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Flett S, Garcia J, Cowley KC. Spinal electrical stimulation to improve sympathetic autonomic functions needed for movement and exercise after spinal cord injury: a scoping clinical review. J Neurophysiol 2022; 128:649-670. [PMID: 35894427 DOI: 10.1152/jn.00205.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Spinal cord injury (SCI) results in sensory, motor and autonomic dysfunction. Obesity, cardiovascular and metabolic diseases are highly prevalent after SCI. Although inadequate voluntary activation of skeletal muscle contributes, it is absent or inadequate activation of thoracic spinal sympathetic neural circuitry and sub-optimal activation of homeostatic (cardiovascular, temperature) and metabolic support systems that truly limits exercise capacity, particularly for those with cervical SCI. Thus, when electrical spinal cord stimulation (SCS) studies aimed at improving motor functions began mentioning effects on exercise-related autonomic functions, a potential new area of clinical application appeared. To survey this new area of potential benefit, we performed a systematic scoping review of clinical SCS studies involving these spinally mediated autonomic functions. Nineteen studies were included, 8 used transcutaneous and 11 used epidural SCS. Improvements in BP at rest or in response to orthostatic challenge were investigated most systematically, whereas reports of improved temperature regulation, whole body metabolism and peak exercise performance were mainly anecdotal. Effective stimulation locations and parameters varied between studies, suggesting multiple stimulation parameters and rostrocaudal spinal locations may influence the same sympathetic function. Brainstem and spinal neural mechanisms providing excitatory drive to sympathetic neurons that activate homeostatic and metabolic tissues that provide support for movement and exercise and their integration with locomotor neural circuitry are discussed. A unifying conceptual framework for the integrated neural control of locomotor and sympathetic function is presented which may inform future research needed to take full advantage of SCS for improving these spinally mediated autonomic functions.
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Affiliation(s)
- Sarah Flett
- Department of Physiology and Pathophysiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Juanita Garcia
- Department of Physiology and Pathophysiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kristine C Cowley
- Department of Physiology and Pathophysiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Effects of trunk muscle activation on trunk stability, arm power, blood pressure and performance in wheelchair rugby players with a spinal cord injury. J Spinal Cord Med 2022; 45:605-613. [PMID: 33166206 PMCID: PMC9246102 DOI: 10.1080/10790268.2020.1830249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective: In wheelchair rugby (WR) athletes with tetraplegia, wheelchair performance may be impaired due to (partial) loss of innervation of upper extremity and trunk muscles, and low blood pressure (BP). The objective was to assess the effects of electrical stimulation (ES)-induced co-contraction of trunk muscles on trunk stability, arm force/power, BP, and WR performance.Design: Cross-sectional study.Setting: Rehabilitation research laboratory and WR court.Participants: Eleven WR athletes with tetraplegia.Interventions: ES was applied to the rectus abdominis, obliquus externus abdominis and erector spinae muscles. For every test, the ES condition was compared to the non-ES condition.Outcome measures: Stability was assessed with reaching tasks, arm force/power with an isokinetic test on a dynamometer, BP during an ES protocol and WR skill performance with the USA Wheelchair Rugby Skill Assessment.Results: Overall reaching distance (ES 14.6 ± 7.5 cm, non-ES 13.4 ± 8.2 cm), and BP showed a significant increase with ES. Arm force (ES 154 ± 106 N, non-ES 148 ± 102 N) and power (ES 37 ± 26 W, non-ES 36 ± 25 W), and WR skills were not significantly improved.Conclusion: ES-induced trunk muscle activation positively affects trunk stability and BP, but not arm force/power. No effects were found in WR skill performance, probably due to abdominal strapping. More research is needed to assess different ES (training) protocols and longitudinal effects.
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Righi G, Del Popolo G. COVID-19 tsunami: the first case of a spinal cord injury patient in Italy. Spinal Cord Ser Cases 2020; 6:22. [PMID: 32303672 PMCID: PMC7163165 DOI: 10.1038/s41394-020-0274-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 03/29/2020] [Accepted: 03/30/2020] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION We present the report of the first, to our best knowledge, case of COVID-19 in a tetraplegic person. CASE PRESENTATION A 56-year-old male with AIS A C4 tetraplegia developed fever during the night, without any prodrome. His general practitioner suspected a urinary tract infection and prescribed him antibiotic therapy. After 2 days of antibiotic therapy the fever still persisted, so the individual was admitted to the local hospital and treated with broad-spectrum antibiotics. After 2 days he was transferred to our spinal unit. Considering the worsening of the chest X-ray and fever despite 48 h of broad-spectrum antibiotic therapy, we strongly suspected viral pneumonia. SARS-CoV-2 was detected and antiviral therapy with Lopinavir/Ritonavir, associated with hydroxychloroquine, was promptly started. Fever ceased after 2 days of therapy. DISCUSSION Blood test and chest X-ray findings in this patient were similar to previously published findings regarding COVID-19. One difference between this case and the known clinical course of COVID-19 is that did not develop cough. Another interesting feature of our case is that, despite tetraplegia, the clinical course was not severe. Persons with COVID-19 remain asymptomatic, these results underscore the need for rehabilitation and SCI professionals to have a high index of suspicion for COVID-19 in their inpatient and outpatient clients. Only inpatient with fever hase being tested for COVID-19. All new patients are submitted to SARS-COV-2 Test. Moreover, routine testing of patients who have to participate in therapy in common gym areas may be warranted.
