1
|
Maffiuletti NA, Dirks ML, Stevens-Lapsley J, McNeil CJ. Electrical stimulation for investigating and improving neuromuscular function in vivo: Historical perspective and major advances. J Biomech 2023; 152:111582. [PMID: 37088030 DOI: 10.1016/j.jbiomech.2023.111582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/04/2023] [Indexed: 04/25/2023]
Abstract
This historical review summarizes the major advances - particularly from the last 50 years - in transcutaneous motor-level electrical stimulation, which can be used either as a tool to investigate neuromuscular function and its determinants (electrical stimulation for testing; EST) or as a therapeutic/training modality to improve neuromuscular and physical function (neuromuscular electrical stimulation; NMES). We focus on some of the most important applications of electrical stimulation in research and clinical settings, such as the investigation of acute changes, chronic adaptations and pathological alterations of neuromuscular function with EST, as well as the enhancement, preservation and restoration of muscle strength and mass with NMES treatment programs in various populations. For both EST and NMES, several major advances converge around understanding and optimizing motor unit recruitment during electrically-evoked contractions, also taking into account the influence of stimulation site (e.g., muscle belly vs nerve trunk) and type (e.g., pulse duration, frequency, and intensity). This information is equally important both in the context of mechanistic research of neuromuscular function as well as for clinicians who believe that improvements in neuromuscular function are required to provide health-related benefits to their patients.
Collapse
Affiliation(s)
| | - Marlou L Dirks
- Department of Public Health and Sports Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK; Human and Animal Physiology, Wageningen University, Wageningen, The Netherlands
| | - Jennifer Stevens-Lapsley
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA; VA Eastern Colorado Geriatric Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, CO, USA
| | - Chris J McNeil
- Integrated Neuromuscular Physiology Laboratory, School of Health and Exercise Sciences, University of British Columbia, Kelowna, Canada
| |
Collapse
|
2
|
Yacyshyn AF, McNeil CJ. Intrinsic Neuromuscular Fatigability in Humans: The Critical Role of Stimulus Frequency. Exerc Sport Sci Rev 2022; 50:97-103. [PMID: 35025843 DOI: 10.1249/jes.0000000000000283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Electrically evoked contractions provide insight into intrinsic neuromuscular fatigability and also represent a valuable technique to maintain muscle mass in a clinical setting. To appropriately investigate intrinsic fatigability and design optimal stimulation protocols, it would seem to be crucial to stimulate the muscle at a frequency equivalent to the mean motor unit discharge rate expected at the target force level.
Collapse
Affiliation(s)
- Alexandra F Yacyshyn
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada
| | | |
Collapse
|
3
|
Yacyshyn AF, Huculak RB, McNeil CJ. The inclusion of interstimulus interval variability does not mitigate electrically-evoked fatigue of the knee extensors. Eur J Appl Physiol 2020; 120:2649-2656. [PMID: 32888057 DOI: 10.1007/s00421-020-04485-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 08/27/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Transcutaneous electrical stimulation (TES) is used to activate muscles when volitional capacity is impaired but potential benefits are limited by rapid force loss (fatigue). Most TES fatigue protocols employ constant-frequency trains, with stimuli at a fixed interstimulus interval (ISI); however, a brief ISI between the first two pulses (variable-frequency train, VFT) to maximize the catchlike property of muscle can attenuate fatigue development. The purpose of this study was to investigate if a VFT that simulates intrinsic variability of voluntary motor unit discharge rates would also mitigate fatigue, owing to the sensitivity of muscle to acute activation history. METHODS On two visits, 24 healthy adults (25.3 ± 3.7 years; 12 females) received 3 min of intermittent TES to the quadriceps of the dominant leg. Trains of eight pulses at 10 Hz were delivered with a constant (100 ms) or variable ISI (80-120 ms). Contractile impulse, rate of force development (RFD), and rate of relaxation (RFR) were determined for each tetanus RESULTS: During fatigue and recovery, contractile impulse did not differ between protocols (p ≥ 0.796) and sexes (p ≥ 0.493), with values of 77 ± 17% control at task end and 125 ± 19% control 2 min later. RFD and RFR also showed no effect of the protocol (p ≥ 0.310) or participant sex (p ≥ 0.119). Both measures slowed (38 ± 23% and 33 ± 22%, respectively) but dissociated during recovery as RFD remained 16 ± 18% below control at 5 min, whereas RFR recovered to control by 30 s (101 ± 22%). CONCLUSION Contrary to expectations, the VFT protocol did not attenuate fatigue development, which suggests no benefit to mimicking the inherent variability of motor unit discharge rates.
Collapse
Affiliation(s)
- Alexandra F Yacyshyn
- School of Health and Exercise Sciences, Faculty of Health and Social Development, The University of British Columbia, Okanagan Campus, 133-1147 Research Road, Kelowna, BC, V1V 1V7, Canada
- Centre for Heart, Lung and Vascular Health, Faculty of Health and Social Development, University of British Columbia, Kelowna, BC, Canada
| | - Robin B Huculak
- School of Health and Exercise Sciences, Faculty of Health and Social Development, The University of British Columbia, Okanagan Campus, 133-1147 Research Road, Kelowna, BC, V1V 1V7, Canada
| | - Chris J McNeil
- School of Health and Exercise Sciences, Faculty of Health and Social Development, The University of British Columbia, Okanagan Campus, 133-1147 Research Road, Kelowna, BC, V1V 1V7, Canada.
- Centre for Heart, Lung and Vascular Health, Faculty of Health and Social Development, University of British Columbia, Kelowna, BC, Canada.
| |
Collapse
|
4
|
Qiu S, Draghici AE, Picard G, Taylor JA. Muscle Fatigue in Response to Electrical Stimulation Pattern and Frequency in Spinal Cord Injury. PM R 2019; 12:699-705. [PMID: 31702873 DOI: 10.1002/pmrj.12282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 10/23/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Functional electrical stimulation (FES) is widely used to induce functional movements for paralyzed muscles. However, rapid muscle fatigue during FES-induced muscle contractions limits FES clinical efficacy. OBJECTIVE To investigate muscle fatigue response across stimulation patterns and frequencies during FES in able-bodied individuals and in those with spinal cord injury (SCI). DESIGN Four stimulation protocols combining 20 and 40 Hz average frequency with either constant frequency trains (CFTs) or with doublet frequency trains (DFTs) were applied to the quadriceps of seven adults with SCI and eight able-bodied participants. SETTING A FES-row training laboratory. PARTICIPANTS Seven individuals with SCI (one female; age range, 25 ± 6 years) and eight age-matched able-bodied participants (one female). INTERVENTION None. MAIN OUTCOME MEASURES Fatigue was defined as the number of contractions until force decreased by 20% from the target level of 25% maximal contraction force. The number of contractions and the stimulation current used during the four stimulation protocols were compared. RESULTS There was a significant effect of frequency, as well as interaction between group and stimulation pattern (P < .05). In both groups, 20-Hz trains increased the number of contractions to fatigue compared to 40-Hz trains. However, the responses to the pattern of stimulation differed. In the able-bodied participants, CFT increased the number of contractions to fatigue compared to DFT, whereas in those with SCI, DFT increased the number of contractions to fatigue. In fact, DFT resulted in similar number of contractions to fatigue in both populations. CONCLUSIONS These results indicate that DFT at 20 Hz may be a better stimulation protocol to delay fatigue onset in the SCI population than the other three protocols. In addition, this work implies that results from able-bodied persons may not be directly applicable to those with SCI.
Collapse
Affiliation(s)
- Shuang Qiu
- Cardiovascular Research Laboratory, Spaulding Hospital Cambridge, Cambridge, MA.,Department of Physical Medicine & Rehabilitation, Harvard Medical School, Cambridge, MA.,Research Center for Brain-Inspired Intelligence, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Adina E Draghici
- Cardiovascular Research Laboratory, Spaulding Hospital Cambridge, Cambridge, MA.,Department of Physical Medicine & Rehabilitation, Harvard Medical School, Cambridge, MA
| | - Glen Picard
- Cardiovascular Research Laboratory, Spaulding Hospital Cambridge, Cambridge, MA
| | - J Andrew Taylor
- Cardiovascular Research Laboratory, Spaulding Hospital Cambridge, Cambridge, MA.,Department of Physical Medicine & Rehabilitation, Harvard Medical School, Cambridge, MA
| |
Collapse
|
5
|
Aksöz EA, Luder MA, Laubacher M, Riener R, Binder-Macleod SA, Hunt KJ. Stochastically modulated inter-pulse intervals to increase the efficiency of functional electrical stimulation cycling. J Rehabil Assist Technol Eng 2018; 5:2055668318767364. [PMID: 31191935 PMCID: PMC6453100 DOI: 10.1177/2055668318767364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 03/07/2018] [Indexed: 11/30/2022] Open
Abstract
Introduction Functional electrical stimulation cycling has various health benefits, but
the mechanical power output and efficiency are very low compared to
volitional muscle activation. Stimulation with variable frequency showed
significantly higher power output values in experiments with a knee
dynamometer. The aim of the present work was to compare stochastic
modulation of inter-pulse interval to constant inter-pulse interval
stimulation during functional electrical stimulation cycling. Methods Seventeen able-bodied subjects participated (n = 17).
Quadriceps and hamstring muscle groups were stimulated with two activation
patterns: P1-constant frequency, P2-stochastic inter-pulse interval. Power
output was measured on functional electrical stimulation ergometer. Results Overall, mean power output with the stochastically modulated pattern P2 was
lower than with P1 (12.57 ± 3.74 W vs. 11.44 ± 3.81 W, P1 vs. P2,
p = 0.022), but no significant differences during the
first 30 s and the last 30 s were observed. Conclusions This study showed that stimulation strategies that use randomized modulation
of inter-pulse intervals can negatively affect power output generation
during functional electrical stimulation cycling. To minimise voluntary
contractions, power measurement and assessment should be focused on the
periods where only the quadriceps are stimulated.
