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Webber CM, Egginton JS, Shin AY, Kaufman KR. Application of a myoelectric elbow flexion assist orthosis in adult traumatic brachial plexus injury: patient perspectives. Prosthet Orthot Int 2021; 45:526-531. [PMID: 34789712 PMCID: PMC8642265 DOI: 10.1097/pxr.0000000000000047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 08/09/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Individuals with brachial plexus injuries (BPIs) can be prescribed assistive devices, including myoelectric elbow orthoses (MEOs), for rehabilitation or functional use after failed treatment for elbow flexion restoration. Although recent case studies indicate potential for clinical improvements after using an MEO after BPI, the patients' perspectives on such use are still unknown. OBJECTIVE To explore patient perspectives on the use of an MEO after surgical treatment for a traumatic BPI. STUDY DESIGN Qualitative using both a focus group and semistructured interviews. METHODS Patients with BPI that used an MEO were recruited. Five patients participated in an in-person focus group, whereas three patients participated in individual phone interviews. Themes that emerged from the focus group were compared against those that emerged from the personal interviews. RESULTS Feedback was grouped into three themes: device usage, hardware performance, and device design. Within each theme, positive elements, areas for improvement, and additional considerations emerged. Patients indicated a positive attitude toward using an MEO as a rehabilitation tool. They desired a streamlined, stronger device to support them and assist during activities of daily living. CONCLUSIONS For patients with BPI, a well-designed MEO that meets their needs could assist with rehabilitation and increase independence in daily activities. Continued patient engagement in the evaluation and development of both medical devices and treatment plans offers the best opportunity for improved outcomes that are important to the patient.
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Affiliation(s)
- Christina M. Webber
- Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN, USA
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Jason S. Egginton
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | | | - Kenton R. Kaufman
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Physiology & Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
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Khodabukus A. Tissue-Engineered Skeletal Muscle Models to Study Muscle Function, Plasticity, and Disease. Front Physiol 2021; 12:619710. [PMID: 33716768 PMCID: PMC7952620 DOI: 10.3389/fphys.2021.619710] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 01/25/2021] [Indexed: 12/20/2022] Open
Abstract
Skeletal muscle possesses remarkable plasticity that permits functional adaptations to a wide range of signals such as motor input, exercise, and disease. Small animal models have been pivotal in elucidating the molecular mechanisms regulating skeletal muscle adaptation and plasticity. However, these small animal models fail to accurately model human muscle disease resulting in poor clinical success of therapies. Here, we review the potential of in vitro three-dimensional tissue-engineered skeletal muscle models to study muscle function, plasticity, and disease. First, we discuss the generation and function of in vitro skeletal muscle models. We then discuss the genetic, neural, and hormonal factors regulating skeletal muscle fiber-type in vivo and the ability of current in vitro models to study muscle fiber-type regulation. We also evaluate the potential of these systems to be utilized in a patient-specific manner to accurately model and gain novel insights into diseases such as Duchenne muscular dystrophy (DMD) and volumetric muscle loss. We conclude with a discussion on future developments required for tissue-engineered skeletal muscle models to become more mature, biomimetic, and widely utilized for studying muscle physiology, disease, and clinical use.
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Affiliation(s)
- Alastair Khodabukus
- Department of Biomedical Engineering, Duke University, Durham, NC, United States
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Askari S, Presacco A, Sahyouni R, Djalilian H, Shkel A, Lin H. Closed Loop Microfabricated Facial Reanimation Device Coupling EMG-Driven Facial Nerve Stimulation with a Chronically Implanted Multichannel Cuff Electrode. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2018; 2018:2206-2209. [PMID: 30440843 DOI: 10.1109/embc.2018.8512778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Permanent facial paralysis and paresis (FP) results from damage to the facial nerve (FN), and is a debilitating condition with substantial functional and psychological consequences for the patient. Unfortunately, surgeons have few tools with which they can satisfactorily reanimate the face. Current strategies employ static (e.g., implantation of nonmuscular material in the face to aid in function/cosmesis) and dynamic options (e.g., gracilis myoneurovascular free tissue transfer) to partially restore volitional facial function and cosmesis. Here, we propose a novel neuroprosthetic approach for facial reanimation that utilizes electromyographic (EMG) input coupled to a chronically implanted multichannel cuff electrode (MCE) to restore instantaneous, volitional, and selective hemifacial movement in a feline model. To accomplish this goal, we developed a single-channel EMG-drive current source coupled with a chronically implanted MCE via a portable microprocessor board. Our results demonstrated a successful feasibility trial in which human EMG input resulted in FN stimulation with subsequent concentric contraction of discrete regions of a feline face.
