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Frazão M, Figueiredo TDG, Cipriano G. Should We Use the Functional Electrical Stimulation-Cycling Exercise in Clinical Practice? Physiological and Clinical Effects Systematic Review With Meta-analysis. Arch Phys Med Rehabil 2024:S0003-9993(24)01057-8. [PMID: 38914190 DOI: 10.1016/j.apmr.2024.06.003] [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: 05/01/2024] [Revised: 05/24/2024] [Accepted: 06/03/2024] [Indexed: 06/26/2024]
Abstract
OBJECTIVE To examine the evidence regarding functional electrical stimulation cycling's (FES-cycling's) physiological and clinical effects. DATA SOURCES The study was conducted in accordance with the preferred reporting items for systematic reviews and meta-analyses protocol. PubMed, Embase, Cochrane Review, CINAHL, Scopus, Sport Discus, and Web of Science databases were used. STUDY SELECTION Randomized controlled trials involving FES-cycling were included. Studies that did not involve FES-cycling in the intervention group or without the control group were excluded. Two reviewers screened titles and abstracts and then conducted a blinded full-text evaluation. A third reviewer resolved the discrepancies. DATA EXTRACTION Meta-analysis was performed using inverse variance for continuous data, with effects measured using the mean difference and random effects analysis models. A 95% confidence interval was adopted. The significance level was set at P<.05, and trends were declared at P=.05 to ≤.10. The I2 method was used for heterogeneity analysis. The minimal clinically important difference was calculated. Methodological quality was assessed using the risk of bias tool for randomized trials. The Grading of Recommendations Assessment, Development, and Evaluation method was used for the quality of the evidence analysis. DATA SYNTHESIS A total of 52 studies were included. Metabolic, cardiocirculatory, ventilatory, and peripheral muscle oxygen extraction variables presented statistical (P<.05) and clinically important differences favoring FES-cycling, with moderate-to-high certainty of evidence. It also presented statistical (P<.05) and clinically important improvements in cardiorespiratory fitness, leg and total body lean mass, power, physical fitness in intensive care (moderate-to-high certainty of evidence), and torque (low certainty of evidence). It presented a trend (P=.05 to ≤.10) of improvement in muscle volume, spasticity, and mobility (low-to-moderate certainty of evidence). It showed no difference (P>.10) in 6-minute walking distance, muscle cross-sectional area, bone density, and length of intensive care unit stay (low-to-moderate certainty of evidence). CONCLUSIONS FES-cycling exercise is a more intense stimulus modality than other comparative therapeutic modalities and presented clinically important improvement in several clinical outcomes.
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Affiliation(s)
- Murillo Frazão
- Lauro Wanderley University Hospital - UFPB/EBSERH, João Pessoa-PB; Postgraduate Program in Health Sciences and Technologies, University of Brasília - UnB, Brasília.
| | | | - Gerson Cipriano
- Postgraduate Program in Health Sciences and Technologies, University of Brasília - UnB, Brasília
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2
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Hamdan PNF, Hamzaid NA, Hasnan N, Abd Razak NA, Razman R, Usman J. Effects of releasing ankle joint during electrically evoked cycling in persons with motor complete spinal cord injury. Sci Rep 2024; 14:6451. [PMID: 38499594 PMCID: PMC10948841 DOI: 10.1038/s41598-024-56955-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 03/13/2024] [Indexed: 03/20/2024] Open
Abstract
Literature has shown that simulated power production during conventional functional electrical stimulation (FES) cycling was improved by 14% by releasing the ankle joint from a fixed ankle setup and with the stimulation of the tibialis anterior and triceps surae. This study aims to investigate the effect of releasing the ankle joint on the pedal power production during FES cycling in persons with spinal cord injury (SCI). Seven persons with motor complete SCI participated in this study. All participants performed 1 min of fixed-ankle and 1 min of free-ankle FES cycling with two stimulation modes. In mode 1 participants performed FES-evoked cycling with the stimulation of quadriceps and hamstring muscles only (QH stimulation), while Mode 2 had stimulation of quadriceps, hamstring, tibialis anterior, and triceps surae muscles (QHT stimulation). The order of each trial was randomized in each participant. Free-ankle FES cycling offered greater ankle plantar- and dorsiflexion movement at specific slices of 20° crank angle intervals compared to fixed-ankle. There were significant differences in the mean and peak normalized pedal power outputs (POs) [F(1,500) = 14.03, p < 0.01 and F(1,500) = 7.111, p = 0.008, respectively] between fixed- and free-ankle QH stimulation, and fixed- and free-ankle QHT stimulation. Fixed-ankle QHT stimulation elevated the peak normalized pedal PO by 14.5% more than free-ankle QH stimulation. Releasing the ankle joint while providing no stimulation to the triceps surae and tibialis anterior reduces power output. The findings of this study suggest that QHT stimulation is necessary during free-ankle FES cycling to maintain power production as fixed-ankle.
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Affiliation(s)
- Puteri Nur Farhana Hamdan
- Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Nur Azah Hamzaid
- Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, 50603, Kuala Lumpur, Malaysia.
- Department of Biomedical Engineering, Faculty of Engineering, Centre of Applied Biomechanics, Universiti Malaya, 50603, Kuala Lumpur, Malaysia.
| | - Nazirah Hasnan
- Department of Rehabilitation Medicine, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Nasrul Anuar Abd Razak
- Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Rizal Razman
- Centre for Sport & Exercise Sciences, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Juliana Usman
- Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
- Department of Biomedical Engineering, Faculty of Engineering, Centre of Applied Biomechanics, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
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Sadowsky CL. Targeting Sarcopenia as an Objective Clinical Outcome in the Care of Children with Spinal Cord-Related Paralysis: A Clinician's View. CHILDREN (BASEL, SWITZERLAND) 2023; 10:837. [PMID: 37238385 PMCID: PMC10217275 DOI: 10.3390/children10050837] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 04/27/2023] [Accepted: 04/29/2023] [Indexed: 05/28/2023]
Abstract
Muscle loss is consistently associated with immobility and paralysis and triggers significant metabolic and functional changes. The negative effects of sarcopenia are amplified in children who are in the process of building their muscle mass as part of development. Because muscle mass loss is consistently associated with increased morbidity and mortality throughout life, optimizing the size and health of muscles following a neurologic injury is an objective target for therapeutic interventions. This review hypothesizes that muscle mass correlates with functional outcomes in children with paralysis related to spinal cord-related neurologic deficits. We propose that the measurement of muscle mass in this population can be used as an objective outcome for clinical long-term care. Finally, some practical clinical approaches to improving muscle mass are presented.
