A Design Method for FES Bone Health Therapy in SCI

Andrews, B.J.; Shippen, James; Armengol, Monica; Gibbons, Robin; Holderbaum, William; Harwin, William

doi:10.4081/ejtm.2016.6419

Cited by 9 publications

(6 citation statements)

References 8 publications

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“…Thus, people with spinal cord injury (SCI) can use an intelligent control device to accomplish certain tasks, such as standing, walking, and cycling. 1 …”

mentioning

confidence: 99%

The Effectiveness of Functional Electrical Stimulation (FES) in On-Off Mode for Enhancing the Cycling Performance of Team Phoenix at 2016 Cybathlon

et al. 2017

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In this study we designed a Functional Electrical Stimulation (FES) trike for a female subject with spinal cord injury to exercise her lower limbs and improve her lower limb muscle condition for attending the 2016 Cybathlon FES bike competition. Our FES pilot was the only female participant, in the FES cycling competition and she rode for Team Phoenix from the Chinese University of Hong Kong. Due to the weakness of muscles in the lower limb of the subject, and due to scoliosis over her thoracolumbar aéra, the mechanical structure of the trike had to be tailor-made to ensure she sat on the bike in a safe and secure position. A six-phase angle-driven stimulation pattern was developed to stimulate quadriceps and hamstrings without gluteus muscles for contraction through four surface electrodes, thereby creating a cycling movement. To improve the cycling endurance and reduce the muscle fatigue, an on-off mode was developed for controlling the stimulation time that allowed the subject to cycle for 20s, then pause while the trike advanced without stimulation for 5s, followed by a subsequent 20 sec stimulation, to continue cycling. The pilot participated in the training procedure including training exercise at home, trike fitting in the trike by modifying the mechanical structure, and conducting the cycling exercise for six months. We observed significant improvements in the pilot’s lower limb condition. The on-off mode enabled our pilot to extend her cycling endurance effectively, from 1 min to 2.5 mins and the distance from 62m to 100m. Over the eight minutes time limit, our team successfully finished 100 m in the Cybathlon FES.

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“…Thus, people with spinal cord injury (SCI) can use an intelligent control device to accomplish certain tasks, such as standing, walking, and cycling. 1 …”

mentioning

confidence: 99%

The Effectiveness of Functional Electrical Stimulation (FES) in On-Off Mode for Enhancing the Cycling Performance of Team Phoenix at 2016 Cybathlon

et al. 2017

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“…The relationships between peak stress, repetition frequency, and total number of loadings per month has yet to be determined in SCI. Furthermore, the 3D distribution of stress due to FES imposed cyclical loading also needs to be considered if an optimum preservation of bone strength is to be achieved .…”

Section: Overview Of the Primary Life Threatening Secondary Conditionmentioning

confidence: 99%

“…Importantly, the volume and intensity of FES rowing training represents a dramatic increase in physical activity above normal ADL, especially in tetraplegia . Recently, we have reported significant force actions during FES rowing, exceeding 1.5 times BW, which have produced widely distributed stresses in the tibia, a bone highly susceptible to fragility fracture following SCI .…”