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Carraro U, Kern H, Gava P, Hofer C, Loefler S, Gargiulo P, Edmunds K, Árnadóttir ÍD, Zampieri S, Ravara B, Gava F, Nori A, Gobbo V, Masiero S, Marcante A, Baba A, Piccione F, Schils S, Pond A, Mosole S. Recovery from muscle weakness by exercise and FES: lessons from Masters, active or sedentary seniors and SCI patients. Aging Clin Exp Res 2017; 29:579-590. [PMID: 27592133 DOI: 10.1007/s40520-016-0619-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 08/09/2016] [Indexed: 12/17/2022]
Abstract
Many factors contribute to the decline of skeletal muscle that occurs as we age. This is a reality that we may combat, but not prevent because it is written into our genome. The series of records from World Master Athletes reveals that skeletal muscle power begins to decline at the age of 30 years and continues, almost linearly, to zero at the age of 110 years. Here we discuss evidence that denervation contributes to the atrophy and slowness of aged muscle. We compared muscle from lifelong active seniors to that of sedentary elderly people and found that the sportsmen have more muscle bulk and slow fiber type groupings, providing evidence that physical activity maintains slow motoneurons which reinnervate muscle fibers. Further, accelerated muscle atrophy/degeneration occurs with irreversible Conus and Cauda Equina syndrome, a spinal cord injury in which the human leg muscles may be permanently disconnected from the nervous system with complete loss of muscle fibers within 5-8 years. We used histological morphometry and Muscle Color Computed Tomography to evaluate muscle from these peculiar persons and reveal that contraction produced by home-based Functional Electrical Stimulation (h-bFES) recovers muscle size and function which is reversed if h-bFES is discontinued. FES also reverses muscle atrophy in sedentary seniors and modulates mitochondria in horse muscles. All together these observations indicate that FES modifies muscle fibers by increasing contractions per day. Thus, FES should be considered in critical care units, rehabilitation centers and nursing facilities when patients are unable or reluctant to exercise.
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Affiliation(s)
- Ugo Carraro
- IRCCS Fondazione Ospedale San Camillo, Venice, Italy
| | - Helmut Kern
- Ludwig Boltzmann Institute of Electrical Stimulation and Physical Rehabilitation, Vienna, Austria
- Institute of Physical Medicine and Rehabilitation, Wilhelminenspital, Vienna, Austria
| | - Paolo Gava
- Laboratory of Translational Myology of the Interdepartmental Research Center of Myology, Department of Biomedical Science, University of Padova, Via Ugo Bassi 58/B, 35131, Padua, Italy
| | - Christian Hofer
- Ludwig Boltzmann Institute of Electrical Stimulation and Physical Rehabilitation, Vienna, Austria
| | - Stefan Loefler
- Ludwig Boltzmann Institute of Electrical Stimulation and Physical Rehabilitation, Vienna, Austria
| | - Paolo Gargiulo
- Institute for Biomedical and Neural Engineering, Reykjavík, Iceland
- Landspítali, Reykjavík, Iceland
| | - Kyle Edmunds
- Institute for Biomedical and Neural Engineering, Reykjavík, Iceland
| | | | - Sandra Zampieri
- Ludwig Boltzmann Institute of Electrical Stimulation and Physical Rehabilitation, Vienna, Austria
- Laboratory of Translational Myology of the Interdepartmental Research Center of Myology, Department of Biomedical Science, University of Padova, Via Ugo Bassi 58/B, 35131, Padua, Italy
| | - Barbara Ravara
- Ludwig Boltzmann Institute of Electrical Stimulation and Physical Rehabilitation, Vienna, Austria
- Laboratory of Translational Myology of the Interdepartmental Research Center of Myology, Department of Biomedical Science, University of Padova, Via Ugo Bassi 58/B, 35131, Padua, Italy
| | - Francesco Gava
- Ludwig Boltzmann Institute of Electrical Stimulation and Physical Rehabilitation, Vienna, Austria
- Laboratory of Translational Myology of the Interdepartmental Research Center of Myology, Department of Biomedical Science, University of Padova, Via Ugo Bassi 58/B, 35131, Padua, Italy
| | - Alessandra Nori
- Laboratory of Translational Myology of the Interdepartmental Research Center of Myology, Department of Biomedical Science, University of Padova, Via Ugo Bassi 58/B, 35131, Padua, Italy
| | - Valerio Gobbo
- Department of Biomedical Science, C.N.R. Institute of Neuroscience, University of Padova, Padua, Italy