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Affiliation(s)
- Cristina L. Sadowsky
- International Center for Spinal Cord Injury, Kennedy Krieger Institute, Baltimore, MD 21205, USA;
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
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Hohl K, Smith AC, Macaluso R, Giffhorn M, Prokup S, O’Dell DR, Kleinschmidt L, Elliott JM, Jayaraman A. Muscle adaptations in acute SCI following overground exoskeleton + FES training: A pilot study. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:963771. [PMID: 36311207 PMCID: PMC9608781 DOI: 10.3389/fresc.2022.963771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 09/23/2022] [Indexed: 11/21/2022]
Abstract
Objective To evaluate the combined effects of robotic exoskeleton and functional electrical stimulation (FES) training on muscle composition during over-ground gait training in persons with acute spinal cord injury (SCI). Design Randomized crossover pilot study. Setting Inpatient-rehabilitation Hospital. Participants Six individuals with acute SCI. Intervention Participants were randomized to either receive training with the Ekso® Bionics exoskeleton combined with FES in addition to standard-of-care or standard-of-care alone. Outcome measures The main outcome measures for the study were quantified using magnetic resonance imaging (MRI), specifically, lower extremity muscle volume and intramuscular adipose tissue (IMAT). Static balance and fall risk were assessed using the Berg Balance Scale. Results Significant improvements were observed in muscle volume in the exoskeleton intervention group when compared to only standard-of-care (p < 0.001). There was no significant difference between the groups in IMAT even though the intervention group saw a reduction in IMAT that trended towards statistical significance (p = 0.07). Static balance improved in both groups, with greater improvements seen in the intervention group. Conclusions Early intervention with robotic exoskeleton may contribute to improved muscle function measured using MRI in individuals with acute SCI.
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Affiliation(s)
- Kristen Hohl
- Max Näder Lab for Rehabilitation Technologies / Outcomes Lab, Shirley Ryan AbilityLab, Chicago, IL, United States
| | - Andrew C. Smith
- Department of Physical Medicine and Rehabilitation, Physical Therapy Program, School of Medicine, University of Colorado, Aurora, CO, United States
| | - Rebecca Macaluso
- Max Näder Lab for Rehabilitation Technologies / Outcomes Lab, Shirley Ryan AbilityLab, Chicago, IL, United States
| | - Matthew Giffhorn
- Max Näder Lab for Rehabilitation Technologies / Outcomes Lab, Shirley Ryan AbilityLab, Chicago, IL, United States
| | - Sara Prokup
- Max Näder Lab for Rehabilitation Technologies / Outcomes Lab, Shirley Ryan AbilityLab, Chicago, IL, United States
| | - Denise R. O’Dell
- Department of Physical Therapy, University of Kentucky College of Health Sciences, Lexington, KY, United States
| | - Lina Kleinschmidt
- Department of Physical Therapy / Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Jim M. Elliott
- Department of Physical Therapy / Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States,Northern Sydney Local Health District, The Kolling Institute and Faculty of Medicine and Health, The University of Sydney, St. Leonards, NSW, Australia
| | - Arun Jayaraman
- Max Näder Lab for Rehabilitation Technologies / Outcomes Lab, Shirley Ryan AbilityLab, Chicago, IL, United States,Department of Physical Therapy / Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States,Department of Physical Medicine / Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States,Correspondence: Arun Jayaraman
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5
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McIntyre A, Sadowsky C, Behrman A, Martin R, Augutis M, Cassidy C, Betz R, Ertzgaard P, Mulcahey MJ. A Systematic Review of the Scientific Literature for Rehabilitation/Habilitation Among Individuals With Pediatric-Onset Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2022; 28:13-90. [PMID: 35521053 PMCID: PMC9009193 DOI: 10.46292/sci21-00046] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Objectives To conduct a systematic review to examine the scientific literature for rehabilitation/habilitation among individuals with pediatric-onset spinal cord injury (SCI). Methods A literature search of multiple databases (i.e., PubMed/MEDLINE, CINAHL, EMBASE, PsychINFO) was conducted and was filtered to include studies involving humans, published as full-length articles up to December 2020, and in English. Included studies met the following inclusion criteria: (1) ≥50% of the study sample had experienced a traumatic, acquired, nonprogressive spinal cord injury (SCI) or a nontraumatic, acquired, noncongenital SCI; (2) SCI onset occurred at ≤21 years of age; and (3) sample was assessed for a rehabilitation/habilitation-related topic. Studies were assigned a level of evidence using an adapted Sackett scale modified down to five levels. Data extracted from each study included author(s), year of publication, country of origin, study design, subject characteristics, rehabilitation/habilitation topic area, intervention (if applicable), and outcome measures. Results One hundred seventy-six studies were included for review (1974-2020) with the majority originating from the United States (81.3%). Most studies were noninterventional observational studies (n = 100; 56.8%) or noninterventional case report studies (n = 5; 2.8%). Sample sizes ranged from 1 to 3172 with a median of 26 (interquartile range [IQR], 116.5). Rehabilitation/habilitation topics were categorized by the International Classification of Functioning, Disability and Health (ICF); most studies evaluated ICF Body Function. There were 69 unique clinical health outcome measures reported. Conclusion The evidence for rehabilitation/habilitation of pediatric-onset SCI is extremely limited; nearly all studies (98%) are level 4-5 evidence. Future studies across several domains should be conducted with novel approaches to research design to alleviate issues related to sample sizes and heterogeneity.
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Affiliation(s)
- Amanda McIntyre
- Parkwood Institute Research, Parkwood Institute, London, Canada
| | - Cristina Sadowsky
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, John Hopkins University, Baltimore, Maryland
,International Center for Spinal Cord Injury, Kennedy Krieger Institute, Baltimore, Maryland
| | - Andrea Behrman
- Department of Neurological Surgery, Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky
,Kosair Charities Center for Pediatric Neurorecovery, Louisville, Kentucky
| | - Rebecca Martin
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, John Hopkins University, Baltimore, Maryland
,International Center for Spinal Cord Injury, Kennedy Krieger Institute, Baltimore, Maryland
| | - Marika Augutis
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institute, Solna, Sweden
| | - Caitlin Cassidy
- St. Joseph’s Health Care London, Parkwood Institute, London, Canada
| | - Randal Betz
- Institute for Spine and Scoliosis, Lawrenceville, New Jersey
,Department of Orthopedics, Mount Sinai Hospital, New York, New York
| | - Per Ertzgaard
- Department of Rehabilitation Medicine, Linköping University, Linköping, Sweden
| | - MJ Mulcahey
- Department of Occupational Therapy, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Woodbury, New Jersey
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Yan D, Vassar R. Neuromuscular electrical stimulation for motor recovery in pediatric neurological conditions: a scoping review. Dev Med Child Neurol 2021; 63:1394-1401. [PMID: 34247385 DOI: 10.1111/dmcn.14974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/28/2021] [Indexed: 12/31/2022]
Abstract
AIM To explore the breadth of pediatric neurological conditions for which neuromuscular electrical stimulation (NMES) has been studied. METHOD Databases (PubMed, Google Scholar, Scopus, and Embase) were searched from 2000 to 2020, using the search terms 'neuromuscular electrical stimulation' OR 'functional electrical stimulation' with at least one of the words 'pediatric OR child OR children OR adolescent', and without the words 'dysphagia OR implanted OR enuresis OR constipation'. Articles focused on adults or individuals with cerebral palsy (CP) were excluded. RESULTS Thirty-five studies met the inclusion criteria, with a total of 353 pediatric participants (293 unique participants; mean age 7y 4mo, range 1wk-38y). NMES was applied in a range of pediatric conditions other than CP, including stroke, spinal cord injury, myelomeningocele, scoliosis, congenital clubfoot, obstetric brachial plexus injury, genetic neuromuscular diseases, and other neuromuscular conditions causing weakness. INTERPRETATION All 35 studies concluded that NMES was well-tolerated and most studies suggested that NMES could augment traditional therapy methods to improve strength. Outcome measurements were heterogeneous. Further research on NMES with larger, randomized studies will help clarify its potential to improve physiology and mobility in pediatric patients with neuromuscular conditions. What this paper adds Neuromuscular electrical stimulation (NMES) appears to be tolerated by pediatric patients. NMES shows potential for augmenting recovery in pediatric patients with a range of rehabilitation needs.