Collapse
Affiliation(s)
- E A Aksöz
- Department of Engineering and Information Technology, Division of Mechanical Engineering, Institute for Rehabilitation and Performance Technology, Bern University of Applied Sciences, Burgdorf, Switzerland.,Department of Health Sciences and Technology, Sensory Motor Systems Lab, ETH Zürich, Zürich, Switzerland
| | - M A Luder
- Department of Engineering and Information Technology, Division of Mechanical Engineering, Institute for Rehabilitation and Performance Technology, Bern University of Applied Sciences, Burgdorf, Switzerland
| | - M Laubacher
- Department of Engineering and Information Technology, Division of Mechanical Engineering, Institute for Rehabilitation and Performance Technology, Bern University of Applied Sciences, Burgdorf, Switzerland.,Department of Health Sciences and Technology, Sensory Motor Systems Lab, ETH Zürich, Zürich, Switzerland
| | - R Riener
- Department of Health Sciences and Technology, Sensory Motor Systems Lab, ETH Zürich, Zürich, Switzerland
| | | | - K J Hunt
- Department of Engineering and Information Technology, Division of Mechanical Engineering, Institute for Rehabilitation and Performance Technology, Bern University of Applied Sciences, Burgdorf, Switzerland
| |
Collapse
|
6
|
Barss TS, Ainsley EN, Claveria-Gonzalez FC, Luu MJ, Miller DJ, Wiest MJ, Collins DF. Utilizing Physiological Principles of Motor Unit Recruitment to Reduce Fatigability of Electrically-Evoked Contractions: A Narrative Review. Arch Phys Med Rehabil 2017; 99:779-791. [PMID: 28935232 DOI: 10.1016/j.apmr.2017.08.478] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 08/08/2017] [Accepted: 08/16/2017] [Indexed: 10/18/2022]
Abstract
Neuromuscular electrical stimulation (NMES) is used to produce contractions to restore movement and reduce secondary complications for individuals experiencing motor impairment. NMES is conventionally delivered through a single pair of electrodes over a muscle belly or nerve trunk using short pulse durations and frequencies between 20 and 40Hz (conventional NMES). Unfortunately, the benefits and widespread use of conventional NMES are limited by contraction fatigability, which is in large part because of the nonphysiological way that contractions are generated. This review provides a summary of approaches designed to reduce fatigability during NMES, by using physiological principles that help minimize fatigability of voluntary contractions. First, relevant principles of the recruitment and discharge of motor units (MUs) inherent to voluntary contractions and conventional NMES are introduced, and the main mechanisms of fatigability for each contraction type are briefly discussed. A variety of NMES approaches are then described that were designed to reduce fatigability by generating contractions that more closely mimic voluntary contractions. These approaches include altering stimulation parameters, to recruit MUs in their physiological order, and stimulating through multiple electrodes, to reduce MU discharge rates. Although each approach has unique advantages and disadvantages, approaches that minimize MU discharge rates hold the most promise for imminent translation into rehabilitation practice. The way that NMES is currently delivered limits its utility as a rehabilitative tool. Reducing fatigability by delivering NMES in ways that better mimic voluntary contractions holds promise for optimizing the benefits and widespread use of NMES-based programs.
Collapse
Affiliation(s)
- Trevor S Barss
- Human Neurophysiology Laboratory, Faculty of Physical Education and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Emily N Ainsley
- Human Neurophysiology Laboratory, Faculty of Physical Education and Recreation, University of Alberta, Edmonton, AB, Canada; Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
| | - Francisca C Claveria-Gonzalez
- Human Neurophysiology Laboratory, Faculty of Physical Education and Recreation, University of Alberta, Edmonton, AB, Canada; Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - M John Luu
- Human Neurophysiology Laboratory, Faculty of Physical Education and Recreation, University of Alberta, Edmonton, AB, Canada; Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
| | - Dylan J Miller
- Human Neurophysiology Laboratory, Faculty of Physical Education and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Matheus J Wiest
- Human Neurophysiology Laboratory, Faculty of Physical Education and Recreation, University of Alberta, Edmonton, AB, Canada; Biomechanics Laboratory, Department of Physical Education, Federal University of Santa Catarina, Florianópolis, Brazil
| | - David F Collins
- Human Neurophysiology Laboratory, Faculty of Physical Education and Recreation, University of Alberta, Edmonton, AB, Canada; Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada.
| |
Collapse
|
7
|
Doll BD, Kirsch NA, Bao X, Dicianno BE, Sharma N. Dynamic optimization of stimulation frequency to reduce isometric muscle fatigue using a modified Hill-Huxley model. Muscle Nerve 2017; 57:634-641. [PMID: 28833237 DOI: 10.1002/mus.25777] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 08/07/2017] [Accepted: 08/12/2017] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Optimal frequency modulation during functional electrical stimulation (FES) may minimize or delay the onset of FES-induced muscle fatigue. METHODS An offline dynamic optimization method, constrained to a modified Hill-Huxley model, was used to determine the minimum number of pulses that would maintain a constant desired isometric contraction force. RESULTS Six able-bodied participants were recruited for the experiments, and their quadriceps muscles were stimulated while they sat on a leg extension machine. The force-time (F-T) integrals and peak forces after the pulse train was delivered were found to be statistically significantly greater than the force-time integrals and peak forces obtained after a constant frequency train was delivered. DISCUSSION Experimental results indicated that the optimized pulse trains induced lower levels of muscle fatigue compared with constant frequency pulse trains. This could have a potential advantage over current FES methods that often choose a constant frequency stimulation train. Muscle Nerve 57: 634-641, 2018.
Collapse
Affiliation(s)
- Brian D Doll
- Bechtel Marine Propulsion Corporation, Pittsburgh, Pennsylvania, USA
| | | | - Xuefeng Bao
- Department of Mechanical Engineering and Materials Science, 636 Benedum Hall, University of Pittsburgh, Pittsburgh, Pennsylvania, 15261, USA
| | - Brad E Dicianno
- Department of Physical Medicine and Rehabilitation Science, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nitin Sharma
- Department of Mechanical Engineering and Materials Science, 636 Benedum Hall, University of Pittsburgh, Pittsburgh, Pennsylvania, 15261, USA.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
8
|
Aksöz EA, Laubacher M, Binder-Macleod S, Hunt KJ. Effect of Stochastic Modulation of Inter-Pulse Interval During Stimulated Isokinetic Leg Extension. Eur J Transl Myol 2016; 26:6160. [PMID: 27990242 PMCID: PMC5128975 DOI: 10.4081/ejtm.2016.6160] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Recumbent cycling exercise achieved by functional electrical stimulation (FES) of the paralyzed leg muscles is effective for cardiopulmonary and musculoskeletal conditioning after spinal cord injury, but its full potential has not yet been realized. Mechanical power output and efficiency is very low and endurance is limited due to early onset of muscle fatigue. The aim of this work was to compare stochastic modulation of the inter-pulse interval (IPI) to constant-frequency stimulation during an isokinetic leg extension task similar to FES-cycling. Seven able-bodied subjects participated: both quadriceps muscles were stimulated (n = 14) with two activation patterns (P1-constant frequency, P2-stochastic IPI). There was significantly higher power output with P2 during the first 30 s (p = 0.0092), the last 30 s (p = 0.018) and overall (p = 0.0057), but there was no overall effect on fatiguability when stimulation frequency was randomly modulated.
Collapse
Affiliation(s)
- Efe Anil Aksöz
- Institute for Rehabilitation and Performance Technology, Bern University of Applied Sciences, Burgdorf, Switzerland; Sensory Motor Systems Lab, ETH Zurich, Zürich, Switzerland
| | - Marco Laubacher
- Institute for Rehabilitation and Performance Technology, Bern University of Applied Sciences, Burgdorf, Switzerland; Sensory Motor Systems Lab, ETH Zurich, Zürich, Switzerland
| | | | - Kenneth J Hunt
- Institute for Rehabilitation and Performance Technology, Bern University of Applied Sciences , Burgdorf, Switzerland
| |
Collapse
|
9
|
Cometti C, Babault N, Deley G. Effects of Constant and Doublet Frequency Electrical Stimulation Patterns on Force Production of Knee Extensor Muscles. PLoS One 2016; 11:e0155429. [PMID: 27167066 PMCID: PMC4864221 DOI: 10.1371/journal.pone.0155429] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 04/28/2016] [Indexed: 11/30/2022] Open
Abstract
This study compared knee extensors’ neuromuscular fatigue in response to two 30-minute stimulation patterns: constant frequency train (CFT) and doublet frequency train (DFT). Fifteen men underwent two separate sessions corresponding to each pattern. Measurements included torque evoked by each contraction and maximal voluntary contractions (MVC) measured before and immediately after the stimulation sessions. In addition, activation level and torque evoked during doublets (Pd) and tetanic contractions at 80-Hz (P80) and 20-Hz (P20) were determined in six subjects. Results indicated greater mean torque during the DFT stimulation session as compared with CFT. But, no difference was obtained between the two stimulation patterns for MVC and evoked torque decreases. Measurements conducted in the subgroup depicted a significant reduction of Pd, P20 and P80. Statistical analyses also revealed bigger P20 immediate reductions after CFT than after DFT. We concluded that DFT could be a useful stimulation pattern to produce and maintain greater force with quite similar fatigue than CFT.