Section: Overview Of the Primary Life Threatening Secondary Conditionmentioning

confidence: 99%

Development of Functional Electrical Stimulation Rowing: The Rowstim Series

2017

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Potentially, functional electrical stimulation (FES)-assisted exercise may have an important therapeutic role in reducing comorbidities associated with spinal cord injury (SCI). Here, we present an overview of these secondary life-threatening conditions, discuss the rationale behind the development of a hybrid exercise called FES rowing, and describe our experience in developing FES rowing technology. FES rowing and sculling are unique forms of adaptive rowing for those with SCI. The paralyzed leg musculature is activated by multiple channels of electrical pulses delivered via self-adhesive electrodes attached to the skin. The stimulated muscle contractions are synchronized with voluntary rowing movements of the upper limbs. A range of steady-state FES rowing exercise intensities have been demonstrated from 15.2 ± 1.8 mL/kg/min in tetraplegia to 22.9 ±7.1 mL/kg/min in paraplegia. We expect that such high levels may help some to achieve significant reductions in the risks to their health, particularly where a dose-response relationship exists as is the case for cardiovascular disease and Type II diabetes. Furthermore, preliminary results suggest that cyclical forces more than 1.5 times body weight are imposed on the leg long bones which may help to reduce the risk of fragility fractures. We have demonstrated the feasibility of FES rowing on land and water using adapted rowing technology that includes; a fixed stretcher indoor ergometer (adapted Concept 2, Model E), a floating stretcher indoor ergometer (adapted Concept 2 Dynamic), a turbine powered water rowing tank, a custom hydraulic sculling simulator and a single scull (adapted Alden 16). This has involved volunteers with paraplegia and tetraplegia with SCI ranging from C4 to T12 AIS A using at least 4-channels of surface electrical stimulation. FES rowers, with SCI, have competed alongside non-SCI rowers over the Olympic distance of 2000 m at the British Indoor Rowing Championships in 2004, 2005, and 2006 and the World Indoor Rowing Championships in 2006 (CRASH-B's) in Boston, MA, USA. The best 2000 m FES rowing performance to date has been achieved by a 23-year-old male, Tom Aggar T12 AIS A, in 10 min 28 s. Moreover, two of our FES rowers with complete paraplegia have gone on to successfully compete in the Adaptive Rowing arms-only category (AM1x) at the World Rowing Championships and Paralympic Games.

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“…FES-rowing is one exercise intervention that is growing in popularity in SCI rehabilitation 8 . Previous studies reported inconsistent bone responses after training with FES-rowing 9–11 and a wide range of foot reaction forces generated by SCI rowers (0.22 to 0.67 body weight (BW)) 12–14 .…”

Section: Introductionmentioning

confidence: 99%

Effect of Adapted Ergometer Setup and Rowing Speed on Lower Extremity Loading in People with and without Spinal Cord Injury

Troy

2021

Preprint

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Introduction: Functional electrical stimulation assisted rowing (FES rowing) on an adapted ergometer is used in spinal cord injury (SCI) rehabilitation. A primary goal is to mechanically load the lower extremity to prevent disuse osteoporosis. Recent studies reported the small foot reaction force in FES rowing was not sufficient to prevent bone loss. Objective: This study aims to investigate the effect of ergometer setup and rowing speed on lower extremity loading in able-bodied and SCI individuals. Design: Twenty able-bodied novice rowers and one experienced SCI rower rowed on an adapted ergometer with different speeds and setups. Motion capture system and force sensors were used to calculate forces and moments at the knee. Main Outcome Measures: Foot reaction force and knee moment for all participants, and tibiofemoral force of the SCI rower. Results: Peak foot reaction forces of able-bodied rowers ranged from 0.28 to 0.45 body weights (BW), which was less than half the force in normal rowing. A fast rowing speed, forward seat position, and large knee RoM were associated with higher foot force and knee moment during able-bodied rowing. The SCI subject had the greatest foot reaction force (0.40 BW) when rowing with small knee RoM at a rear seat position and the highest tibiofemoral force (2.23 BW) with large knee RoM at a rear seat position. Conclusion: Ergometer setup and speed can double the force generation at the foot during both able-bodied rowing and FES-rowing. Rowing forms (range of motion and speed) that resulted in the greatest foot reaction force were different for able-bodied rowers and SCI rowers, indicating a trade-off between motion and force generation in FES-rowing that warrants further investigation with more SCI rowers. Clinicians and physical therapist should be aware that ergometer setups can be easily adjusted to modify rowing forms and loading patterns of users with SCI.

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A Design Method for FES Bone Health Therapy in SCI

Cited by 9 publications

References 8 publications

The Effectiveness of Functional Electrical Stimulation (FES) in On-Off Mode for Enhancing the Cycling Performance of Team Phoenix at 2016 Cybathlon

The Effectiveness of Functional Electrical Stimulation (FES) in On-Off Mode for Enhancing the Cycling Performance of Team Phoenix at 2016 Cybathlon

Development of Functional Electrical Stimulation Rowing: The Rowstim Series

Effect of Adapted Ergometer Setup and Rowing Speed on Lower Extremity Loading in People with and without Spinal Cord Injury

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