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Dolbow DR, Bersch I, Gorgey AS, Davis GM. The Clinical Management of Electrical Stimulation Therapies in the Rehabilitation of Individuals with Spinal Cord Injuries. J Clin Med 2024; 13:2995. [PMID: 38792536 PMCID: PMC11122106 DOI: 10.3390/jcm13102995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/09/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024] Open
Abstract
Background: People with spinal cord injuries (SCIs) often have trouble remaining active because of paralysis. In the past, exercise recommendations focused on the non-paralyzed muscles in the arms, which provides limited benefits. However, recent studies show that electrical stimulation can help engage the paralyzed extremities, expanding the available muscle mass for exercise. Methods: The authors provide an evidence-based approach using expertise from diverse fields, supplemented by evidence from key studies toward the management of electrical stimulation therapies in individuals with SCIs. Literature searches were performed separately using the PubMed, Medline, and Google Scholar search engines. The keywords used for the searches included functional electrical stimulation cycling, hybrid cycling, neuromuscular electrical stimulation exercise, spinal cord injury, cardiovascular health, metabolic health, muscle strength, muscle mass, bone mass, upper limb treatment, diagnostic and prognostic use of functional electrical stimulation, tetraplegic hands, and hand deformities after SCI. The authors recently presented this information in a workshop at a major rehabilitation conference. Additional information beyond what was presented at the workshop was added for the writing of this paper. Results: Functional electrical stimulation (FES) cycling can improve aerobic fitness and reduce the risk of cardiovascular and metabolic diseases. The evidence indicates that while both FES leg cycling and neuromuscular electrical stimulation (NMES) resistance training can increase muscle strength and mass, NMES resistance training has been shown to be more effective for producing muscle hypertrophy in individual muscle groups. The response to the electrical stimulation of muscles can also help in the diagnosis and prognosis of hand dysfunction after tetraplegia. Conclusions: Electrical stimulation activities are safe and effective methods for exercise and testing for motor neuron lesions in individuals with SCIs and other paralytic or paretic conditions. They should be considered part of a comprehensive rehabilitation program in diagnosing, prognosing, and treating individuals with SCIs to improve function, physical activity, and overall health.
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Affiliation(s)
- David R. Dolbow
- Physical Therapy Program, College of Osteopathic Medicine, William Carey University, 710 William Carey Parkway, Hattiesburg, MS 39401, USA
| | - Ines Bersch
- International FES Centre®, Swiss Paraplegia Centre, CH-6207 Nottwil, Switzerland
| | - Ashraf S. Gorgey
- Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire VA Medical Center, Richmond, VA 23249, USA;
| | - Glen M. Davis
- Discipline of Exercise and Sport Sciences, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia
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2
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Lee H, Cho S, Kim D, Lee T, Kim HS. Bioelectric medicine: unveiling the therapeutic potential of micro-current stimulation. Biomed Eng Lett 2024; 14:367-392. [PMID: 38645592 PMCID: PMC11026362 DOI: 10.1007/s13534-024-00366-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 02/16/2024] [Accepted: 02/18/2024] [Indexed: 04/23/2024] Open
Abstract
Bioelectric medicine (BEM) refers to the use of electrical signals to modulate the electrical activity of cells and tissues in the body for therapeutic purposes. In this review, we particularly focused on the microcurrent stimulation (MCS), because, this can take place at the cellular level with sub-sensory application unlike other stimuli. These extremely low-level currents mimic the body's natural electrical activity and are believed to promote various physiological processes. To date, MCS has limited use in the field of BEM with applications in several therapeutic purposes. However, recent studies provide hopeful signs that MCS is more scalable and widely applicable than what has been used so far. Therefore, this review delves into the landscape of MCS, shedding light on the multifaceted applications and untapped potential of MCS in the realm of healthcare. Particularly, we summarized the hierarchical mediation from cell to whole body responses by MCS including its physiological applications. Our final objective of this review is to contribute to the growing body of literature that unveils the captivating potential of BEM, with MCS poised at the intersection of technological innovation and the intricacies of the human body.
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Affiliation(s)
- Hana Lee
- Department of Biomedical Engineering, Yonsei University, Seoul, Gangwon 26493 South Korea
| | - Seungkwan Cho
- Gfyhealth Inc., Seongnam, Gyeonggi 13488 South Korea
| | - Doyong Kim
- Department of Biomedical Engineering, Yonsei University, Seoul, Gangwon 26493 South Korea
| | - Taehyun Lee
- Gfyhealth Inc., Seongnam, Gyeonggi 13488 South Korea
| | - Han Sung Kim
- Department of Biomedical Engineering, Yonsei University, Seoul, Gangwon 26493 South Korea
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3
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Allen CB, Williamson TK, Norwood SM, Gupta A. Do Electrical Stimulation Devices Reduce Pain and Improve Function?-A Comparative Review. Pain Ther 2023; 12:1339-1354. [PMID: 37751060 PMCID: PMC10616008 DOI: 10.1007/s40122-023-00554-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 08/30/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Multiple forms of electrical stimulation (ES) potentially offer widely varying clinical benefits. Diminished function commonly associated with acute and chronic pain lessens productivity and increases medical costs. This review aims to compare the relative effects of various forms of ES on functional and pain outcomes. METHODS A comprehensive literature search focused on studies of commonly marketed forms of ES used for treatment of pain and improvement of function. Peer-reviewed manuscripts were categorized as "Important" (systematic review or meta-analysis, randomized controlled trial, observational cohort study) and "Minor" (retrospective case series, case report, opinion review) for each identified form of ES. RESULTS AND DISCUSSION Varying forms of ES have markedly different technical parameters, applications, and indications, based on clinically meaningful impact on pain perception, function improvement, and medication reduction. Despite being around for decades, there is limited quality evidence for most forms of ES, although there are several notable exceptions for treatment of specific indications. Neuromuscular electrical stimulation (NMES) has well-demonstrated beneficial effects for rehabilitation of selective spinal cord injured (SCI), post-stroke, and debilitated inpatients. Functional electrical stimulation (FES) has similarly shown effectiveness in rehabilitation of some stroke, SCI, and foot drop outpatients. H-Wave® device stimulation (HWDS) has moderate supportive evidence for treatment of acute and refractory chronic pain, consistently demonstrating improvements in function and pain measures across diverse populations. Interestingly, transcutaneous electrical nerve stimulation (TENS), the most widely used form of ES, demonstrated insignificant or very low levels of pain and functional improvement. CONCLUSION Ten of 13 reviewed forms of ES have only limited quality evidence for clinically significant reduction of pain or improvement of function across different patient populations. NMES and FES have reasonably demonstrated effectiveness, albeit for specific clinical rehabilitation indications. HWDS was associated with the most clinically significant outcomes, in terms of functional improvement combined with reduction of pain and medication use. More rigorous long-term clinical trials are needed to further validate appropriate use and specific indications for most forms of ES. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Christian B Allen
- University of the Incarnate Word School of Osteopathic Medicine, San Antonio, TX, 78235, USA
| | - Tyler K Williamson
- Department of Orthopaedic Surgery, University of Texas Health San Antonio, San Antonio, TX, 78229, USA
| | | | - Ashim Gupta
- Future Biologics, Lawrenceville, GA, 30043, USA.
- Regenerative Orthopaedics, Noida, Uttar Pradesh, 201301, India.
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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: 0] [Impact Index Per Article: 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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Dolbow DR, Gorgey AS, Johnston TE, Bersch I. Electrical Stimulation Exercise for People with Spinal Cord Injury: A Healthcare Provider Perspective. J Clin Med 2023; 12:jcm12093150. [PMID: 37176591 PMCID: PMC10179213 DOI: 10.3390/jcm12093150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/05/2023] [Accepted: 04/15/2023] [Indexed: 05/15/2023] Open
Abstract
Electrical stimulation exercise has become an important modality to help improve the mobility and health of individuals with spinal cord injury (SCI). Electrical stimulation is used to stimulate peripheral nerves in the extremities to assist with muscle strengthening or functional activities such as cycling, rowing, and walking. Electrical stimulation of the peripheral nerves in the upper extremities has become a valuable tool for predicting the risk of hand deformities and rehabilitating functional grasping activities. The purpose of this paper is to provide healthcare providers perspective regarding the many rehabilitation uses of electrical stimulation in diagnosing and treating individuals with SCI. Electrical stimulation has been shown to improve functional mobility and overall health, decrease spasticity, decrease the risk of cardiometabolic conditions associated with inactivity, and assist in the diagnosis/prognosis of hand deformities in those with tetraplegia. Studies involving non-invasive stimulation of the spinal nerves via external electrodes aligned with the spinal cord and more invasive stimulation of electrodes implanted in the epidural lining of the spinal cord have demonstrated improvements in the ability to stand and enhanced the stepping pattern during ambulation. Evidence is also available to educate healthcare professionals in using functional electrical stimulation to reduce muscle spasticity and to recognize limitations and barriers to exercise compliance in those with SCI. Further investigation is required to optimize the dose-response relationship between electrical stimulation activities and the mobility and healthcare goals of those with SCI and their healthcare providers.
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Affiliation(s)
- David R Dolbow
- Department of Physical Therapy, College of Osteopathic Medicine, William Carey University, Hattiesburg, MS 39401, USA
| | - Ashraf S Gorgey
- Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire VA Medical Center, Richmond, VA 23249, USA
- College of Medicine, Virginia Commonwealth University, Richmond, VA 23298, USA
| | - Therese E Johnston
- Department of Physical Therapy, Arcadia University, Glenside, PA 19038, USA
| | - Ines Bersch
- International FES Centre®, Swiss Paraplegic Center, CH-6207 Nottwil, Switzerland
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Ibitoye MO, Hamzaid NA, Ahmed YK. Effectiveness of FES-supported leg exercise for promotion of paralysed lower limb muscle and bone health-a systematic review. BIOMED ENG-BIOMED TE 2023:bmt-2021-0195. [PMID: 36852605 DOI: 10.1515/bmt-2021-0195] [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: 06/17/2021] [Accepted: 02/07/2023] [Indexed: 03/01/2023]
Abstract
Leg exercises through standing, cycling and walking with/without FES may be used to preserve lower limb muscle and bone health in persons with physical disability due to SCI. This study sought to examine the effectiveness of leg exercises on bone mineral density and muscle cross-sectional area based on their clinical efficacy in persons with SCI. Several literature databases were searched for potential eligible studies from the earliest return date to January 2022. The primary outcome targeted was the change in muscle mass/volume and bone mineral density as measured by CT, MRI and similar devices. Relevant studies indicated that persons with SCI that undertook FES- and frame-supported leg exercise exhibited better improvement in muscle and bone health preservation in comparison to those who were confined to frame-assisted leg exercise only. However, this observation is only valid for exercise initiated early (i.e., within 3 months after injury) and for ≥30 min/day for ≥ thrice a week and for up to 24 months or as long as desired and/or tolerable. Consequently, apart from the positive psychological effects on the users, leg exercise may reduce fracture rate and its effectiveness may be improved if augmented with FES.
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Affiliation(s)
- Morufu Olusola Ibitoye
- Department of Biomedical Engineering, Faculty of Engineering and Technology, University of Ilorin, Ilorin, Nigeria
| | - Nur Azah Hamzaid
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur Malaysia
| | - Yusuf Kola Ahmed
- Department of Biomedical Engineering, Faculty of Engineering and Technology, University of Ilorin, Ilorin, Nigeria
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Rosley N, Hasnan N, Hamzaid NA, Davis GM, Manaf H. Effects of a combined progressive resistance training and functional electrical stimulation-evoked cycling exercise on lower limb muscle strength of individuals with incomplete spinal cord injury: A randomized controlled study. Turk J Phys Med Rehabil 2023; 69:23-30. [PMID: 37201013 PMCID: PMC10186013 DOI: 10.5606/tftrd.2023.9418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 03/10/2022] [Indexed: 05/20/2023] Open
Abstract
Objectives This study was conducted to investigate the effects of combined progressive resistance training (PRT) and functional electrical stimulation-evoked leg cycling exercise (FES-LCE) on isometric peak torque and muscle volume in individuals with incomplete spinal cord injury. Patients and methods In the single-blind, randomized controlled trial performed between April 2015 and August 2016, 28 participants were randomized between two exercise interventions (FES-LCE+PRT and FES-LCE alone), and training was conducted over 12 weeks. The isometric muscle peak torque and muscle volume for both lower limbs were measured at the baseline and after 6 and 12 weeks. Linear mixed-model analysis of variance was performed to test the effects of FES-LCE+PRT versus FES-LCE on each outcome measure over time via an intention-to-treat analysis. Results Twenty-three participants (18 males, 5 females; mean age: 33.4±9.7 years; range 21 to 50 years) completed study (10 in the FES-LCE+PRT group, and 13 in the FES-LCE group). The 12-week pre-and posttraining change for left hamstrings' muscle peak torque in the FES-LCE+PRT group (mean difference=4.5±7.9 Nm, 45% change, p<0.05) was consistently higher than that in the FES-LCE group (mean difference=2.4±10.3 Nm, 4% change; p<0.018). The improvement in the right quadriceps muscle's peak torque of the FES-LCE+PRT group (mean difference=19±7.6 Nm, 31% change, p<0.05) was more significant compared to the FES-LCE group. The left muscle volume showed a remarkable increase after 12 weeks in the FES-LCE+PRT group (mean difference=0.3±9.3 L, 7% change, p<0.05). Conclusion The combination of PRT and FES-LCE was better in improving lower limb muscle strength and volume in chronic incomplete individuals with spinal cord injury.