Collapse
Affiliation(s)
- Carole Cometti
- INSERM U1093, "Cognition, Action, et Plasticité Sensorimotrice", Faculté des Sciences du Sport, Université de Bourgogne-Franche-Comté, Dijon, France
- Centre d'Expertise de la Performance, Faculté des Sciences du Sport, Université de Bourgogne-Franche-Comté, Dijon, France
| | - Nicolas Babault
- INSERM U1093, "Cognition, Action, et Plasticité Sensorimotrice", Faculté des Sciences du Sport, Université de Bourgogne-Franche-Comté, Dijon, France
- Centre d'Expertise de la Performance, Faculté des Sciences du Sport, Université de Bourgogne-Franche-Comté, Dijon, France
- * E-mail:
| | - Gaëlle Deley
- INSERM U1093, "Cognition, Action, et Plasticité Sensorimotrice", Faculté des Sciences du Sport, Université de Bourgogne-Franche-Comté, Dijon, France
- Centre d'Expertise de la Performance, Faculté des Sciences du Sport, Université de Bourgogne-Franche-Comté, Dijon, France
| |
Collapse
|
10
|
Deley G, Denuziller J, Babault N, Taylor JA. Effects of electrical stimulation pattern on quadriceps isometric force and fatigue in individuals with spinal cord injury. Muscle Nerve 2015; 52:260-4. [DOI: 10.1002/mus.24530] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2014] [Indexed: 11/07/2022]
Affiliation(s)
- Gaelle Deley
- INSERM - U1093 Cognition; Action; et Plasticité Sensorimotrice; Université de Bourgogne; Dijon France
- Cardiovascular Research Laboratory; Spaulding Rehabilitation Hospital; and Department of Physical Medicine and Rehabilitation; Harvard Medical School; Boston Massachusetts USA
| | - Jeremy Denuziller
- INSERM - U1093 Cognition; Action; et Plasticité Sensorimotrice; Université de Bourgogne; Dijon France
| | - Nicolas Babault
- INSERM - U1093 Cognition; Action; et Plasticité Sensorimotrice; Université de Bourgogne; Dijon France
| | - John Andrew Taylor
- Cardiovascular Research Laboratory; Spaulding Rehabilitation Hospital; and Department of Physical Medicine and Rehabilitation; Harvard Medical School; Boston Massachusetts USA
| |
Collapse
|
11
|
Feasibility of neuromuscular electrical stimulation immediately after cardiovascular surgery. Arch Phys Med Rehabil 2014; 96:63-8. [PMID: 25218214 DOI: 10.1016/j.apmr.2014.08.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 08/07/2014] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To determine the safety and feasibility of neuromuscular electrical stimulation (NMES) from postoperative days (PODs) 1 to 5 after cardiovascular surgery. DESIGN Pre-post interventional study. SETTING Surgical intensive care unit and thoracic surgical ward of a university hospital. PARTICIPANTS Consecutive patients (N=144) who underwent cardiovascular surgery were included. Patients with peripheral arterial disease, psychiatric disease, neuromuscular disease, and dementia were excluded. Patients with severe chronic renal failure and those who required prolonged mechanical ventilation after surgery were also excluded because of the possibility of affecting the outcome of a future controlled study. INTERVENTIONS NMES to the lower extremities was implemented from PODs 1 to 5. MAIN OUTCOME MEASURES Feasibility outcomes included compliance, the number of the patients who had changes in systolic blood pressure (BP) >20 mmHg or an increase in heart rate >20 beats/min during NMES, and the incidence of temporary pacemaker malfunction or postoperative cardiac arrhythmias. RESULTS Sixty-eight of 105 eligible patients participated in this study. Sixty-one (89.7%) of them completed NMES sessions. We found no patients who had excessive changes in systolic blood pressure, increased heart rate, or pacemaker malfunction during NMES. Incidence of atrial fibrillation during the study period was 26.9% (7/26) for coronary artery bypass surgery, 18.2% (4/22) for valvular surgery, and 20.0% (4/20) for combined or aortic surgery. No sustained ventricular arrhythmia or ventricular fibrillation was observed. CONCLUSIONS The results of this study demonstrate that NMES can be safely implemented even in patients immediately after cardiovascular surgery.
Collapse
|
12
|
Deley G, Denuziller J, Babault N, Taylor J. Effects of electrical stimulation pattern on quadriceps isometric force and fatigue in individuals with spinal cord injury. Ann Phys Rehabil Med 2014. [DOI: 10.1016/j.rehab.2014.03.860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
13
|
Deley G, Denuziller J, Babault N, Taylor J. Effets du pattern d’électrostimulation sur la force isométrique du quadriceps chez les personnes lésées médullaires. Ann Phys Rehabil Med 2014. [DOI: 10.1016/j.rehab.2014.03.891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
14
|
Minogue CM, Caulfield BM, Lowery MM. Whole body oxygen uptake and evoked torque during subtetanic isometric electrical stimulation of the quadriceps muscles in a single 30-minute session. Arch Phys Med Rehabil 2014; 95:1750-8. [PMID: 24769070 DOI: 10.1016/j.apmr.2014.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 03/14/2014] [Accepted: 04/04/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the time course of fatigue in torque output and oxygen uptake during isometric subtetanic neuromuscular electrical stimulation (NMES) to facilitate the design of NMES-based rehabilitation protocols that can accumulate a defined aerobic exercise volume within a given time period. DESIGN Single-arm intervention study with within-subject comparisons. SETTING University research laboratory. PARTICIPANTS Volunteer sample of healthy men (N=11; mean age, 34.2 ± 11.5 y; range, 19-53 y; body mass, 79.1 ± 11.7 kg; range, 58-100 kg). INTERVENTION A single 30-minute session of continuous bilateral isometric quadriceps NMES at 4 Hz evoking a mean twitch amplitude of 12% of the maximum voluntary contraction. MAIN OUTCOME MEASURES Whole body oxygen consumption rate (V˙o2), and evoked torque were measured simultaneously throughout. RESULTS Mean increment in V˙o2 was 596 ± 238 mL/min, and average exercise intensity during the session was 3 ±.47 metabolic equivalents. The V˙o2 and torque declined slowly at a rate of -.54%±.31% and -.47%±.57% per minute, respectively. CONCLUSIONS Despite having a higher incremental V˙o2, the observed fatigue rate was considerably less than that previously reported during intermittent isometric tetanic stimulation, suggesting that subtetanic isometric NMES is more sustainable for exercise interventions aimed at accumulating a therapeutic aerobic exercise volume.
Collapse
Affiliation(s)
- Conor M Minogue
- School of Electrical, Electronic and Communications Engineering, University College, Dublin, Ireland.
| | - Brian M Caulfield
- School of Public Health, Physiotherapy and Population Science, University College, Dublin, Ireland
| | - Madeleine M Lowery
- School of Electrical, Electronic and Communications Engineering, University College, Dublin, Ireland
| |
Collapse
|
15
|
Deley G, Laroche D, Babault N. Effects of electrical stimulation pattern on quadriceps force production and fatigue. Muscle Nerve 2014; 49:760-3. [PMID: 24639131 DOI: 10.1002/mus.24210] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 02/05/2014] [Accepted: 02/10/2014] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Mixed stimulation programs (MIX) that switch from constant frequency trains (CFT) to variable frequency trains have been proposed to offset the rapid fatigue induced by CFT during electrical stimulation. However, this has never been confirmed with long stimulation patterns, such as those used to evoke functional contractions. The purpose of this study was to test the hypothesis that MIX programs were less fatiguing than CFTs in strength training-like conditions (6-s contractions, 30-min). METHODS Thirteen healthy subjects underwent 2 sessions corresponding to MIX and CFT programs. Measurements included maximal voluntary isometric torque and torque evoked by each contraction. RESULTS There were greater decreases of voluntary and evoked torque (P < 0.05) after CFT than MIX, and mean torque was 13 ± 1% higher during the MIX session (P < 0.05). CONCLUSIONS These findings confirm that combining train types might be a useful strategy to offset rapid fatigue during electrical stimulation sessions with long-duration contractions.
Collapse
Affiliation(s)
- Gaelle Deley
- INSERM - U1093, Cognition, Action, et Plasticité Sensorimotrice, Université de Bourgogne, Dijon, Bourgogne, France
| | | | | |
Collapse
|
16
|
Papaiordanidou M, Billot M, Varray A, Martin A. Neuromuscular fatigue is not different between constant and variable frequency stimulation. PLoS One 2014; 9:e84740. [PMID: 24392155 PMCID: PMC3879309 DOI: 10.1371/journal.pone.0084740] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 11/27/2013] [Indexed: 11/18/2022] Open
Abstract
This study compared fatigue development of the triceps surae induced by two electrical stimulation protocols composed of constant and variable frequency trains (CFTs, VFTs, 450 trains, 30 Hz, 167 ms ON, 500 ms OFF and 146 ms ON, 500 ms OFF respectively). For the VFTs protocol a doublet (100 Hz) was used at the beginning of each train. The intensity used evoked 30% of a maximal voluntary contraction (MVC) and was defined using CFTs. Neuromuscular tests were performed before and after each protocol. Changes in excitation-contraction coupling were assessed by analysing the M-wave [at rest (Mmax) and during MVC (Msup)] and associated peak twitch (Pt). H-reflex [at rest (Hmax) and during MVC (Hsup)] and the motor evoked potential (MEP) during MVC were studied to assess spinal and corticospinal excitability of the soleus muscle. MVC decrease was similar between the protocols (−8%, P<0.05). Mmax, Msup and Pt decreased after both protocols (P<0.01). Hmax/Mmax was decreased (P<0.05), whereas Hsup/Msup and MEP/Msup remained unchanged after both protocols. The results indicate that CFTs and VFTs gave rise to equivalent neuromuscular fatigue. This fatigue resulted from alterations taking place at the muscular level. The finding that cortical and spinal excitability remained unchanged during MVC indicates that spinal and/or supraspinal mechanisms were activated to compensate for the loss of spinal excitability at rest.
Collapse
Affiliation(s)
- Maria Papaiordanidou
- Aix-Marseille University, CNRS, ISM UMR 7287, Marseille, France
- Movement to Health Laboratory, Euromov, Montpellier 1 University, Montpellier, France
- * E-mail:
| | - Maxime Billot
- Movement to Health Laboratory, Euromov, Montpellier 1 University, Montpellier, France
- GRAME, Faculté de Médecine, Département de Kinésiologie, Université Laval, Québec, Canada
| | - Alain Varray
- Movement to Health Laboratory, Euromov, Montpellier 1 University, Montpellier, France
| | - Alain Martin
- INSERM U1093 Cognition, Action et Plasticité Sensorimotrice, Université de Bourgogne, UFR STAPS, Dijon, France
| |
Collapse
|
17
|
van Lunteren E, Moyer M. The Effects of K(+) Channel Blockade on Eccentric and Isotonic Twitch and Fatiguing Contractions in situ. Front Physiol 2012; 3:383. [PMID: 23060809 PMCID: PMC3460371 DOI: 10.3389/fphys.2012.00383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 09/08/2012] [Indexed: 11/16/2022] Open
Abstract
K(+) channel blockers like 3,4-diaminopyridine (DAP) can double isometric muscle force. Functional movements require more complex concentric and eccentric contractions, however the effects of K(+) channel blockade on these types of contractions in situ are unknown. Extensor digitorum longus (EDL) muscles were stimulated in situ with and without DAP in anesthetized rats and fatigability was addressed using a series of either concentric or eccentric contractions. During isotonic protocols (5-100% load), DAP significantly shifted shortening- and maximum shortening velocity-load curves upward and to the right and increased power and work. Maximum shortening, maximum shortening velocity, and power doubled while work increased by ∼250% during isotonic contraction at 50% load. During isotonic fatigue, DAP significantly augmented maximum shortening, work, shortening velocity, and power. During constant velocity eccentric protocols (2-12 mm/s), DAP increased muscle force during eccentric contractions at 6, 8, 10, and 12 mm/s. During eccentric contraction at a constant velocity of 6 mm/s while varying the stimulation frequency, DAP significantly increased muscle force during 20, 40, and 70 Hz. The effects of DAP on muscle contractile performance during eccentric fatigue varied with level of fatigue. DAP-induced contractile increases during isotonic contractions were similar to those produced during previously studied isometric contractions, while the DAP effect during eccentric contractions was more modest. These findings are especially important in attempting to optimize functional electrical stimulation parameters for spinal cord injury patients while also preventing rapid fatigue of those muscles.