| | - Stefano Masiero
- Rehabilitation Unit, Department of Neuroscience, University of Padova, Padua, Italy
| | | | - Alfonc Baba
- IRCCS Fondazione Ospedale San Camillo, Venice, Italy
| | | | | | - Amber Pond
- Anatomy Department, Southern Illinois University, School of Medicine, Carbondale, IL, USA
| | - Simone Mosole
- Ludwig Boltzmann Institute of Electrical Stimulation and Physical Rehabilitation, Vienna, Austria.
- Laboratory of Translational Myology of the Interdepartmental Research Center of Myology, Department of Biomedical Science, University of Padova, Via Ugo Bassi 58/B, 35131, Padua, Italy.
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Koh ES, Kim HC, Lim JY. The effects of electromyostimulation application timing on denervated skeletal muscle atrophy. Muscle Nerve 2017; 56:E154-E161. [PMID: 28345221 DOI: 10.1002/mus.25656] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 03/06/2017] [Accepted: 03/20/2017] [Indexed: 12/25/2022]
Abstract
INTRODUCTION In this study we evaluated the effect of electromyostimulation (EMS) on myosin heavy chain (MHC) isoform expression in denervated rat muscles to determine the optimal timing for EMS application. METHODS EMS was initiated on post-injury day 1 for the group with denervation receiving immediate EMS (DIEMS) and on post-injury day 15 for the group with denervation receiving delayed EMS (DDEMS) in rat denervated muscles. Muscle wet weight and muscle fiber cross-sectional area (FCSA) were measured. MHC isoforms were analyzed in both protein homogenates and single muscle fibers. RESULTS The expression levels of IIx and IIb isoforms of MHC were significantly lower and higher, respectively, in the gastrocnemius muscles of the DIEMS group, but not the DDEMS group. The DIEMS group also showed larger FCSA and a lower proportion of hybrid single fibers compared with the DDEMS group. DISCUSSION These results indicate that immediate EMS is more effective than delayed EMS for aiding recovery of denervation-induced MHC changes. Muscle Nerve 56: E154-E161, 2017.
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Affiliation(s)
- Eun Sil Koh
- Department of Rehabilitation Medicine, National Medical Center, Seoul, Republic of Korea.,Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hee Chan Kim
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jae-Young Lim
- Mechanic & Molecular Myology Laboratory, Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, 173-82, Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
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Willand MP, Chiang CD, Zhang JJ, Kemp SWP, Borschel GH, Gordon T. Daily Electrical Muscle Stimulation Enhances Functional Recovery Following Nerve Transection and Repair in Rats. Neurorehabil Neural Repair 2014; 29:690-700. [DOI: 10.1177/1545968314562117] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background. Incomplete recovery following surgical reconstruction of damaged peripheral nerves is common. Electrical muscle stimulation (EMS) to improve functional outcomes has not been effective in previous studies. Objective. To evaluate the efficacy of a new, clinically translatable EMS paradigm over a 3-month period following nerve transection and immediate repair. Methods. Rats were divided into 6 groups based on treatment (EMS or no treatment) and duration (1, 2, or 3 months). A tibial nerve transection injury was immediately repaired with 2 epineurial sutures. The right gastrocnemius muscle in all rats was implanted with intramuscular electrodes. In the EMS group, the muscle was electrically stimulated with 600 contractions per day, 5 days a week. Terminal measurements were made after 1, 2, or 3 months. Rats in the 3-month group were assessed weekly using skilled and overground locomotion tests. Neuromuscular junction reinnervation patterns were also examined. Results. Muscles that received daily EMS had significantly greater numbers of reinnervated motor units with smaller average motor unit sizes. The majority of muscle endplates were reinnervated by a single axon arising from a nerve trunk with significantly fewer numbers of terminal sprouts in the EMS group, the numbers being small. Muscle mass and force were unchanged but EMS improved behavioral outcomes. Conclusions. Our results demonstrated that EMS using a moderate stimulation paradigm immediately following nerve transection and repair enhances electrophysiological and behavioral recovery.