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Affiliation(s)
- Derek Yan
- Winston Churchill High School, Potomac, MD, USA
| | - Rachel Vassar
- Department of Neurology, Division of Pediatric Neurology, University of California San Francisco, San Francisco, CA, USA
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Furlan JC, Pakosh M, Craven BC, Popovic MR. Insights on the Potential Mechanisms of Action of Functional Electrical Stimulation Therapy in Combination With Task-Specific Training: A Scoping Review. Neuromodulation 2021; 25:1280-1288. [PMID: 34031937 DOI: 10.1111/ner.13403] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 03/12/2021] [Accepted: 03/30/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES This scoping review was undertaken to synthetize and appraise the literature on the potential mechanisms of action of functional electrical stimulation therapy in combination with task-specific training (FEST + TST) in the rehabilitation following stroke, spinal cord injury, traumatic brain injury, or multiple sclerosis. MATERIALS AND METHODS The literature search was performed using multiple databases (including APA, PsycInfo, Medline, PubMed, EMBASE, CCRCT, and Cochrane Database of Systematic Reviews) from 1946 to June 2020. The literature search used the following terms: (spinal cord injury, paraplegia, tetraplegia, quadriplegia, stroke, multiple sclerosis, traumatic brain injury, or acquired brain injury) AND (functional electrical stimulation or FES). The search included clinical and preclinical studies without limits to language. RESULTS Of the 8209 titles retrieved from the primary search, 57 publications fulfilled the inclusion and exclusion criteria for this scoping review. While most publications were clinical studies (n = 50), there were only seven preclinical studies using animal models. The results of this review suggest that FEST + TST can result in multiple effects on different elements from the muscle to the cerebral cortex. However, most studies were focused on the muscle changes after FEST + TST. CONCLUSIONS The results of this scoping review suggest that FEST + TST can result in multiple effects on different elements of the neuromuscular system, while most research studies were focused on the muscle changes after FEST + TST. Despite the efficacy of the FEST + TST in the neurorehabilitation after CNS injury or disease, the results of this review underline an important knowledge gap with regards to the actual mechanism of action of FEST + TST.
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Affiliation(s)
- Julio Cesar Furlan
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, ON, Canada.,Lyndhurst Centre, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,KITE - Research Institute, University Health Network, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Maureen Pakosh
- Library & Information Services, Rumsey Cardiac Centre Library, University Health Network, Toronto Rehabilitation Institute, Toronto, ON, Canada
| | - Beverley Catharine Craven
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, ON, Canada.,Lyndhurst Centre, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,KITE - Research Institute, University Health Network, Toronto, ON, Canada
| | - Milos Radomir Popovic
- KITE - Research Institute, University Health Network, Toronto, ON, Canada.,Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
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Gorgey AS, Khalil RE, Davis JC, Carter W, Gill R, Rivers J, Khan R, Goetz LL, Castillo T, Lavis T, Sima AP, Lesnefsky EJ, Cardozo CC, Adler RA. Skeletal muscle hypertrophy and attenuation of cardio-metabolic risk factors (SHARC) using functional electrical stimulation-lower extremity cycling in persons with spinal cord injury: study protocol for a randomized clinical trial. Trials 2019; 20:526. [PMID: 31443727 PMCID: PMC6708188 DOI: 10.1186/s13063-019-3560-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 07/06/2019] [Indexed: 12/16/2022] Open
Abstract
Background Persons with spinal cord injury (SCI) are at heightened risks of developing unfavorable cardiometabolic consequences due to physical inactivity. Functional electrical stimulation (FES) and surface neuromuscular electrical stimulation (NMES)-resistance training (RT) have emerged as effective rehabilitation methods that can exercise muscles below the level of injury and attenuate cardio-metabolic risk factors. Our aims are to determine the impact of 12 weeks of NMES + 12 weeks of FES-lower extremity cycling (LEC) compared to 12 weeks of passive movement + 12 weeks of FES-LEC on: (1) oxygen uptake (VO2), insulin sensitivity, and glucose disposal in adults with SCI; (2) skeletal muscle size, intramuscular fat (IMF), and visceral adipose tissue (VAT); and (3) protein expression of energy metabolism, protein molecules involved in insulin signaling, muscle hypertrophy, and oxygen uptake and electron transport chain (ETC) activities. Methods/Design Forty-eight persons aged 18–65 years with chronic (> 1 year) SCI/D (AIS A-C) at the C5-L2 levels, equally sub-grouped by cervical or sub-cervical injury levels and time since injury, will be randomized into either the NMES + FES group or Passive + FES (control group). The NMES + FES group will undergo 12 weeks of evoked RT using twice-weekly NMES and ankle weights followed by twice-weekly progressive FES-LEC for an additional 12 weeks. The control group will undergo 12 weeks of passive movement followed by 12 weeks of progressive FES-LEC. Measurements will be performed at baseline (B; week 0), post-intervention 1 (P1; week 13), and post-intervention 2 (P2; week 25), and will include: VO2 measurements, insulin sensitivity, and glucose effectiveness using intravenous glucose tolerance test; magnetic resonance imaging to measure muscle, IMF, and VAT areas; muscle biopsy to measure protein expression and intracellular signaling; and mitochondrial ETC function. Discussion Training through NMES + RT may evoke muscle hypertrophy and positively impact oxygen uptake, insulin sensitivity, and glucose effectiveness. This may result in beneficial outcomes on metabolic activity, body composition profile, mitochondrial ETC, and intracellular signaling related to insulin action and muscle hypertrophy. In the future, NMES-RT may be added to FES-LEC to improve the workloads achieved in the rehabilitation of persons with SCI and further decrease muscle wasting and cardio-metabolic risks. Trial registration ClinicalTrials.gov, NCT02660073. Registered on 21 Jan 2016.