Collapse
Affiliation(s)
- Erik van Lunteren
- Pulmonary, Critical Care and Sleep Division, Department of Medicine, Cleveland VA Medical Center, Case Western Reserve UniversityCleveland, OH, USA
| | - Michelle Moyer
- Pulmonary, Critical Care and Sleep Division, Department of Medicine, Cleveland VA Medical Center, Case Western Reserve UniversityCleveland, OH, USA
| |
Collapse
|
18
|
Abstract
The existing functional electrical stimulation (FES) techniques often required to solve the complex "inverse dynamic problem" to calculate the muscle torques for moving along a desired trajectory. According to the threshold control theory of voluntary motor control, a bio-mimetic threshold control strategy for the FES controller is designed and tested in the human arm movement. The arm is modeled as three segments connected by two hinges joints. The movement is driven by seven muscles and limited in the horizontal plane. All muscles are described by a modified Hill-type muscle model. Simulation results suggest that the threshold FES control system can realize point to point movement and can approximately follow the desired traces in presence of feedback delays up to 20 ms. The movement can also maintain stability under external perturbation or external load. The control system can be employed in clinical application because of the following advantages: (1) The control strategy includes some mature control techniques which had been realized in hardware. (2) Only sophisticated sensors of goniometer and the surface electrodes are needed to provide feedbacks and muscle stimulation. (3) The performance of the control system will not be critically influenced by the slight change of musculo-tendon parameters and feedback delays, and even the parameters of controller are fixed.
Collapse
Affiliation(s)
- L. LAN
- School of Electrical and Electronic Engineering, Nanyang Technological University, Singapore
| | - K. Y. ZHU
- School of Electrical and Electronic Engineering, Nanyang Technological University, Singapore
| | - C. Y. WEN
- School of Electrical and Electronic Engineering, Nanyang Technological University, Singapore
| |
Collapse
|
19
|
Nguyen R, Masani K, Micera S, Morari M, Popovic MR. Spatially distributed sequential stimulation reduces fatigue in paralyzed triceps surae muscles: a case study. Artif Organs 2011; 35:1174-80. [PMID: 21501192 DOI: 10.1111/j.1525-1594.2010.01195.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Functional electrical stimulation (FES) is limited by the rapid onset of muscle fatigue caused by localized nerve excitation repeatedly activating only a subset of motor units. The purpose of this study was to investigate reducing fatigue by sequentially changing, pulse by pulse, the area of stimulation using multiple surface electrodes that cover the same area as one electrode during conventional stimulation. Paralyzed triceps surae muscles of an individual with complete spinal cord injury were stimulated, via the tibial nerve, through four active electrodes using spatially distributed sequential stimulation (SDSS) that was delivered by sending a stimulation pulse to each electrode one after another with 90° phase shift between successive electrodes. For comparison, single electrode stimulation was delivered through one active electrode. For both modes of stimulation, the resultant frequency to the muscle as a whole was 40 Hz. Isometric ankle torque was measured during fatiguing stimulations lasting 2 min. Each mode of stimulation was delivered a total of six times over 12 separate days. Three fatigue measures were used for comparison: fatigue index (final torque normalized to maximum torque), fatigue time (time for torque to drop by 3 dB), and torque-time integral (over the entire trial). The measures were all higher during SDSS (P < 0.001), by 234, 280, and 171%, respectively. The results are an encouraging first step toward addressing muscle fatigue, which is one of the greatest problems for FES.
Collapse
Affiliation(s)
- Robert Nguyen
- Automatic Control Laboratory, ETH Zurich, Switzerland
| | | | | | | | | |
Collapse
|
20
|
de Vaal MH, Neville J, Scherman J, Zilla P, Litow M, Franz T. Mechanical loadings on pectoral pacemaker implants: correlation of in-line and transverse force of the Pectoralis major. Ann Biomed Eng 2010; 38:3338-46. [PMID: 20526676 DOI: 10.1007/s10439-010-0085-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2010] [Accepted: 05/23/2010] [Indexed: 11/28/2022]
Abstract
Recently we presented a method for the assessment of in vivo forces on pectoral device implants motivated from technological and clinical advancements toward smaller implantable cardiac pacemakers and the altered structural demands arising from the reduced device size. Objective of this study was the investigation of the intra-species proportionality of in-line force and transverse reaction force of the Pectoralis major for the characterization of mechanical in vivo loadings on pectoral implants. Two Chacma baboons (23.9 ± 1.2 kg) received bilaterally one chronic and one acute pectoral sub-muscular instrumented pacemaker (IPM) implant. The Pectoralis major muscle was electrically stimulated and resulting in-line and transverse muscle force were measured. The correlation of in-line force and transverse force of the Pectoralis major was investigated using linear regression analyses. The proportionality of in-line and transverse force of the Pectoralis major was found to be subject-specific (R² = 0.17, p < 0.003). Including morphometric parameters, i.e., length along line of action, width over implant and stress, in the regression analysis provided a strong intra-species correlation between in-line and transverse force (R² = 0.71, p < 10⁻⁷). The novel intra-species correlation provides a tool toward the characterization of mechanical in vivo loading conditions of pectoral device implants.
Collapse
Affiliation(s)
- M H de Vaal
- Cardiovascular Research Unit, Chris Barnard Department of Cardiothoracic Surgery, Faculty of Health Sciences, University of Cape Town, Private Bag X3, 7935 Observatory, Cape Town, South Africa
| | | | | | | | | | | |
Collapse
|
21
|
Novel patterns of functional electrical stimulation have an immediate effect on dorsiflexor muscle function during gait for people poststroke. Phys Ther 2010; 90:55-66. [PMID: 19926681 PMCID: PMC2802826 DOI: 10.2522/ptj.20090140] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Foot drop is a common gait impairment after stroke. Functional electrical stimulation (FES) of the ankle dorsiflexor muscles during the swing phase of gait can help correct foot drop. Compared with constant-frequency trains (CFTs), which typically are used during FES, novel stimulation patterns called variable-frequency trains (VFTs) have been shown to enhance isometric and nonisometric muscle performance. However, VFTs have never been used for FES during gait. OBJECTIVE The purpose of this study was to compare knee and ankle kinematics during the swing phase of gait when FES was delivered to the ankle dorsiflexor muscles using VFTs versus CFTs. DESIGN A repeated-measures design was used in this study. PARTICIPANTS Thirteen individuals with hemiparesis following stroke (9 men, 4 women; age=46-72 years) participated in the study. METHODS Participants completed 20- to 40-second bouts of walking at their self-selected walking speeds. Three walking conditions were compared: walking without FES, walking with dorsiflexor muscle FES using CFTs, and walking with dorsiflexor FES using VFTs. RESULTS Functional electrical stimulation using both CFTs and VFTs improved ankle dorsiflexion angles during the swing phase of gait compared with walking without FES (X+/-SE=-2.9 degrees +/- 1.2 degrees). Greater ankle dorsiflexion in the swing phase was generated during walking with FES using VFTs (X+/-SE=2.1 degrees +/- 1.5 degrees) versus CFTs (X+/-SE=0.3+/-1.3 degrees). Surprisingly, dorsiflexor FES resulted in reduced knee flexion during the swing phase and reduced ankle plantar flexion at toe-off. CONCLUSIONS The findings suggest that novel FES systems capable of delivering VFTs during gait can produce enhanced correction of foot drop compared with traditional FES systems that deliver CFTs. The results also suggest that the timing of delivery of FES during gait is critical and merits further investigation.
Collapse
|
22
|
LEE SAMUELCK, DING JUN, PROSSER LAURAA, WEXLER ANTHONYS, BINDER-MACLEOD STUARTA. A predictive mathematical model of muscle forces for children with cerebral palsy. Dev Med Child Neurol 2009; 51:949-58. [PMID: 19703211 PMCID: PMC7935412 DOI: 10.1111/j.1469-8749.2009.03350.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM The purpose of this study was to determine if our previously developed muscle model could be used to predict forces of the quadriceps femoris and triceps surae muscles of children with spastic diplegic cerebral palsy (CP). METHOD Twenty-two children with CP (12 males, 10 females; mean age 10y, SD 2y, range 7-13y; Gross Motor Function Classification System levels II and III) participated. A physiologically based mathematical model with four free parameters is presented. RESULTS For individuals with CP, the model predicted well the force profile throughout each contraction and both peak force and force-time integral responses to a wide range of stimulation frequencies (5-100Hz) and different stimulation patterns (constant-, variable-, and doublet-frequency trains) both for nonfatigued and fatigued muscles. INTERPRETATION The significance of this work is the insight the model can provide into the physiology of muscle in CP. Additionally, the model can potentially be applied clinically to design optimal electrical stimulation patterns for interventions to address impairments in strength and function in individuals with CP, such as functional electrical stimulation-assisted cycling.
