FES-cycling training in Spinal Cord Injured patients

Mazzoleni, Stefano; Stampacchia, G.; Gerini, Adriana; Tombini, T.; Carrozza, Maria Chiara

doi:10.1109/embc.2013.6610755

Cited by 13 publications

(11 citation statements)

References 18 publications

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“…Furthermore, ES appears to be well tolerated and has been studied in regard to its effects on preventing skeletal muscle atrophy as well as improving skeletal muscle volume and function. Although the effects of ES on muscle volume in patients with SCI remains unclear [7][8][9], a recent meta-analysis has suggested that ES of the abdominal muscles is an effective technique for improving respiratory function in such patients [10]. The only other meta-analysis found describes the possible effects of ES on increasing bone mineral density below the level of the injury in patients with chronic SCI [11].…”

Section: Introductionmentioning

confidence: 99%

Effect of electrical stimulation on muscle atrophy and spasticity in patients with spinal cord injury – a systematic review with meta-analysis

et al. 2019

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Study design This work is a systematic review with meta-analysis Objective Evaluate the effect of electrical stimulation (ES) on skeletal muscle volume and spasticity in individuals with spinal cord injury (SCI). Setting University of Brasilia, Brazil Methods Searches were conducted of the Cochrane Library, MEDLINE, CINAHL, PEDro, PsycINFO and EMBASE electronic databases for relevant articles published up to June 2018. No restrictions were imposed regarding the year of publication. The inclusion criteria were randomized controlled trials involving adults with SCI comparing ES to an active or passive control. Two independent reviewers extracted the data from the selected studies and methodological quality was assessed using the PEDro scale. Results The initial search led to the retrieval of 164 studies, seven of which met the eligibility criteria, but only six were included in the meta-analysis. The six studies comprised 104 patients with complete or incomplete SCI. In the two studies that investigated the use of ES on muscle volume of the lower limbs, the overall effect was statistically significant in patients with acute SCI (mean difference: 0.86; 95% CI: 0.04 to 1.69; p < 0.04). Among the four studies that examined the use of ES for spasticity of the lower limb, the overall effect was non-significant (mean difference: 0.55; 95% CI: −0.31 to 1.41; p = 0.21). Conclusions Electrical stimulation was found to be an effective method for increasing muscle volume in SCI patients, but had no effect on spasticity. Further investigation of the effect of ES on spasticity in SCI is needed.

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Section: Introductionmentioning

confidence: 99%

Effect of electrical stimulation on muscle atrophy and spasticity in patients with spinal cord injury – a systematic review with meta-analysis

et al. 2019

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“…Several studies have presented evidence of health and fitness benefits emerging from cycling assisted by functional electrical stimulation (FES Cycling) for subjects with spinal cord injury (SCI) . Among the benefits conferred by current evidences , emphasis has been placed on potential therapeutic effects related to active contraction of paralyzed muscles improving muscular and skeletal metabolism , cardiopulmonary condition , and general improvement of physiological and psychological performance, including partial recovery of leg function in incomplete SCI subjects .…”

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confidence: 99%

Cadence Tracking and Disturbance Rejection in Functional Electrical Stimulation Cycling for Paraplegic Subjects: A Case Study

et al. 2017

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Functional electrical stimulation cycling has been proposed as an assistive technology with numerous health and fitness benefits for people with spinal cord injury, such as improvement in cardiovascular function, increase in muscular mass, and reduction of bone mass loss. However, some limitations, for example, lack of optimal control strategies that would delay fatigue, may still prevent this technology from achieving its full potential. In this work, we performed experiments on a person with complete spinal cord injury using a stationary tadpole trike when both cadence tracking and disturbance rejection were evaluated. In addition, two sets of experiments were conducted 6 months apart and considering activation of different muscles. The results showed that reference tracking is achieved above the cadence of 25 rpm with mean absolute errors between 1.9 and 10% when only quadriceps are activated. The disturbance test revealed that interferences may drop the cadence but do not interrupt a continuous movement if the cadence does not drop below 25 rpm, again when only quadriceps are activated. When other muscle groups were added, strong spasticity caused larger errors on reference tracking, but not when a disturbance was applied. In addition, spasticity caused the last experiments to result in less smooth cycling.

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“…There were 12 studies for qualitative synthesis, such as one RCT study and 11 non-RCT studies. Eight of them were quantitatively analyzed for meta-analysis (Sköld et al, 2002;Krause et al, 2008;Szecsi and Schiller, 2009;Mazzoleni et al, 2013Mazzoleni et al, , 2017Ralston et al, 2013;Kuhn et al, 2014;Yas ˛ar et al, 2015), and four studies were excluded due to reasons, such as case report (n = 1) (Fattal et al, 2018), no MAS result of post-test (n = 2) (Reichenfelser et al, 2012;Popovic-Maneski et al, 2018), and only LEMS data included (n = 1) (Sadowsky et al, 2013). The flowchart is shown as Figure 1.…”

Section: Studies Includedmentioning

confidence: 99%

“…However, Arnold et al (1992) found that FES-cycling training 30 min per session for 3 months improved cardiovascular fitness and thigh girths, but spasticity became intense in the individuals with SCI. Some studies showed no effect of FES-cycling training on spasticity in the patients with SCI (Sköld et al, 2002;Mazzoleni et al, 2013;Ralston et al, 2013). These controversial findings may be due to small sample sizes, heterogeneity of the studied populations, different training protocols, and the different assessment tools used.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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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, R2 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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FES-cycling training in Spinal Cord Injured patients

Cited by 13 publications

References 18 publications

Effect of electrical stimulation on muscle atrophy and spasticity in patients with spinal cord injury – a systematic review with meta-analysis

Effect of electrical stimulation on muscle atrophy and spasticity in patients with spinal cord injury – a systematic review with meta-analysis

Cadence Tracking and Disturbance Rejection in Functional Electrical Stimulation Cycling for Paraplegic Subjects: A Case Study

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

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