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Affiliation(s)
- Ashraf S Gorgey
- Spinal Cord Injury & Disorders Service, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA. .,Department of Physical Medicine & Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA.
| | - Refka E Khalil
- Spinal Cord Injury & Disorders Service, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
| | - John C Davis
- Spinal Cord Injury & Disorders Service, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
| | - William Carter
- Department of Physical Medicine & Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
| | - Ranjodh Gill
- Endocrinology Service, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA.,Endocrine Division, School of Medicine Virginia Commonwealth University, Richmond, VA, USA
| | - Jeannie Rivers
- Endocrine Division, School of Medicine Virginia Commonwealth University, Richmond, VA, USA
| | - Rehan Khan
- Radiology Service, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
| | - Lance L Goetz
- Spinal Cord Injury & Disorders Service, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA.,Department of Physical Medicine & Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
| | - Teodoro Castillo
- Spinal Cord Injury & Disorders Service, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA.,Department of Physical Medicine & Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
| | - Timothy Lavis
- Spinal Cord Injury & Disorders Service, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA.,Department of Physical Medicine & Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
| | - Adam P Sima
- Department of Biostatistics, School of Medicine Virginia Commonwealth University, Richmond, VA, USA
| | - Edward J Lesnefsky
- Cardiology Service, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA.,Division of Cardiology, Department of Internal Medicine, Pauley Heart Center Virginia Commonwealth University, Richmond, VA, USA
| | - Christopher C Cardozo
- Center for the Medical Consequences of Spinal Cord Injury, James J Peters VA Medical Center, Bronx, NY, USA.,Departments of Medicine and Rehabilitation Medicine, Icahn School of Medicine, New York, NY, USA
| | - Robert A Adler
- Endocrinology Service, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA.,Endocrine Division, School of Medicine Virginia Commonwealth University, Richmond, VA, USA
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Felter CE, Neuland EE, Iuculano SC, Dean J. Interdisciplinary, Intensive, Activity-Based Treatment for Intrauterine Spinal Cord Infarct: A Case Report. Top Spinal Cord Inj Rehabil 2019; 25:97-103. [PMID: 30774293 DOI: 10.1310/sci18-00025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Intrauterine spinal cord infarcts (IUSCI) with resulting tetraplegia are extremely rare, and there is minimal evidence describing outcomes in this population. This case describes the functional progress of a 3-year-old girl born with IUSCI who participated in activity-based therapies (ABT). Children have developing nervous systems and are particularly suited to benefit from ABT. Over the course of treatment, the child in this case has demonstrated improvements in developmental milestone achievement including fine and gross motor skills and social/cognitive development. Intense, interdisciplinary ABT should be considered for the treatment of children with IUSCI.
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Affiliation(s)
- Cara E Felter
- Department of Physical Therapy and Rehabilitation Science, University of Maryland, School of Medicine, Baltimore, Maryland
| | - Erin E Neuland
- International Center for Spinal Cord Injury, Hugo W. Moser Research Institute at Kennedy Krieger Institute, Baltimore, Maryland
| | - Shannon C Iuculano
- International Center for Spinal Cord Injury, Hugo W. Moser Research Institute at Kennedy Krieger Institute, Baltimore, Maryland
| | - Janet Dean
- International Center for Spinal Cord Injury, Hugo W. Moser Research Institute at Kennedy Krieger Institute, Baltimore, Maryland
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Lo CC, Lin PY, Hoe ZY, Chen JJJ. Near Infrared Spectroscopy Study of Cortical Excitability During Electrical Stimulation-Assisted Cycling for Neurorehabilitation of Stroke Patients. IEEE Trans Neural Syst Rehabil Eng 2018; 26:1292-1300. [PMID: 29877854 DOI: 10.1109/tnsre.2018.2829804] [Citation(s) in RCA: 8] [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
In addition to generating functional limb movement via electrical stimulation, other research proposed lower intensity stimulation for stroke patients from proprioceptive and neuro-biofeedback aspects. This paper investigates the effects of different intensity levels of electrical stimulation during passive cycling on cortical activation using multichannel near infrared spectroscopy (NIRS) covering premotor cortex, supplementary motor area, sensorimotor cortex (SMC), and secondary sensory cortex (S2) regions. Sixteen subjects, including nine stroke patients and seven normal subjects, were instructed to perform passive cycling driven by an ergometer at a pace of 50 rpm under conditions without electrical stimulation (NES) and with low-intensity electrical stimulation (LES) at 10 mA and high-intensity electrical stimulation (HES) at 30 mA. Changes in oxyhemoglobin in different brain regions and the derived interhemispheric correlation coefficient (IHCC) representing the symmetry in response of two hemispheres were evaluated to observe cortical activation and cerebral autoregulation. Our results showed that cortical activation of normal subjects exhibited overall deactivations in HES compared with that under LES and NES. In stroke patients, bilateral S2 activated significantly greater under LES compared with those under NES and HES. The IHCC of the normal group displayed a significant higher value in SMC compared with that of the stroke group. This paper utilized noninvasive NIRS to observe hemodynamic changes and bilateral autoregulation symmetry from IHCC suggesting that passive cycling with LES could better facilitate cortical activation compared with that obtained with NES or HES. The results of this paper could provide general guidelines to simplify the settings of electrical stimulation-assisted-passive cycling in clinical use.
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Musselman KE, Manns P, Dawe J, Delgado R, Yang JF. The Feasibility of Functional Electrical Stimulation to Improve Upper Extremity Function in a Two-year-old Child with Perinatal Stroke: A Case Report. Phys Occup Ther Pediatr 2018; 38:97-112. [PMID: 28071962 DOI: 10.1080/01942638.2016.1255291] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIMS To evaluate the effectiveness and feasibility (i.e. tolerability, adherence) of functional electrical stimulation (FES) for the upper extremity (UE) in a two-year-old child with perinatal stroke. METHODS Forty hours of FES over eight weeks was prescribed. FES to the hemiplegic triceps, extensor carpi radialis longus and brevis, extensor carpi ulnaris and extensor digitorum was timed with reaching during play. Assessments were performed before, during, and two months post-intervention. UE function (Melbourne Assessment 2 (MA2), Assisting Hand Assessment (AHA)) and spasticity (Modified Tardieu with electrogoniometry and electromyography) were measured. The mother completed a semi-structured interview post-intervention. Descriptive statistics were used for adherence and UE measures. A repeated-measures ANOVA compared Modified Tardieu parameters (e.g. catch angle) over time. Conventional content analysis was used for the interview data. RESULTS The child completed 39.2/40 hours. Immediately post-intervention, improvements were observed on MA2's Range of Motion subscale and catch angle (Modified Tardieu, p < 0.001). Two months post-intervention, improvements were observed on MA2's Accuracy and Fluency subscales. No change in AHA score occurred. Three themes emerged from the interview: (1) Ingredients for program success; (2) Information about the FES device; and (3) The child's response. CONCLUSIONS UE FES was feasible in a two-year-old child with hemiplegia.