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Affiliation(s)
- Gabriele Righi
- Spinal Unit, Careggi University Hospital, Firenze, Italy
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McCaughey EJ, Boswell-Ruys CL, Hudson AL, Gandevia SC, Butler JE. Optimal electrode position for abdominal functional electrical stimulation. J Appl Physiol (1985) 2018; 125:1062-1068. [PMID: 30024337 DOI: 10.1152/japplphysiol.00446.2018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abdominal functional electrical stimulation (abdominal FES) improves respiratory function. Despite this, clinical use remains low, possibly due to lack of agreement on the optimal electrode position. This study aimed to ascertain the optimal electrode position for abdominal FES, assessed by expiratory twitch pressure. Ten able-bodied participants received abdominal FES using electrodes placed: 1) on the posterolateral abdominal wall and at the motor points of 2) the external oblique muscles plus rectus abdominis muscles, and 3) the external obliques alone. Gastric (Pga) and esophageal (Pes) twitch pressures were measured using a gastroesophageal catheter. Single-stimulation pulses were applied at functional residual capacity during step increments in stimulation current to maximal tolerance or until Pga plateaued. Stimulation applied on the posterolateral abdominal wall led to a 71% and 53% increase in Pga and Pes, respectively, compared with stimulation of the external oblique and rectus abdominis muscles ( P < 0.001) and a 95% and 56% increase in Pga and Pes, respectively, compared with stimulation of the external oblique muscles alone ( P < 0.001). Stimulation of both the external oblique and rectus abdominis muscles led to an 18.3% decrease in Pga compared with stimulation of only the external oblique muscles ( P = 0.040), with inclusion of the rectus abdominis having no effect on Pes ( P = 0.809). Abdominal FES applied on the posterolateral abdominal wall generated the highest expiratory twitch pressures. As expiratory pressure is a good indicator of expiratory muscle strength and, thus, cough efficacy, we recommend this electrode position for all therapeutic applications of abdominal FES. NEW & NOTEWORTHY While abdominal functional electrical stimulation (abdominal FES) can improve respiratory function, clinical use remains low. This is at least partly due to lack of agreement on the optimal electrode position. Therefore, this study aimed to ascertain the optimal electrode position for abdominal FES. We show that electrodes placed on the posterolateral abdominal wall generated the highest expiratory twitch pressures. As such, we recommend this electrode position for all therapeutic applications of abdominal FES.
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Affiliation(s)
- Euan J McCaughey
- Neuroscience Research Australia, Randwick, New South Wales , Australia.,School of Medical Sciences, University of New South Wales , Kensington, New South Wales , Australia
| | - Claire L Boswell-Ruys
- Neuroscience Research Australia, Randwick, New South Wales , Australia.,School of Medical Sciences, University of New South Wales , Kensington, New South Wales , Australia.,Prince of Wales Hospital, Randwick, New South Wales , Australia
| | - Anna L Hudson
- Neuroscience Research Australia, Randwick, New South Wales , Australia.,School of Medical Sciences, University of New South Wales , Kensington, New South Wales , Australia
| | - Simon C Gandevia
- Neuroscience Research Australia, Randwick, New South Wales , Australia.,School of Medical Sciences, University of New South Wales , Kensington, New South Wales , Australia.,Prince of Wales Hospital, Randwick, New South Wales , Australia
| | - Jane E Butler
- Neuroscience Research Australia, Randwick, New South Wales , Australia.,School of Medical Sciences, University of New South Wales , Kensington, New South Wales , Australia
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Walter JS, Posluszny J, Dieter R, Dieter RS, Sayers S, Iamsakul K, Staunton C, Thomas D, Rabbat M, Singh S. Stimulation of abdominal and upper thoracic muscles with surface electrodes for respiration and cough: Acute studies in adult canines. J Spinal Cord Med 2018; 41:326-336. [PMID: 28614985 PMCID: PMC6055958 DOI: 10.1080/10790268.2017.1335447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE To optimize maximal respiratory responses with surface stimulation over abdominal and upper thorax muscles and using a 12-Channel Neuroprosthetic Platform. METHODS Following instrumentation, six anesthetized adult canines were hyperventilated sufficiently to produce respiratory apnea. Six abdominal tests optimized electrode arrangements and stimulation parameters using bipolar sets of 4.5 cm square electrodes. Tests in the upper thorax optimized electrode locations, and forelimb moment was limited to slight-to-moderate. During combined muscle stimulation tests, the upper thoracic was followed immediately by abdominal stimulation. Finally, a model of glottal closure for cough was conducted with the goal of increased peak expiratory flow. RESULTS Optimized stimulation of abdominal muscles included three sets of bilateral surface electrodes located 4.5 cm dorsal to the lateral line and from the 8th intercostal space to caudal to the 13th rib, 80 or 100 mA current, and 50 Hz stimulation frequency. The maximal expired volume was 343 ± 23 ml (n=3). Optimized upper thorax stimulation included a single bilateral set of electrodes located over the 2nd interspace, 60 to 80 mA, and 50 Hz. The maximal inspired volume was 304 ± 54 ml (n=4). Sequential stimulation of the two muscles increased the volume to 600 ± 152 ml (n=2), and the glottal closure maneuver increased the flow. CONCLUSIONS Studies in an adult canine model identified optimal surface stimulation methods for upper thorax and abdominal muscles to induce sufficient volumes for ventilation and cough. Further study with this neuroprosthetic platform is warranted.
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Affiliation(s)
- James S. Walter
- Research Services, Edward Hines Jr. VA Hospital, Hines, Illinois, USA,Urology Departments, Loyola University, Stritch School of Medicine, Maywood, Illinois, USA,Correspondence to: James S. Walter, Edward Hines Jr. VA Hospital (151), 5000 South 5th Avenue, Hines, IL 60141, USA.
