical and morphological parameters of the lower limbs that are likely to affect CoT. Methods: Eleven runners (age: 29-54 years) participated in an ultra-endurance competition consisting of three running stages of 25, 55 and 13 km on three consecutive days. Anthropometric characteristics, body composition, morphological properties of the gastrocnemius medialis, maximal explosive power of the lower limb and V'O2max were determined before the competition. In addition, biomechanics of running and CoT was determined, before and immediately after each running stage. Results: Performance was directly proportional to V'O2max (r=0.77), and F (r=0.36) and inversely proportional to CoT (r=-0.30). Low CoT values were significantly related to high maximal power of the lower limbs (r=-0.74), vertical stiffness (r=-0.65); and low foot-print index (FPI, r=0.70), step frequency (r=0.62) and external work (r=0.60). About 50% of the increase in CoT during the stages of the competition was accounted for by changes in FPI, which represents a global evaluation of medio-lateral displacement of the foot during the whole stance phase, which in turn are associated with the myotendinous characteristics of the lower limb. Conclusions: lower CoT values were related to greater muscular power and lower FPI, suggesting that a better ankle stability is likely to achieve better performance in ultra endurance running competition.
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Samozino P, Rejc E, Di Prampero PE, Belli A, Morin JB. Optimal force-velocity profile in ballistic movements--altius: citius or fortius? Med Sci Sports Exerc 2012; 44:313-22. [PMID: 21775909 DOI: 10.1249/mss.0b013e31822d757a] [Citation(s) in RCA: 192] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE The study's purpose was to determine the respective influences of the maximal power (Pmax) and the force-velocity (F-v) mechanical profile of the lower limb neuromuscular system on performance in ballistic movements. METHODS A theoretical integrative approach was proposed to express ballistic performance as a mathematical function of Pmax and F-v profile. This equation was (i) validated from experimental data obtained on 14 subjects during lower limb ballistic inclined push-offs and (ii) simulated to quantify the respective influence of Pmax and F-v profile on performance. RESULTS The bias between performances predicted and obtained from experimental measurements was 4%-7%, confirming the validity of the proposed theoretical approach. Simulations showed that ballistic performance was mostly influenced not only by Pmax but also by the balance between force and velocity capabilities as described by the F-v profile. For each individual, there is an optimal F-v profile that maximizes performance, whereas unfavorable F-v balances lead to differences in performance up to 30% for a given Pmax. This optimal F-v profile, which can be accurately determined, depends on some individual characteristics (limb extension range, Pmax) and on the afterload involved in the movement (inertia, inclination). The lower the afterload, the more the optimal F-v profile is oriented toward velocity capabilities and the greater the limitation of performance imposed by the maximal velocity of lower limb extension. CONCLUSIONS High ballistic performances are determined by both maximization of the power output capabilities and optimization of the F-v mechanical profile of the lower limb neuromuscular system.
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Affiliation(s)
- Pierre Samozino
- Laboratory of Exercise Physiology (EA4338), University of Savoy, Le Bourget du Lac, France.
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Salvadego D, Lazzer S, Marzorati M, Porcelli S, Rejc E, Simunic B, Pisot R, di Prampero PE, Grassi B. Functional impairment of skeletal muscle oxidative metabolism during knee extension exercise after bed rest. J Appl Physiol (1985) 2011; 111:1719-26. [PMID: 21921243 DOI: 10.1152/japplphysiol.01380.2010] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A functional evaluation of skeletal muscle oxidative metabolism during dynamic knee extension (KE) incremental exercises was carried out following a 35-day bed rest (BR) (Valdoltra 2008 BR campaign). Nine young male volunteers (age: 23.5 ± 2.2 yr; mean ± SD) were evaluated. Pulmonary gas exchange, heart rate and cardiac output (by impedance cardiography), skeletal muscle (vastus lateralis) fractional O(2) extraction, and brain (frontal cortex) oxygenation (by near-infrared spectroscopy) were determined during incremental KE. Values at exhaustion were considered "peak". Peak heart rate (147 ± 18 beats/min before vs. 146 ± 17 beats/min after BR) and peak cardiac output (17.8 ± 3.3 l/min before vs. 16.1 ± 1.8 l/min after BR) were unaffected by BR. As expected, brain oxygenation did not decrease during KE. Peak O(2) uptake was lower after vs. before BR, both when expressed as liters per minute (0.99 ± 0.17 vs. 1.26 ± 0.27) and when normalized per unit of quadriceps muscle mass (46.5 ± 6.4 vs. 56.9 ± 11.0 ml·min(-1)·100 g(-1)). Skeletal muscle peak fractional O(2) extraction, expressed as a percentage of the maximal values obtained during a transient limb ischemia, was lower after (46.3 ± 12.1%) vs. before BR (66.5 ± 11.2%). After elimination, by the adopted exercise protocol, of constraints related to cardiovascular O(2) delivery, a decrease in peak O(2) uptake and muscle peak capacity of fractional O(2) extraction was found after 35 days of BR. These findings suggest a substantial impairment of oxidative function at the muscle level, "downstream" with respect to bulk blood flow to the exercising muscles, that is possibly at the level of blood flow distribution/O(2) utilization inside the muscle, peripheral O(2) diffusion, and intracellular oxidative metabolism.