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Affiliation(s)
- Kristin E Musselman
- a Toronto Rehabilitation Institute-University Health Network , Toronto , ON , Canada.,b Department of Physical Therapy , Faculty of Medicine, University of Toronto , Toronto , ON , Canada.,c School of Physical Therapy, College of Medicine, University of Saskatchewan , Saskatoon , SK , Canada.,d Rehabilitation Sciences Institute, University of Toronto , Toronto , ON , Canada
| | - Patricia Manns
- e Department of Physical Therapy , Faculty of Rehabilitation Medicine, University of Alberta , Edmonton , AB , Canada
| | - Jaclyn Dawe
- d Rehabilitation Sciences Institute, University of Toronto , Toronto , ON , Canada
| | - Rhina Delgado
- f University of Alberta Hospital , Edmonton , AB , Canada
| | - Jaynie F Yang
- e Department of Physical Therapy , Faculty of Rehabilitation Medicine, University of Alberta , Edmonton , AB , Canada.,g Neuroscience & Mental Health Institute, University of Alberta , Edmonton , AB , Canada
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Capelari TV, Borin JS, Grigol M, Saccani R, Zardo F, Cechetti F. EVALUATION OF MUSCLE STRENGTH IN MEDULLAR INJURY: A LITERATURE REVIEW. COLUNA/COLUMNA 2017. [DOI: 10.1590/s1808-185120171604179802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: To identify the tools used to evaluate muscle strength in subjects with spinal cord injury in both clinical practice and scientific research. Methods: Initially, the literature review was carried out to identify the tools used in scientific research. The search was conducted in the following databases: Virtual Health Library (VHL), Pedro, and PubMed. Studies published between 1990 and 2016 were considered and selected, depicting an evaluation of muscle strength as an endpoint or for characterization of the sample. Next, a survey was carried out with physiotherapists to identify the instruments used for evaluation in clinical practice, and the degree of satisfaction of professionals with respect to them. Results: 495 studies were found; 93 were included for qualitative evaluation. In the studies, we verified the use of manual muscle test with different graduation systems, isokinetic dynamometer, hand-held dynamometer, and manual dynamometer. In clinical practice, the manual muscle test using the motor score recommended by the American Spinal Cord Injury Association was the most used method, despite the limitations highlighted by the physiotherapists interviewed. Conclusion: In scientific research, there is great variation in the methods and tools used to evaluate muscle strength in individuals with spinal cord injury, differently from clinical practice. The tools available and currently used have important limitations, which were highlighted by the professionals interviewed. No instrument depicts direct relationship of muscle strength and functionality of the subject. There is no consensus as to the best method for assessing muscle strength in spinal cord injury, and new instruments are needed that are specific for use in this population.
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Affiliation(s)
| | | | - Melissa Grigol
- Pontifícia Universidade Católica do Rio Grande do Sul, Brazil
| | | | - Franciele Zardo
- Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil
| | - Fernanda Cechetti
- Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil; Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil
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Nardone R, Orioli A, Golaszewski S, Brigo F, Sebastianelli L, Höller Y, Frey V, Trinka E. Passive cycling in neurorehabilitation after spinal cord injury: A review. J Spinal Cord Med 2017; 40:8-16. [PMID: 27841091 PMCID: PMC5376131 DOI: 10.1080/10790268.2016.1248524] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
CONTEXT/OBJECTIVE Passive cycling (PC) may represent a potential alternative neurorehabilitation program for patients who are too weak or medically unstable to repeatedly practice active movements. We review here the most important animal and human studies addressing PC after spinal cord injury (SCI). METHODS A MEDLINE search was performed using following terms: "passive", "cycling", "pedaling", "pedalling","spinal cord injury". RESULTS Experimental studies revealed that PC modulated spinal reflex and reduced spasticity. PC also reduced autonomic dysreflexia and elicited cardio-protective effects. Increased levels of mRNA for brain-derived neurotrophic factor, glial cell line-derived neurotrophic factor and neurotrophin-4 were found. In contrast, human studies failed to show an effect of PC on spasticity reduction and did not support its application for prevention of cardiovascular disease-related secondary complications. CONCLUSION Available evidence to support the use of PC as standard treatment in patients with SCI is still rather limited. Since it is conceivable that PC motion could elicit sensory inputs to activate cortical structures and induce cortical plasticity changes leading to improved lower limb motor performance, further carefully designed prospective studies in subjects with SCI are needed.
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Affiliation(s)
- Raffaele Nardone
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria,Department of Neurology, Franz Tappeiner Hospital, Merano, Italy,Spinal Cord Injury and Tissue Regeneration Center, Paracelsus Medical University, Salzburg, Austria,Correspondence to: Raffaele Nardone, Department of Neurology – “F. Tappeiner” Hospital – Meran/o, Via Rossini, 5, 39012 Meran/o (BZ) – Italy. E-mail address:
| | - Andrea Orioli
- Department of Neurology, Franz Tappeiner Hospital, Merano, Italy
| | - Stefan Golaszewski
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria
| | - Francesco Brigo
- Department of Neurology, Franz Tappeiner Hospital, Merano, Italy,Department of Neurological and Movement Sciences. Section of Clinical Neurology, University of Verona, Italy
| | | | - Yvonne Höller
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria
| | - Vanessa Frey
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria,Spinal Cord Injury and Tissue Regeneration Center, Paracelsus Medical University, Salzburg, Austria
| | - Eugen Trinka
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria,Spinal Cord Injury and Tissue Regeneration Center, Paracelsus Medical University, Salzburg, Austria
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14
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Bosques G, Martin R, McGee L, Sadowsky C. Does therapeutic electrical stimulation improve function in children with disabilities? A comprehensive literature review. J Pediatr Rehabil Med 2016; 9:83-99. [PMID: 27285801 DOI: 10.3233/prm-160375] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The use of therapeutic electrical stimulation for medical purposes is not new; it has been described in medical textbooks since the 18th century, but its use has been limited due to concerns for tolerance and lack of research showing efficacy. The purpose of this review is to discuss the potential clinical applicability, while clarifying the differences in electrical stimulation (ES) treatments and the theory behind potential benefits to remediate functional impairments in youth.The literature review was performed as follows: A total of 37 articles were reviewed and the evidence for use in pediatric diagnoses is reported.The synthesis of the literature suggests that improvements in various impairments may be possible with the integration of ES. Most studies were completed on children with cerebral palsy (CP). Electrical stimulation may improve muscle mass and strength, spasticity, passive range of motion (PROM), upper extremity function, walking speed, and positioning of the foot and ankle kinematics during walking. Sitting posture and static/dynamic sitting balance may be improved with ES to trunk musculature. Bone mineral density may be positively affected with the use of Functional Electrical Stimulation (FES) ergometry. ES may also be useful in the management of urinary tract dysfunction and chronic constipation. Among all reviewed studies, reports of direct adverse reactions to electrical stimulation were rare.In conclusion, NMES and FES appear to be safe and well tolerated in children with various disabilities. It is suggested that physiatrists and other healthcare providers better understand the indications and parameters in order to utilize these tools effectively in the pediatric population. MeSH terms: Electrical stimulation; child; review.