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Affiliation(s)
- Nurhaida Rosley
- Physiotherapy programme, Faculty of Pharmacy and Health Sciences, Universiti Kuala Lumpur, Royal College of Medicine Perak, Perak, Malaysia
| | - Nazirah Hasnan
- Discipline of Rehabilitation Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nur Azah Hamzaid
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Glen M Davis
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Haidzir Manaf
- Clinical and Rehabilitation Exercise Research Group, Faculty of Health Sciences, Universiti Teknologi MARA, Puncak Alam Campus, Selangor, Malaysia
- Integrative Pharmacogenomics Institute, Universiti Teknologi MARA, Puncak Alam Campus, Selangor, Malaysia
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Gorgey AS, Goldsmith J, Alazzam A, Trainer R. Effects of percutaneously-implanted epidural stimulation on cardiovascular autonomic function and spasticity after complete spinal cord injury: A case report. Front Neurosci 2023; 17:1112853. [PMID: 36875669 PMCID: PMC9978801 DOI: 10.3389/fnins.2023.1112853] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/26/2023] [Indexed: 02/18/2023] Open
Abstract
Importance There is a revived interest to explore spinal cord epidural stimulation (SCES) to improve physical function after spinal cord injury (SCI). This case report highlights the potential of eliciting multiple functional improvements with a single SCES configuration, a strategy which could improve clinical translation. Objective To determine whether SCES intended to facilitate walking also acutely yields benefits in cardiovascular autonomic regulation and spasticity. Design Case report from data collected at two timepoints 15 weeks apart from March to June 2022 as part of a larger clinical trial. Setting Research lab at Hunter Holmes McGuire VA Medical Center. Participant 27-year-old male, 7 years post a C8 motor complete spinal cord injury. Intervention A SCES configuration intended to enhance exoskeleton-assisted walking training applied for autonomic and spasticity management. Main outcomes and measures The primary outcome was cardiovascular autonomic response to a 45-degree head-up-tilt test. Systolic blood pressure (SBP), heart rate (HR), and absolute power of the low-frequency (LF) and high-frequency (HF) components of a heart-rate variability analysis were collected in supine and tilt with and without the presence of SCES. Right knee flexor and knee extensor spasticity was assessed via isokinetic dynamometry with and without SCES. Results At both assessments with SCES off, transitioning from supine to tilt decreased SBP (assessment one: 101.8 to 70 mmHg; assessment two: 98.9 to 66.4 mmHg). At assessment one, SCES on in supine (3 mA) increased SBP (average 117 mmHg); in tilt, 5 mA stabilized SBP near baseline values (average 111.5 mmHg). At assessment two, SCES on in supine (3 mA) increased SBP (average 140 mmHg in minute one); decreasing amplitude to 2 mA decreased SBP (average 119 mmHg in minute five). In tilt, 3 mA stabilized SBP near baseline values (average 93.2 mmHg). Torque-time integrals at the right knee were reduced at all angular velocities for knee flexors (range: -1.9 to -7.8%) and knee extensors (range: -1 to -11.4%). Conclusions and relevance These results demonstrate that SCES intended to facilitate walking may also enhance cardiovascular autonomic control and attenuate spasticity. Using one configuration to enhance multiple functions after SCI may accelerate clinical translation. Clinical trial registration https://clinicaltrials.gov/ct2/show/, identifier NCT04782947.
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Affiliation(s)
- Ashraf S. Gorgey
- Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire VA Medical Center, Richmond, VA, United States
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, United States
| | - Jacob Goldsmith
- Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire VA Medical Center, Richmond, VA, United States
| | - Ahmad Alazzam
- Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire VA Medical Center, Richmond, VA, United States
| | - Robert Trainer
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, United States
- Physical Medicine and Rehabilitation, Hunter Holmes McGuire VA Medical Center, Richmond, VA, United States
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Lemos N, Fernandes GL, Ribeiro AM, Maia-Lemos PS, Contiero W, Croos-Bezerra V, Tomlison G, Faber J, Oliveira ASB, Girão MJBC. Rehabilitation of People With Chronic Spinal Cord Injury Using a Laparoscopically Implanted Neurostimulator: Impact on Mobility and Urinary, Anorectal, and Sexual Functions. Neuromodulation 2023; 26:233-245. [PMID: 35248460 DOI: 10.1016/j.neurom.2022.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 12/01/2021] [Accepted: 01/04/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVES This study aimed to assess the impact of the laparoscopic implantation of neuromodulation electrodes (Possover-LION procedure) on mobility and on sexual, urinary, and anorectal functions of people with chronic spinal cord injury (SCI). MATERIAL AND METHODS Longitudinal analysis of 30 patients with chronic SCI (21 ASIA impairment scale (AIS) A, eight AIS B, and one AIS C) submitted to the Possover-LION procedure for bilateral neuromodulation of femoral, sciatic, and pudendal nerves. Assessments were performed before the surgical procedure and at 3, 6, and 12 months postoperatively. The primary outcome was evolution in walking, measured by the Walking Index for Spinal Cord Injury score, preoperatively and at 12 months. Secondary outcomes were changes in overall mobility (Mobility Assessment Tool for Evaluation of Rehabilitation score), urinary function and quality of life (Qualiveen questionnaire), and bowel (time for bowel emptying proceedings and Wexner's Fecal Incontinence Severity Index [FISI]) and sexual functions (International Index of Erectile Function for men and Female Sexual Function Index for women). Surgical time, intraoperative bleeding, and perioperative complications were also recorded. RESULTS Qualitatively, 18 of 25 (72%) patients with thoracic injury and 3 of 5 (60%) patients with cervical injury managed to establish a walker-assisted gait at one-year follow-up (p < 0.0001). A total of 11 (47.8%) have improved in their urinary incontinence (p < 0.0001), and seven (30.4%) improved their enuresis (p = 0.0156). The FISI improved from a median of 9 points preoperatively to 5.5 at 12 months (p = 0.0056). Of note, 20 of 28 (71.4%) patients reported an improvement on genital sensitivity at 12 months postoperatively (p < 0.0001), but this was not reflected in sexual quality-of-life questionnaires. CONCLUSIONS Patients experienced improved mobility and genital sensitivity and a reduction in the number of urinary and fecal incontinence episodes. By demonstrating reproducible outcomes and safety, this study helps establish the Possover-LION procedure as an addition to the therapeutic armamentarium for the rehabilitation of patients with chronic SCI. CLINICAL TRIAL REGISTRATION This study was registered at the WHO Clinical Trials Database through the Brazilian Registry of Clinical Trials-REBEC (Universal Tracking Number: U1111-1261-4428).
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Affiliation(s)
- Nucelio Lemos
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Toronto, Toronto, Canada; Department of Gynecology, Federal University of São Paulo, São Paulo, Brazil; Department of Gynecology and Neuropelveology, Increasing-Institute of Care and Rehabilitation in Neuropelveology and Gynecology, São Paulo, Brazil.
| | - Gustavo L Fernandes
- Department of Gynecology, Federal University of São Paulo, São Paulo, Brazil; Department of Gynecology and Neuropelveology, Increasing-Institute of Care and Rehabilitation in Neuropelveology and Gynecology, São Paulo, Brazil; Department of Obstetrics and Gynecology, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Augusta M Ribeiro
- Department of Gynecology, Federal University of São Paulo, São Paulo, Brazil; Department of Gynecology and Neuropelveology, Increasing-Institute of Care and Rehabilitation in Neuropelveology and Gynecology, São Paulo, Brazil
| | - Priscila S Maia-Lemos
- Department of Gynecology and Neuropelveology, Increasing-Institute of Care and Rehabilitation in Neuropelveology and Gynecology, São Paulo, Brazil
| | - Wellington Contiero
- Department of Gynecology, Federal University of São Paulo, São Paulo, Brazil; Department of Gynecology and Neuropelveology, Increasing-Institute of Care and Rehabilitation in Neuropelveology and Gynecology, São Paulo, Brazil
| | - Victor Croos-Bezerra
- Department of Gynecology, Federal University of São Paulo, São Paulo, Brazil; Department of Gynecology and Neuropelveology, Increasing-Institute of Care and Rehabilitation in Neuropelveology and Gynecology, São Paulo, Brazil
| | - George Tomlison
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Jean Faber
- Department of Neurology and Neurosurgery, Federal University of São Paulo, São Paulo, Brazil
| | - Acary S B Oliveira
- Department of Neurology and Neurosurgery, Federal University of São Paulo, São Paulo, Brazil
| | - Manoel J B C Girão
- Department of Gynecology, Federal University of São Paulo, São Paulo, Brazil
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Gouveia D, Cardoso A, Carvalho C, Almeida A, Gamboa Ó, Ferreira A, Martins Â. Approach to Small Animal Neurorehabilitation by Locomotor Training: An Update. Animals (Basel) 2022; 12:ani12243582. [PMID: 36552502 PMCID: PMC9774773 DOI: 10.3390/ani12243582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 12/05/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
Neurorehabilitation has a wide range of therapies to achieve neural regeneration, reorganization, and repair (e.g., axon regeneration, remyelination, and restoration of spinal circuits and networks) to achieve ambulation for dogs and cats, especially for grade 1 (modified Frankel scale) with signs of spinal shock or grade 0 (deep pain negative), similar to humans classified with ASIA A lesions. This review aims to explain what locomotor training is, its importance, its feasibility within a clinical setting, and some possible protocols for motor recovery, achieving ambulation with coordinated and modulated movements. In addition, it cites some of the primary key points that must be present in the daily lives of veterinarians or rehabilitation nurses. These can be the guidelines to improve this exciting exercise necessary to achieve ambulation with quality of life. However, more research is essential in the future years.
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Affiliation(s)
- Débora Gouveia
- Arrábida Veterinary Hospital—Arrábida Animal Rehabilitation Center, 2925-538 Setubal, Portugal
- Superior School of Health, Protection and Animal Welfare, Polytechnic Institute of Lusophony, Campo Grande, 1950-396 Lisboa, Portugal
- Faculty of Veterinary Medicine, Lusófona University, Campo Grande, 1749-024 Lisboa, Portugal
- Correspondence:
| | - Ana Cardoso
- Arrábida Veterinary Hospital—Arrábida Animal Rehabilitation Center, 2925-538 Setubal, Portugal
| | - Carla Carvalho
- Arrábida Veterinary Hospital—Arrábida Animal Rehabilitation Center, 2925-538 Setubal, Portugal
| | - António Almeida
- Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisboa, Portugal
| | - Óscar Gamboa
- Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisboa, Portugal
| | - António Ferreira
- Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisboa, Portugal
- CIISA—Centro Interdisciplinar-Investigaçāo em Saúde Animal, Faculdade de Medicina Veterinária, Av. Universi dade Técnica de Lisboa, 1300-477 Lisboa, Portugal
| | - Ângela Martins
- Arrábida Veterinary Hospital—Arrábida Animal Rehabilitation Center, 2925-538 Setubal, Portugal
- Superior School of Health, Protection and Animal Welfare, Polytechnic Institute of Lusophony, Campo Grande, 1950-396 Lisboa, Portugal
- Faculty of Veterinary Medicine, Lusófona University, Campo Grande, 1749-024 Lisboa, Portugal
- Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisboa, Portugal
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11
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Fallahzadeh Abarghuei A, Karimi MT, Yazdi nejad A, Zeighami H, Mohammadi A, Basir Shabestari S. The Effects of Lower Limb Orthoses on Health Aspects of the Spinal Cord Injury Patients: A Systematic Review Using International Classification of Functioning, Disability, and Health (ICF) as a Reference Framework. Med J Islam Repub Iran 2022; 36:153. [PMID: 36654846 PMCID: PMC9832937 DOI: 10.47176/mjiri.36.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Indexed: 12/24/2022] Open
Abstract
Background: One of the most important approaches in the rehabilitation of spinal cord injury (SCI) patients is the use of different orthoses. To date, no review has been published that analyzed the effects of orthoses on health aspects of spinal cord injury clients using the International Classification of Functioning, Disability and Health (ICF). Methods: A systematic literature search was done in some databases, including Medline, PubMed, Cochrane centered register of the controlled trial (CCTR), Cochrane database of systematic reviews (CDSR), a database of abstracts of reviews of effects (DARE), Embase, Google Scholar, and ISI Web of Knowledge. SCI was used in conjunction with terms like orthotic device, mechanical orthoses, external power orthoses, assistive devices, and functional electrical. The time frame for this search was from 1970 to 2022. Results: A total of 200 papers were found. Based on the titles and abstracts, 100 related papers were detected. After careful evaluation of the papers, 47 studies were selected for final analysis-53 papers were excluded due to duplication, non-English language, and lack of full-text. Conclusion: The results of 32 studies (70% of studies) support the efficiency of orthoses in walking and standing of SCI patients. In most of the included studies, the efficiency of orthoses was evaluated mostly based on body functions and structures, and their impact on other outcomes such as participation and quality of life (QoL) of SCI patients was unclear.