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Affiliation(s)
| | | | | | | | | | - Tessa Gordon
- The Hospital for Sick Children, Toronto, Ontario, Canada
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Cavalcante EVV, Silva LGMD, Montenegro EJN, Pontes Filho NTD. Efeito da eletroestimulação no músculo desnervado de animais: revisão sistemática. FISIOTERAPIA EM MOVIMENTO 2012. [DOI: 10.1590/s0103-51502012000300022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUÇÃO: A recuperação funcional após a lesão nervosa periférica está relacionada a fatores intrínsecos e extrínsecos ao sistema nervoso periférico, tais como a gravidade da lesão e a condição dos órgãos-alvo. A atrofia constitui uma das principais alterações do músculo após a lesão nervosa e, uma vez instalada, atua como barreira ao crescimento axonal durante a reinervação muscular. O uso da eletroestimulação é rotineiro no campo da fisioterapia e tem o objetivo de minimizar ou impedir a atrofia muscular e, assim, favorecer a recuperação da lesão nervosa periférica. OBJETIVO: Avaliar os efeitos da eletroestimulação sobre as características tróficas do músculo desnervado. MÉTODOS: Artigos publicados entre 1990 e 2010 e indexados aos bancos de dados da PUBMED foram selecionados utilizando os seguintes descritores: "muscle denervation AND electric stimulation" e "muscular atrophy AND electric stimulation". Foram considerados como critério de inclusão os estudos experimentais em animais (ratos) que utilizassem a lesão nervosa periférica como modelo de desnervação e que avaliassem o efeito da eletroestimulação muscular sobre a área de secção transversa e/ou a massa muscular de músculos desnervados. RESULTADOS: Nove artigos foram selecionados para a revisão. CONCLUSÕES: O efeito da eletroestimulação está diretamente relacionado à característica do protocolo de intervenção, que, quando aplicado de maneira adequada, apresenta o efeito de retardar e, em alguns casos, impedir a atrofia do músculo desnervado.
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8
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Effects of activity-dependent strategies on regeneration and plasticity after peripheral nerve injuries. Ann Anat 2011; 193:347-53. [DOI: 10.1016/j.aanat.2011.02.012] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Revised: 02/14/2011] [Accepted: 02/24/2011] [Indexed: 12/27/2022]
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Johnson AM, Connor NP. Effects of electrical stimulation on neuromuscular junction morphology in the aging rat tongue. Muscle Nerve 2011; 43:203-11. [PMID: 21254085 DOI: 10.1002/mus.21819] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Alterations in neuromuscular junction (NMJ) structure in cranial muscles may contribute to age-related deficits in critical sensorimotor actions such as swallowing. Neuromuscular electrical stimulation (NMES) is used in swallowing therapy, but it is unclear how NMJ structure is affected or if NMJ morphology is best measured in two or three dimensions. Two- and three-dimensional measurements of NMJ morphology in the genioglossus muscle were compared in rats that had undergone 8 weeks of hypoglossal nerve stimulation vs. untreated controls. The relationship between motor endplate volume and nerve terminal volume had a mean positive slope in 90% of the young adult controls, but it was positive in only 50% of the old controls; 89% of NMES old rats had a positive slope. NMJ measurements were more accurate when measured in three dimensions. In the NMJ, aging and NMES are associated with changes in the pre- and post-synaptic relationship.