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Affiliation(s)
- Glendaliz Bosques
- University of Texas - Health Science Center at Houston (UTHealth), Houston, TX, USA.,Shriners Hospital for Children, Houston, TX, USA
| | - Rebecca Martin
- Kennedy Krieger Institute, Baltimore, MD, USA.,Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Leah McGee
- Shriners Hospital for Children, Houston, TX, USA
| | - Cristina Sadowsky
- Kennedy Krieger Institute, Baltimore, MD, USA.,Johns Hopkins University School of Medicine, Baltimore, MD, USA
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15
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Wei ZJ, Zhou XH, Fan BY, Lin W, Ren YM, Feng SQ. Proteomic and bioinformatic analyses of spinal cord injury‑induced skeletal muscle atrophy in rats. Mol Med Rep 2016; 14:165-74. [PMID: 27177391 PMCID: PMC4918545 DOI: 10.3892/mmr.2016.5272] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 05/03/2016] [Indexed: 11/06/2022] Open
Abstract
Spinal cord injury (SCI) may result in skeletal muscle atrophy. Identifying diagnostic biomarkers and effective targets for treatment is an important challenge in clinical work. The aim of the present study is to elucidate potential biomarkers and therapeutic targets for SCI‑induced muscle atrophy (SIMA) using proteomic and bioinformatic analyses. The protein samples from rat soleus muscle were collected at different time points following SCI injury and separated by two‑dimensional gel electrophoresis and compared with the sham group. The identities of these protein spots were analyzed by mass spectrometry (MS). MS demonstrated that 20 proteins associated with muscle atrophy were differentially expressed. Bioinformatic analyses indicated that SIMA changed the expression of proteins associated with cellular, developmental, immune system and metabolic processes, biological adhesion and localization. The results of the present study may be beneficial in understanding the molecular mechanisms of SIMA and elucidating potential biomarkers and targets for the treatment of muscle atrophy.
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Affiliation(s)
- Zhi-Jian Wei
- Department of Orthopaedics, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Xian-Hu Zhou
- Department of Orthopaedics, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Bao-You Fan
- Department of Orthopaedics, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Wei Lin
- Department of Orthopaedics, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Yi-Ming Ren
- Department of Orthopaedics, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Shi-Qing Feng
- Department of Orthopaedics, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
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Pool D, Elliott C, Bear N, Donnelly CJ, Davis C, Stannage K, Valentine J. Neuromuscular electrical stimulation-assisted gait increases muscle strength and volume in children with unilateral spastic cerebral palsy. Dev Med Child Neurol 2016; 58:492-501. [PMID: 26555148 DOI: 10.1111/dmcn.12955] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/15/2015] [Indexed: 12/26/2022]
Abstract
AIM To determine if neuromuscular electrical stimulation (NMES) applied to the ankle dorsiflexors during gait improves muscle volume and strength in children with unilateral spastic cerebral palsy (CP). METHOD Thirty-two children (15 females, 17 males; mean age 10y 8mo, age range 5y 5mo-18y 1mo) with unilateral spastic CP and a Gross Motor Function Classification System of level I or level II were randomly assigned to either the 8-week daily NMES treatment group or control group (usual or conventional treatments). Outcomes at week 8 (post-NMES) and week 14 (carryover) included magnetic resonance imaging for muscle volumes (tibialis anterior, anterior compartment, and gastrocnemius), strength (hand-held dynamometry for isometric dorsiflexion strength and heel raises for functional strength), and clinical measures for lower limb selective motor control. RESULTS At week 8, the treatment group demonstrated significantly (p<0.05) increased muscle volumes for tibialis anterior, anterior compartment, medial and lateral gastrocnemius, and dorsiflexion strength not only when compared to their baseline values but also when compared to the control group at week 8. At week 14, both tibialis anterior and lateral gastrocnemius volumes in the treatment group remained significantly increased when compared to their baseline values. However, only lateral gastrocnemius volumes had significantly greater values when compared to the control group at week 14. There were no between group differences in the clinical measures for lower limb selective motor control at week 8 and 14. INTERPRETATION Eight weeks of daily NMES-assisted gait increases muscle volume and strength of the stimulated ankle dorsiflexors in children with unilateral spastic CP. These changes are use-dependent and do not carry over after the 8-week treatment period. Gastrocnemius volume also increased post-treatment with carryover at week 14.
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Affiliation(s)
- Dayna Pool
- Department of Physiotherapy and Paediatric Rehabilitation, Princess Margaret Hospital for Children, Perth, WA, Australia.,School of Sport Science Exercise and Health, The University of Western Australia, Perth, WA, Australia
| | - Catherine Elliott
- Faculty of Health Science, Curtin University of Technology, Perth, WA, Australia
| | - Natasha Bear
- Department of Physiotherapy and Paediatric Rehabilitation, Princess Margaret Hospital for Children, Perth, WA, Australia
| | - Cyril J Donnelly
- School of Sport Science Exercise and Health, The University of Western Australia, Perth, WA, Australia
| | - Caroline Davis
- School of Sport Science Exercise and Health, The University of Western Australia, Perth, WA, Australia
| | - Katherine Stannage
- Department of Orthopaedics, Princess Margaret Hospital for Children, Perth, WA, Australia
| | - Jane Valentine
- Department of Paediatric Rehabilitation, Princess Margaret Hospital for Children, Perth, WA, Australia
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17
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Gorgey AS, Poarch HJ, Dolbow DD, Castillo T, Gater DR. Effect of adjusting pulse durations of functional electrical stimulation cycling on energy expenditure and fatigue after spinal cord injury. ACTA ACUST UNITED AC 2015; 51:1455-68. [PMID: 25803753 DOI: 10.1682/jrrd.2014.02.0054] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Revised: 07/29/2014] [Indexed: 11/05/2022]
Abstract
The purpose of the current study was to determine the effects of three different pulse durations (200, 350, and 500 microseconds [P200, P350, and P500, respectively]) on oxygen uptake (VO2), cycling performance, and energy expenditure (EE) percentage of fatigue of the knee extensor muscle group immediately and 48 to 72 h after cycling in persons with spinal cord injury (SCI). A convenience sample of 10 individuals with motor complete SCI participated in a repeated-measures design using a functional electrical stimulation (FES) cycle ergometer over a 3 wk period. There was no difference among the three FES protocols on relative VO2 or cycling EE. Delta EE between exercise and rest was 42% greater in both P500 and P350 compared with P200 (p = 0.07), whereas recovery VO2 was 23% greater in P350 compared with P200 (p = 0.03). There was no difference in the outcomes of the three pulse durations on muscle fatigue. Knee extensor torque significantly decreased immediately after (p < 0.001) and 48 to 72 h after (p < 0.001) FES leg cycling. Lengthening pulse duration did not affect submaximal or relative VO2 or EE, total EE, and time to fatigue. Greater recovery VO2 and delta EE were noted in P350 and P500 compared with P200. An acute bout of FES leg cycling resulted in torque reduction that did not fully recover 48 to 72 h after cycling.