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Affiliation(s)
- Abolghasem Fallahzadeh Abarghuei
- Department of Occupational Therapy, School of Rehabilitation Sciences, Shiraz
University of Medical Sciences, Shiraz, Iran ,Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences,
Shiraz, Iran
| | - Mohammad Taghi Karimi
- Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences,
Shiraz, Iran, Corresponding author:Mohammad Taghi Karimi,
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12
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Bersch I, Alberty M, Fridén J. Robot-assisted training with functional electrical stimulation enhances lower extremity function after spinal cord injury. Artif Organs 2022; 46:2009-2014. [PMID: 35976046 DOI: 10.1111/aor.14386] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 06/04/2022] [Accepted: 08/10/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Functional Electrical Stimulation (FES) synchronized with robot-assisted lower extremity training is used in spinal cord injury (SCI) rehabilitation to promote residual function. METHODS Data of SCI inpatients who trained lower limb mobilization on a stationary robotic system were retrospectively analyzed. The primary outcome was the improvement of muscle strength from the first through to the last training session during FES-induced as well as voluntarily induced flexion and extension. The secondary outcome was the sum score of voluntary muscle function in the lower limbs before and after the training period. RESULTS Data from 72 patients with SCI (AIS A-D) were analyzed. For extension, FES-assisted strength increased (p<0.001) from 25.2 to 44.0 N, voluntary force (p<0.001) from 24.4 to 39.9 N. For flexion, FES-assisted flexion (p<0.006) increased from 14.1 to 19.0 N, voluntary flexion (p<0.005) from 12.6 to 17.1 N. There was a significant correlation between the increase in FES-assisted force and voluntary flexion (r=0.730, p=0.001) as well as between the increase in FES-assisted force and voluntary extension (r=0.881, p<0.001). The sum score in muscle test increased from 15 to 24 points. CONCLUSION Robot-assisted training with FES seems to support the regeneration of residual functions after SCI. This is evidenced by an improvement in motor function and strength in the lower limbs.
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Affiliation(s)
- Ines Bersch
- International FES Centre®, Swiss Paraplegic Centre Nottwil, Switzerland
| | - Marie Alberty
- International FES Centre®, Swiss Paraplegic Centre Nottwil, Switzerland
| | - Jan Fridén
- International FES Centre®, Swiss Paraplegic Centre Nottwil, Switzerland.,Department of Tetrahand Surgery, Swiss Paraplegic Centre Nottwil, Switzerland
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13
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Barclay A, Gray SR, Paul L, Rooney S. The effects of cycling using lower limb active passive trainers in people with neurological conditions: a systematic review. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2022. [DOI: 10.12968/ijtr.2020.0171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Active passive trainers are frequently used as a safe, feasible way for people with neurological disabilities to exercise. However, evidence regarding their efficacy is limited. The aim of this study was to review the literature investigating the effects of lower limb active passive trainer cycling, with or without functional electrical stimulation, on spasticity, cardiovascular fitness, function and quality of life in people with neurological conditions Methods Five electronic databases were searched from inception to June 2021. Studies included: randomised controlled trials using lower limb active passive trainers as a cycling intervention; participants with neurological conditions, such as multiple sclerosis, spinal cord injury, stroke and Parkinson's disease; and at least one outcome related to spasticity, cardiovascular fitness, physical function or quality of life. Results A total of 12 articles were included (n=423 participants, 52% male). Of these, six used functional electrical stimulation-assisted active passive trainer interventions, and the remaining six used active passive trainer interventions alone. A meta-analysis demonstrated statistically significant improvement in walking endurance; however, this only included stroke studies (6-Minute Walk Test performance, P<0.00001). No statistically significant improvement in walking speed was found (P=0.31). A significant improvement in spasticity was reported by three studies (two using the active passive trainer intervention alone, one using the active passive trainer with functional electrical stimulation). One study reported improvement in quality of life. Few studies considered cardiovascular fitness. Conclusions The included studies featured heterogeneous designs, outcome measures, exercise prescriptions and participant disability levels, which made comparison difficult. Active passive trainer interventions appear to improve walking endurance in people with stroke; however, the effect on other outcomes and in other conditions remains unclear. It also remains uncertain as to whether functional electrical stimulation-assisted cycling is more beneficial than active passive trainer cycling alone.
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Affiliation(s)
- Alison Barclay
- Neurorehabilitation Unit, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Stuart R Gray
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Lorna Paul
- School of Health and Life Science, Glasgow Caledonian University, Glasgow, UK
| | - Scott Rooney
- School of Health and Life Science, Glasgow Caledonian University, Glasgow, UK
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14
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Advanced Equipment Development and Clinical Application in Neurorehabilitation for Spinal Cord Injury: Historical Perspectives and Future Directions. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12094532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Partial to complete paralysis following spinal cord injury (SCI) causes deterioration in health and has severe effects on the ability to perform activities of daily living. Following the discovery of neural plasticity, neurorehabilitation therapies have emerged that aim to reconstruct the motor circuit of the damaged spinal cord. Functional electrical stimulation (FES) has been incorporated into devices that reconstruct purposeful motions in the upper and lower limbs, the most recent of which do not require percutaneous electrode placement surgery and thus enable early rehabilitation after injury. FES-based devices have shown promising results for improving upper limb movement, including gripping and finger function, and for lower limb function such as the ability to stand and walk. FES has also been employed in hybrid cycling and rowing to increase total body fitness. Training using rehabilitation robots is advantageous in terms of consistency of quality and quantity of movements and is particularly applicable to walking training. Initiation of motor reconstruction at the early stage following SCI is likely to advance rapidly in the future, with the combined use of technologies such as regenerative medicine, brain machine interfaces, and rehabilitation robots with FES showing great promise.
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15
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Itodo OA, Flueck JL, Raguindin PF, Stojic S, Brach M, Perret C, Minder B, Franco OH, Muka T, Stucki G, Stoyanov J, Glisic M. Physical activity and cardiometabolic risk factors in individuals with spinal cord injury: a systematic review and meta-analysis. Eur J Epidemiol 2022; 37:335-365. [PMID: 35391647 PMCID: PMC9187578 DOI: 10.1007/s10654-022-00859-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 03/07/2022] [Indexed: 11/29/2022]
Abstract
Physical inactivity in individuals with spinal cord injury (SCI) has been suggested to be an important determinant of increased cardiometabolic disease (CMD) risk. However, it remains unclear whether physically active SCI individuals as compared to inactive or less active individuals have truly better cardiometabolic risk profile. We aimed to systematically review and quantify the association between engagement in regular physical activity and/or exercise interventions and CMD risk factors in individuals with SCI. Four medical databases were searched and studies were included if they were clinical trials or observational studies conducted in adult individuals with SCI and provided information of interest. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was applied to rate the certainty of evidence. Of 5816 unique citations, 11 randomized clinical trials, 3 non-randomized trial and 32 cross-sectional studies comprising more than 5500 SCI individuals were included in the systematic review. In meta-analysis of RCTs and based on evidence of moderate certainty, physical activity in comparison to control intervention was associated with: (i) better glucose homeostasis profile [WMD of glucose, insulin and Assessment of Insulin Resistance (HOMA-IR) were - 3.26 mg/dl (95% CI - 5.12 to - 1.39), - 3.19 μU/ml (95% CI - 3.96 to - 2.43)] and - 0.47 (95% CI - 0.60 to - 0.35), respectively], and (ii) improved cardiorespiratory fitness [WMD of relative and absolute oxygen uptake relative (VO2) were 4.53 ml/kg/min (95% CI 3.11, 5.96) and 0.26 L/min (95% CI 0.21, 0.32) respectively]. No differences were observed in blood pressure, heart rate and lipids (based on evidence of low/moderate certainty). In meta-analysis of cross-sectional studies and based on the evidence of very low to low certainty, glucose [WMD - 3.25 mg/dl (95% CI - 5.36, - 1.14)], insulin [- 2.12 μU/ml (95% CI - 4.21 to - 0.03)] and total cholesterol [WMD - 6.72 mg/dl (95% CI - 13.09, - 0.34)] were lower and HDL [WMD 3.86 mg/dl (95% CI 0.66, 7.05)] and catalase [0.07 UgHb-1 (95% CI 0.03, 0.11)] were higher in physically active SCI individuals in comparison to reference groups. Based on limited number of cross-sectional studies, better parameters of systolic and diastolic cardiac function and lower carotid intima media thickness were found in physically active groups. Methodologically sound clinical trials and prospective observational studies are required to further elaborate the impact of different physical activity prescriptions alone or in combination with other life-style interventions on CMD risk factors in SCI individuals.
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Affiliation(s)
- Oche Adam Itodo
- Swiss Paraplegic Research, Guido A. Zäch Str. 1, 6207, Nottwil, Switzerland
- Graduate School for Health Sciences, University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
| | | | - Peter Francis Raguindin
- Swiss Paraplegic Research, Guido A. Zäch Str. 1, 6207, Nottwil, Switzerland
- Graduate School for Health Sciences, University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
| | - Stevan Stojic
- Swiss Paraplegic Research, Guido A. Zäch Str. 1, 6207, Nottwil, Switzerland
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
| | - Mirjam Brach
- Swiss Paraplegic Research, Guido A. Zäch Str. 1, 6207, Nottwil, Switzerland
| | - Claudio Perret
- Sports Medicine, Swiss Paraplegic Centre Nottwil, 6207, Nottwil, Switzerland
| | - Beatrice Minder
- Public Health and Primary Care Library, University Library of Bern, University of Bern, Bern, Switzerland
| | - Oscar H Franco
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
| | - Taulant Muka
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
| | - Gerold Stucki
- Swiss Paraplegic Research, Guido A. Zäch Str. 1, 6207, Nottwil, Switzerland
| | - Jivko Stoyanov
- Swiss Paraplegic Research, Guido A. Zäch Str. 1, 6207, Nottwil, Switzerland
| | - Marija Glisic
- Swiss Paraplegic Research, Guido A. Zäch Str. 1, 6207, Nottwil, Switzerland.
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland.
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16
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Acute physiological comparison of sub-maximal exercise on a novel adapted rowing machine and arm crank ergometry in people with a spinal cord injury. Spinal Cord 2022; 60:694-700. [PMID: 35110695 PMCID: PMC8810340 DOI: 10.1038/s41393-022-00757-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 01/19/2022] [Accepted: 01/20/2022] [Indexed: 12/01/2022]
Abstract
Study design Non-randomized crossover trial. Objectives The objective of this study was to assess the oxygen uptake during exercise using the Adapted ROWing machine (AROW) compared to the more commonly used Arm Crank Ergometry (ACE) for people with spinal cord injury/disease (SCI/D) with or without trunk stability. Setting Canada, Vancouver. Methods Participants were from a convenience sample of 14 adults with SCI/D (age 21–63 y) which include those with lumbar to low cervical impairments currently exercising at least once per week using cardiovascular exercise equipment at our Physical Activity Research Centre. The interventions were non-randomized steady-state exercise bouts at self-selected low and moderate workloads on the AROW and ACE for 5 min each. Our primary outcomes were the rate of oxygen consumption (mL/kg/min) and the Borg 0–10 Rating Scale of Perceived Exertion (RPE). Results A repeated measures two-way ANOVA (p < 0.05) indicated that exercising on the AROW resulted significantly greater oxygen consumption and perceived exertion than ACE at similar sub-maximal workloads which may be explained by the differences in efficiency between the devices (Partial eta squared = 0.84, F stat = 48.25; Partial eta squared = 0.86, F stat = 53.54). Conclusions We have demonstrated that this form of upper extremity exercise had a greater RPE and VO2 on the ACE at a given workload. Thus, the AROW could provide a functional upper extremity workout that can be used for daily exercise for those with varying levels of SCI.
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17
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Alashram AR, Annino G, Mercuri NB. Changes in spasticity following functional electrical stimulation cycling in patients with spinal cord injury: A systematic review. J Spinal Cord Med 2022; 45:10-23. [PMID: 32406810 PMCID: PMC8890523 DOI: 10.1080/10790268.2020.1763713] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Spasticity is one of the most common secondary impairment after spinal cord injury (SCI). It can lead to an increase in the level of disability. The functional electrical stimulation cycling (FES-cycling) promotes recovery in patients with SCI. No systematic review has been published examining the influence of FES-cycling on the spasticity of lower extremities post-SCI.Objective: This review aimed to investigate the effects of the FES-cycling on the lower extremities spasticity in patients with SCI.Methods: PubMed, Scopus, PEDro, REHABDATA, Web of Science, and MEDLINE were searched until December 2019. The methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) scale.Results: Ten studies were met the inclusion criteria. Two were randomized clinical trials, cohort study (n = 2), and pilot study (n=6). The scores on the PEDro scale ranged from one to nine, with a median score of three. The results showed evidence for the beneficial effects of FES-cycling on the spasticity of lower extremities in individuals with SCI.Conclusion: The FES-cycling intervention may reduce the lower extremities spasticity in patients with various injury levels of SCI. It is not a suitable intervention for medically unstable patients or with contraindication for lower extremities movement. Further randomized controlled trials with a large sample size strongly warranted to confirm our findings.