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Affiliation(s)
- Desy Salvadego
- Department of Medical and Biological Sciences, University of Udine, Udine, Italy
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Lazzer S, Salvadego D, Rejc E, Buglione A, Antonutto G, di Prampero PE. The energetics of ultra-endurance running. Eur J Appl Physiol 2011; 112:1709-15. [DOI: 10.1007/s00421-011-2120-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Accepted: 08/05/2011] [Indexed: 10/17/2022]
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Harkema S, Gerasimenko Y, Hodes J, Burdick J, Angeli C, Chen Y, Ferreira C, Willhite A, Rejc E, Grossman RG, Edgerton VR. Effect of epidural stimulation of the lumbosacral spinal cord on voluntary movement, standing, and assisted stepping after motor complete paraplegia: a case study. Lancet 2011; 377:1938-47. [PMID: 21601270 PMCID: PMC3154251 DOI: 10.1016/s0140-6736(11)60547-3] [Citation(s) in RCA: 695] [Impact Index Per Article: 53.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Repeated periods of stimulation of the spinal cord and training increased the ability to control movement in animal models of spinal cord injury. We hypothesised that tonic epidural spinal cord stimulation can modulate spinal circuitry in human beings into a physiological state that enables sensory input from standing and stepping movements to serve as a source of neural control to undertake these tasks. METHODS A 23-year-old man who had paraplegia from a C7-T1 subluxation as a result of a motor vehicle accident in July 2006, presented with complete loss of clinically detectable voluntary motor function and partial preservation of sensation below the T1 cord segment. After 170 locomotor training sessions over 26 months, a 16-electrode array was surgically placed on the dura (L1-S1 cord segments) in December 2009, to allow for chronic electrical stimulation. Spinal cord stimulation was done during sessions that lasted up to 250 min. We did 29 experiments and tested several stimulation combinations and parameters with the aim of the patient achieving standing and stepping. FINDINGS Epidural stimulation enabled the man to achieve full weight-bearing standing with assistance provided only for balance for 4·25 min. The patient achieved this standing during stimulation using parameters identified as specific for standing while providing bilateral load-bearing proprioceptive input. We also noted locomotor-like patterns when stimulation parameters were optimised for stepping. Additionally, 7 months after implantation, the patient recovered supraspinal control of some leg movements, but only during epidural stimulation. INTERPRETATION Task-specific training with epidural stimulation might reactivate previously silent spared neural circuits or promote plasticity. These interventions could be a viable clinical approach for functional recovery after severe paralysis. FUNDING National Institutes of Health and Christopher and Dana Reeve Foundation.
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Affiliation(s)
- Susan Harkema
- Department of Neurological Surgery, Kentucky Spinal Cord Research Center, University of Louisville, KY, USA
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Lazzer S, Salvadego D, Rejc E, Buglione A, Antonutto G, di Prampero PE. The Energetics Of Ultra-endurance Running Race: "Magraid". Med Sci Sports Exerc 2011. [DOI: 10.1249/01.mss.0000402984.27078.6e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Rejc E, Lazzer S, Antonutto G, Grassi B, Simunic B, Pisot R, di Prampero PE. A 35-day Bed Rest Decreases the Bilateral Deficit During Explosive Efforts of the Lower Limbs. Med Sci Sports Exerc 2011. [DOI: 10.1249/01.mss.0000402288.01913.a3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Rejc E, Lazzer S, Antonutto G. Energy expenditure and dietary intake of athletes during an ultraendurance event developed by hiking, cycling and mountain climbing. J Sports Med Phys Fitness 2010; 50:296-302. [PMID: 20842090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
AIM To investigate exercise intensity, energy expenditure and energy balance of athletes during an ultraendurance event (UE) consisting in hiking, cycling and mountain climbing. METHODS Four athletes participated in this study. Maximal oxygen uptake (VO2max) and "VO2-heart rate" relationships during cycling and walking were determined by indirect calorimetry during two graded exercise tests. Body mass and body fat mass were measured before and after the UE. During the UE, heart rate (HR), diet intake, gastrointestinal disturbances and route characteristics were monitored. RESULTS UE duration was 19 h29 min over a distance of 108 km, with 6768 meters of altitude difference. Body mass and percent of body fat mass tended to decrease after UE (-3.2% and -8.9%, respectively). During the locomotion phases, mean exercise intensity was 50.8±10.4% of VO2max and 65.8±7.6% of HRmax. Energy expenditure amounted to 51.0±3.4 MJ. Energy supplied from diet and body fat mass oxidation was 20.4±10.7 MJ and 17.3±2.4 MJ, respectively. During the UE, athletes did not suffer of any gastrointestinal disorder. CONCLUSION Mean exercise intensity corresponded to 51% VO2max: it was independent from the locomotion type, and it can be considered an adequate intensity for UEs with similar characteristics. Although athletes successfully completed the UE, the self regulation of energy intake led athletes to a negative energy balance. Estimation of energy expenditure prior the begin of UEs would allow athletes to better plan the diet energy intake.
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Affiliation(s)
- E Rejc
- Department of Biomedical Sciences and Technologies, University of Udine, Udine, Italy
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