Collapse
Affiliation(s)
- SAMUEL C K LEE
- Department of Physical Therapy, University of Delaware, Newark, DE, USA.,Research Department, Shriners Hospitals for Children, Philadelphia, PA 19140, USA
| | - JUN DING
- Department of Physical Therapy, University of Delaware, Newark, DE, USA
| | - LAURA A PROSSER
- Department of Physical Therapy, University of Delaware, Newark, DE, USA.,Research Department, Shriners Hospitals for Children, Philadelphia, PA 19140, USA
| | - ANTHONY S WEXLER
- Departments of Mechanical and Aeronautical Engineering, Civil and Environmental Engineering, and Land and Water resources, University of California, Davis, CA, USA
| | | |
Collapse
|
23
|
Holtermann A, Grönlund C, Ingebrigtsen J, Karlsson JS, Roeleveld K. Duration of differential activations is functionally related to fatigue prevention during low-level contractions. J Electromyogr Kinesiol 2009; 20:241-5. [PMID: 19481957 DOI: 10.1016/j.jelekin.2009.04.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2008] [Revised: 04/30/2009] [Accepted: 04/30/2009] [Indexed: 10/20/2022] Open
Abstract
The aim of this study was to investigate the importance of duration of differential activations between the heads of the biceps brachii on local fatigue during prolonged low-level contractions. Fifteen subjects carried out isometric elbow flexion at 5% of maximal voluntary contraction (MVC) for 30 min. MVCs were performed before and at the end of the prolonged contraction. Surface electromyographic (EMG) signals were recorded from both heads of the biceps brachii. Differential activation was analysed based on the difference in EMG amplitude (activation) between electrodes situated at the two heads. Differential activations were quantified by the power spectral median frequency of the difference in activation between the heads throughout the contraction. The inverse of the median frequency was used to describe the average duration of the differential activations. The relation between average duration of the differential activations and the fatigue-induced reduction in maximal force was explored by linear regression analysis. The main finding was that the average duration of differential activation was positively associated to relative maximal force at the end of the 30 min contraction (R(2)=0.5, P<0.01). The findings of this study highlight the importance of duration of differential activations for local fatigue, and support the hypothesis that long term differential activations prevent fatigue during prolonged low-level contractions.
Collapse
Affiliation(s)
- A Holtermann
- Human Movement Sciences Programme, Norwegian University of Science and Technology, Trondheim, Norway.
| | | | | | | | | |
Collapse
|
24
|
Abstract
Neuromuscular electrical stimulation can improve motor function in those affected by paralysis, but its use is limited by a high rate of muscular fatigue. Variable stimulation patterns have been examined in young adults with and without spinal cord injury, but much less investigation has been devoted to studying the effects of variable stimulation patterns administered to older adults or those paralyzed by stroke. Significant changes occur in the neuromuscular system with age that may affect the response to variable stimulation patterns. We administered three, 3-min intermittent stimulation patterns to the median nerves of 10 individuals with hemiplegia from stroke and 10 age-matched able-bodied adults: (1) constant 20 HZ, (2) a pattern that began at 20 HZ and progressively increased to 40 HZ in the latter half of the task, and (3) a 20-HZ pattern that switched to a 20-HZ doublet pattern after 90 s. In the able-bodied group the doublet pattern produced significantly higher force time integrals (FTI) (1409.72 +/- 3.15 N s) than the 20-40-HZ pattern (1067.46 +/- 1.15 N s) or the 20-HZ pattern (831 +/- 1.87 N s). In the poststroke individuals the doublet pattern also produced the highest FTI (724.04 +/- 2.02 N s), and there was no significant difference between the 20-40-HZ (636.42 +/- 1.65 N s) and 20-HZ (583.64 +/- 3.02 N s) patterns. These results indicate that protocols that incorporate doublets in the later stages of fatigue are effective in older adults and in older adults with paralysis from stroke.
Collapse
Affiliation(s)
- Barbara M Doucet
- Department of Occupational Therapy, University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | | |
Collapse
|
25
|
Effect of burst frequency and duration of kilohertz-frequency alternating currents and of low-frequency pulsed currents on strength of contraction, muscle fatigue, and perceived discomfort. Phys Ther 2008; 88:1167-76. [PMID: 18703676 DOI: 10.2522/ptj.20080001] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Low-frequency pulsed currents (LPCs) and kilohertz-frequency alternating currents (KACs) are used clinically to augment muscle contractions. Treatment effectiveness may be enhanced by selecting stimulation parameters that evoke the strongest contractions with minimal discomfort and fatigue. OBJECTIVE The objective of this study was to compare maximally induced strength (force-producing capacity) of contractions, muscle fatigue, and discomfort associated with an LPC and with 3 KACs differing in frequency and duration of burst modulation. DESIGN This was a repeated-measures trial, with randomized order of current presentation. SETTING The study was conducted in the physical therapy laboratory at the University of Haifa. SUBJECTS Twenty-six volunteers without impairments, with a mean age of 27.4 years (SD=5.0, range=21-45), participated. INTERVENTION All currents were applied in separate sessions to the wrist extensors of each subject. Currents consisted of an LPC with a 50-Hz pulse frequency and 3 KACs with a 2.5-kHz carrier frequency, including the "Russian current" (RC) burst modulated at 50 Hz with 25 cycles per burst and 2 currents burst modulated at 20 or 50 Hz with 10 cycles per burst. MEASUREMENT The maximal electrically induced isometric force, the force integral of 21 electrically induced consecutive contractions, and the degree of discomfort were recorded. RESULTS Force of contraction was not affected by type of current. The LPC was least fatiguing, and the RC was most fatiguing, with the 2 other KACs having an intermediate effect. Degree of discomfort was higher with the KAC modulated at 20 Hz. CONCLUSIONS When comfort, strength, and fatigue are considered jointly, the LPC is advantageous. Electrically induced fatigue is affected by the number of cycles per second, rather than the number of bursts per second.
Collapse
|
26
|
Cairns SP, Robinson DM, Loiselle DS. Double-sigmoid model for fitting fatigue profiles in mouse fast- and slow-twitch muscle. Exp Physiol 2008; 93:851-62. [DOI: 10.1113/expphysiol.2007.041285] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
27
|
Ding J, Chou LW, Kesar TM, Lee SCK, Johnston TE, Wexler AS, Binder-Macleod SA. Mathematical model that predicts the force-intensity and force-frequency relationships after spinal cord injuries. Muscle Nerve 2007; 36:214-22. [PMID: 17503498 PMCID: PMC2633444 DOI: 10.1002/mus.20806] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
We have previously developed and tested a muscle model that predicts the effect of stimulation frequency on muscle force responses. The aim of this study was to enhance our isometric mathematical model to predict muscle forces in response to stimulation trains with a wide range of frequencies and intensities for the quadriceps femoris muscles of individuals with spinal cord injuries. Isometric forces were obtained experimentally from 10 individuals with spinal cord injuries (time after injury, 1.5-8 years) and then compared to forces predicted by the model. Our model predicted accurately the force-time integrals (FTI) and peak forces (PF) for stimulation trains of a wide range of frequencies (12.5-80 HZ) and intensities (150-600-mus pulse duration), and two different stimulation patterns (constant-frequency trains and doublet-frequency trains). The accurate predictions of our model indicate that our model, which now incorporates the effects of stimulation frequency, intensity, and pattern on muscle forces, can be used to design optimal customized stimulation strategies for spinal cord-injured patients.
Collapse
Affiliation(s)
- Jun Ding
- Interdisciplinary Graduate Program in Biomechanics and Movement Science, University of Delaware, Newark, Delaware, USA
| | | | | | | | | | | | | |
Collapse
|
28
|
Indurthy M, Griffin L. Effect of random interpulse interval modulation on neuromuscular fatigue. Muscle Nerve 2007; 36:807-15. [PMID: 17724736 DOI: 10.1002/mus.20882] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Neuromuscular endurance during electrical stimulation may be enhanced if naturally occurring motor unit firing patterns are used. Variability in the interpulse interval (IPI) distribution may enable brief periods of rest and optimization of force output. Nine individuals participated in three 3-minute fatigue protocols of the thenar muscles elicited by supramaximal stimulation of the median nerve. All protocols consisted of a mean IPI of 33.3 ms and differed only in the type of IPI modulation, which was constant (0%), random (+/-20%), or ramped from 0% to +/-20%. M-wave amplitude declined following all protocols and the reduction was smallest following the ramp protocol. There was no significant difference among the starting or final forces or between the overall force-time integrals for the three protocols. Thus, IPI variability did not improve endurance time during electrical stimulation and the M-wave amplitude was not a reliable indicator of muscle force output.
Collapse
Affiliation(s)
- Maritha Indurthy
- Department of Mechanical Engineering, University of Texas at Austin, Austin, Texas, USA
| | | |
Collapse
|
29
|
Maladen RD, Perumal R, Wexler AS, Binder-Macleod SA. Effects of activation pattern on nonisometric human skeletal muscle performance. J Appl Physiol (1985) 2007; 102:1985-91. [PMID: 17272410 DOI: 10.1152/japplphysiol.00729.2006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
During volitional muscle activation, motor units often fire with varying discharge patterns that include brief, high-frequency bursts of activity. These variations in the activation rate allow the central nervous system to precisely control the forces produced by the muscle. The present study explores how varying the instantaneous frequency of stimulation pulses within a train affects nonisometric muscle performance. The peak excursion produced in response to each stimulation train was considered as the primary measure of muscle performance. The results showed that at each frequency tested between 10 and 50 Hz, variable-frequency trains that took advantage of the catchlike property of skeletal muscle produced greater excursions than constant-frequency trains. In addition, variable-frequency trains that could achieve targeted trajectories with fewer pulses than constant-frequency trains were identified. These findings suggest that similar to voluntary muscle activation patterns, varying the instantaneous frequency within a train of pulses can be used to improve muscle performance during functional electrical stimulation.
