The appropriate selection of individual-specific spinal cord epidural stimulation (scES) parameters is crucial to re-enable independent standing with self-assistance for balance in individuals with chronic, motor complete spinal cord injury, which is a key achievement toward the recovery of functional mobility. To date, there are no available algorithms that contribute to the selection of scES parameters for facilitating standing in this population. Here, we introduce a novel framework for EMG data processing that implements spectral analysis by continuous wavelet transform and machine learning methods for characterizing epidural stimulation-promoted EMG activity resulting in independent standing. Analysis of standing data collected from eleven motor complete research participants revealed that independent standing was promoted by EMG activity characterized by lower median frequency, lower variability of median frequency, lower variability of activation pattern, lower variability of instantaneous maximum power, and higher total power. Additionally, the high classification accuracy of assisted and independent standing allowed the development of a prediction algorithm that can provide feedback on the effectiveness of muscle-specific activation for standing promoted by the tested scES parameters. This framework can support researchers and clinicians during the process of selection of epidural stimulation parameters for standing motor rehabilitation.
It has been suggested that neuroplasticity-promoting neuromodulation can restore sensory-motor pathways after spinal cord injury (SCI), reactivating the dormant locomotor neuronal circuitry. We introduce a neuro-rehabilitative approach that leverages locomotor training with multi-segmental spinal cord transcutaneous electrical stimulation (scTS). We hypothesized that scTS neuromodulates spinal networks, complementing the neuroplastic effects of locomotor training, result in a functional progression toward recovery of locomotion. We conducted a case-study to test this approach on a 27-year-old male classified as AIS A with chronic SCI. The training regimen included task-driven non-weight-bearing training (1 month) followed by weight-bearing training (2 months). Training was paired with multi-level continuous and phase-dependent scTS targeting function-specific motor pools. Results suggest a convergence of cross-lesional networks, improving kinematics during voluntary non-weight-bearing locomotor-like stepping. After weight-bearing training, coordination during stepping improved, suggesting an important role of afferent feedback in further improvement of voluntary control and reorganization of the sensory-motor brain-spinal connectome.
The purpose of the present study was to investigate changes in the energy cost of locomotion during walking (Cw) related to the changes in body mass (BM, kg) and body composition in adolescents with obesity. Twenty-six (12 boys and 14 girls) obese adolescents (mean: BMI, 33.6±3.7 kg/m2; 42.7±4.5 % fat mass) followed a 9-month multidisciplinary inpatient weight-reduction program consisting of lifestyle education, moderate energy restriction, and regular physical activity in a specialized institution. At baseline (M0), by the end of the 9-month program (M9) and after 4-months follow-up (M13), V’O2 and V’CO2 of standardized activity program were assessed by whole-body indirect calorimetry over 24 hours, and body composition was assessed by DXA. At M9, adolescents showed a 18% reduction in BM (p<0.001), 40% in total FM; while FFM (kg) remained stable in boys but decreased by ~6% in girls (p=0.001). Similarly, the mean Cw decreased by 20% (p<0.001). At M13, BM, FM and Cw were slightly higher compared than at M9. In conclusion, moderate energy restriction and regular moderate physical activities improved walking economy, improved exercise tolerance and induced beneficial changes in body composition of adolescents with obesity.
Novelty bullets
• Reduction of FM in the trunk region, and consequently reducing the work carried out by respiratory muscles, contribute to reduce Cw in adolescents with obesity.
• A lower cost of walking can be effective in improving exercise tolerance and quality of life in obese adolescents.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.