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Affiliation(s)
- Aaron M Johnson
- Department of Surgery, University of Wisconsin-Madison, Madison, WI 53792, USA
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Kim J, Han SJ, Shin DH, Lee WS, Choi JY. Subthreshold continuous electrical stimulation facilitates functional recovery of facial nerve after crush injury in rabbit. Muscle Nerve 2011; 43:251-8. [PMID: 21254091 DOI: 10.1002/mus.21840] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We sought to determine whether electrical stimulation (ES) with subthreshold, continuous, low-frequency impulses is a viable clinical method for improving functional recovery after facial nerve crush injury. In 10 rabbits, bilateral crush injuries were made on the facial nerve by compression for 30 s with mosquito forceps, causing complete facial paralysis. Subthreshold continuous direct current ES with 20-Hz square-wave pulses was applied to the proximal stump on one side for 4 weeks. Vibrissae movement returned significantly earlier on the ES side, with a less variable recovery time. Electrophysiologically, the stimulated side had a significantly shorter latency, longer duration, and faster conduction velocity. Light and transmission electron microscopy revealed that the electrical stimulation also markedly decreased Wallerian degeneration. The average numbers of fluorescent, double-labeled nerve cells were significantly different between the ES and non-ES sides. This study shows that subthreshold, continuous, low-frequency ES immediately after a crush injury of the facial nerve results in earlier recovery of facial function and shorter overall recovery time.
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Affiliation(s)
- Jin Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul 120-752, Korea
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Udina E, Puigdemasa A, Navarro X. Passive and active exercise improve regeneration and muscle reinnervation after peripheral nerve injury in the rat. Muscle Nerve 2011; 43:500-9. [PMID: 21305568 DOI: 10.1002/mus.21912] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2010] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Lesions of peripheral nerves cause loss of motor and sensory function and also lead to hyperreflexia and hyperalgesia. Activity-dependent therapies promote axonal regeneration and functional recovery and may improve sensory-motor coordination and restoration of adequate circuitry at the spinal level. METHODS We compared the effects of passive (bicycle) and active (treadmill) exercise on nerve regeneration and modulation of the spinal H reflex after transection and repair of the rat sciatic nerve. Animals were evaluated during 2 months using electrophysiological, functional, and histological methods. RESULTS Moderate exercise for 1 hour/day, either active treadmill walking or passive cycling, improved muscle reinnervation, increased the number of regenerated axons in the distal nerve, and reduced the increased excitability of spinal reflexes after nerve lesion. DISCUSSION Maintenance of denervated muscle activity and afferent input, by active or passive exercise, may increase trophic factor release to act on regenerating axons and to modulate central neuronal plasticity.
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Affiliation(s)
- Esther Udina
- Group of Neuroplasticity and Regeneration, Institute of Neurosciences and Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, Bellaterra E-08193, Spain
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The potential of electrical stimulation to promote functional recovery after peripheral nerve injury — comparisons between rats and humans. HOW TO IMPROVE THE RESULTS OF PERIPHERAL NERVE SURGERY 2011; 100:3-11. [DOI: 10.1007/978-3-211-72958-8_1] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Lim JY, Han TR. Effect of electromyostimulation on apoptosis-related factors in denervation and reinnervation of rat skeletal muscles. Muscle Nerve 2010; 42:422-30. [PMID: 20589896 DOI: 10.1002/mus.21719] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Electromyostimulation (EMS) has been utilized to reduce muscle atrophy, but its effect on denervated muscles is controversial. This study was performed to determine the effect of EMS on intramuscular changes and apoptosis during denervation and reinnervation following nerve damage. Rat sciatic nerves were denervated completely (CD) or partially (PD), and EMS was applied for 2 weeks. The same numbers of cases were followed without EMS. Nerve conduction studies, muscle weights, terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay to measure apoptotic changes, and Western blot were done 4, 8, and 12 weeks after injury. TUNEL-positive nuclei of CD muscles (18.6 +/- 5.5%) were more prevalent than those of PD muscles (7.5 +/- 3.3%). The EMS group showed greater muscle weight, fewer positive nuclei (4.7 +/- 1.9%), and lower BAX and Bcl-2 expression levels compared with the non-EMS group at 4 weeks after PD but not after CD. Denervated muscle atrophy delayed by EMS may be linked with enhanced anti-apoptosis under the control of apoptosis-related factors.