| | - Joseph Posluszny
- Research Services, Edward Hines Jr. VA Hospital, Hines, Illinois, USA,Surgery Services, Edward Hines Jr. VA Hospital, Hines, Illinois, USA
| | - Raymond Dieter
- Research Services, Edward Hines Jr. VA Hospital, Hines, Illinois, USA
| | - Robert S. Dieter
- Cardiology Services, Edward Hines Jr. VA Hospital, Hines, Illinois, USA,Cardiology Departments, Loyola University, Stritch School of Medicine, Maywood, Illinois, USA
| | - Scott Sayers
- Research Services, Edward Hines Jr. VA Hospital, Hines, Illinois, USA,Thoracic and Cardiovascular Surgery Departments, Loyola University, Stritch School of Medicine, Maywood, Illinois, USA
| | | | | | - Donald Thomas
- Research Services, Edward Hines Jr. VA Hospital, Hines, Illinois, USA,Surgery Services, Edward Hines Jr. VA Hospital, Hines, Illinois, USA
| | - Mark Rabbat
- Cardiology Services, Edward Hines Jr. VA Hospital, Hines, Illinois, USA,Cardiology Departments, Loyola University, Stritch School of Medicine, Maywood, Illinois, USA
| | - Sanjay Singh
- Research Services, Edward Hines Jr. VA Hospital, Hines, Illinois, USA
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Hachmann JT, Calvert JS, Grahn PJ, Drubach DI, Lee KH, Lavrov IA. Review of Epidural Spinal Cord Stimulation for Augmenting Cough after Spinal Cord Injury. Front Hum Neurosci 2017; 11:144. [PMID: 28400726 PMCID: PMC5368218 DOI: 10.3389/fnhum.2017.00144] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 03/13/2017] [Indexed: 12/13/2022] Open
Abstract
Spinal cord injury (SCI) remains a debilitating condition for which there is no cure. In addition to loss of somatic sensorimotor functions, SCI is also commonly associated with impairment of autonomic function. Importantly, cough dysfunction due to paralysis of expiratory muscles in combination with respiratory insufficiency can render affected individuals vulnerable to respiratory morbidity. Failure to clear sputum can aggravate both risk for and severity of respiratory infections, accounting for frequent hospitalizations and even mortality. Recently, epidural stimulation of the lower thoracic spinal cord has been investigated as novel means for restoring cough by evoking expiratory muscle contraction to generate large positive airway pressures and expulsive air flow. This review article discusses available preclinical and clinical evidence, current challenges and clinical potential of lower thoracic spinal cord stimulation (SCS) for restoring cough in individuals with SCI.
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Affiliation(s)
- Jan T Hachmann
- Department of Neurologic Surgery, Mayo Clinic Rochester, MN, USA
| | | | - Peter J Grahn
- Department of Neurologic Surgery, Mayo Clinic Rochester, MN, USA
| | - Dina I Drubach
- Department of Neurologic Surgery, Mayo Clinic Rochester, MN, USA
| | - Kendall H Lee
- Department of Neurologic Surgery, Mayo ClinicRochester, MN, USA; Department of Physiology and Biomedical Engineering, Mayo ClinicRochester, MN, USA; Department of Physical Medicine and Rehabilitation, Mayo ClinicRochester, MN, USA
| | - Igor A Lavrov
- Department of Neurologic Surgery, Mayo Clinic Rochester, MN, USA
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Haviv L, Friedman H, Bierman U, Glass I, Plotkin A, Weissbrod A, Shushan S, Bluvshtein V, Aidinoff E, Sobel N, Catz A. Using a Sniff Controller to Self-Trigger Abdominal Functional Electrical Stimulation for Assisted Coughing Following Cervical Spinal Cord Lesions. IEEE Trans Neural Syst Rehabil Eng 2017; 25:1461-1471. [PMID: 28166501 DOI: 10.1109/tnsre.2016.2632754] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Individuals with cervical spinal cord lesions (SCLs) typically depend on caregivers to manually assist in coughing by pressing against their abdominal wall. Coughing can also be assisted by functional electric stimulation (FES) applied to abdominal muscles via surface electrodes. Efficacy of FES, however, depends on precise temporal synchronization. The sniff controller is a trigger that enables paralyzed individuals to precisely control external devices through alterations in nasal airflow. We hypothesized that FES self-triggering by sniff controller may allow for effective cough timing. After optimizing parameters in 16 able-bodied subjects, we measured peak expiratory flow (PEF) in 14 subjects with SCL who coughed with or without assistance. Assistance was either manual assistance of a caregiver, caregiver activated FES, button self-activated FES (for SCL participants who could press a button), or sniff-controlled self-activated FES. We found that all assisted methods provided equally effective improvements, increasing PEF on average by 25 ± 27% (F[4,52] = 7.99, p = 0.00004 ). There was no difference in efficacy between methods of assistance ( F[3,39] = 0.41, p = 0.75 ). Notably, sniff-controlled FES was the only method of those tested that can be activated by all paralyzed patients alone. This provides for added independence that is a critical factor in quality of life following SCL.
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Walter JS, Thomas D, Sayers S, Perez-Tamayo RA, Crish T, Singh S. Respiratory responses to stimulation of abdominal and upper-thorax intercostal muscles using multiple Permaloc electrodes. JOURNAL OF REHABILITATION RESEARCH AND DEVELOPMENT 2015; 52:85-96. [PMID: 26230516 DOI: 10.1682/jrrd.2014.01.0018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 11/19/2014] [Indexed: 11/05/2022]
Abstract
Stimulation of abdominal and upper-thoracic muscles was studied with the long-term goal of improved respiratory care for spinal cord injury (SCI) patients. A 12-channel stimulator and multiple surface and implanted Permaloc electrodes were evaluated in five anesthetized canines. Abdominal stimulation with 100 mA using four bilateral sets of surface electrodes placed on the midaxillary line at the 7th through 13th intercostal spaces and with a closed airway at a large lung volume produced an expiratory tracheal pressure of 109 +/- 29 cm H2O (n = 2, mean +/- standard error of the mean). Similar high pressures were induced with implanted electrodes at the same locations. Upper-thoracic stimulation with 40 mA and four sets of implanted electrodes ventral to the axilla induced inspiratory pressures of -12 +/- 2 cm H2O (n = 5). Combined extradiaphragmatic pacing with an open airway produced a tidal volume of 440 +/- 45 mL (n = 4). The robust respiratory volumes and pressures suggest applications in SCI respiratory care.