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Affiliation(s)
- Anas R. Alashram
- School of Neuroscience, Faculty of Medicine and Surgery, University of Rome “Tor Vergata”, Rome, Italy,Department of Medicine Systems, University of Rome “Tor Vergata”, Rome, Italy,Correspondence to: Anas R. Alashram, Department of Medicine Systems, Faculty of Medicine and Surgery, University of Rome “Tor Vergata”, Via Cracovia, 50, 00133Roma RM, Italy.
| | - Giuseppe Annino
- Department of Medicine Systems, University of Rome “Tor Vergata”, Rome, Italy
| | - Nicola Biagio Mercuri
- School of Neuroscience, Faculty of Medicine and Surgery, University of Rome “Tor Vergata”, Rome, Italy,Department of Medicine Systems, University of Rome “Tor Vergata”, Rome, Italy
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18
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Fang CY, Lien ASY, Tsai JL, Yang HC, Chan HL, Chen RS, Chang YJ. The Effect and Dose-Response of Functional Electrical Stimulation Cycling Training on Spasticity in Individuals With Spinal Cord Injury: A Systematic Review With Meta-Analysis. Front Physiol 2021; 12:756200. [PMID: 34867459 PMCID: PMC8640241 DOI: 10.3389/fphys.2021.756200] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/21/2021] [Indexed: 01/10/2023] Open
Abstract
Background: To investigate the effect and dose-response of functional electrical stimulation cycling (FES-cycling) training on spasticity in the individuals with spinal cord injury (SCI). Method: Five electronic databases [PubMed, Scopus, Medline (Proquest), Embase, and Cochrane Central Register of Controlled Trials (CENTRAL)] were searched before September 2021. The human trials and studies of English language were only included. Two authors independently reviewed and extracted the searched studies. The primary outcome measure was spasticity assessed by Modified Ashworth Scale or Ashworth Scale for lower limbs. The secondary outcome measures were walking abilities, such as 6 Min Walk Test (6MWT), Timed Up and Go (TUG), and lower limbs muscle strength (LEMS). A subgroup analysis was performed to investigate the efficacious threshold number of training sessions. A meta-regression analysis was used to examine the linear relationship between the training sessions and the effect on spasticity. Results: A total of 764 studies were identified. After screening, 12 selected studies were used for the qualitative synthesis, in which eight of them were quantitatively analyzed. Eight studies included ninety-nine subjects in total with SCI (male: female = 83:16). The time since injury was from less than 4 weeks to 17 years. The age ranged from 20 to 67 years. American Spinal Injury Association (ASIA) impairment level of the number of participants was 59 for ASIA A, 11 for ASIA B, 18 for ASIA C, and 11 for ASIA D. There were 43 subjects with tetraplegia and 56 subjects with paraplegia. Spasticity decreased significantly (95% CI = - 1.538 to - 0.182, p = 0.013) in favor of FES-cycling training. The walking ability and LEMS also improved significantly in favor of FES-cycling training. The subgroup analysis showed that spasticity decreased significantly only in more than 20 training sessions (95% CI = - 1.749 to - 0.149, p = 0.020). The meta-regression analysis showed training sessions and spasticity were not significantly associated (coefficient = - 0.0025, SE = 0.0129, p = 0.849, R 2 analog = 0.37). Conclusion: Functional electrical stimulation-cycling training can improve spasticity, walking ability, and the strength of the lower limbs in the individuals with SCI. The number of training sessions is not linearly related to the decrease of spasticity. Twenty sessions of FES-cycling training are required to obtain the efficacy to decrease spasticity.
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Affiliation(s)
- Chia-Ying Fang
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Angela Shin-Yu Lien
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan.,Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Jia-Ling Tsai
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsiao-Chu Yang
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsiao-Lung Chan
- Department of Electrical Engineering, College of Engineering, Chang Gung University, Taoyuan, Taiwan.,Neuroscience Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Rou-Shayn Chen
- Neuroscience Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Neurology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ya-Ju Chang
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan.,Neuroscience Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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19
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Nash MS, Farkas GJ, Tiozzo E, Gater DR. Exercise to mitigate cardiometabolic disorders after spinal cord injury. Curr Opin Pharmacol 2021; 62:4-11. [PMID: 34864560 DOI: 10.1016/j.coph.2021.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 10/21/2021] [Indexed: 01/14/2023]
Abstract
The cardiometabolic disorder (CMD) is a syndrome caused by coalescing of cardiovascular, endocrine, pro-thrombotic, and inflammatory health risks. Together, these risks confer a hazard as health-threatening as coronary artery disease or type2 diabetes, whether an individual has a diagnosis of coronary disease or diabetes, or not. CMD is most often defined by three or more of five clinically assessed risk components, notably obesity, insulin resistance, hypertension, hypertriglyceridemia, and depressed high-density lipoprotein cholesterol. Evidence currently suggests that worldwide CMD is expanding at a pandemic rate, and it is known that people living with spinal cord injuries (SCI) qualify for the diagnosis at more than 50% of the prevalence of a non-disabled cohort. A recent evidence-based guideline warned of the current state of CMD following SCI and recommended early lifestyle intervention incorporating exercise and prudent nutrition as a first-line disease countermeasure. This monograph will define the CMD following SCI, explore its underlying pathophysiology, and provide evidence that recommends exercise for CMD health hazards after SCI.
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Affiliation(s)
- Mark S Nash
- Department of Neurological Surgery, The University of Miami Miller School of Medicine, Miami, FL 33136, USA; Department of Physical Medicine & Rehabilitation, The University of Miami Miller School of Medicine, Miami, FL 33136, USA; Department of Physical Therapy, The University of Miami Miller School of Medicine, Miami, FL 33136, USA; The Miami Project to Cure Paralysis, The University of Miami Miller School of Medicine, Miami, FL 33136, USA.
| | - Gary J Farkas
- Department of Physical Medicine & Rehabilitation, The University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Eduard Tiozzo
- Department of Physical Medicine & Rehabilitation, The University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - David R Gater
- Department of Neurological Surgery, The University of Miami Miller School of Medicine, Miami, FL 33136, USA; Department of Physical Medicine & Rehabilitation, The University of Miami Miller School of Medicine, Miami, FL 33136, USA; The Miami Project to Cure Paralysis, The University of Miami Miller School of Medicine, Miami, FL 33136, USA
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20
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Selph SS, Skelly AC, Wasson N, Dettori JR, Brodt ED, Ensrud E, Elliot D, Dissinger KM, McDonagh M. Physical Activity and the Health of Wheelchair Users: A Systematic Review in Multiple Sclerosis, Cerebral Palsy, and Spinal Cord Injury. Arch Phys Med Rehabil 2021; 102:2464-2481.e33. [PMID: 34653376 DOI: 10.1016/j.apmr.2021.10.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 09/10/2021] [Accepted: 10/02/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To understand the benefits and harms of physical activity in people who may require a wheelchair with a focus on people with multiple sclerosis (MS), cerebral palsy (CP), and spinal cord injury (SCI). DATA SOURCES Searches were conducted in MEDLINE, Cumulative Index to Nursing and Allied Health, PsycINFO, Cochrane CENTRAL, and Embase (January 2008 through November 2020). STUDY SELECTION Randomized controlled trials, nonrandomized trials, and cohort studies of observed physical activity (at least 10 sessions on 10 days) in participants with MS, CP, and SCI. DATA EXTRACTION We conducted dual data abstraction, quality assessment, and strength of evidence. Measures of physical functioning are reported individually where sufficient data exist and grouped as "function" where data are scant. DATA SYNTHESIS No studies provided evidence for prevention of cardiovascular conditions, development of diabetes, or obesity. Among 168 included studies, 44% enrolled participants with MS (38% CP, 18% SCI). Studies in MS found walking ability may be improved with treadmill training and multimodal exercises; function may be improved with treadmill, balance exercises, and motion gaming; balance is likely improved with balance exercises and may be improved with aquatic exercises, robot-assisted gait training (RAGT), motion gaming, and multimodal exercises; activities of daily living (ADL), female sexual function, and spasticity may be improved with aquatic therapy; sleep may be improved with aerobic exercises and aerobic fitness with multimodal exercises. In CP, balance may be improved with hippotherapy and motion gaming; function may be improved with cycling, treadmill, and hippotherapy. In SCI, ADL may be improved with RAGT. CONCLUSIONS Depending on population and type of exercise, physical activity was associated with improvements in walking, function, balance, depression, sleep, ADL, spasticity, female sexual function, and aerobic capacity. Few harms of physical activity were reported in studies. Future studies are needed to address evidence gaps and to confirm findings.
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Affiliation(s)
- Shelley S Selph
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon.
| | | | - Ngoc Wasson
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon
| | | | | | - Erik Ensrud
- Department of Medicine, Oregon Health and Science University, Portland, Oregon
| | - Diane Elliot
- Department of Medicine, Oregon Health and Science University, Portland, Oregon
| | - Kristin M Dissinger
- Department of Medicine, Oregon Health and Science University, Portland, Oregon
| | - Marian McDonagh
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon
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21
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Atkins KD, Bickel CS. Effects of functional electrical stimulation on muscle health after spinal cord injury. Curr Opin Pharmacol 2021; 60:226-231. [PMID: 34464934 DOI: 10.1016/j.coph.2021.07.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/16/2021] [Accepted: 07/26/2021] [Indexed: 10/20/2022]
Abstract
Spinal cord injury is a devastating condition interrupting voluntary movement and motor control. In response to unloading, skeletal muscle undergoes numerous adaptations, including rapid and profound atrophy, intramuscular fat accumulation, impaired muscular glucose metabolism and decreased force generation and muscle performance. Functional electrical stimulation (FES) involves electrically stimulating affected muscles to contract in a coordinated manner to create a functional movement or task. Effects of FES-cycling, rowing and resistance training on muscle health are described here. Briefly, FES-cycling and resistance training may slow muscle atrophy or facilitate muscle hypertrophy, and all modalities benefit muscle composition and performance to some extent. These interventions show promise as future rehabilitative tools after spinal cord injury.
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Affiliation(s)
- Kelly D Atkins
- Department of Physical Therapy, Samford University, Birmingham, AL, USA
| | - C Scott Bickel
- Department of Physical Therapy, Samford University, Birmingham, AL, USA.
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22
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Figoni SF, Dolbow DR, Crawford EC, White ML, Pattanaik S. Does aerobic exercise benefit persons with tetraplegia from spinal cord injury? A systematic review. J Spinal Cord Med 2021; 44:690-703. [PMID: 32043944 PMCID: PMC8477928 DOI: 10.1080/10790268.2020.1722935] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
CONTEXT This review synthesizes the findings of previous research studies on the cardiovascular and metabolic benefits of aerobic exercise for individuals with tetraplegia secondary to spinal cord injury. They are often less active due to muscular paralysis, sensory loss, and sympathetic nervous system dysfunction that result from injury. Consequently, these persons are at higher risk for exercise intolerance and secondary health conditions. OBJECTIVE To evaluate the evidence concerning efficacy of aerobic exercise training for improving health and exercise performance in persons with tetraplegia from cervical injury. METHODS The search engines PubMed and Google Scholar were used to locate published research. The final 75 papers were selected on the basis of inclusion criteria. The studies were then rank-ordered using Physiotherapy Evidence Database. RESULTS Studies combining individuals with tetraplegia and paraplegia show that voluntary arm-crank training can increase mean peak power output by 33%. Functional electrical stimulation leg cycling was shown to induce higher peak cardiac output and stroke volume than arm-crank exercise. A range of peak oxygen uptake (VO2peak) values have been reported (0.57-1.32 L/min). Both VO2peak and cardiac output may be enhanced via increased muscle pump in the legs and venous return to the heart. Hybrid exercise (arm-crank and functional electrical stimulation leg cycling) can result in greater peak oxygen uptake and cardiovascular responses. CONCLUSION Evidence gathered from this systematic review of literature is inconclusive due to the lack of research focusing on those with tetraplegia. Higher power studies (level 1-3) are needed with the focus on those with tetraplegia.
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Affiliation(s)
- Stephen F Figoni
- Spinal Cord Injury/Disorders Healthcare Group (128), Tibor Rubin VA Medical Center, Long Beach, California, USA
| | - David R Dolbow
- Physical Therapy Program, William Carey University, Hattiesburg, Mississippi, USA
| | - Edwin C Crawford
- Physical Therapy Program, William Carey University, Hattiesburg, Mississippi, USA
| | - Margaret L White
- Physical Therapy Program, William Carey University, Hattiesburg, Mississippi, USA
| | - Sambit Pattanaik
- College of Osteopathic Medicine, William Carey University, Hattiesburg, Mississippi, USA
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Everaert DG, Okuma Y, Abdollah V, Ho C. Timing and dosage of FES cycling early after acute spinal cord injury: A case series report. J Spinal Cord Med 2021; 44:S250-S255. [PMID: 34292125 PMCID: PMC8604517 DOI: 10.1080/10790268.2021.1953323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE To understand the progression in parameters of functional electrical stimulation (FES) cycling dosage (including duration, velocity, stimulation amplitudes, power output), and the resulting changes in muscle mass early after acute spinal cord injury (SCI). METHODS Three participants, 24-38 years old, with neurological injury level C4-T4, severity AIS (American Spinal Injury Association Impairment Scale) A-C, started FES cycling 16-20 days post injury while admitted at a level-1 trauma center in Canada, and continued for 8-13 weeks in a rehabilitation hospital. They performed three sessions/week of 15-45 min FES cycling, supine or sitting. FES parameters, cycling performance, and muscle cross-sectional area (CSA) in thighs and calves were measured every 2 weeks. RESULTS Progression in power output, but not in session duration, was limited in two participants who experienced stimulation-associated referred pain or apprehension, requiring limitation of stimulation amplitudes for up to 65 days after the start of FES cycling. Participants started with 15 min cycling at 20 RPM with no resistance (0 W), and progressed to 30-45 min at 30 RPM producing 8.8-19.0 W average power/session after 2-3 months. Initially, muscle CSA decreased in all 3 participants (up to 16% after 6 weeks), and recovered later after a variable period of FES cycling (up to 16% at 13.3 weeks). CONCLUSION Progression of FES cycling in the first 3 months after injury required a highly individualized approach, guided by participant response, rather than standardized increments in stimulation intensity or duration. Changes in muscle CSA did not always correspond with the dose of FES cycling.