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Affiliation(s)
- Ashraf S Gorgey
- Spinal Cord Injury and Disorders Service, Hunter Holmes McGuire Department of Veterans Affairs Medical Center, Richmond, VA
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18
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Yaşar E, Yılmaz B, Göktepe S, Kesikburun S. The effect of functional electrical stimulation cycling on late functional improvement in patients with chronic incomplete spinal cord injury. Spinal Cord 2015; 53:866-9. [PMID: 25687513 DOI: 10.1038/sc.2015.19] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 01/09/2015] [Accepted: 01/14/2015] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Prospective single-arm study. OBJECTIVES To investigate the effect of functional electrical stimulation (FES) cycling on late functional recovery, spasticity, gait parameters and oxygen consumption during walking in patients with chronic incomplete spinal cord injury (SCI). SETTING Turkish Armed Forces Rehabilitation Center, Ankara, Turkey. METHODS Ten patients with chronic (duration of more than 2 years) incomplete SCI who could ambulate at least 10 m independently or with the assistance of a cane or walker, but no hip-knee-ankle-foot orthosis. The subjects underwent 1-h FES cycling sessions three times a week for 16 weeks. Outcome measures including the total motor score, the Functional Independence Measure (FIM) score, the Modified Ashworth Scale for knee spasticity, temporal spatial gait parameters and oxygen consumption rate during walking were assessed at baseline, 3 and 6 months after the baseline. RESULTS There were statistically significant improvements in total motor scores, the FIM scores and spasticity level at the 6-month follow-up (P<0.01). The changes in gait parameters reached no significant level (P>0.05). Oxygen consumption rate of the patients showed significant reduction at only 6 months compared with baseline (P<0.01). CONCLUSION The results suggest that FES cycling may provide some functional improvements in the late period of SCI. SPONSORSHIP The study was supported by The Scientific and Technological Research Council of Turkey (TUBITAK).
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Affiliation(s)
- E Yaşar
- Gülhane Military Medical Academy, Department of Physical Medicine and Rehabilitation, Turkish Armed Forces Rehabilitation Center, Ankara, Turkey
| | - B Yılmaz
- Gülhane Military Medical Academy, Department of Physical Medicine and Rehabilitation, Turkish Armed Forces Rehabilitation Center, Ankara, Turkey
| | - S Göktepe
- Gülhane Military Medical Academy, Department of Physical Medicine and Rehabilitation, Turkish Armed Forces Rehabilitation Center, Ankara, Turkey
| | - S Kesikburun
- Gülhane Military Medical Academy, Department of Physical Medicine and Rehabilitation, Turkish Armed Forces Rehabilitation Center, Ankara, Turkey
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19
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Gorgey AS, Dolbow DR, Dolbow JD, Khalil RK, Gater DR. The effects of electrical stimulation on body composition and metabolic profile after spinal cord injury--Part II. J Spinal Cord Med 2015; 38:23-37. [PMID: 25001669 PMCID: PMC4293531 DOI: 10.1179/2045772314y.0000000244] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Diet and exercise are cornerstones in the management of obesity and associated metabolic complications, including insulin resistance, type 2 diabetes, and disturbances in the lipid profile. However, the role of exercise in managing body composition adaptations and metabolic disorders after spinal cord injury (SCI) is not well established. The current review summarizes evidence about the efficacy of using neuromuscular electrical stimulation or functional electrical stimulation in exercising the paralytic lower extremities to improve body composition and metabolic profile after SCI. There are a number of trials that investigated the effects on muscle cross-sectional area, fat-free mass, and glucose/lipid metabolism. The duration of the intervention in these trials varied from 6 weeks to 24 months. Training frequency ranged from 2 to 5 days/week. Most studies documented significant increases in muscle size but no noticeable changes in adipose tissue. While increases in skeletal muscle size after twice weekly training were greater than those trials that used 3 or 5 days/week, other factors such as differences in the training mode, i.e. resistance versus cycling exercise and pattern of muscle activation may be responsible for this observation. Loading to evoke muscle hypertrophy is a key component in neuromuscular training after SCI. The overall effects on lean mass were modest and did not exceed 10% and the effects of training on trunk or pelvic muscles remain unestablished. Most studies reported improvement in glucose metabolism with the enhancement of insulin sensitivity being the major factor following training. The effect on lipid profile is unclear and warrants further investigation.
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Affiliation(s)
- Ashraf S. Gorgey
- Correspondence to: Ashraf S. Gorgey, Department of Veterans Affairs, Hunter Holmes McGuire Medical Center, Spinal Cord Injury & Disorders Service, 1201 Broad Rock Boulevard, Richmond, VA 23249, USA.
| | - David R. Dolbow
- School of Human Performance and Recreation, University of Southern Mississippi, Hattiesburg, MS, USA
| | - James D. Dolbow
- Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire VAMC, Richmond, VA, USA
| | - Refka K. Khalil
- Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire VAMC, Richmond, VA, USA
| | - David R. Gater
- Department of Physical Medicine and Rehabilitation, Penn State University, Penn State College of Medicine, Hershey, PA, USA
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21
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Mayson TA, Harris SR. Functional electrical stimulation cycling in youth with spinal cord injury: A review of intervention studies. J Spinal Cord Med 2014; 37:266-77. [PMID: 24621033 PMCID: PMC4064576 DOI: 10.1179/2045772313y.0000000183] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
CONTEXT Preliminary research suggests that functional electrical stimulation cycling (FESC) might be a promising intervention for youth with spinal cord injury (SCI). OBJECTIVE To review the evidence on FESC intervention in youth with SCI. METHODS Systematic literature searches were conducted during December 2012. Two reviewers independently selected titles, abstracts, and full-text articles. Of 40 titles retrieved, six intervention studies met inclusion criteria and were assessed using American Academy for Cerebral Palsy and Developmental Medicine Levels of Evidence and Conduct Questions for Group Design. RESULTS The study results were tabulated based on levels of evidence, with outcomes categorized according to the International Classification of Functioning, Disability, and Health framework. Evidence from the six included studies suggests that FESC is safe for youth with SCI, with no increase in knee/hip injury or hip displacement. Results from one level II randomized controlled trial suggest that a thrice weekly, 6-month FESC program can positively influence VO2 levels when compared with passive cycling, as well as quadriceps strength when compared with electrical stimulation and passive cycling. CONCLUSIONS FESC demonstrates limited yet encouraging results as a safe modality to mitigate effects of inactivity in youth with SCI. More rigorous research involving a greater number of participants is needed before clinicians can be confident of its effectiveness.