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Affiliation(s)
- James S Walter
- Research and Development Service, Edward Hines Jr., Department of Veterans Affairs (VA) Hospital, Hines, IL
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9
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Hamzaid NA, Tean LT, Davis GM, Suhaimi A, Hasnan N. Electrical stimulation-evoked contractions blunt orthostatic hypotension in sub-acute spinal cord-injured individuals: two clinical case studies. Spinal Cord 2014; 53:375-9. [DOI: 10.1038/sc.2014.187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 07/25/2014] [Accepted: 09/29/2014] [Indexed: 02/07/2023]
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McBain RA, Boswell-Ruys CL, Lee BB, Gandevia SC, Butler JE. Electrical Stimulation of Abdominal Muscles to Produce Cough in Spinal Cord Injury. Neurorehabil Neural Repair 2014; 29:362-9. [DOI: 10.1177/1545968314552527] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Background. Surface electrical stimulation of the abdominal muscles, with electrodes placed in the posterolateral position, combined with a voluntary cough can assist clearance of airway secretions in individuals with high-level spinal cord injury (SCI). Objective. To determine whether an increase in stimulus intensity of the trains of electrical stimuli delivered to the expiratory muscles has an increasing effect on a stimulated voluntary cough and to determine at which stimulus intensity a plateau of cough peak expiratory flow occurs. Methods. In 7 healthy individuals with a SCI at and above C7, gastric pressure ( Pga), esophageal pressure ( Pes), peak expiratory cough flow (PEFcough), and expiratory volume were measured as participants coughed voluntarily with simultaneous trains of electrical stimuli delivered over the abdominal muscles (50 Hz, 1-s duration). The intensity of the stimulation was increased incrementally. Results: A plateau in PEFcough occurred in all 7 individuals at a mean of 211 ± 29 mA (range 120-360 mA). Peak values reached for Pga, Pes, and PEFcough were 83.0 ± 8.0 cm H2O, 66.1 ± 5.6 cm H2O, and 4.0 ± 0.4 l/s respectively. Conclusions. The plateau in expiratory cough flow that was associated with increasing expiratory pressures is indicative of dynamic airway compression. This suggests that the evoked cough will be effective in creating more turbulent airflow to further assist in dislodging mucus and secretions.
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Affiliation(s)
- Rachel A. McBain
- Neuroscience Research Australia, Randwick, NSW, Australia
- University of New South Wales, Randwick, NSW, Australia
| | - Claire L. Boswell-Ruys
- Neuroscience Research Australia, Randwick, NSW, Australia
- University of New South Wales, Randwick, NSW, Australia
- Prince of Wales Hospital, Randwick, NSW, Australia
| | - Bonsan B. Lee
- Neuroscience Research Australia, Randwick, NSW, Australia
- University of New South Wales, Randwick, NSW, Australia
- Prince of Wales Hospital, Randwick, NSW, Australia
| | - Simon C. Gandevia
- Neuroscience Research Australia, Randwick, NSW, Australia
- University of New South Wales, Randwick, NSW, Australia
| | - Jane E. Butler
- Neuroscience Research Australia, Randwick, NSW, Australia
- University of New South Wales, Randwick, NSW, Australia
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McCaughey EJ, McLean AN, Allan DB, Gollee H. Detection of the motor points of the abdominal muscles. Eur J Appl Physiol 2014; 114:2483-9. [PMID: 25113093 DOI: 10.1007/s00421-014-2966-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Accepted: 07/25/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE Abdominal functional electrical stimulation (AFES) is a technique intended to improve respiratory function in tetraplegia where breathing is affected due to abdominal muscle paralysis. Although it is known that optimal muscle contraction is achieved when electrical stimulation is applied close to the muscle motor point, AFES studies have used a variety of electrode positions. This study aims to investigate the feasibility of using Neuromuscular Electrical Stimulation to detect the motor points of the abdominal muscles, and to evaluate the intrasubject repeatability and intersubject uniformity of their positions, to find the most suitable AFES electrode location. METHODS Low frequency stimulation (0.5 Hz) was applied to the abdominal muscles of 10 able bodied and five tetraplegic participants. The electrode positions which achieved the strongest muscle contractions were recorded as the motor point positions, with measurements repeated once. For five able bodied participants, assessments were repeated after 18 months, in seated and supine positions. RESULTS Intersubject uniformity ranged from 2.8 to 8.8%. Motor point positions were identified with intrasubject repeatability of <1.7 cm, deemed adequate relative to standard AFES electrode size. Intrasubject repeatability shows motor point positions changed little (<1.7 cm) after 18 months but varied between seated and supine positions with repeatability of up to 3.1 cm. CONCLUSIONS A simple technique to locate the motor points of the abdominal muscles is presented and shown to have an adequate intrasubject repeatability, enabling the optimum AFES electrode location to be identified for each user.