Collapse
Affiliation(s)
- Ryan D Maladen
- Dept. of Physical Therapy, University of Delaware, Newark, DE, USA
| | | | | | | |
Collapse
|
30
|
Scott WB, Lee SCK, Johnston TE, Binkley J, Binder-Macleod SA. Effect of electrical stimulation pattern on the force responses of paralyzed human quadriceps muscles. Muscle Nerve 2007; 35:471-8. [PMID: 17212347 DOI: 10.1002/mus.20717] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Most studies examining the effect of electrical stimulation pattern on the force response of muscle have been done in able-bodied persons. The purpose of this study was to examine the electrically elicited force responses of the paralyzed quadriceps femoris muscles of persons with spinal cord injuries (SCI) to see whether stimulation patterns that increase the force response in non-paralyzed muscle will do so in paralyzed muscle. Thirteen subjects ranging in age from 11 to 24 years old with motor-complete SCI were studied. Isometric muscle performance was tested using 6-pulse constant-frequency trains (CFTs), variable-frequency trains (VFTs), and doublet-frequency trains (DFTs) delivered at mean frequencies of 10, 20, 33, 50, and 100 HZ. In the non-fatigued and fatigued condition, the VFT and DFT peak forces were greater than the CFT peak forces at 10 HZ. In addition, in the fatigued condition the 20-HZ VFT peak forces were greater than the CFT peak forces, and there was a trend for the DFT peak forces to be greater than the CFT peak forces. In the non-fatigued condition, the 33-HZ and 50-HZ DFT force-time integrals were greater than both the CFT and VFT force-time integrals. In the fatigued condition, there was no significant effect of train-type on the force-time integrals. These results differ from those previously reported from studies using able-bodied persons and indicate that findings from studies of the electrically elicited force responses of the muscles of able-bodied persons do not apply to the paralyzed muscles of persons with SCI.
Collapse
Affiliation(s)
- Wayne B Scott
- Graduate Program in Biomechanics and Movement Science, University of Delaware, Newark, Delaware, USA.
| | | | | | | | | |
Collapse
|
31
|
Kesar T, Binder-Macleod S. Effect of frequency and pulse duration on human muscle fatigue during repetitive electrical stimulation. Exp Physiol 2006; 91:967-76. [PMID: 16873456 DOI: 10.1113/expphysiol.2006.033886] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Different combinations of stimulation frequency and intensity can generate a targeted force during functional electrical stimulation (FES). This study compared isometric performance and muscle fatigue during repetitive stimulation with three different combinations of frequency and pulse duration that produced the same initial peak forces: protocol 1 used long pulse duration (fixed at 600 micros) and 11.5 +/- 1.2 Hz (low frequency); protocol 2 used 30 Hz (medium frequency) and medium pulse duration (150 +/- 21 micros); and protocol 3 used 60 Hz (high frequency) and short pulse duration (131 +/- 24 micros). Twenty and 60 Hz pre- and postfatigue testing trains were delivered at the pulse duration used by the fatiguing trains and at 600 micros pulse duration. The percentage decline in peak force between the first and last fatiguing train of each protocol was the measure of muscle performance. The declines in peak force of the 60 Hz testing trains were used to measure muscle fatigue. The 20 Hz:60 Hz peak force ratio was used as a measure of low-frequency fatigue. The results showed that protocol 1 produced the least decline in peak force in response to the fatiguing trains, as well as the least muscle fatigue and low-frequency fatigue when the pulse duration was maintained at the level used by the fatiguing trains. Interestingly, protocol 2 produced the least muscle fatigue, and there were no differences in the levels of low-frequency fatigue across protocols when a comparable motor unit population was tested using 600 micros pulse duration. The results suggest that if the frequency and intensity are kept constant during FES, using the lowest frequency and longest pulse duration may maximize performance.
Collapse
Affiliation(s)
- Trisha Kesar
- Department of Physical Therapy, 301 McKinly Laboratory, University of Delaware, Newark, DE 19716, USA
| | | |
Collapse
|
32
|
Elder CP, Mahoney ET, Black CD, Slade JM, Dudley GA. Oxygen cost of dynamic or isometric exercise relative to recruited muscle mass. DYNAMIC MEDICINE : DM 2006; 5:9. [PMID: 16965630 PMCID: PMC1579205 DOI: 10.1186/1476-5918-5-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2005] [Accepted: 09/11/2006] [Indexed: 11/10/2022]
Abstract
BACKGROUND Oxygen cost of different muscle actions may be influenced by different recruitment and rate coding strategies. The purpose of this study was to account for these strategies by comparing the oxygen cost of dynamic and isometric muscle actions relative to the muscle mass recruited via surface electrical stimulation of the knee extensors. METHODS Comparisons of whole body pulmonary delta VO2 were made in seven young healthy adults (1 female) during 3 minutes of dynamic or isometric knee extensions, both induced by surface electrical stimulation. Recruited mass was quantified in T2 weighted spin echo magnetic resonance images. RESULTS The delta VO2 for dynamic muscle actions, 242 +/- 128 ml x min(-1) (mean +/- SD) was greater (p = 0.003) than that for isometric actions, 143 +/- 99 ml x min(-1). Recruited muscle mass was also greater (p = 0.004) for dynamic exercise, 0.716 +/- 282 versus 0.483 +/- 0.139 kg. The rate of oxygen consumption per unit of recruited muscle (VO2(RM)) was similar in dynamic and isometric exercise (346 +/- 162 versus 307 +/- 198 ml x kg(-1) x min(-1); p = 0.352), but the VO2(RM) calculated relative to initial knee extensor torque was significantly greater during dynamic exercise 5.1 +/- 1.5 versus 3.6 +/- 1.6 ml x kg(-1) x Nm(-1) x min(-1) (p = 0.019). CONCLUSION These results are consistent with the view that oxygen cost of dynamic and isometric actions is determined by different circumstances of mechanical interaction between actin and myosin in the sarcomere, and that muscle recruitment has only a minor role.
Collapse
Affiliation(s)
| | - Edward T Mahoney
- Department of Kinesiology, The University of Georgia, Athens, GA, USA
| | | | - Jill M Slade
- Department of Kinesiology, The University of Georgia, Athens, GA, USA
| | - Gary A Dudley
- Department of Kinesiology, The University of Georgia, Athens, GA, USA
- Crawford Research Institute, Shepherd Center, Atlanta, GA, USA
| |
Collapse
|
33
|
The Effect of Rest Intervals on Knee-Extension Torque Production with Neuromuscular Electrical Stimulation. J Sport Rehabil 2006. [DOI: 10.1123/jsr.15.2.116] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Context:Previous studies using neuromuscular electrical stimulation (NMES) have suggested that 30-second rest intervals are too short for sufficient recovery.Objective:To compare the effect of rest interval on knee-extension torque production.Design:Counterbalanced mixed design to test independent variable, rest interval; ANOVA to analyze dependent variable, percentage decline.Setting:Athletic training research laboratory.Participants:24 healthy men and women.Intervention:Participants performed knee extension under 2 contraction conditions, maximum voluntary isometric contraction (MVIC) and NMES with either 30- or 120-second rest between repetitions.Main Outcome Measure:Peak torque produced during each repetition of a 5-repetition set.Results:The main effect for rest interval was significant (F1,23= 30.30,P= .001), as was the main effect for condition (F1,23= 11.18,P= .003).Conclusions:A 120-second rest between repetitions is recommended when using NMES in early rehabilitation because force decline across repetitions with 30-second rest during NMES is greater than with MVIC.
Collapse
|
34
|
Shimada Y, Ito H, Matsunaga T, Misawa A, Kawatani M, Itoi E. Reduction of muscle fatigue by catchlike-inducing intermittent electrical stimulation in rat skeletal muscle. Biomed Res 2006; 27:183-9. [PMID: 16971771 DOI: 10.2220/biomedres.27.183] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Catchlike property is the force enhancement produced when a brief, high-frequency burst of pulses is added to a constant low-frequency stimulation. In functional electrical stimulation, constant low-frequency stimulation of approximately 20 Hz has primarily been used to reduce muscle fatigue. The purpose of this study was to investigate the effects of catchlike-inducing intermittent stimulation on muscle fatigue in relation to continuous intermittent low-frequency stimulation. Twenty-two adult male Wistar ST rats were randomly assigned into the constant frequency stimulation (CFS) group or the catchlike-inducing stimulation (CIS) group. In the CFS group, constant low-frequency stimulation of 20 Hz was applied intermittently (4 seconds "ON"/15 seconds "OFF"). In the CIS group, a single electrical burst of 100 Hz was applied at the start of the every 4-second period of stimulation. The muscle fatigue test lasted for 16 min and isometric muscle force, muscle fatigue, and muscular workload were evaluated. CIS significantly increased the maximum muscular force (under fatigued condition) and workload, and significantly decreased muscle fatigue (p < 0.05). The results of this study suggest that catchlike-inducing intermittent electrical stimulation is useful in the clinical administration of functional electrical stimulation.
Collapse
Affiliation(s)
- Yoichi Shimada
- Rehabilitation Division, Akita University School of Medicine, Akita, Japan.
| | | | | | | | | | | |
Collapse
|
35
|
Kurosawa K, Futami R, Watanabe T, Hoshimiya N. Joint angle control by FES using a feedback error learning controller. IEEE Trans Neural Syst Rehabil Eng 2005; 13:359-71. [PMID: 16200759 DOI: 10.1109/tnsre.2005.847355] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The feedback error learning (FEL) scheme was studied for a functional electrical stimulation (FES) controller. This FEL controller was a hybrid regulator with a feedforward and a feedback controller. The feedforward controller learned the inverse dynamics of a controlled object from feedback controller outputs while control. A four-layered neural network and the proportional-integral-derivative (PID) controller were used for each controller. The palmar/dorsi-flexion angle of the wrist was controlled in both computer simulation and FES experiments. Some controller parameters, such as the learning speed coefficient and the number of neurons, were determined in simulation using an artificial forward model of the wrist. The forward model was prepared by using a neural network that can imitate responses of subject's wrist to electrical stimulation. Then, six able-bodied subjects' wrist was controlled with the FEL controller by delivering stimuli to one antagonistic muscle pair. Results showed that the FEL controller functioned as expected and performed better than the conventional PID controller adjusted by the Chien, Hrones and Reswick method for a fast movement with the cycle period of 2 s, resulting in decrease of the average tracking error and shortened delay in the response. Furthermore, learning iteration was shortened if the feedforward controller had been trained in advance with the artificial forward model.