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Affiliation(s)
- Dirk G. Everaert
- Faculty of Medicine and Dentistry, Division of Physical Medicine & Rehabilitation, University of Alberta, Edmonton, Alberta, Canada
| | - Yoshino Okuma
- Faculty of Medicine and Dentistry, Division of Physical Medicine & Rehabilitation, University of Alberta, Edmonton, Alberta, Canada
- Alberta Health Services, Edmonton, Alberta, Canada
| | - Vahid Abdollah
- Faculty of Medicine and Dentistry, Division of Physical Medicine & Rehabilitation, University of Alberta, Edmonton, Alberta, Canada
- Faculty of Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Chester Ho
- Faculty of Medicine and Dentistry, Division of Physical Medicine & Rehabilitation, University of Alberta, Edmonton, Alberta, Canada
- Alberta Health Services, Edmonton, Alberta, Canada
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Topical application of CNTF, GDNF and BDNF in combination attenuates blood-spinal cord barrier permeability, edema formation, hemeoxygenase-2 upregulation, and cord pathology. PROGRESS IN BRAIN RESEARCH 2021; 266:357-376. [PMID: 34689864 DOI: 10.1016/bs.pbr.2021.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Spinal cord injury (SCI) is one of the leading causes of disability in Military personnel for which no suitable therapeutic strategies are available till today. Thus, exploration of novel therapeutic measures is highly needed to enhance the quality of life of SCI victims. Previously, topical application of BDNF and GDNF in combination over the injured spinal cord after 90min induced marked neuroprotection. In present investigation, we added CNTF in combination with BDNF and/or GDNF treatment to examine weather the triple combination applied over the traumatic cord after 90 or 120min could thwart cord pathology. Since neurotrophins attenuate nitric oxide (NO) production in SCI, the role of carbon monoxide (CO) production that is similar to NO in inducing cell injury was explored using immunohistochemistry of the constitutive isoform of enzyme hemeoxygenase-2 (HO-2). SCI inflicted over the right dorsal horn of the T10-11 segments by making an incision of 2mm deep and 5mm long upregulated the HO-2 immunostaining in the T9 and T12 segments after 5h injury. These perifocal segments are associated with breakdown of the blood-spinal cord barrier (BSCB), edema development and cell injuries. Topical application of CNTF with BDNF and GDNF in combination (10ng each) after 90 and 120min over the injured spinal cord significantly attenuated the BSCB breakdown, edema formation, cell injury and overexpression of HO-2. These observations are the first to show that CNTF with BDNF and GDNF induced superior neuroprotection in SCI probably by downregulation of CO production, not reported earlier.
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Cavka K, Fuller DD, Tonuzi G, Fox EJ. Diaphragm Pacing and a Model for Respiratory Rehabilitation After Spinal Cord Injury. J Neurol Phys Ther 2021; 45:235-242. [PMID: 34049339 PMCID: PMC8711094 DOI: 10.1097/npt.0000000000000360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Cervical spinal cord injury (CSCI) can cause severe respiratory impairment. Although mechanical ventilation (MV) is a lifesaving standard of care for these patients, it is associated with diaphragm atrophy and dysfunction. Diaphragm pacing (DP) is a strategy now used acutely to promote MV weaning and to combat the associated negative effects. Initial reports indicate that DP also may promote neuromuscular plasticity and lead to improvements in spontaneous diaphragm activation and respiratory function. These outcomes suggest the need for reevaluation of respiratory rehabilitation for patients with CSCI using DP and consideration of new rehabilitation models for these patients and their unique care needs. SUMMARY OF KEY POINTS This article discusses the rationale for consideration of DP as a rehabilitative strategy, particularly when used in combination with established respiratory interventions. In addition, a model of respiratory rehabilitation and recovery (RRR) is presented, providing a framework for rehabilitation and consideration of DP as an adjuvant rehabilitation approach. The model promotes goals such as respiratory recovery and independence, and lifelong respiratory health, via interdisciplinary care, respiratory training, quantitative measurement, and use of adjuvant strategies such as DP. Application of the model is demonstrated through a description of an inpatient rehabilitation program that applies model components to patients with CSCI who require DP. RECOMMENDATIONS FOR CLINICAL PRACTICE As DP use increases for patients with acute CSCI, so does the need and opportunity to advance rehabilitation approaches for these patients. This perspective article is a critical step in addressing this need and motivating the advancement of rehabilitation strategies for CSCI patients. (See Video Abstract, Supplemental Digital Content, available at: http://links.lww.com/JNPT/A348).
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Affiliation(s)
- Kathryn Cavka
- Brooks Rehabilitation, Jacksonville, Florida (K.C., G.T., E.J.F.); and Department of Physical Therapy, University of Florida, Gainesville (D.D.F., E.J.F.)
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van der Scheer JW, Goosey-Tolfrey VL, Valentino SE, Davis GM, Ho CH. Functional electrical stimulation cycling exercise after spinal cord injury: a systematic review of health and fitness-related outcomes. J Neuroeng Rehabil 2021; 18:99. [PMID: 34118958 PMCID: PMC8196442 DOI: 10.1186/s12984-021-00882-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 05/19/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES The objective of this review was to summarize and appraise evidence on functional electrical stimulation (FES) cycling exercise after spinal cord injury (SCI), in order to inform the development of evidence-based clinical practice guidelines. METHODS PubMed, the Cochrane Central Register of Controlled Trials, EMBASE, SPORTDiscus, and CINAHL were searched up to April 2021 to identify FES cycling exercise intervention studies including adults with SCI. In order to capture the widest array of evidence available, any outcome measure employed in such studies was considered eligible. Two independent reviewers conducted study eligibility screening, data extraction, and quality appraisal using Cochranes' Risk of Bias or Downs and Black tools. Each study was designated as a Level 1, 2, 3 or 4 study, dependent on study design and quality appraisal scores. The certainty of the evidence for each outcome was assessed using GRADE ratings ('High', 'Moderate', 'Low', or 'Very low'). RESULTS Ninety-two studies met the eligibility criteria, comprising 999 adults with SCI representing all age, sex, time since injury, lesion level and lesion completeness strata. For muscle health (e.g., muscle mass, fiber type composition), significant improvements were found in 3 out of 4 Level 1-2 studies, and 27 out of 32 Level 3-4 studies (GRADE rating: 'High'). Although lacking Level 1-2 studies, significant improvements were also found in nearly all of 35 Level 3-4 studies on power output and aerobic fitness (e.g., peak power and oxygen uptake during an FES cycling test) (GRADE ratings: 'Low'). CONCLUSION Current evidence indicates that FES cycling exercise improves lower-body muscle health of adults with SCI, and may increase power output and aerobic fitness. The evidence summarized and appraised in this review can inform the development of the first international, evidence-based clinical practice guidelines for the use of FES cycling exercise in clinical and community settings of adults with SCI. Registration review protocol: CRD42018108940 (PROSPERO).
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Affiliation(s)
- Jan W van der Scheer
- Peter Harrison Centre for Disability Sport, School for Sport, Exercise and Health Sciences, Loughborough University, Epinal Way, Loughborough, LE11 3TU, UK
- The Healthcare Improvement Studies (THIS) Institute, Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt Building, Cambridge, CB2 OAH, UK
| | - Victoria L Goosey-Tolfrey
- Peter Harrison Centre for Disability Sport, School for Sport, Exercise and Health Sciences, Loughborough University, Epinal Way, Loughborough, LE11 3TU, UK
| | - Sydney E Valentino
- Department of Kinesiology, McMaster University, Room IWC EG115, 1280 Main St. W., Hamilton, ON, L8S 4K1, Canada
| | - Glen M Davis
- Discipline of Exercise and Sport Sciences, Faculty of Medicine and Health, Sydney School of Health Sciences, University of Sydney, Sydney, NSW, 2006, Australia
| | - Chester H Ho
- Division of Physical Medicine & Rehabilitation, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, T6G 2R3, Canada.
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Gurcay E, Karaahmet OZ, Cankurtaran D, Nazlı F, Umay E, Güzel Ş, Gurcay AG. Functional electrical stimulation cycling in patients with chronic spinal cord injury: a pilot study. Int J Neurosci 2021; 132:421-427. [PMID: 33998960 DOI: 10.1080/00207454.2021.1929212] [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: 10/21/2022]
Abstract
OBJECTIVE To examine the therapeutic value of lower extremity functional electrical stimulation (FES) - evoked cycling on functional independence, health status, gait parameters, pulmonary functions, and biochemical values in patients with chronic complete/incomplete spinal cord injury (SCI). MATERIALS AND METHODS Fifteen patients with SCI (duration of more than 6 months) who were able to stand up and walk with long leg braces or assistive devices and had stable neurological status and trunk balance undertook FES cycling for 6 weeks (three times per week). The main outcomes were: Functional Independence Measure (FIM), Nottingham Health Profile (NHP), 6-minute walk test (6MWT), and 20-meter walk test (20MWT). Secondary outcomes include measurements of pulmonary function tests and biochemical values. All parameters were evaluated at the beginning and end of the program. RESULTS Improvements were seen in motor and total scores of FIM (p = 0.007), physical mobility subscale of NHP (p = 0.011), 6MWT (p = 0.001), and 20MWT (p = 0.011). In pulmonary functions, only forced vital capacity (FVC) levels demonstrated a significant increase compared with baseline (p = 0.011). Biochemical values reached no significant level. CONCLUSION The results of this study showed that the FES cycling exercise program improves motor and total FIM scores, gait parameters, and FVC values of pulmonary functions in patients with chronic SCI experience. The FES cycle might be a valuable and well-tolerated intervention in clinical rehabilitation.
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Affiliation(s)
- Eda Gurcay
- Gaziler Physical Therapy and Rehabilitation Education and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Ozgur Zeliha Karaahmet
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Damla Cankurtaran
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Fatma Nazlı
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Ebru Umay
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Şükran Güzel
- Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Baskent University, Ankara, Turkey
| | - Ahmet Gurhan Gurcay
- School of Medicine, Department of Neurosurgery, Yıldırım Beyazıt University, Ankara, Turkey
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Johns J, Krogh K, Rodriguez GM, Eng J, Haller E, Heinen M, Laredo R, Longo W, Montero-Colon W, Korsten M. Management of Neurogenic Bowel Dysfunction in Adults after Spinal Cord Injury Suggested citation: Jeffery Johns, Klaus Krogh, Gianna M. Rodriguez, Janice Eng, Emily Haller, Malorie Heinen, Rafferty Laredo, Walter Longo, Wilda Montero-Colon, Mark Korsten. Management of Neurogenic Bowel Dysfunction in Adults after Spinal Cord Injury: Clinical Practice Guideline for Healthcare Providers. Journal of Spinal Cord Med. 2021. Doi:10.1080/10790268.2021.1883385. J Spinal Cord Med 2021; 44:442-510. [PMID: 33905316 PMCID: PMC8115581 DOI: 10.1080/10790268.2021.1883385] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Jeffery Johns
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Klaus Krogh
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Gianna M Rodriguez
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Janice Eng
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Emily Haller
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Malorie Heinen
- University of Kansas Health Care System, Kansas City, Kansas, USA
| | | | - Walter Longo
- Department of Surgery, Division of Gastrointestinal Surgery, Yale University, New Haven, Connecticut, USA
| | | | - Mark Korsten
- Icahn School of Medicine at Mount Sinai, Department of Internal Medicine, Division of Gastroenterology, New York, New York, USA
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Calabrò RS, Billeri L, Ciappina F, Balletta T, Porcari B, Cannavò A, Pignolo L, Manuli A, Naro A. Toward improving functional recovery in spinal cord injury using robotics: a pilot study focusing on ankle rehabilitation. Expert Rev Med Devices 2021; 19:83-95. [PMID: 33616471 DOI: 10.1080/17434440.2021.1894125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background: Conventional physical therapy interventions are strongly recommended to improve ambulation potential and upright mobility in persons with incomplete spinal cord injury (iSCI). Ankle rehabilitation plays a significant role, as it aims to stem drop foot consequences.Research question: This pilot study aimed to assess the neurophysiological underpinnings of robot-aided ankle rehabilitation (using a platform robot) compared to conventional physiotherapy and its efficacy in improving gait performance and balance in persons with iSCI.Methods: Ten individuals with subacute/chronic iSCI (six males and four females, 39 ± 13 years, time since injury 8 ± 4 months, ASIA impairment scale grade C-D) were provided with one-month intensive training for robot-aided ankle rehabilitation (24 sessions, 1 h daily, six times a week). Clinical (10-Meter Walk Test (10MWT), 6-Minute Walk Test (6MWT), and Timed Up and Go test (TUG)), and electrophysiological aftereffects (surface-EMG from tibialis anterior and medial gastrocnemius muscles to estimate muscle activation patterns; and corticomuscular coherence-CMC-to assess functional synchronization between sensorimotor cortex and muscles, i.e. the functional integrity of corticospinal output) were assessed at baseline (PRE) and after the trial completion (POST). The experimental group (EG) data were compared with those coming from a retrospective control group (CG; n = 10) matched for clinical-demographic characteristics, who previously underwent conventional ankle rehabilitation.Results: the EG achieved a greater improvement in balance and gait as compared to the CG (TUG EG from 70 ± 18 to 45 ± 15 s, p = 0.002; CG from 68 ± 21 to 48 ± 18 s, p = 0.01; group-comparison p = 0.001; 10MWT EG from 0.43 ± 0.11 to 0.51 ± 0.09 m/s, p = 0.006; CG from 0.4 ± 0.13 to 0.45 ± 0.12, p = 0.01; group-comparison p = 0.006; 6 MWT EG from 231 ± 13 to 274 ± 15 m, p < 0.001; CG from 236 ± 13 to 262 ± 15 m, p = 0.003; group-comparison p = 0.01). Furthermore, the EG showed a retraining of muscle activation (an increase within proper movements, with a reduction of co-contractions) and CMC (beta frequency increase within proper movements, i.e. in a framework of preserved motor coordination). The improvements in CMC, gait, balance, and muscle activation were not correlated with each other.Conclusions: Robot-aided ankle rehabilitation improved gait performance by selectively ameliorating CMC, muscle activation patterns, and, lastly, gait balance and speed. Despite CMC, gait, balance, and muscle activation were not correlated, this pilot study suggests that robot-aided ankle rehabilitation may favor a better communication between above-SCI and below-SCI structures. This communication improvement may depend on a more synchronized corticospinal output (as per CMC increase) and a better responsiveness of below-SCI motorneurons to corticospinal output (as per specific and ankle movement focused muscle activation increases at the surface EMG), thus favoring greater recruitment of spinal motor units and, ultimately, improving muscle activation pattern and strength.Significance: Adopting robot-aided ankle rehabilitation protocols for persons with iSCI in the subacute/chronic phase may allow achieving a clinically significant improvement in gait performance.