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Affiliation(s)
- E J McCaughey
- Centre for Rehabilitation Engineering, School of Engineering, University of Glasgow, Glasgow, Scotland, UK,
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12
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Acqua AMD, Döhnert MB, Dos Santos LJ. Neuromuscular Electrical Stimulation with Russian Current for Expiratory Muscle Training in Patients with Chronic Obstructive Pulmonary Disease. J Phys Ther Sci 2012. [DOI: 10.1589/jpts.24.955] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Butler JE, Lim J, Gorman RB, Boswell-Ruys C, Saboisky JP, Lee BB, Gandevia SC. Posterolateral Surface Electrical Stimulation of Abdominal Expiratory Muscles to Enhance Cough in Spinal Cord Injury. Neurorehabil Neural Repair 2010; 25:158-67. [DOI: 10.1177/1545968310378509] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Background. Spinal cord injury (SCI) patients have respiratory complications because of abdominal muscle weakness and paralysis, which impair the ability to cough. Objective. This study aims to enhance cough in high-level SCI subjects (n = 11, SCI at or above T6) using surface electrical stimulation of the abdominal muscles via 2 pairs of posterolaterally placed electrodes. Methods. From total lung capacity, subjects performed maximum expiratory pressure (MEP) efforts against a closed airway and voluntary cough efforts. Both efforts were performed with and without superimposed trains of electrical stimulation (50 Hz, 1 second) at a submaximal intensity set to evoke a gastric pressure ( Pga) of 40 cm H2O at functional residual capacity. Results. In the MEP effort, stimulation increased the maximal Pga (from 21.4 ± 7.0 to 59.0 ± 5.7 cm H2O) and esophageal pressure ( Pes; 47.2 ± 11.7 to 65.6 ± 13.6 cm H2O). During the cough efforts, stimulation increased Pga (19.5 ± 6.0 to 57.9 ± 7.0 cm H2O) and Pes (31.2 ± 8.7 to 56.6 ± 10.5 cm H2O). The increased expiratory pressures during cough efforts with stimulation increased peak expiratory flow (PEF, by 36% ± 5%), mean expiratory flow (by 80% ± 8%), and expired lung volume (by 41% ± 16%). In every subject, superimposed electrical stimulation improved peak expiratory flow during cough efforts (by 0.99 ± 0.12 L/s; range, 0.41-1.80 L/s). Wearing an abdominal binder did not improve stimulated cough flows or pressures. Conclusions. The increases in Pga and PEF with electrical stimulation using the novel posterolateral electrode placement are 2 to 3 times greater than improvements reported in other studies. This suggests that posterolateral electrical stimulation of abdominal muscles is a simple noninvasive way to enhance cough in individuals with SCI.
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Affiliation(s)
- Jane E. Butler
- Prince of Wales Medical Research Institute, Randwick, New South Wales, Australia
- University of New South Wales, Randwick, New South Wales, Australia
| | - Julianne Lim
- Prince of Wales Medical Research Institute, Randwick, New South Wales, Australia
- University of New South Wales, Randwick, New South Wales, Australia
| | - Robert B. Gorman
- Prince of Wales Medical Research Institute, Randwick, New South Wales, Australia
- University of New South Wales, Randwick, New South Wales, Australia
| | - Claire Boswell-Ruys
- Prince of Wales Medical Research Institute, Randwick, New South Wales, Australia
- University of New South Wales, Randwick, New South Wales, Australia
| | - Julian P. Saboisky
- Prince of Wales Medical Research Institute, Randwick, New South Wales, Australia
- University of New South Wales, Randwick, New South Wales, Australia
| | - Bonsan B. Lee
- Prince of Wales Medical Research Institute, Randwick, New South Wales, Australia
- University of New South Wales, Randwick, New South Wales, Australia
- Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Simon C. Gandevia
- Prince of Wales Medical Research Institute, Randwick, New South Wales, Australia
- University of New South Wales, Randwick, New South Wales, Australia
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Reid WD, Brown JA, Konnyu KJ, Rurak JM, Sakakibara BM. Physiotherapy secretion removal techniques in people with spinal cord injury: a systematic review. J Spinal Cord Med 2010; 33:353-70. [PMID: 21061895 PMCID: PMC2964024 DOI: 10.1080/10790268.2010.11689714] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To address whether secretion removal techniques increase airway clearance in people with chronic spinal cord injury (SCI). DATA SOURCES AND STUDY SELECTION MEDLINE/PubMed, CINAHL, EMBASE, and PsycINFO were searched from inception to May 2009 for population keywords (spinal cord injury, paraplegia, tetraplegia, quadriplegia) paired with secretion removal-related interventions and outcomes. Inclusion criteria for articles were a research study, irrespective of design, that examined secretion removal in people with chronic SCI published in English. REVIEW METHODS Two reviewers determined whether articles met the inclusion criteria, abstracted information, and performed a quality assessment using PEDro or Downs and Black criteria. Studies were then given a level of evidence based on a modified Sackett scale. RESULTS Of 2416 abstracts and titles retrieved, 24 met the inclusion criteria. Subjects were young (mean, 31 years) and 84% were male. Most evidence was level 4 or 5 and only 2 studies were randomized controlled trials. Three reports described outcomes for secretion removal techniques in addition to cough, whereas most articles examined the immediate effects of various components of cough. Studies examining insufflation combined with manual assisted cough provided the most consistent, high-level evidence. Compelling recent evidence supports the use of respiratory muscle training or electrical stimulation of the expiratory muscles to facilitate airway clearance in people with SCI. CONCLUSION Evidence supporting the use of secretion removal techniques in SCI, while positive, is limited and mostly of low level. Treatments that increase respiratory muscle force show promise as effective airway clearance techniques.
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Affiliation(s)
- W. Darlene Reid
- Muscle Biophysics Lab, Department of Physical Therapy, University of British Columbia, British Columbia, Canada
| | - Jennifer A Brown
- Acute Spine Program, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Kristin J Konnyu
- Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, Ontario, Canada
| | - Jennifer M.E Rurak
- Muscle Biophysics Lab, Department of Physical Therapy, University of British Columbia, British Columbia, Canada
| | - Brodie M Sakakibara
- Spinal Cord Injury Rehabilitation Evidence (SCIRE), GF Strong Research Lab, University of British Columbia, Vancouver, British Columbia, Canada
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Walter JS, Wurster RD, Zhu Q, Staunton C, Laghi F. Stimulating multiple respiratory muscles with intramuscular Permaloc electrodes. J Spinal Cord Med 2010; 33:135-43. [PMID: 20486532 PMCID: PMC2869278 DOI: 10.1080/10790268.2010.11689688] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE To test the feasibility of implanting intramuscular electrodes (Permaloc, Synapse Biomedical Inc, Oberlin OH) with self-securing polypropylene anchors to stimulate upper-intercostal and abdominal muscles plus the diaphragm. METHODS/RESULTS In 6 anesthetized dogs, 12 Permaloc electrodes were implanted in the 3 respiratory muscles (4 in each muscle group). Tidal volume with diaphragmatic stimulation was 310 +/- 38 mL (mean +/- SE); with upper intercostal stimulation, it was 68 +/- 18 mL; and with combined diaphragm intercostal stimulation, it was 438 +/- 78 mL. By study design, stimulation in the upper intercostal muscles was limited to not more than slight/moderate contraction of the serratus and latissimus muscles overlying the ribs. Abdominal muscle stimulation produced exhaled volumes of 38 +/- 20 mL (this stimulation was limited by the maximal output of the stimulator of 25 milliamperes). Combined diaphragm intercostal stimulation followed by abdominal muscle stimulation increased exhaled volumes from 312 +/- 31 mL to 486 +/- 58 mL (P = 0.024). CONCLUSIONS Permaloc electrodes can be successfully implanted in upper intercostal and abdominal muscles in addition to the diaphragm. Combined diaphragm intercostal stimulation followed by abdominal muscle stimulation increased the exhaled volumes recorded with diaphragmatic stimulation alone.