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Affiliation(s)
- Jae-Young Lim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Republic of Korea
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Giannikas D, Karabasi A, Fotinopoulos E, Tyllianakis M. Open transtrapezial injuries of the thumb: operative treatment. THE JOURNAL OF TRAUMA 2008; 65:1468-1470. [PMID: 19077644 DOI: 10.1097/ta.0b013e31815eb765] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Open transtrapezium injuries of the thumb are not common and sufficiently described injuries. We have clinically and radiologically evaluated six patients with transtrapezium injury of the thumb. The average follow-up time was 65 months. All injuries occurred in young people, who had high-energy trauma to their thumb. Fracture of the trapezium with exposure of the first carpometacarpal joint was a constant along with soft tissue damage. The latter included thumb tendons, digital nerves and arteries, motor branch of the median nerve, palmar or dorsal branch of the radial artery, and thenar musculature. All trapezium fractures were fixed with mini 1.5 mm screws. All the other injured structures were repaired by microsurgical techniques. Physiotherapy protocols with emphasis to electrostimulation were used within 2 weeks postoperatively. Clinical assessment included objective and subjective criteria, which revealed moderate loss of motion because of musculature loss either by direct trauma or by denervation. No correlation was found between types of trapezium fracture and disability. Internal osteosynthesis with 1.5 mini cortical screws provided excellent stability. Despite the severity of the initial trauma the results were surprisingly good.
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Marqueste T, Decherchi P, Desplanches D, Favier R, Grelot L, Jammes Y. Chronic electrostimulation after nerve repair by self-anastomosis: effects on the size, the mechanical, histochemical and biochemical muscle properties. Acta Neuropathol 2006; 111:589-600. [PMID: 16520970 DOI: 10.1007/s00401-006-0035-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2005] [Revised: 11/03/2005] [Accepted: 12/10/2005] [Indexed: 11/25/2022]
Abstract
This study tests the effects of chronic electrostimulation on denervated/reinnervated skeletal muscle in producing an optimal restoration of size and mechanical and histochemical properties. We compared tibialis anterior muscles in four groups of rats: in unoperated control (C) and 10 weeks following nerve lesion with suture (LS) in the absence of electrostimulation and in the presence of muscle stimulation with either a monophasic rectangular current (LSEm) or a biphasic modulated current (LSEb). The main results were (1) muscle atrophy was reduced in LSEm (-26%) while it was absent in LSEb groups (-8%); (2) the peak twitch amplitude decreased in LS and LSEm but not in LSEb groups, whereas the contraction time was shorter; (3) muscle reinnervation was associated with the emergence of type IIC fibers and proportions of types I, IIA and IIB fibers recovered in the superficial portion of LSEb muscles; (4) the ratio of oxidative to glycolytic activities decreased in the three groups with nerve injury and repair; however, this decrease was more accentuated in LSEm groups. We conclude that muscle electrostimulation following denervation and reinnervation tends to restore size and functional and histochemical properties during reinnervation better than is seen in unstimulated muscle.