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Affiliation(s)
| | - Luana Billeri
- IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
| | | | - Tina Balletta
- IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
| | - Bruno Porcari
- IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
| | | | | | | | - Antonino Naro
- IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
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McMillan DW, Maher JL, Jacobs KA, Nash MS, Gater DR. Exercise Interventions Targeting Obesity in Persons With Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2021; 27:109-120. [PMID: 33814889 PMCID: PMC7983638 DOI: 10.46292/sci20-00058] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Spinal cord injury (SCI) results in an array of cardiometabolic complications, with obesity being the most common component risk of cardiometabolic disease (CMD) in this population. Recent Consortium for Spinal Cord Medicine Clinical Practice Guidelines for CMD in SCI recommend physical exercise as a primary treatment strategy for the management of CMD in SCI. However, the high prevalence of obesity in SCI and the pleiotropic nature of this body habitus warrant strategies for tailoring exercise to specifically target obesity. In general, exercise for obesity management should aim primarily to induce a negative energy balance and secondarily to increase the use of fat as a fuel source. In persons with SCI, reductions in the muscle mass that can be recruited during activity limit the capacity for exercise to induce a calorie deficit. Furthermore, the available musculature exhibits a decreased oxidative capacity, limiting the utilization of fat during exercise. These constraints must be considered when designing exercise interventions for obesity management in SCI. Certain forms of exercise have a greater therapeutic potential in this population partly due to impacts on metabolism during recovery from exercise and at rest. In this article, we propose that exercise for obesity in SCI should target large muscle groups and aim to induce hypertrophy to increase total energy expenditure response to training. Furthermore, although carbohydrate reliance will be high during activity, certain forms of exercise might induce meaningful postexercise shifts in the use of fat as a fuel. General activity in this population is important for many components of health, but low energy cost of daily activities and limitations in upper body volitional exercise mean that exercise interventions targeting utilization and hypertrophy of large muscle groups will likely be required for obesity management.
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Affiliation(s)
- David W. McMillan
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, UHealth/Jackson Memorial, Miami, Florida
- Department of Physical Medicine & Rehabilitation, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
| | - Jennifer L. Maher
- Department of Health, University of Bath, Claverton Down, Bath, United Kingdom
| | - Kevin A. Jacobs
- Department of Kinesiology and Sport Sciences, University of Miami, Coral Gables, Florida
| | - Mark S. Nash
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, UHealth/Jackson Memorial, Miami, Florida
| | - David R. Gater
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, UHealth/Jackson Memorial, Miami, Florida
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Johns J, Krogh K, Rodriguez GM, Eng J, Haller E, Heinen M, Laredo R, Longo W, Montero-Colon W, Wilson C, Korsten M. Management of Neurogenic Bowel Dysfunction in Adults after Spinal Cord Injury: Clinical Practice Guideline for Health Care Providers. Top Spinal Cord Inj Rehabil 2021; 27:75-151. [PMID: 34108835 PMCID: PMC8152174 DOI: 10.46292/sci2702-75] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Jeffery Johns
- Vanderbilt University Medical Center, Nashville, Tennessee USA
| | | | | | - Janice Eng
- University of British Columbia, Vancouver Canada
| | | | - Malorie Heinen
- University of Kansas Health Care System, Kansas City, Kansas USA
| | | | | | | | - Catherine Wilson
- Diplomate, American Board of Professional Psychology (RP) Private Practice, Denver, Colorado
| | - Mark Korsten
- Icahn School of Medicine @ Mt Sinai, New York, New York USA
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Farrow M, Nightingale TE, Maher J, McKay CD, Thompson D, Bilzon JL. Effect of Exercise on Cardiometabolic Risk Factors in Adults With Chronic Spinal Cord Injury: A Systematic Review. Arch Phys Med Rehabil 2020; 101:2177-2205. [DOI: 10.1016/j.apmr.2020.04.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 03/27/2020] [Accepted: 04/11/2020] [Indexed: 12/14/2022]
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Kapadia N, Moineau B, Popovic MR. Functional Electrical Stimulation Therapy for Retraining Reaching and Grasping After Spinal Cord Injury and Stroke. Front Neurosci 2020; 14:718. [PMID: 32742254 PMCID: PMC7364342 DOI: 10.3389/fnins.2020.00718] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 06/16/2020] [Indexed: 12/31/2022] Open
Abstract
Neurological conditions like hemiplegia following stroke or tetraplegia following spinal cord injury, result in a massive compromise in motor function. Each of the two conditions can leave individuals dependent on caregivers for the rest of their lives. Once medically stable, rehabilitation is the main stay of treatment. This article will address rehabilitation of upper extremity function. It is long known that moving the affected limb is crucial to recovery following any kind of injury. Overtime, it has also been established that just moving the affected extremities does not suffice, and that the movements have to involve patient’s participation, be as close to physiologic movements as possible, and should ideally stimulate the entire neuromuscular circuitry involved in producing the desired movement. For over four decades now, functional electrical stimulation (FES) is being used to either replace or retrain function. The FES therapy discussed in this article has been used to retrain upper extremity function for over 15 years. Published data of pilot studies and randomized control trials show that FES therapy produces significant changes in arm and hand function. There are specific principles of the FES therapy as applied in our studies: (i) stimulation is applied using surface stimulation electrodes, (ii) there is minimum to virtually no pain during application, (iii) each session lasts no more than 45–60 min, (iv) the technology is quite robust and can make up for specificity to a certain extent, and (v) fine motor function like two finger precision grip can be trained (i.e., thumb and index finger tip to tip pinch). The FES therapy protocols can be successfully applied to individuals with paralysis resulting from stroke or spinal cord injury.
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Affiliation(s)
- Naaz Kapadia
- Rehabilitation Engineering Laboratory, The KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,CRANIA, University Health Network and University of Toronto, Toronto, ON, Canada.,The KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
| | - Bastien Moineau
- Rehabilitation Engineering Laboratory, The KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada.,Myant Inc., Toronto, ON, Canada
| | - Milos R Popovic
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,CRANIA, University Health Network and University of Toronto, Toronto, ON, Canada.,The KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
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Duffell LD, Donaldson NDN. A Comparison of FES and SCS for Neuroplastic Recovery After SCI: Historical Perspectives and Future Directions. Front Neurol 2020; 11:607. [PMID: 32714270 PMCID: PMC7344227 DOI: 10.3389/fneur.2020.00607] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 05/25/2020] [Indexed: 12/17/2022] Open
Abstract
There is increasing evidence that neuroplastic changes can occur even years after spinal cord injury, leading to reduced disability and better health which should reduce the cost of healthcare. In motor-incomplete spinal cord injury, recovery of leg function may occur if repetitive training causes afferent input to the lumbar spinal cord. The afferent input may be due to activity-based therapy without electrical stimulation but we present evidence that it is faster with electrical stimulation. This may be spinal cord stimulation or peripheral nerve stimulation. Recovery is faster if the stimulation is phasic and that the patient is trying to use their legs during the training. All the published studies are small, so all conclusions are provisional, but it appears that patients with more disability (AIS A and B) may need to continue using stimulation and for them, an implanted stimulator is likely to be convenient. Patients with less disability (AIS C and D) may make useful recovery and improve their quality of life from a course of therapy. This might be locomotion therapy but we argue that cycling with electrical stimulation, which uses biofeedback to encourage descending drive, causes rapid recovery and might be used with little supervision at home, making it much less expensive. Such an electrical therapy followed by conventional physiotherapy might be affordable for the many people living with chronic SCI. To put this in perspective, we present some information about what treatments are funded in the UK and the US.
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Affiliation(s)
- Lynsey D Duffell
- Implanted Devices Group, University College London, London, United Kingdom.,Aspire CREATe, University College London, London, United Kingdom
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The Effects of Electrical Stimulation Parameters in Managing Spasticity After Spinal Cord Injury: A Systematic Review. Am J Phys Med Rehabil 2020; 98:484-499. [PMID: 30300228 DOI: 10.1097/phm.0000000000001064] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Controversial findings about the effects of neuromuscular electrical stimulation and functional electrical stimulation in managing spasticity have been raised after spinal cord injury. A systematic review was conducted to identify the range of the stimulation parameters that may alleviate spasticity. Three independent reviewers searched Medline (PubMed), web of knowledge, Scopus, Cochrane Central, Virtual Health Library, and Physiotherapy Evidence Database until January 2018. Inclusion criteria were applications of neuromuscular electrical stimulation/functional electrical stimulation on the lower limb muscles, stimulation parameters (frequency, pulse duration, and amplitude of current), and measures of spasticity after spinal cord injury. The primary outcome was spasticity as measured by the Modified Ashworth Scale and the secondary outcome was spasticity assessed by other indirect measures. Twenty-three clinical and nonclinical trials were included with 389 subjects. Neuromuscular electrical stimulation/functional electrical stimulation provided reductions in spasticity by 45%-60% with decrease in electromyography activity and increase in range of motion after spinal cord injury. The identified stimulation parameters were frequency of 20-30 Hz, pulse duration of 300-350 μs, and amplitude of the current greater than 100 mA. Neuromuscular electrical stimulation/functional electrical stimulation provides an effective rehabilitation strategy in managing spasticity. However, a recommendation of the stimulation parameters cannot be accurately assumed because of high variability in the methodology, design, and heterogeneity of the included studies.
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Duenas VH, Cousin CA, Rouse C, Fox EJ, Dixon WE. Distributed Repetitive Learning Control for Cooperative Cadence Tracking in Functional Electrical Stimulation Cycling. IEEE TRANSACTIONS ON CYBERNETICS 2020; 50:1084-1095. [PMID: 30530349 DOI: 10.1109/tcyb.2018.2882755] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Closed-loop control of functional electrical stimulation coupled with motorized assistance to induce cycling is a rehabilitative strategy that can improve the mobility of people with neurological conditions (NCs). However, robust control methods, which are currently pervasive in the cycling literature, have limited effectiveness due to the use of high stimulation intensity leading to accelerated fatigue during cycling protocols. This paper examines the design of a distributed repetitive learning controller (RLC) that commands an independent learning feedforward term to each of the six stimulated lower-limb muscle groups and an electric motor during the tracking of a periodic cadence trajectory. The switched controller activates lower limb muscles during kinematic efficient regions of the crank cycle and provides motorized assistance only when most needed (i.e., during the portions of the crank cycle where muscles evoke a low torque output). The controller exploits the periodicity of the desired cadence trajectory to learn from previous control inputs for each muscle group and electric motor. A Lyapunov-based stability analysis guarantees asymptotic tracking via an invariance-like corollary for nonsmooth systems. The switched distributed RLC was evaluated in experiments with seven able-bodied individuals and five participants with NCs. A mean root-mean-squared cadence error of 3.58 ± 0.43 revolutions per minute (RPM) (0.07 ± 7.35% average error) and 4.26 ± 0.84 RPM (0.1 ± 8.99% average error) was obtained for the healthy and neurologically impaired populations, respectively.