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Affiliation(s)
- James S Walter
- Research Service, Edward Hines Veterans Administration Hospital, Ines, Illinois 60141, USA.
| | - Robert D Wurster
- Research Service, Edward Hines Veterans Administration Hospital, Ines, Illinois
,Department of Urology, Loyola University Medical Center, Maywood, Illinois
,Department of Neurological Surgery and Physiology, Loyola University Medical Center, Maywood, Illinois
| | - Qianlong Zhu
- Research Service, Edward Hines Veterans Administration Hospital, Ines, Illinois
| | - Christine Staunton
- Research Service, Edward Hines Veterans Administration Hospital, Ines, Illinois
| | - Franco Laghi
- Section of Pulmonary and Critical Care Medicine, Edward Hines Veterans Administration Hospital, Ines, Illinois
,Divison of Pulmonary and Critical Care Medicine, Loyola University Medical Center, Maywood, Illinois
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16
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Kathiresan G, Huntor K, Fraser PH, Jeyaraman S. A Review of Abdominal Muscle Stimulation for Patients with Spinal Cord Injury. J Phys Ther Sci 2010. [DOI: 10.1589/jpts.22.455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
| | - Kenneth Huntor
- Biomedical Reserch Center, Central Manchester University Hospital NHS Foundation
| | - Peter H Fraser
- Biomedical Reserch Center, Central Manchester University Hospital NHS Foundation
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Yoshida M, Murayama Y, Chishaki A, Sunagawa K. Noninvasive transcutaneous bionic baroreflex system prevents severe orthostatic hypotension in patients with spinal cord injury. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2009; 2008:1985-7. [PMID: 19163081 DOI: 10.1109/iembs.2008.4649578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Central baroreflex failure in patients with spinal cord injury results in serious orthostatic hypotension. We examined if transcutaneous electrical stimulation regulates arterial pressure in those patients. We identified skin regions capable of increasing arterial pressure and determined respective transfer function. Using the transfer function, we designed the feedback regulator (i.e., bionic baroreflex system) to control arterial pressure. Orthostatic stress decreased arterial pressure profoundly. Activation of bionic regulator restored and maintained arterial pressure at pre-specified levels. We conclude that the transcutaneous bionic system is noninvasive and capable of stabilizing arterial pressure in patients with spinal cord injury.
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Lee BB, Boswell-Ruys C, Butler JE, Gandevia SC. Surface functional electrical stimulation of the abdominal muscles to enhance cough and assist tracheostomy decannulation after high-level spinal cord injury. J Spinal Cord Med 2008; 31:78-82. [PMID: 18533416 PMCID: PMC2435038 DOI: 10.1080/10790268.2008.11753985] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE Evaluation of noninvasive stimulation modalities to augment cough and assist tracheostomy decannulation in high-level tetraplegia. STUDY DESIGN Single case study. METHODS A 65-year-old man with C4 ASIA C tetraplegia had delayed rehabilitation due to a tracheostomy and recurrent pneumonia primarily resulting from ineffective cough. Anterior surface electrical stimulation (SES) of the abdominal musculature was conducted to train an effective cough and enable decannulation. Training occurred daily for 4 weeks. The patient was tested 1 year later with posterolateral SES to determine the relative clinical effect of this delivery method. RESULTS At baseline, the addition of anterior SES increased maximal expiratory pressure (80%), maximal expiratory cough pressure (67%), and peak expiratory flow rate (11%). Three weeks after training began, the patient was decannulated following a program of SES and assisted and voluntary coughing. Upon testing 1 year later, SES with posterolaterally placed electrodes also produced an enhancement of voluntary cough attempts. CONCLUSIONS Noninvasive SES can potentially assist decannulation of tracheostomies.
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Affiliation(s)
- Bonsan B Lee
- Prince of Wales Spinal Medicine Department, Prince of Wales Hospital, Sydney, New South Wales, Australia.
| | - Claire Boswell-Ruys
- 2Prince of Wales Medical Research Institute, Sydney, New South Wales, Australia
| | - Jane E Butler
- 2Prince of Wales Medical Research Institute, Sydney, New South Wales, Australia
| | - Simon C Gandevia
- 2Prince of Wales Medical Research Institute, Sydney, New South Wales, Australia
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McLachlan CS, Yow SZ. Co-ordinated intra-abdominal and intra-thoracic pressures regulate cough assisted cardiac circulatory support. Int J Cardiol 2008; 123:191-2. [PMID: 17321615 DOI: 10.1016/j.ijcard.2006.11.134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2006] [Accepted: 11/12/2006] [Indexed: 11/27/2022]
Abstract
Periodically case studies emerge that demonstrate voluntary and forced coughing in ventricular fibrillation or asystole can maintain consciousness for up to 100 s. Forced cough is effective in producing co-ordinated abdominal muscle contraction and increases in intra-abdominal and thoracic pressures. These co-ordinated pressure changes are likely to be responsible for assisted circulation. In this short communication we discuss some of the possible abdominal physiological mechanisms for cough assisted circulatory support.