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Affiliation(s)
- T Marqueste
- Laboratoire des Déterminants Physiologiques de l'Activité Physique (UPRES EA 3285), Faculté des Sciences du Sport de Marseille-Luminy, Institut Fédératif de Recherches Etienne-Jules MAREY (IFR 107), Université de la Méditerranée (Aix-Marseille II), France
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Johnston TE, Smith BT, Betz RR. Strengthening of Partially Denervated Knee Extensors Using Percutaneous Electric Stimulation in a Young Man With Spinal Cord Injury. Arch Phys Med Rehabil 2005; 86:1037-42. [PMID: 15895354 DOI: 10.1016/j.apmr.2004.11.002] [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: 11/20/2022]
Abstract
OBJECTIVE To evaluate the effects of percutaneous electric stimulation on knee extensor strength and muscle hypertrophy, gait, and energy cost of walking in a young man with partial denervation of the knee extensors. DESIGN One-way repeated measures. SETTING Pediatric orthopedic hospital. PARTICIPANT A man in his early twenties, who had an L2 American Spinal Injury Association class D spinal cord injury, presented with strength deficits in his left knee extensors and reported falling frequently. When walking, his left knee remained locked in extension throughout stance. Electromyographic testing revealed chronic denervation and reinnervation changes. INTERVENTION Because of sensory difficulties with surface stimulation, a percutaneous electrode was surgically implanted near the femoral nerve. The subject exercised isometrically with a research grade stimulator for 1 hour a day until his strength plateaued. MAIN OUTCOME MEASURES Quadriceps femoris strength and hypertrophy, gait, and energy cost of walking were recorded preintervention, every 2 months during the strengthening phase, and 2 months after withdrawal. RESULTS Voluntary isometric torque improved from 7 to 14.8Nm (112%) and decreased to 8.5Nm after stimulation was withdrawn. Mean circumferential measures of the thigh improved from 12.3 to 13.5cm (9.8%) and then decreased to 13.1cm. Gait kinematics and kinetics were unchanged, although the subject reported greater stability in his left knee and fewer falls. CONCLUSIONS The study indicates that percutaneous electric stimulation could be used to strengthen partially denervated muscle and to affect function. However, gains in strength may not be maintained once treatment is withdrawn.
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Abstract
Functioning free-muscle transfers are now an important, even essential, tool in the current management of patients with brachial plexus injury. They are indicated for the restoration of elbow flexion in patients who delay presentation(those seen after 6 to 9 mo). Double free-muscle transfers provide the possibility of simple grasp function when combined with nerve transfers or grafts for restoration of shoulder motion, hand sensation, and triceps function.
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Affiliation(s)
- Allen T Bishop
- Division of Hand Surgery, Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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18
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Somia NN, Zonnevijlle ED, Stremel RW, Maldonado C, Gossman MD, Barker JH. Multi-channel orbicularis oculi stimulation to restore eye-blink function in facial paralysis. Microsurgery 2002; 21:264-70. [PMID: 11746558 DOI: 10.1002/micr.1050] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Facial paralysis due to facial nerve injury results in the loss of function of the muscles of the hemiface. The most serious complication in extreme cases is the loss of vision. In this study, we compared the effectiveness of single- and multiple-channel electrical stimulation to restore a complete and cosmetically acceptable eye blink. We established bilateral orbicularis oculi muscle (OOM) paralysis in eight dogs; the OOM of one side was directly stimulated using single-channel electrical stimulation and the opposite side was stimulated using multi-channel electrical stimulation. The changes in the palpebral fissure and complete palpebral closure were measured. The difference in current intensities between the multi-channel and single-channel simulation groups was significant, while only multi-channel stimulation produced complete eyelid closure. The latest electronic stimulation circuitry with high-quality implantable electrodes will make it possible to regulate precisely OOM contractions and thus generate complete and cosmetically acceptable eye-blink motion in patients with facial paralysis.
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Affiliation(s)
- N N Somia
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Louisville, 511 South Floyd Street, Louisville, KY 40292, USA
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19
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Abstract
Research conducted over the past 25 years has demonstrated that muscle activity, not neurotrophic substances, is the most important factor in the regulation of specific physiological and biochemical properties of muscle fibers. Application of this knowledge has led to considerable experimentation with chronic electrical stimulation as a possible clinical tool for the treatment of denervated muscles. Evidence accumulated from animal studies has indicated that direct electrical stimulation of denervated muscles can to a large extent substitute for innervation and preserve or restore the normal properties of the muscles. Appropriate stimulation parameters were critical for a successful intervention, and the best results were obtained when the stimulation pattern resembled the firing pattern of the normal motoneuron. Thus, fast muscles required intermittent, brief, high frequency stimulation and slow muscles needed continuous, low frequency stimulation. For human denervated muscles, critical questions still remain to be resolved before electrical stimulation will yield the optimum benefit. Research must be performed in human subjects to define the appropriate stimulation parameters the stimulation current, and the type and placement of electrodes.