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Effects of hybrid-functional electrical stimulation (FES) rowing whole-body exercise on neurologic improvement in subacute spinal cord injury: secondary outcomes analysis of a randomized controlled trial. Spinal Cord 2020; 58:914-920. [PMID: 32094516 PMCID: PMC7415604 DOI: 10.1038/s41393-020-0445-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 02/15/2020] [Accepted: 02/17/2020] [Indexed: 11/29/2022]
Abstract
Study Design Secondary outcome measures analysis of a randomized, controlled study. Objective To assess the effects of hybrid-functional electrical stimulation (FES) rowing on motor and sensory recovery in individuals with spinal cord injury (SCI) 6–18 months post-injury. Setting Outpatient rehabilitation network. Methods 25 participants 6–12 months after SCI were randomly assigned to hybrid-FES rowing (n=10) or standard of care (n=15) groups. The hybrid-FES rowing group completed 6 months of rowing scheduled 3 times per week for 26 weeks at an exercise intensity of 70–85% of maximal heart rate. The standard of care group either participated in an arm ergometer exercise program (n=6) or a waitlist without an explicit exercise program (n=9). Changes in motor score and combined sensory score of the International Standards for Neurological Classification of SCI (ISNCSCI) were analyzed. Results Both groups demonstrated increases in motor and combined sensory scores, but no significant differences were noted between intervention groups (motor difference mean ↑1.3 (95% CI, −1.9 to 4.4), combined sensory difference mean ↓10 (−30 to 18)). There was an average of 63% adherence to the hybrid-FES rowing protocol, with no significant correlation in changes in motor or combined sensory score in the hybrid-FES rowing group with total distance or time rowed. Conclusions No significant effects to neurologic improvement were found with hybrid-FES rowing when compared with standard of care interventions in individuals with SCI 6–18 months post-injury.
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Practical Application of Recent Advances in Diagnostic, Prognostic, and Therapeutic Modalities for Spinal Cord Injury. World Neurosurg 2020; 136:330-336. [PMID: 31931244 DOI: 10.1016/j.wneu.2020.01.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 01/01/2020] [Accepted: 01/02/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Spinal cord injury remains a highly morbid entity, with limited treatment modalities in both acute and chronic settings. Clinical research efforts to improve therapeutic guidelines are confounded by initial evaluation inaccuracies, as presentations are frequently complicated by trauma and objective diagnostic and prognostic methods are poorly defined. The purpose of our study was to review recent practical advances for further delineation of these injuries and how such classification may benefit the development of novel treatments. METHODS A review was carried out of recent studies reported within the last 5 years for prognostic and diagnostic modalities of acute spinal cord injury. RESULTS Substantial efforts have been made to improve the timeliness and accuracy of the initial assessment, not only for the purpose of enhancing prognostication but also in determining the efficacy of new treatments. Whether it be applying traumatic brain injury principles to limit injury extent, external stimulators used for chronic pain conditions to enhance the effects of physical therapy, or creative algorithms incorporating various nerve or muscle transfer techniques, innovative and practical solutions continue to be developed in lieu of definitive treatment. Further development will benefit from enhanced stratification of injury from accurate and practical assessment modalities. CONCLUSIONS Recent advances in accurate, timely, and practical classification methods of acute spinal cord injury will assist in the development of novel treatment approaches for both acute and chronic injury alike.
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Duffell LD, Paddison S, Alahmary AF, Donaldson N, Burridge J. The effects of FES cycling combined with virtual reality racing biofeedback on voluntary function after incomplete SCI: a pilot study. J Neuroeng Rehabil 2019; 16:149. [PMID: 31771600 PMCID: PMC6880599 DOI: 10.1186/s12984-019-0619-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 11/06/2019] [Indexed: 11/20/2022] Open
Abstract
Background Functional Electrical Stimulation (FES) cycling can benefit health and may lead to neuroplastic changes following incomplete spinal cord injury (SCI). Our theory is that greater neurological recovery occurs when electrical stimulation of peripheral nerves is combined with voluntary effort. In this pilot study, we investigated the effects of a one-month training programme using a novel device, the iCycle, in which voluntary effort is encouraged by virtual reality biofeedback during FES cycling. Methods Eleven participants (C1-T12) with incomplete SCI (5 sub-acute; 6 chronic) were recruited and completed 12-sessions of iCycle training. Function was assessed before and after training using the bilateral International Standards for Neurological Classification of SCI (ISNC-SCI) motor score, Oxford power grading, Modified Ashworth Score, Spinal Cord Independence Measure, the Walking Index for Spinal Cord Injury and 10 m-walk test. Power output (PO) was measured during all training sessions. Results Two of the 6 participants with chronic injuries, and 4 of the 5 participants with sub-acute injuries, showed improvements in ISNC-SCI motor score > 8 points. Median (IQR) improvements were 3.5 (6.8) points for participants with a chronic SCI, and 8.0 (6.0) points for those with sub-acute SCI. Improvements were unrelated to other measured variables (age, time since injury, baseline ISNC-SCI motor score, baseline voluntary PO, time spent training and stimulation amplitude; p > 0.05 for all variables). Five out of 11 participants showed moderate improvements in voluntary cycling PO, which did not correlate with changes in ISNC-SCI motor score. Improvement in PO during cycling was positively correlated with baseline voluntary PO (R2 = 0.50; p < 0.05), but was unrelated to all other variables (p > 0.05). The iCycle was not suitable for participants who were too weak to generate a detectable voluntary torque or whose effort resulted in a negative torque. Conclusions Improved ISNC-SCI motor scores in chronic participants may be attributable to the iCycle training. In sub-acute participants, early spontaneous recovery and changes due to iCycle training could not be distinguished. The iCycle is an innovative progression from existing FES cycling systems, and positive results should be verified in an adequately powered controlled trial. Trial registration ClinicalTrials.gov, NCT03834324. Registered 06 February 2019 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03834324. Protocol V03, dated 06.08.2015.
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Affiliation(s)
- Lynsey D Duffell
- Department of Medical Physics & Biomedical Engineering, University College London, Malet Place Engineering Building, Gower Street, London, WC1E 6BT, UK.
| | - Sue Paddison
- London Spinal Cord Injury Centre, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Ahmad F Alahmary
- Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Nick Donaldson
- Department of Medical Physics & Biomedical Engineering, University College London, Malet Place Engineering Building, Gower Street, London, WC1E 6BT, UK
| | - Jane Burridge
- Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
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Sijobert B, Le Guillou R, Fattal C, Azevedo Coste C. FES-Induced Cycling in Complete SCI: A Simpler Control Method Based on Inertial Sensors. SENSORS 2019; 19:s19194268. [PMID: 31581489 PMCID: PMC6806329 DOI: 10.3390/s19194268] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 08/29/2019] [Accepted: 09/26/2019] [Indexed: 12/13/2022]
Abstract
This article introduces a novel approach for a functional electrical stimulation (FES) controller intended for FES-induced cycling based on inertial measurement units (IMUs). This study aims at simplifying the design of electrical stimulation timing patterns while providing a method that can be adapted to different users and devices. In most of studies and commercial devices, the crank angle is used as an input to trigger stimulation onset. We propose instead to use thigh inclination as the reference information to build stimulation timing patterns. The tilting angles of both thighs are estimated from one inertial sensor located above each knee. An IF–THEN rule algorithm detects, online and automatically, the thigh peak angles in order to start and stop the stimulation of quadriceps muscles, depending on these events. One participant with complete paraplegia was included and was able to propel a recumbent trike using the proposed approach after a very short setting time. This new modality opens the way for a simpler and user-friendly method to automatically design FES-induced cycling stimulation patterns, adapted to clinical use, for multiple bike geometries and user morphologies.
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Affiliation(s)
- Benoît Sijobert
- Institut National de Recherche en Informatique et en Automatique (INRIA), Université de Montpellier, 34095 Montpellier, France.
| | - Ronan Le Guillou
- Institut National de Recherche en Informatique et en Automatique (INRIA), Université de Montpellier, 34095 Montpellier, France.
| | | | - Christine Azevedo Coste
- Institut National de Recherche en Informatique et en Automatique (INRIA), Université de Montpellier, 34095 Montpellier, France.
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A cross-sectional comparison between cardiorespiratory fitness, level of lesion and red blood cell distribution width in adults with chronic spinal cord injury. J Sci Med Sport 2019; 23:106-111. [PMID: 31558360 DOI: 10.1016/j.jsams.2019.08.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 08/13/2019] [Accepted: 08/16/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To assess; (1) differences in red blood cell distribution width between individuals with chronic (>1year), motor-complete cervical (n=21), upper-thoracic (n=27) and thoracolumbar (n=15) spinal cord injury and, (2) associations between red blood cell distribution width and cardiorespiratory fitness. DESIGN Prospective multi-center, cross-sectional study. METHODS Peak oxygen uptake was determined using an upper-body arm-crank exercise test to volitional exhaustion and red blood cell distribution width was measured using an automated hematology system. RESULTS There were significant (p<0.009) differences between groups classified by level of injury in absolute and relative peak oxygen uptake, peak power output and red blood cell distribution width. A significant (p<0.001) large negative association (r = -0.524) was found between relative peak oxygen uptake and red blood cell distribution width. Unbiased recursive partitioning, while revealing study site specific differences in red blood cell distribution width, identified homogenous subgroups based specifically on cardiorespiratory fitness irrespective of additional demographic and injury characteristics. CONCLUSION The strong negative association between cardiorespiratory fitness and red blood cell distribution width in individuals with paraplegia parallel those previously observed in non-disabled individuals. Higher red blood cell distribution width values are an independent risk factor for increased cardiovascular mortality, heart failure, and coronary heart disease and may reflect several underlying exacerbated metabolic responses such as oxidative stress and systemic inflammation. These data emphasize the importance of maintaining a high aerobic capacity following spinal cord injury.
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Soybaş Z, Şimşek S, Erol FMB, Erdoğan UÇ, Şimşek EN, Şahin B, Marçalı M, Aydoğdu B, Elbüken Ç, Melik R. Real-Time In Vivo Control of Neural Membrane Potential by Electro-Ionic Modulation. iScience 2019; 17:347-358. [PMID: 31326701 PMCID: PMC6651852 DOI: 10.1016/j.isci.2019.06.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 05/11/2019] [Accepted: 06/28/2019] [Indexed: 11/11/2022] Open
Abstract
Theoretically, by controlling neural membrane potential (Vm) in vivo, motion, sensation, and behavior can be controlled. Until now, there was no available technique that can increase or decrease ion concentration in vivo in real time to change neural membrane potential. We introduce a method that we coin electro-ionic modulation (EIM), wherein ionic concentration around a nerve can be controlled in real time and in vivo. We used an interface to regulate the Ca2+ ion concentration around the sciatic nerve of a frog and thus achieved stimulation and blocking with higher resolution and lower current compared with electrical stimulation. As EIM achieves higher controllability of Vm, it has potential to replace conventional methods used for the treatment of neurological disorders and may bring a new perspective to neuromodulation techniques. EIM regulates extracellular ion concentration in vivo in real time EIM stimulates or blocks the nerve via Ca2+ ion depletion or enhancement EIM achieves selective stimulation or blocking of large or small axons EIM is the most superior neuromodulation method for real-life applications
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Affiliation(s)
- Zafer Soybaş
- Department of Electrical and Electronics Engineering, TOBB University of Economics & Technology, Ankara 06510, Turkey
| | - Sefa Şimşek
- Department of Electrical and Electronics Engineering, TOBB University of Economics & Technology, Ankara 06510, Turkey
| | - F M Betül Erol
- Faculty of Medicine, Hacettepe University, Ankara 06100, Turkey
| | - U Çiya Erdoğan
- Department of Electrical and Electronics Engineering, TOBB University of Economics & Technology, Ankara 06510, Turkey
| | - Esra N Şimşek
- Department of Electrical and Electronics Engineering, TOBB University of Economics & Technology, Ankara 06510, Turkey
| | - Büşra Şahin
- Department of Electrical and Electronics Engineering, TOBB University of Economics & Technology, Ankara 06510, Turkey
| | - Merve Marçalı
- Institute of Materials Science and Nanotechnology, National Nanotechnology Research Center (UNAM), Bilkent University, Ankara 06800, Turkey
| | - Bahattin Aydoğdu
- Department of Pediatric Surgery, Dicle University Medical Faculty, Diyarbakır 21280, Turkey
| | - Çağlar Elbüken
- Institute of Materials Science and Nanotechnology, National Nanotechnology Research Center (UNAM), Bilkent University, Ankara 06800, Turkey
| | - Rohat Melik
- Department of Electrical and Electronics Engineering, TOBB University of Economics & Technology, Ankara 06510, Turkey.