Collapse
Affiliation(s)
- Kenji Kurosawa
- Department of Electrical Engineering, Graduate School of Engineering, Tohoku University, Sendai 980-8579, Japan.
| | | | | | | |
Collapse
|
36
|
Binder-Macleod S, Kesar T. Catchlike property of skeletal muscle: Recent findings and clinical implications. Muscle Nerve 2005; 31:681-93. [PMID: 15736271 DOI: 10.1002/mus.20290] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The catchlike property of skeletal muscle is the force augmentation produced by the inclusion of an initial, brief, high-frequency burst of two to four pulses at the start of a subtetanic low-frequency stimulation train. Catchlike-inducing trains take advantage of the catchlike property of skeletal muscle and augment muscle performance compared with constant-frequency trains, especially in the fatigued state. Literature spanning more than 30 years has provided comprehensive information about the catchlike property of skeletal muscle. The pattern of the catchlike-inducing train that maximizes muscle performance is fairly similar across different muscles of different species and under various stimulation conditions. This review summarizes the mechanisms of the catchlike property, factors affecting force augmentation, techniques used to identify patterns of catchlike-inducing trains that maximize muscle performance, and potential clinical applications to provide a historical and current perspective of our understanding of the catchlike property.
Collapse
Affiliation(s)
- Stuart Binder-Macleod
- Department of Physical Therapy, 301 McKinly Laboratory, University of Delaware, Newark, Delaware 19716, USA.
| | | |
Collapse
|
37
|
Scott WB, Lee SCK, Johnston TE, Binder-Macleod SA. Switching stimulation patterns improves performance of paralyzed human quadriceps muscle. Muscle Nerve 2005; 31:581-8. [PMID: 15779000 DOI: 10.1002/mus.20300] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The clinical efficacy of functional electrical stimulation (FES) is limited by the rapid onset of fatigue. Functional electrical stimulation applications typically stimulate skeletal muscles with constant-frequency trains (CFTs). Our laboratory has identified trains that we call doublet-frequency trains (DFTs) and that produce greater forces than CFTs, but more fatigue during repetitive activation than comparable CFTs. The purpose of this study was to see whether a series of CFTs followed by DFTs would reach a targeted isometric peak force more times than either train type alone during repetitive isometric activation of the paralyzed quadriceps muscles of subjects with spinal cord injuries (SCI). The combination of CFTs followed by DFTs reached the targeted isometric force 14% more often than the CFTs alone and 18% more often than the DFTs alone. These findings confirm that switching train types may be a useful strategy to offset the rapid fatigue of the functionally important quadriceps muscle that persons with SCI experience when using FES.
Collapse
Affiliation(s)
- Wayne B Scott
- Graduate Program in Biomechanics and Movement Science, University of Delaware, Newark, Delaware, USA
| | | | | | | |
Collapse
|
38
|
Laouris Y, Bevan L, Reinking RM, Stuart DG. Associations between force and fatigue in fast-twitch motor units of a cat hindlimb muscle. Can J Physiol Pharmacol 2004; 82:577-88. [PMID: 15523515 DOI: 10.1139/y04-062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Associations were quantified between the control force and fatigue-induced force decline in 22 single fast-twitch-fatigable motor units of 5 deeply anesthetized adult cats. The units were subjected to intermittent stimulation at 1 train/s for 360 s. Two stimulation patterns were delivered in a pseudo-random manner. The first was a 500-ms train with constant interpulse intervals. The second pattern had the same number of stimuli, mean stimulus rate, and stimulus duration, but the stimulus pulses were rearranged to increase the force produced by the units in the control (prefatigue) state. The associations among the control peak tetanic force of these units, 3 indices of fatigue, and total cumulative force during fatiguing contractions were dependent, in part, on the stimulation pattern used to produce fatigue. The associations were also dependent, albeit to a lesser extent, on the force measure (peak vs. integrated) and the fatigue index used to quantify fatigue. It is proposed that during high-force fatiguing contractions, neural mechanisms are potentially available to delay and reduce the fatigue of fast-twitch-fatigable units for brief, but functionally relevant, periods. In contrast, the fatigue of slow-twitch fatigue-resistant units seems more likely to be controlled largely, if not exclusively, by metabolic processes within their muscle cells.Key words: cat, catch-like property, fatigue, force, motor units, size principle.
Collapse
Affiliation(s)
- Y Laouris
- Department of Physiology, University of Arizona College of Medicine, Tucson, AZ 85724, USA
| | | | | | | |
Collapse
|
39
|
Allman BL, Cheng AJ, Rice CL. Quadriceps fatigue caused by catchlike-inducing trains is not altered in old age. Muscle Nerve 2004; 30:743-51. [PMID: 15468338 DOI: 10.1002/mus.20161] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The relative loss of peak force from electrical stimulation protocols has provided inconsistent results when used to compare muscle fatigability between young and old adults. In addition to the effect of task on these comparisons, age-related alterations in the development and relaxation of force are possible factors that have not been considered. The purposes of this study were to compare the fatigability of the quadriceps of young (26.7 +/- 1.0 years) and old men (78.3 +/- 1.3 years), as assessed by changes in peak force, force time integral (FTI), and half-relaxation time (HRT), during intermittent electrical stimulation protocols, and to determine whether manipulation of the activation frequency affected the comparisons. Fatigue was caused by constant-frequency (CF), and catchlike-inducing (CI) train protocols, both of which consisted of intermittent trains (6 pulses on: 650 ms off) of stimulation. After each protocol, the force-generating capacity of the fatigued muscle was assessed with three trains of stimuli: a CF train, a CI train and a 1-s 50-HZ train. There was no effect of age on the loss of peak force or the development of low-frequency fatigue induced by either protocol. Conversely, irrespective of the protocol, the FTI was better maintained by approximately 9% in the old than young men. Because peak force did not differ between groups during fatigue, it is likely that the FTI was preserved by the exacerbated slowing of HRT in the quadriceps of the old men. The results confirm an apparent paradox between muscle fatigue and stimulation with CI trains: a single CI train produces greater force than a CF train in a fatigued muscle, but there is greater fatigue induced by repetitive CI than CF train stimulation. Old age did not affect this fatigue paradox.
Collapse
Affiliation(s)
- Brian L Allman
- Canadian Centre for Activity and Aging, School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
| | | | | |
Collapse
|
40
|
Scott WB, Binder-Macleod SA. Changing stimulation patterns improves performance during electrically elicited contractions. Muscle Nerve 2003; 28:174-80. [PMID: 12872321 DOI: 10.1002/mus.10412] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The clinical efficacy of functional electrical stimulation (FES) is limited by the rapid onset of fatigue. FES applications use electrical stimuli separated by regular interpulse intervals (constant-frequency trains or CFTs) to activate muscles. However, doublet-frequency trains (DFTs) may produce greater forces than CFTs, but also produce more fatigue. DFTs contain a series of doublets, two pulses separated by a short (5-ms) interpulse interval. We hypothesized that a combination of CFTs followed by DFTs would improve performance compared to either train type alone. Quadriceps muscles of 15 normal subjects were fatigued with either 150 DFTs, or initially fatigued with CFTs until the targeted isometric force was no longer produced and then switched to DFTs. The combination reached the targeted isometric force (mean +/- SEM) more times (59.80 +/- 4.03) than either the CFTs alone (51.20 +/- 3.50) or DFTs alone (55.33 +/- 3.81). This finding suggests that combining train types may be a useful strategy to offset the rapid fatigue that persons with neurological dysfunction, such as spinal cord injury, experience when using FES.
Collapse
Affiliation(s)
- Wayne B Scott
- Interdisciplinary Graduate Program in Biomechanics and Movement Science, University of Delaware, Newark, Delaware, USA
| | | |
Collapse
|
41
|
Lamb SE, Oldham JA, Morse RE, Evans JG. Neuromuscular stimulation of the quadriceps muscle after hip fracture: a randomized controlled trial. Arch Phys Med Rehabil 2002; 83:1087-92. [PMID: 12161829 DOI: 10.1053/apmr.2002.33645] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To study the feasibility and effect of neuromuscular stimulation on recovery of mobility after surgical fixation for hip fracture. DESIGN Double-blind study with stratified randomization. SETTING Home-based rehabilitation program. PARTICIPANTS Twenty-four women over the age of 75 years with hip fracture. INTERVENTIONS Neuromuscular or placebo stimulation of the quadriceps muscle of the fractured leg, applied for 3 hours a day, for 6 weeks, commencing 1 week after surgery. MAIN OUTCOME MEASURES Recovery of walking speed and ability, postural stability, lower-limb muscle power, and pain at 7 and 13 weeks after surgery. RESULTS Women in the neuromuscular stimulation group showed faster recovery of mobility. Of the women receiving stimulation, 9 of 12 recovered their prior levels of indoor mobility ability by 13 weeks compared with 3 of 12 in the placebo group (Fisher exact test, P=.046). There were no differences in recovery of walking speed in the first 7 weeks, but women in the stimulation group had greater recovery between 7 and 13 weeks (mean difference=-.13m/s; 95% confidence interval, -.23 to -.01). CONCLUSIONS Neuromuscular stimulation at home is feasible and may be effective in speeding recovery of mobility after surgical fixation of hip fracture.
Collapse
Affiliation(s)
- Sarah E Lamb
- Interdisciplinary Research Centre in Health, Coventry University, UK.
| | | | | | | |
Collapse
|
42
|
Perumal R, Wexler AS, Ding J, Binder-Macleod SA. Modeling the length dependence of isometric force in human quadriceps muscles. J Biomech 2002; 35:919-30. [PMID: 12052394 DOI: 10.1016/s0021-9290(02)00049-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Functional electrical stimulation is used to restore movement and function of paralyzed muscles by activating skeletal muscle artificially. An accurate and predictive mathematical model can facilitate the design of stimulation patterns that produce the desired force. The present study is a first step in developing a mathematical model for non-isometric muscle contractions. The goals of this study were to: (1) identify how our isometric force model's parameters vary with changes in knee joint angle, (2) identify the best knee flexion angle to parameterize this model, and (3) validate the model by comparing experimental data to predictions in response to a wide range of stimulation frequencies and muscle lengths. Results showed that by parabolically varying one of the free parameters with knee joint angle and fixing the other parameters at the values identified at 40 degrees of knee flexion, the model could predict the force responses to a wide range of stimulation frequencies and patterns at different muscle lengths. This work showed that the current isometric force model is capable of predicting the changes in skeletal muscle force at different muscle lengths.