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Affiliation(s)
- Tanja A. Mayson
- Correspondence to: Tanja A. Mayson, Therapy Department, Sunny Hill Health Centre for Children, 3644 Slocan St. Vancouver, BC, Canada, V5M 3E8.
| | - Susan R. Harris
- Department of Physical Therapy, University of British Columbia, Friedman Building, Vancouver, BC, Canada
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Gorgey AS, Dolbow DR, Cifu DX, Gater DR. Neuromuscular electrical stimulation attenuates thigh skeletal muscles atrophy but not trunk muscles after spinal cord injury. J Electromyogr Kinesiol 2013; 23:977-84. [DOI: 10.1016/j.jelekin.2013.04.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Revised: 12/27/2012] [Accepted: 04/08/2013] [Indexed: 12/14/2022] Open
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Nery MB, Driver S, Vanderbom KA. Systematic framework to classify the status of research on spinal cord injury and physical activity. Arch Phys Med Rehabil 2013; 94:2027-31. [PMID: 23643686 DOI: 10.1016/j.apmr.2013.04.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 04/11/2013] [Accepted: 04/22/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To systematically classify the physical activity research for individuals with a spinal cord injury by using the behavioral epidemiologic framework; and to identify where the physical activity research for individuals with a spinal cord injury has focused between 2000 and 2012. DESIGN Relevant research was identified and then categorized into 1 of 5 phases by following the coding rules of the behavioral epidemiology framework. Phase 1 studies link physical activity and health outcomes, phase 2 studies validate or develop measures of physical activity, phase 3 studies identify factors that influence behavior or examine explanatory theories of behavior, phase 4 studies evaluate interventions, and phase 5 studies disseminate health promotion programs or policies and translate research into practice. SETTING Specific keywords were identified and then searched through EBSCOhost, PubMed, and Google Scholar. PARTICIPANTS Not applicable. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Not applicable. RESULTS One hundred and thirteen articles met the criteria. Of the articles, 55% were categorized as phase 1, 12% as phase 2, 24% as phase 3, 5% as phase 4, and 4% as phase 5. CONCLUSIONS Most studies were categorized as phase 1, 2, or 3, which implies that this field is still in the early stages of development and research should focus on intervention development and dissemination.
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Affiliation(s)
- Mara B Nery
- Department of Exercise and Sport Science, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR.
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Damiano DL, Prosser LA, Curatalo LA, Alter KE. Muscle plasticity and ankle control after repetitive use of a functional electrical stimulation device for foot drop in cerebral palsy. Neurorehabil Neural Repair 2013; 27:200-7. [PMID: 23042834 PMCID: PMC3579660 DOI: 10.1177/1545968312461716] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND/OBJECTIVES The primary goal was to determine whether repetitive functional electrical stimulation (FES) for unilateral foot drop increases tibialis anterior (TA) muscle size compared with an untreated baseline and the contralateral side in cerebral palsy (CP). Secondary goals were to determine whether positive changes in muscle size and gait, if found, accumulated during the 3 intervals during which participants used the device. FES devices differ from traditional orthoses that often restrict muscle activation and may exacerbate weakness, promote continued dependence on orthoses, or precipitate functional decline. METHODS Participants were 14 independent ambulators with inadequate dorsiflexion in swing, with a mean age of 13.1 years, evaluated before and after the 3-month baseline, 1-month device accommodation, 3-month primary intervention, and 3-month follow-up phases. The FES device (WalkAide) stimulated the common fibular nerve to dorsiflex the ankle and evert the foot while monitoring use. TA muscle ultrasound, gait velocity, and ankle kinematic data for barefoot and device conditions are reported. RESULTS Ultrasound measures of TA anatomic cross-sectional area and muscle thickness increased in the intervention compared with baseline and with the contralateral side and were maintained at follow-up. Maximum ankle dorsiflexion decreased at baseline but improved or was maintained during the intervention phase with and without the device, respectively. Muscle size gains were preserved at follow-up, but barefoot ankle motion returned to baseline values. CONCLUSIONS This FES device produced evidence of use-dependent muscle plasticity in CP. Permanent improvements in voluntary ankle control after repetitive stimulation were not demonstrated.
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Kostrominova TY, Reiner DS, Haas RH, Ingermanson R, McDonough PM. Automated methods for the analysis of skeletal muscle fiber size and metabolic type. INTERNATIONAL REVIEW OF CELL AND MOLECULAR BIOLOGY 2013; 306:275-332. [PMID: 24016528 DOI: 10.1016/b978-0-12-407694-5.00007-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
It is of interest to quantify the size, shape, and metabolic subtype of skeletal muscle fibers in many areas of biomedical research. To do so, skeletal muscle samples are sectioned transversely to the length of the muscle and labeled for extracellular or membrane proteins to delineate the fiber boundaries and additionally for biomarkers related to function or metabolism. The samples are digitally photographed and the fibers "outlined" for quantification of fiber cross-sectional area (CSA) using pointing devices interfaced to a computer, which is tedious, prone to error, and can be nonobjective. Here, we review methods for characterizing skeletal muscle fibers and describe new automated techniques, which rapidly quantify CSA and biomarkers. We discuss the applications of these methods to the characterization of mitochondrial dysfunctions, which underlie a variety of human afflictions, and we present a novel approach, utilizing images from the online Human Protein Atlas to predict relationships between fiber-specific protein expression, function, and metabolism.
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Affiliation(s)
- Andrea L Behrman
- Department of Physical Therapy, University of Florida, Gainsville, FL, USA
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Wilcox JT, Cadotte D, Fehlings MG. Spinal cord clinical trials and the role for bioengineering. Neurosci Lett 2012; 519:93-102. [PMID: 22366402 DOI: 10.1016/j.neulet.2012.02.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Accepted: 02/08/2012] [Indexed: 12/31/2022]
Abstract
There is considerable need for bringing effective therapies for spinal cord injury (SCI) to the clinic. Excellent medical and surgical management has mitigated poor prognoses after SCI; however, few advances have been made to return lost function. Bioengineering approaches have shown great promise in preclinical rodent models, yet there remains a large translational gap to carry these forward in human trials. Herein, we provide a framework of human clinical trials, an overview of past trials for SCI, as well as bioengineered approaches that include: directly applied pharmacologics, cellular transplantation, biomaterials and functional neurorehabilitation. Success of novel therapies will require the correct application of comprehensive preclinical studies with well-designed and expertly conducted human clinical trials. While biologics and bioengineered strategies are widely considered to represent the high potential benefits for those who have sustained a spinal injury, few such therapies have been thoroughly tested with appreciable efficacy for use in human SCI. With these considerations, we propose that bioengineered strategies are poised to enter clinical trials.
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Affiliation(s)
- Jared T Wilcox
- Institute of Medical Science, University of Toronto, Toronto, Canada M5S 1A8
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