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Rahimi M, Torkaman G, Ghabaee M, Ghasem-Zadeh A. Advanced weight-bearing mat exercises combined with functional electrical stimulation to improve the ability of wheelchair-dependent people with spinal cord injury to transfer and attain independence in activities of daily living: a randomized controlled trial. Spinal Cord 2019; 58:78-85. [PMID: 31312016 DOI: 10.1038/s41393-019-0328-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 07/01/2019] [Accepted: 07/03/2019] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Randomized controlled trial. OBJECTIVE To determine the effects of advanced weight-bearing mat exercises (AWMEs) with/without functional electrical stimulation (FES) of the quadriceps and gastrocnemius muscles on the ability of wheelchair-dependent people with spinal cord injury (SCI) to transfer and attain independence in activities of daily living (ADLs). SETTING An outpatient clinic, Iran. METHODS People with traumatic chronic paraplegia (N = 16) were randomly allocated to three groups. The exercise group (EX; N = 5) performed AWMEs of quadruped unilateral reaching and tall-kneeling for 24 weeks (3 days/week). Sessions were increased from 10 min to 54 min over the 24-week period. The exercise-FES group (EX + FES; N = 5) performed AWMEs simultaneously with FES of the quadriceps and gastrocnemius muscles. The control group performed no exercise and no FES (N = 6). The primary outcomes were the total Spinal Cord Independence Measure-III (SCIM-III) to reflect independence with ADL, and the sum of the four SCIM-III transfer items to reflect ability to transfer. There were six other outcomes. RESULTS The mean (95% CI) between-group differences of the four transfer items of the SCIM-III for the EX vs. control group was 1.8 points (0.2-3.4), and for the EX + FES vs. control group was 2 points (0.4-3.6). The equivalent differences for the total SCIM-III scores were 2.7 points (-0.6-6.0) and 4.1 points (0.8-7.4), respectively. There were no significant between-group differences for any other outcomes. CONCLUSIONS Advanced weight-bearing mat exercises improve the ability of wheelchair-dependent people with SCI to transfer and attain independence in ADL.
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Affiliation(s)
- Mostafa Rahimi
- Department of Physiotherapy, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Giti Torkaman
- Department of Physiotherapy, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
| | - Mojdeh Ghabaee
- Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Ghasem-Zadeh
- Departments of Medicine and Endocrinology, Austin Health, The University of Melbourne, Melbourne, VIC, Australia
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Rouse CA, Downey RJ, Gregory CM, Cousin CA, Duenas VH, Dixon WE. FES Cycling in Stroke: Novel Closed-Loop Algorithm Accommodates Differences in Functional Impairments. IEEE Trans Biomed Eng 2019; 67:738-749. [PMID: 31170062 DOI: 10.1109/tbme.2019.2920346] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The objective of this paper was to develop and test a novel control algorithm that enables stroke survivors to pedal a cycle in a desired cadence range despite varying levels of functional abilities after stroke. METHODS A novel algorithm was developed which automatically adjusts 1) the intensity of functional electrical stimulation (FES) delivered to the leg muscles, and 2) the current delivered to an electric motor. The algorithm automatically switches between assistive, uncontrolled, and resistive modes to accommodate for differences in functional impairment, based on the mismatch between the desired and actual cadence. Lyapunov-based methods were used to theoretically prove that the rider's cadence converges to the desired cadence range. To demonstrate the controller's real-world performance, nine chronic stroke survivors performed two cycling trials: 1) volitional effort only and 2) volitional effort accompanied by the control algorithm assisting and resisting pedaling as needed. RESULTS With a desired cadence range of 50-55 r/min, the developed controller resulted in an average rms cadence error of 1.90 r/min, compared to 6.16 r/min during volitional-only trials. CONCLUSION Using FES and an electric motor with a two-sided cadence control objective to assist and resist volitional efforts enabled stroke patients with varying strength and abilities to pedal within a desired cadence range. SIGNIFICANCE A protocol design that constrains volitional movements with assistance and resistance from FES and a motor shows potential for FES cycles and other rehabilitation robots during stroke rehabilitation.
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Vova JA, Eggebrecht EM. Utilizing Functional Electrical Stimulation and Exoskeletons in Pediatrics: a Closer Look at Their Roles in Gait and Functional Changes in Cerebral Palsy. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2019. [DOI: 10.1007/s40141-019-00215-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Azevedo Coste C, Wolf P. FES-Cycling at Cybathlon 2016: Overview on Teams and Results. Artif Organs 2018. [PMID: 29516578 DOI: 10.1111/aor.13139] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | - Peter Wolf
- Sensory-Motor Systems Lab, ETH Zurich, Zurich, Switzerland
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Fattal C, Sijobert B, Daubigney A, Fachin-Martins E, Lucas B, Casillas JM, Azevedo C. Training with FES-assisted cycling in a subject with spinal cord injury: Psychological, physical and physiological considerations. J Spinal Cord Med 2018; 43:402-413. [PMID: 30001192 PMCID: PMC7249253 DOI: 10.1080/10790268.2018.1490098] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
CONTEXT People with spinal cord injury (SCI) experience the effects of a sedentary lifestyle very early on. Literature data suggest that programs using FES-assisted cycling would contribute to reduce the consequences of physical inactivity. The objective was to assess the feasibility of 12-month training on a FES-assisted bike of a subject with paraplegia for 21 years, T3, Asia Impairment Scale (AIS) A. An evaluation of morbidity, self-esteem, satisfaction, quality of life and duration of pedaling was performed. The impact on pain, cardiorespiratory function, body composition and bone metabolism were also assessed. FINDINGS The acceptability score of the training constraints increased from 51 to 59/65 and satisfaction was high around 8/10. The pedaling duration increased from 1' to 26' on the recumbent bike and from 1' to 15' on open terrain. No significant changes were found with BMD and cardiorespiratory measures during exercise tests. SF 36 showed significant improvement of more than 10% and the Rosenberg Self Esteem score rapidly improved from 36 to 39/40. At the end of the training, the patient reached the objective of the Cybathlon 2016 by covering 750 m in less than 8 minutes, at an average speed of 5.80 km/hr. CONCLUSION/CLINICAL RELEVANCE A person with high and complete level of SCI for more than 20 years can undertake this type of challenge if the prerequisites are met; this training is without danger if the safety precautions are respected; the challenge of participating in a competition had a powerful impact on JP's self-esteem and perceived quality of life.
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Affiliation(s)
- Charles Fattal
- Centre de Rééducation/Réadaptation Fonctionnelle
COS-Divio, Dijon, France,Institut National de Recherche en Informatique et
Automatique, CAMIN Université de Montpellier,
France,Faculdade de Ceilâ ndia, Universidade de
Brasilia, Brazil,Correspondence to: Charles Fattal, MD, PhD, CRF La Chtaigneraie, Rue
Bernard Astruc 95180 Menucourt, France.
| | - Benoit Sijobert
- Institut National de Recherche en Informatique et
Automatique, CAMIN Université de Montpellier,
France
| | - Anne Daubigney
- Centre de Rééducation/Réadaptation Fonctionnelle
COS-Divio, Dijon, France
| | | | - Brigitte Lucas
- Centre de Rééducation/Réadaptation Fonctionnelle
COS-Divio, Dijon, France
| | | | - Christine Azevedo
- Institut National de Recherche en Informatique et
Automatique, CAMIN Université de Montpellier,
France
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Nene AV, Rainha Campos A, Grabljevec K, Lopes A, Skoog B, Burns AS. Clinical Assessment of Spasticity in People With Spinal Cord Damage: Recommendations From the Ability Network, an International Initiative. Arch Phys Med Rehabil 2018; 99:1917-1926. [PMID: 29432722 DOI: 10.1016/j.apmr.2018.01.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 01/09/2018] [Accepted: 01/12/2018] [Indexed: 11/29/2022]
Abstract
A thorough assessment of the extent and severity of spasticity, and its effect on functioning, is central to the effective management of spasticity in persons with spinal cord damage (SCD). These individuals however do not always receive adequate assessment of their spasticity. Inadequate assessment compromises management when the effect of spasticity and/or need for intervention are not fully recognized. Assessment is also central to determining treatment efficacy. A barrier to spasticity assessment has been the lack of consensus on clinical and functional measures suitable for routine clinical practice. To extend on existing work, a working group of the Ability Network identified and consolidated information on possible measures, and then synthesized and formulated findings into practical recommendations for assessing spasticity and its effect on function in persons with SCD. Sixteen clinical and functional measures that have been used for this purpose were identified using a targeted literature review. These were mapped to the relevant domains of the International Classification of Functioning, Disability and Health to assess the breadth of their coverage; coverage of many domains was found to be lacking, suggesting a focus for future work. The advantages, disadvantages, and usefulness of the measures were assessed using a range of criteria, with a focus on usefulness and feasibility in routine clinical practice. Based on this evaluation, a selection of measures suitable for initial and follow-up assessments are recommended. The recommendations are intended to have broad applicability to a variety of health care settings where people with SCD are managed.
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Affiliation(s)
- Anand V Nene
- Roessingh Center for Rehabilitation, Roessingh Research & Development, Enschede, The Netherlands, Canada.
| | | | | | - Arminda Lopes
- Centre of Physical and Rehabilitation Medicine of the South, São Brás de Alportel, Portugal, Canada
| | - Bengt Skoog
- Sahlgrenska University Hospital, Gothenburg, Sweden, Canada
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Zhou R, Alvarado L, Ogilvie R, Chong SL, Shaw O, Mushahwar VK. Non-gait-specific intervention for the rehabilitation of walking after SCI: role of the arms. J Neurophysiol 2018; 119:2194-2211. [PMID: 29364074 DOI: 10.1152/jn.00569.2017] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Arm movements modulate leg activity and improve gait efficiency; however, current rehabilitation interventions focus on improving walking through gait-specific training and do not actively involve the arms. The goal of this project was to assess the effect of a rehabilitation strategy involving simultaneous arm and leg cycling on improving walking after incomplete spinal cord injury (iSCI). We investigated the effect of 1) non-gait-specific training and 2) active arm involvement during training on changes in over ground walking capacity. Participants with iSCI were assigned to simultaneous arm-leg cycling (A&L) or legs only cycling (Leg) training paradigms, and cycling movements were assisted with electrical stimulation. Overground walking speed significantly increased by 0.092 ± 0.022 m/s in the Leg group and 0.27 ± 0.072m/s in the A&L group after training. Whereas the increases in the Leg group were similar to those seen after current locomotor training strategies, increases in the A&L group were significantly larger than those in the Leg group. Walking distance also significantly increased by 32.12 ± 8.74 m in the Leg and 91.58 ± 36.24 m in the A&L group. Muscle strength, sensation, and balance improved in both groups; however, the A&L group had significant improvements in most gait measures and had more regulated joint kinematics and muscle activity after training compared with the Leg group. We conclude that electrical stimulation-assisted cycling training can produce significant improvements in walking after SCI. Furthermore, active arm involvement during training can produce greater improvements in walking performance. This strategy may also be effective in people with other neural disorders or diseases. NEW & NOTEWORTHY This work challenges concepts of task-specific training for the rehabilitation of walking and encourages coordinated training of the arms and legs after spinal cord injury. Cycling of the legs produced significant improvements in walking that were similar in magnitude to those reported with gait-specific training. Moreover, active engagement of the arms simultaneously with the legs generated nearly double the improvements obtained by leg training only. The cervico-lumbar networks are critical for the improvement of walking.
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Affiliation(s)
- Rui Zhou
- Neuroscience & Mental Health Institute, Faculty of Medicine & Dentistry, University of Alberta , Edmonton, Alberta , Canada.,Sensory Motor Adaptive Rehabilitation Technology (SMART) Network, University of Alberta , Edmonton, Alberta , Canada
| | - Laura Alvarado
- Neuroscience & Mental Health Institute, Faculty of Medicine & Dentistry, University of Alberta , Edmonton, Alberta , Canada.,Sensory Motor Adaptive Rehabilitation Technology (SMART) Network, University of Alberta , Edmonton, Alberta , Canada
| | - Robert Ogilvie
- Division of Physical Medicine & Rehabilitation, Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta , Edmonton, Alberta , Canada.,Sensory Motor Adaptive Rehabilitation Technology (SMART) Network, University of Alberta , Edmonton, Alberta , Canada
| | - Su Ling Chong
- Division of Physical Medicine & Rehabilitation, Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta , Edmonton, Alberta , Canada.,Sensory Motor Adaptive Rehabilitation Technology (SMART) Network, University of Alberta , Edmonton, Alberta , Canada
| | - Oriana Shaw
- Division of Physical Medicine & Rehabilitation, Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta , Edmonton, Alberta , Canada.,Sensory Motor Adaptive Rehabilitation Technology (SMART) Network, University of Alberta , Edmonton, Alberta , Canada
| | - Vivian K Mushahwar
- Neuroscience & Mental Health Institute, Faculty of Medicine & Dentistry, University of Alberta , Edmonton, Alberta , Canada.,Division of Physical Medicine & Rehabilitation, Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta , Edmonton, Alberta , Canada.,Sensory Motor Adaptive Rehabilitation Technology (SMART) Network, University of Alberta , Edmonton, Alberta , Canada
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Rabelo M, de Moura Jucá RVB, Lima LAO, Resende-Martins H, Bó APL, Fattal C, Azevedo-Coste C, Fachin-Martins E. Overview of FES-Assisted Cycling Approaches and Their Benefits on Functional Rehabilitation and Muscle Atrophy. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1088:561-583. [DOI: 10.1007/978-981-13-1435-3_26] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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