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Gollee H, Hunt KJ, Allan DB, Fraser MH, McLean AN. A control system for automatic electrical stimulation of abdominal muscles to assist respiratory function in tetraplegia. Med Eng Phys 2007; 29:799-807. [PMID: 17035064 DOI: 10.1016/j.medengphy.2006.08.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2006] [Revised: 08/04/2006] [Accepted: 08/22/2006] [Indexed: 11/25/2022]
Abstract
People with tetraplegia have poor respiratory function leading to limited tidal volume (V(T)) and reduced cough peak flow (CPF). These problems may cause respiratory failure during the initial admission or subsequent intercurrent illness. Electrical stimulation of the abdominal muscles during expiration can improve respiratory function by increasing V(T) and CPF. We developed a novel control system to automatically trigger muscle stimulation, synchronised with the subject's voluntary respiratory activity. The system was tested in four subjects with a functionally complete lesion at level C4 to C6, aged between 16 and 46 years, 3 months to 5 years post injury, who were breathing spontaneously. The algorithm delivered automatic stimulation patterns, detecting cough and quiet breathing while suppressing stimulation during other activities such as speaking. Marked increases in V(T) (between 9% and 71% of baseline) and CPF (between 31% and 54% of baseline) were observed, suggesting that the technique may have potential use in both acute and established tetraplegia to increase minute ventilation and to improve cough clearance of secretions.
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Affiliation(s)
- H Gollee
- Centre for Rehabilitation Engineering, University of Glasgow, UK.
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21
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Lim J, Gorman RB, Saboisky JP, Gandevia SC, Butler JE. Optimal electrode placement for noninvasive electrical stimulation of human abdominal muscles. J Appl Physiol (1985) 2007; 102:1612-7. [PMID: 17185493 DOI: 10.1152/japplphysiol.00865.2006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abdominal muscles are the most important expiratory muscles for coughing. Spinal cord-injured patients have respiratory complications because of abdominal muscle weakness and paralysis and impaired ability to cough. We aimed to determine the optimal positioning of stimulating electrodes on the trunk for the noninvasive electrical activation of the abdominal muscles. In six healthy subjects, we compared twitch pressures produced by a single electrical pulse through surface electrodes placed either posterolaterally or anteriorly on the trunk with twitch pressures produced by magnetic stimulation of nerve roots at the T10level. A gastroesophageal catheter measured gastric pressure (Pga) and esophageal pressure (Pes). Twitches were recorded at increasing stimulus intensities at functional residual capacity (FRC) in the seated posture. The maximal intensity used was also delivered at total lung capacity (TLC). At FRC, twitch pressures were greatest with electrical stimulation posterolaterally and magnetic stimulation at T10and smallest at the anterior site (Pga, 30 ± 3 and 33 ± 6 cmH2O vs. 12 ± 3 cmH2O; Pes 8 ± 2 and 11 ± 3 cmH2O vs. 5 ± 1 cmH2O; means ± SE). At TLC, twitch pressures were larger. The values for posterolateral electrical stimulation were comparable to those evoked by thoracic magnetic stimulation. The posterolateral stimulation site is the optimal site for generating gastric and esophageal twitch pressures with electrical stimulation.
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Affiliation(s)
- Julianne Lim
- Prince of Wales Medical Research Institute and University of New South Wales, Randwick, Sydney, Australia
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22
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Spivak E, Keren O, Niv D, Levental J, Steinberg F, Barak D, Chen B, Zupan A, Catz A. Electromyographic signal-activated functional electrical stimulation of abdominal muscles: the effect on pulmonary function in patients with tetraplegia. Spinal Cord 2007; 45:491-5. [PMID: 17325697 DOI: 10.1038/sj.sc.3102039] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Paralysis of abdominal muscles is the main cause of respiratory dysfunctions in patients with lower cervical spinal cord lesion. Activation of the abdominal muscles using functional electrical stimulation (FES) improved respiratory function in these patients. But application of FES frequently requires a caregiver, and it may not be well synchronized with the patient's respiratory activity. OBJECTIVE To perform preliminary examination of electromyographic (EMG)-activated FES for caregiver-independent and synchronized cough and expiration induction in tetraplegia. DESIGN Self-controlled study. SETTING Loewenstein Rehabilitation Center, Raanana, Israel. SUBJECTS A total of 10 male patients with complete or almost complete tetraplegia. MAIN OUTCOME MEASURES Peak expiratory flow (PEF), forced vital capacity (FVC), and maximal voluntary ventilation (MVV). METHODS The outcome measures were examined with the abdominal muscles unassisted or assisted by various methods. These included manual assistance or application of FES, activated by a caregiver, by the patient, or by EMG signals elicited from the patient's muscle. RESULTS Manual assistance improved the mean PEF value by 36.7% (P<0.01) and the mean FVC value by 15.4% (P=0.01). FES did not significantly change most measurements, and patient-activated FES even reduced PEF (P<0.05). But following EMG-activated FES PEF and FVC values were higher than those following patient-activated FES (P<0.05 for PEF; P<0.01 for FVC), and their mean values were higher by 15.8 and 18.9%, respectively. CONCLUSIONS Abdominal FES failed to improve respiratory function in this study, but applying FES to abdominal muscles by EMG from the patient's muscle may promote caregiver-free respiration and coughing in persons with cervical SCL.