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Affiliation(s)
- A Eberstein
- Department of Rehabilitation Medicine, NY 10016, USA
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20
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Salerno GM, Bleicher JN, McBride DM. Restoration of paralyzed orbicularis oculi muscle function by controlled electrical current. J INVEST SURG 1991; 4:445-56. [PMID: 1777439 DOI: 10.3109/08941939109141175] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A canine model of facial nerve paralysis was studied to apply controlled electrical current to the peripherally denervated orbicularis oculi muscle, in the attempt to effectively restore the absent function of this denervated muscle. After unilateral facial nerve neurotmesis was performed in eight dogs, the denervated orbicularis oculi muscles of four dogs were electrically stimulated for 75 postoperative days (40 min/day). Denervated and normal orbicularis oculi muscles were electrophysiologically studied and compared with the Student t test. During the study period, minimum closure of denervated treated orbicularis oculi muscles was evoked with average stimulus strength (80-ms duration) of 1.61 +/- 0.22 log mA x ms, not significantly different from that of denervated nontreated or normal orbicularis oculi muscles. From days 10 through 30 only, maximum closure of denervated treated orbicularis oculi muscles was achieved with mean pulse strength (80-ms duration) of 2.37 +/- 0.09 log mA x ms, significantly lower (P less than .01) than that evoking the same type of contraction from denervated nontreated muscles (80-ms duration, mean 2.83 +/- 0.10 log mA x ms). In addition, denervated treated muscle pulse strength eliciting maximum contraction was not significantly different from that of normal orbicularis oculi muscles during the same period. This finding was not observed, however, from day 40 through the end of the study. This investigation demonstrates (1) the transient reversal of denervation changes of paralyzed orbicularis oculi muscle by daily electrical stimulation, and (2) the feasibility of restoring orbicularis oculi muscle function by controlled electrical current.
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Affiliation(s)
- G M Salerno
- Creighton University School of Medicine, Department of Surgery, Omaha, NE 68131
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21
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Bondoux-Jahan M, Sebille A. Conditioning lesion effects on rat sciatic nerve regeneration are influenced by electrical stimulation delivered to denervated muscles. Brain Res 1989; 490:350-4. [PMID: 2765869 DOI: 10.1016/0006-8993(89)90253-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The rate of regeneration and the initial delay of the fastest growing fibers of the rat sciatic nerve were electrophysiologically evaluated after a freeze at mid-thigh. A prior section or a prior freeze at the ankle level increased the rate of regeneration and decreased the initial delay with different magnitudes. These phenomena are named 'conditioning lesion effects'. A daily electrical stimulation transcutaneously delivered to the foot sole muscles from the day following their denervation by the prior lesion did not modify the increased rate of regeneration but prevented the decrease of the initial delay whatever the type of the prior lesion. Therefore, the initiation of earlier sprouting of the parent axons seems to be specifically controlled by a signal associated with muscle denervation properties.
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Affiliation(s)
- M Bondoux-Jahan
- Laboratoire de Physiologie, Faculté de Médecine Saint Antoine, Paris, France
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22
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Sébille A, Fontanges P, Legagneux J, Mira JC, Pécot-Déchavassine M. Portable stimulator for direct electrical stimulation of denervated muscles in laboratory animals. JOURNAL OF BIOMEDICAL ENGINEERING 1988; 10:371-2. [PMID: 3236862 DOI: 10.1016/0141-5425(88)90073-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
A portable lightweight stimulator for small animals is described. It delivers pulse trains of high intensity and is convenient for denervated muscle studies. It does not cause discomfort and does not restrict activity.
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Affiliation(s)
- A Sébille
- Laboratoire de Physiologie, Faculté de Médecine Saint Antoine, Paris
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