Development of Functional Electrical Stimulation Rowing: The Rowstim Series

Abstract

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.

Timing and Modulation of Activity in the Lower Limb Muscles During Indoor Rowing: What Are the Key Muscles to Target in FES-Rowing Protocols?

“…FES rowing is a cyclical activity that can be manually controlled, typically using a thumb operated switch mounted on the rowing machine handle or boat oar [1,3,36]. Automatic control is also possible, without any manual switch, using fuzzy logic control-however, users prefer to have a switch command input as this appears less 'robotic' [37,38]. We are motivated to determine if EMG analysis might lead to the design of improved controllers that use muscle synergies seen in able bodied rowing.…”

Towards the Development of Full Motion FES Rowing with Accurate Ergometry: RowStim IV

“…Indoor rowing competitions use an estimate of the distance rowed to determine the award of gold, silver or bronze medals. In the C2 performance monitor distance rowed is based on a measurement of mechanical power using an assumption expressed in equation (1). The exact methods used by C2 are proprietary, however, Van Holst [5] suggests a plausible derivation of this relationship based on the physics of ergometer rowing.…”

“…ES Rowing involves electrical activation of the paralyzed legs of individuals with spinal cord injury. In its present form, based on an adapted Concept2 (C2) air damper ergometer, this was developed at the University of Alberta in the early 1990s, [1]. The RowStim series has been developed to improve both cardiovascular and bone health for individuals with spinal cord injury in one physical exercise.…”

“…The RowStim series has been developed to improve both cardiovascular and bone health for individuals with spinal cord injury in one physical exercise. Variants have also been developed both for international indoor rowing competitions (BIRCs and CRASH-Bs) and for on-water demonstrations [1].…”

Functional Electrical Stimulation

“…The clinical applications presented in this issue cover various contexts: post‐stroke hemiplegic upper limb therapy (Malesevic et al , Irimia et al ), complete spinal cord injuries (SCI) assisted cycling (Fonseca et al , Tefertiller and Gerber , Andrews et al ), obesity treatment (Lonys et al ), Parkinson's disease (PD) gait assistance (Sijobert et al ), and cerebral palsy (CP) gait assistance (Rose et al ).…”