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Affiliation(s)
- E Spivak
- Loewenstein Rehabilitation Hospital, Raanana, Israel
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23
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Lasserson D, Mills K, Arunachalam R, Polkey M, Moxham J, Kalra L. Differences in motor activation of voluntary and reflex cough in humans. Thorax 2006; 61:699-705. [PMID: 16601089 PMCID: PMC2104707 DOI: 10.1136/thx.2005.057901] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To study motor activation patterns of voluntary and reflex cough adjusted for cough flow rates. METHODS Surface electromyography (EMG) and cough flow rate were measured in 10 healthy volunteers. Voluntary cough was assessed for 20 efforts in each quintile of increasing cough flow rate. Reflex cough was assessed for 25 efforts produced by nebulised l-tartaric acid. EMG was recorded over the expiratory (rectus abdominis, obliques, lower intercostals) and accessory (trapezius, pectoralis major, deltoid, latissimus dorsi) muscles. EMG activity, burst duration and onset were compared for each quintile of voluntary cough, and between voluntary and reflex cough matched for cough flow rate. RESULTS EMG activity and burst duration of expiratory and accessory muscles during voluntary cough increased in proportion to cough flow. Expiratory muscles had longer EMG burst duration (difference 68 ms (95% CI 34 to 102), p<0.01) and earlier onset of EMG activity (difference 44 ms (95% CI 20 to 68), p<0.0001) compared with accessory muscles. EMG activity in all muscles was increased (mean 110.2% v 56.1%, p<0.001) and burst duration (mean 206 ms v 280 ms, p = 0.013) decreased in reflex cough compared with voluntary cough of equal flow rate. There were no differences in EMG onset (difference 8 ms (95% CI 25 to -9) or burst duration (difference 27 ms (95% CI 58 to -4) between expiratory and accessory muscles. CONCLUSIONS Functional organisation of motor activity differs between voluntary and reflex cough. Voluntary cough is characterised by sequential activation whereas reflex cough is associated with early and simultaneous activation of expiratory and accessory muscles.
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Affiliation(s)
- D Lasserson
- Department of Stroke Medicine, King's College London School of Medicine, Denmark Hill Campus, Bessemer Road, London SE5 9PJ, UK
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Navarro X, Krueger TB, Lago N, Micera S, Stieglitz T, Dario P. A critical review of interfaces with the peripheral nervous system for the control of neuroprostheses and hybrid bionic systems. J Peripher Nerv Syst 2006; 10:229-58. [PMID: 16221284 DOI: 10.1111/j.1085-9489.2005.10303.x] [Citation(s) in RCA: 439] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Considerable scientific and technological efforts have been devoted to develop neuroprostheses and hybrid bionic systems that link the human nervous system with electronic or robotic prostheses, with the main aim of restoring motor and sensory functions in disabled patients. A number of neuroprostheses use interfaces with peripheral nerves or muscles for neuromuscular stimulation and signal recording. Herein, we provide a critical overview of the peripheral interfaces available and trace their use from research to clinical application in controlling artificial and robotic prostheses. The first section reviews the different types of non-invasive and invasive electrodes, which include surface and muscular electrodes that can record EMG signals from and stimulate the underlying or implanted muscles. Extraneural electrodes, such as cuff and epineurial electrodes, provide simultaneous interface with many axons in the nerve, whereas intrafascicular, penetrating, and regenerative electrodes may contact small groups of axons within a nerve fascicle. Biological, technological, and material science issues are also reviewed relative to the problems of electrode design and tissue injury. The last section reviews different strategies for the use of information recorded from peripheral interfaces and the current state of control neuroprostheses and hybrid bionic systems.
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Affiliation(s)
- Xavier Navarro
- Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, Bellaterra, Spain.
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Baker S, Davenport P, Sapienza C. Examination of strength training and detraining effects in expiratory muscles. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2005; 48:1325-33. [PMID: 16478374 DOI: 10.1044/1092-4388(2005/092)] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2004] [Revised: 12/18/2004] [Accepted: 04/28/2005] [Indexed: 05/06/2023]
Abstract
PURPOSE The purpose of this study was to determine strength gains following expiratory muscle strength training (EMST) and to determine detraining effects when the training stimulus is removed. METHOD Thirty-two healthy participants were enrolled in an EMST program. Sixteen participants trained for 4 weeks (Group 1) and 16 participants trained for 8 weeks (Group 2). All 32 participants were detrained for 8 weeks. Maximum expiratory pressure (MEP) was used to document change in expiratory muscle strength throughout the study. RESULTS Group 1 had a 41% increase and Group 2 had a 51% increase in MEP following the training. Mean MEP, for both groups, was significantly greater than baseline at the end of the training period (p = .0001), at the 4th week of detraining (p = .0001), and at the 8th week of detraining (p = .0001). The results also indicated that there was no significant difference in mean MEP between the groups at baseline, end of training, or throughout the detraining period (p = .960). DISCUSSION The results suggest that expiratory muscle strength gains following a 4- and 8-week EMST program do not differ significantly. Additionally, detraining rates do not appear to be dependent on length of training time.
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Britton D, Goldstein B, Jones-Redmond J, Esselman P. Baclofen pump intervention for spasticity affecting pulmonary function. J Spinal Cord Med 2005; 28:343-7. [PMID: 16396387 PMCID: PMC1864906 DOI: 10.1080/10790268.2005.11753832] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Muscle spasticity may adversely affect pulmonary function after spinal cord injury (SCI). However, there is limited information regarding the treatment of spasticity as a determinant of pulmonary function. This study presents the case of a man with C4 tetraplegia who had severe spasticity and difficulty weaning from ventilatory support. METHODS Case presentation. RESULTS Severe spasticity likely contributed to respiratory compromise in this patient. Successful and rapid weaning from the ventilator occurred within 3 weeks of baclofen pump placement. CONCLUSIONS Randomized clinical trials among SCI patients with significant spasticity are needed to determine whether intervention with a baclofen pump facilitates earlier ventilatory weaning.
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Affiliation(s)
- Deanna Britton
- Speech-Language Pathology Clinical Specialist, Harborview Medical Center, 325 Ninth Avenue, Box 359819, Seattle, WA 98104, USA.
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