Collapse
Affiliation(s)
- Ramu Perumal
- Department of Mechanical Engineering, University of Delaware, Newark, DE, USA
| | | | | | | |
Collapse
|
43
|
Russ DW, Vandenborne K, Walter GA, Elliott M, Binder-Macleod SA. Effects of muscle activation on fatigue and metabolism in human skeletal muscle. J Appl Physiol (1985) 2002; 92:1978-86. [PMID: 11960948 DOI: 10.1152/japplphysiol.00483.2001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Increasing stimulation frequency has been shown to increase fatigue but not when the changes in force associated with changes in frequency have been controlled. An effect of frequency, independent of force, may be associated with the metabolic cost resulting from the additional activations. Here, two separate experiments were performed on human medial gastrocnemius muscles. The first experiment (n = 8) was designed to test the effect of the number of pulses on fatigue. The declines in force during two repetitive, 150-train stimulation protocols that produced equal initial forces, one using 80-Hz trains and the other using 100-Hz trains, were compared. Despite a difference of 600 pulses (23.5%), the protocols produced similar rates and amounts of fatigue. In the second experiment, designed to test the effect of the number of pulses on the metabolic cost of contraction, 31P-NMR spectra were collected (n = 6) during two ischemic, eight-train stimulation protocols (80- and 100-Hz) that produced comparable forces despite a difference of 320 pulses (24.8%). No differences were found in the changes in P(i) concentration, phosphocreatine concentration, and intracellular pH or in the ATP turnover produced by the two trains. These results suggest that the effect of stimulation frequency on fatigue is related to the force produced, rather than to the number of activations. In addition, within the range of frequencies tested, increasing total activations did not increase metabolic cost.
Collapse
Affiliation(s)
- David W Russ
- Graduate Program in Biomechanics and Movement Sciences, University of Delaware, Newark 19716, USA
| | | | | | | | | |
Collapse
|
44
|
Ding J, Wexler AS, Binder-Macleod SA. A predictive fatigue model--I: Predicting the effect of stimulation frequency and pattern on fatigue. IEEE Trans Neural Syst Rehabil Eng 2002; 10:48-58. [PMID: 12173739 DOI: 10.1109/tnsre.2002.1021586] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Previously we developed a mathematical force- and fatigue-model system that could predict fatigue produced by a wide range of frequencies and pulse patterns. However, the models tended to overestimate the forces produced by higher frequency trains. This paper presents modifications to our previously developed force- and fatigue-model system to improve the accuracy in predicting forces during repetitive activation of human skeletal muscle. By comparing the predictions produced by the modified force and fatigue models to those by our previous models, the modification appears to be successful. The current force- and fatigue-model system accounts for about 93% variance in experimental data produced by fatigue protocols consisting of trains with a wide range of frequencies and pulse patterns. In addition, the present models successfully predict the effect of stimulation frequency and pulse pattern on muscle fatigue. The success of our current force- and fatigue-model system suggests its potential use in helping to identify the optimal activation pattern to use during the clinical application of functional electrical stimulation.
Collapse
Affiliation(s)
- Jun Ding
- Interdisciplinary Graduate Program in Biomechanics and Movement Science, University of Delaware, Newark 19716, USA
| | | | | |
Collapse
|
45
|
Ratkevicius A, Quistorff B. Metabolic costs of force generation for constant-frequency and catchlike-inducing electrical stimulation in human tibialis anterior muscle. Muscle Nerve 2002; 25:419-26. [PMID: 11870720 DOI: 10.1002/mus.10064] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Metabolic costs of force generation were compared for constant-frequency and catchlike-inducing electrical stimulation. Repetitive catchlike-inducing trains consisted of 2 interpulse intervals (IPIs) at 12.5 ms, 1 IPI at 25 ms, and 5 IPIs at 50 ms. Constant-frequency trains consisted of 8 IPIs at 37.5 ms. One train was delivered to the peroneal nerve every 2.5 s for 36 times under ischemic conditions. Anaerobic adenosine triphosphate (ATP) turnover was determined using 31-phosphorus magnetic resonance spectroscopy (P-MRS) of the human tibialis anterior muscle. Compared with constant-frequency trains, catchlike-inducing trains produced a faster force generation and were more effective in maintaining the force--time integral as well as peak force. However, ATP costs of force generation were similar for the catchlike-inducing and constant-frequency stimulation (6.7 plus/minus 1.1 and 6.6 plus/minus 1.0 micromol ATP/kg wet weight/Ncenter dots, respectively, P = 0.601). This suggests that the positive effects of catchlike-inducing stimulation on force maintenance are mediated by potentiated Ca(2+) release from the sarcoplasmic reticulum rather than by lower metabolic costs of muscle force generation. Our findings also suggest that catchlike-inducing stimulation produces larger forces in fatigued muscle than constant-frequency trains and thus may be beneficial for muscle training or rehabilitation when muscle loading needs to be maintained in repetitive contractions.
Collapse
Affiliation(s)
- Aivaras Ratkevicius
- NMR Center, Department of Medical Biochemistry and Genetics A, Panum Institute, University of Copenhagen, Blegdamsveg 3, DK-2200 Copenhagen N, Denmark.
| | | |
Collapse
|
46
|
Kebaetse MB, Turner AE, Binder-Macleod SA. Effects of stimulation frequencies and patterns on performance of repetitive, nonisometric tasks. J Appl Physiol (1985) 2002; 92:109-16. [PMID: 11744649 DOI: 10.1152/jappl.2002.92.1.109] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The purpose of this paper was to determine the effects of stimulation pattern and frequency on repetitive human knee movements. Quadriceps femoris muscles were stimulated against a load equal to 10% of each subject's maximum voluntary isometric force. The main variable of interest was the number of repetitions in which the leg reached a target angle of 40 degrees of knee extension. Sixteen different trains were tested, including 1) six constant-frequency trains with frequencies ranging from 9 to 100 Hz, 2) five variable-frequency trains with an initial 5-ms triplet and mean frequencies ranging from 11 to 35 Hz, and 3) five doublet-frequency trains, which used doublets (2 pulses with a 5-ms interpulse interval) to replace single pulses, with mean frequencies of 17-57 Hz. Testing was stopped when the subject failed to reach the target angle for three consecutive activations. Results showed that no single pattern was best for all subjects. The 33- and 100-Hz constant-frequency trains, 35-Hz variable-frequency trains, and 27- and 36-Hz doublet frequency trains each met the target the most times for some subjects. The results showed that, under our testing conditions, higher frequency trains were better suited for producing repetitive knee movements than lower frequency trains.
Collapse
Affiliation(s)
- Maikutlo B Kebaetse
- Interdisciplinary Programs in Biomechanics and Movement Science, McKinly Laboratory, University of Delaware, Newark, Delaware 19107, USA
| | | | | |
Collapse
|
47
|
Binder-Macleod SA, Scott WB. Comparison of fatigue produced by various electrical stimulation trains. ACTA PHYSIOLOGICA SCANDINAVICA 2001; 172:195-203. [PMID: 11472306 DOI: 10.1046/j.1365-201x.2001.00864.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Previous work has shown that variable-frequency trains (VFTs) that use an initial doublet to take advantage of the catch-like property of muscle produce more force in fatigued muscle than constant-frequency trains (CFTs); however, it is unclear whether repetitive activation with VFTs is more or less fatiguing than repetitive activation with CFTs. The purpose of this research was to investigate the forces and fatigue produced by various stimulation trains during repetitive isometric muscle contractions. Two force measurements, peak force and force-time integral, were used to measure the performance of the human quadriceps muscle. Three fatiguing protocols, each consisting exclusively of either CFTs, trains with an initial doublet (VFTs), or trains with doublets separated by longer intervals [doublet-frequency trains (DFTs)], were tested. In addition, force responses to each of the three train types were tested before and immediately following each fatiguing protocol. Regardless of the fatiguing protocol, the doublet-frequency testing trains produced the greatest peak forces and force-time integrals before and immediately following the fatiguing protocols. Repetitive activation with exclusively DFTs produced greater attenuation of the testing trains than repetitive activation with CFTs or VFTs. These results suggest that clinical applications of electrical stimulation to activate skeletal muscle may need to contain a combination of train types to optimize performance.
Collapse
|
48
|
Abstract
The purpose of this review was to examine three issues that limit our understanding of motor unit physiology: (1) the range and distribution of the innervation ratios in a muscle; (2) the association between discharge rate and force; and (3) the variation in motor unit activity across contractions that differ in speed and type. We suggest that if more data were available on these issues, the understanding of neuromuscular function would be enhanced substantially, especially with regard to plasticity in the motor neuron pool, adequacy of the neural drive to muscle, and flexibility of activation patterns across various types of contractions. Current data are limited and these limitations influence our ability to interpret adaptations in muscle function in health and disease.
Collapse
Affiliation(s)
- R M Enoka
- Department of Kinesiology and Applied Physiology, University of Colorado, Boulder, Colorado 80309-0354, USA.
| | | |
Collapse
|
49
|
|
50
|
Kebaetse MB, Lee SC, Binder-Macleod SA. A novel stimulation pattern improves performance during repetitive dynamic contractions. Muscle Nerve 2001; 24:744-52. [PMID: 11360257 DOI: 10.1002/mus.1065] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The purpose of this study was to determine the effect of three different stimulation patterns on repetitive knee movements. Each subject's quadriceps femoris was stimulated with: (1) a constant-frequency train (CFT) with an interpulse interval (IPI) of 50 ms; (2) a variable-frequency train (VFT)-similar to the CFT, except with an initial doublet with an IPI of 5 ms; and (3) a doublet-frequency train (DFT) with multiple doublets (doublet IPI 5 ms) separated by 50 ms, while the muscle was resisted by a load equal to 10% of the muscle's maximum voluntary isometric contraction. The muscle was stimulated while the knee moved through a 50 degrees arc of motion (90 degrees to 40 degrees of flexion). Testing was stopped when the subject failed to reach the target three consecutive times. Results showed that DFTs reached the target (mean +/- SD) 36.4 +/- 14.4 times, followed by VFTs (25.4 +/- 17.9) and CFTs (17.4 +/- 11.9). The DFT was the best pattern for producing shortening contractions. The results suggest that DFTs may have significant benefits during clinical functional electrical stimulation.
Collapse
Affiliation(s)
- M B Kebaetse
- Interdisciplinary Programs in Biomechanics and Movement Science, University of Delaware, Newark, Delaware, USA
| | | | | |
Collapse
|