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BACKGROUND: Secretion removal is a key issue in patients with respiratory diseases, and is known to be most effective at vibration frequencies of ϳ13 Hz and with the greatest amplitudes possible. The Acapella devices and the water bottle are used for secretion removal in daily clinical practice but without detailed knowledge on optimal settings. The aim of this study was to evaluate the 3 different Acapella devices and the water bottle at various settings and flows to determine the optimal devices and settings for effective secretion removal. METHODS: Three different Acapella devices were tested at flows of 6, 12, 20, 30, 40, and 50 L/min, and at all 5 settings. The water bottle was filled with 5, 10, or 15 cm of water, and tested at flows of 3, 6, 10, 12, and 20 L/min. For all devices and combinations of settings, we measured the frequency and amplitude of the vibrations, as well as the required pressure to generate vibrations. RESULTS: Setting 4 was the best for all 3 Acapella devices, and the filling height of the water bottle should be 5 cm. At these settings, all devices elicited vibration frequencies between 12 and 15 Hz, which is theoretically optimal for secretion mobilization. The resistance pressures of the devices to elicit these vibrations were between 5 and 11 cm H 2 O. However, the Acapella devices elicit higher vibration amplitudes (5-8 cm H 2 O) than the water bottle (1.8 cm H 2 O) CONCLUSIONS: Setting 4 was optimal for all 3 Acapella devices. The Acapella devices may be more efficient for secretion mobilization than the water bottle, because they elicit greater amplitude of vibrations.

Assessments covering neurological functioning, mobility, and self-care are used in clinical practice during first rehabilitation of patients with SCI, while others covering autonomic functioning, pain, participation, or quality of life are still missing. Based on these observations and national and international requirements, a meaningful standard for an assessment toolkit, applicable in general and in specific subgroups, needs to be defined and implemented.

Surface ES may serve as a diagnostic tool to detect an UMN or LMN lesion of the key actuator muscles affecting the tenodesis grasp. These findings provide information that is essential for the choice of treatment to optimise function of the tetraplegic hand.

Functional electrical stimulation (FES) provides a good possibility to activate paralysed muscles and it has been shown to elicit substantial physiological and health benefits. For successful application of FES, a perfect symbiosis of the bike and the pilot has to be achieved. The road to the Cybathlon 2016 describes the different pieces needed for FES cycling in spinal cord injury. The systematic optimisation of the stimulation parameters and the Cybatrike, and sophisticated training contributed to the team’s success as the fastest surface-electrode team in the competition.

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Nerve transfers (neurotizations) performed under optimal conditions can restore some voluntary control in muscles of the upper extremities in patients with tetraplegia. However, the type of motoneuron lesions in target muscles for nerve transfers influences the functional outcome. Using standardized maps of motor point topography, surface electrical stimulation reliably defines the kind and extent of motoneuron lesion in the selected muscles. In a muscle with an intact lower motor motoneuron, nerve transfers can often successfully reinnervate the chosen key muscle. Conversely, in a lower motoneuron lesion, the nerve transfer outcome is less predictable. However, direct muscle stimulation appears to ameliorate the morphological precondition, a finding which necessitates new preoperative approaches to optimize reinnervation in denervated/partially denervated muscles. Therefore, understanding the impact of electrical stimulation in diagnostics, prognostics and treatments of upper limbs in tetraplegia is critical for neurotization procedures.

Background Damage to lower motor neuron causes denervation and degeneration of the muscles affected. Experimental and clinical studies of muscle denervation in lower extremities demonstrated that direct electrical stimulation (ES) of muscle can prevent denervation atrophy and restore contractility. The aim of this study was to identify possible myogenic effect of ES on denervated forearm and hand muscles in persons with spinal cord injury (SCI) and tetraplegia. Methods This prospective interventional study with repeated measurement design included 22 patients aged 48·6 (± 15·7), 0·25 (0·1/46) years after spinal cord lesion, AIS A-D. In each patient, two electrophysiologically-confirmed denervated muscles in the hand and forearm were analyzed – one extrinsic (Extensor Carpi Ulnaris - ECU) and one intrinsic (1st Dorsal Interosseus - IOD1). Muscles were stimulated for 33 min, five times per week over a 12-weeks period. Using ultrasonography (USG), muscle thickness (MT) and pennation angle (PA) of these muscles were determined at start and end of the stimulation period. Findings MT of IOD1 increased from 6·3 mm (± 3·2 mm) to 9·2 mm (± 2·4 mm) ( p = 0·004) and the PA from 5·5° (± 3·0°) to 11° (± 2·2°) ( p = 0·001). The corresponding values for the ECU were 5·5 mm (± 2·5 mm) to 7·0 mm (± 2·2 mm) ( p = 0·039) and 5·5° (± 3·4°) to 9·4° (± 3·8°) ( p = 0·005), respectively. The correlation of MT between baseline and completion was r = 0·58 ( p = 0·037) for the ECU and r = 0·63 ( p = 0·008) for the IOD1. Interpretation 12 weeks of direct muscle stimulation increases the MT and PA of the denervated intrinsic and extrinsic hand muscles studied. Funding Swiss Paraplegic Centre, Switzerland