Monitoring Muscle Growth and Tissue Changes Induced by Electrical Stimulation of Denervated Degenerated Muscles With CT and Stereolithographic 3D Modeling

Helgason, Þórður; Gargiulo, Paolo; Jóhannesdóttir, Fjóla; Ingvarsson, Páll; Knútsdóttir, Sigrún; Guðmundsdóttir, Vilborg; Yngvason, Stefán

doi:10.1111/j.1525-1594.2005.29073.x

Cited by 37 publications

(27 citation statements)

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“…Other experimental stimulation studies have not shown any improvement of mass or force (Dow et al, 2006). In humans with spinal cord injury, studies using spiral CT have shown promising results from electrical stimulation of denervated muscle (Helgason et al, 2005). There has been a paucity of electrical stimulation studies on humans with peripheral nerve injury (Eberstein and Eberstein, 1996).…”

Section: Surgical Considerationsmentioning

confidence: 99%

Evaluation and management of peripheral nerve injury

Campbell

2008

Clinical Neurophysiology

589

462

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Common etiologies of acute traumatic peripheral nerve injury (TPNI) include penetrating injury, crush, stretch, and ischemia. Management of TPNI requires familiarity with the relevant anatomy, pathology, pathophysiology, and the surgical principles, approaches and concerns. Surgical repair of TPNI is done at varying time intervals after the injury, and there are a number of considerations in deciding whether and when to operate. In neurapraxia, the compound muscle and nerve action potentials on stimulating distal to the lesion are maintained indefinitely; stimulation above the lesion reveals partial or complete conduction block. The picture in axonotmesis and neurotmesis depends on the time since injury. The optimal timing for an electrodiagnostic study depends upon the clinical question being asked. Although conventional teaching usually holds that an electrodiagnostic study should not be done until about 3 weeks after the injury, in fact a great deal of important information can be obtained by studies done in the first week. Proximal nerve injuries are problematic because the long distance makes it difficult to reinnervate distal muscles before irreversible changes occur. Decision making regarding exploration must occur more quickly, and exploration using intraoperative nerve action potential recording to guide the choice of surgical procedure is often useful.

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Section: Surgical Considerationsmentioning

confidence: 99%

Evaluation and management of peripheral nerve injury

Campbell

2008

Clinical Neurophysiology

589

462

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“…It was also widely believed that FES was unsuitable in DDMtraining. Kern, however, not only showed that DDM patients can indeed be trained with FES using surfaceelectrodes, but also that FES training is able to restore the ability of muscles to perform tetanic contractions, that, in fact, are essential to prevent/recover atrophy by loading the muscles [23, 41,42,43]. The crucial indicator for the therapy is, of course, muscle growth.…”

Section: Table 3 Remarkable Clinical Occurrences For Patient 3 Which mentioning

confidence: 99%

3D Modelling and monitoring of denervated muscle under Functional Electrical Stimulation treatment and associated bone structural changes

Gargiulo

2011

Eur J Transl Myol

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A novel clinical rehabilitation method for patients who have permanent and non recoverable muscle denervation in the legs was developed in the frame of the European Project RISE. The technique is based on FES and the project results shows, in these severely disabled patients, restoration of muscle tissue and function. This study propose novel methods based on image processing technique and medical modelling to monitor growth in denervated muscle treated with FES. Geometrical and structural changes in muscle and bone are studied and modelled. Secondary effects on the bone mineral density produced by the stimulation treatment and due the elicited muscle contraction are also investigated. The restoration process in DDM is an important object of discussion since there isn't yet a complete understanding of the mechanisms regulating growth in denervated muscle. This study approaches the problem from a macroscopic point of view, developing 3-dimensional models of the whole stimulated muscles and following changes in volume, geometry and density very accurately. The method is based on the acquisition of high resolution Spiral CT scans from patients who have long-term flaccid paraplegia and the use of special image processing tools allowing tissue discriminations and muscle segmentation. Three patients were measured at different points of time during 4 years of electrical stimulation treatment. In this study is quantitatively demonstrated the influences of FES treatment on the different quadriceps bellies. The rectus femoris muscle is positioned in the middle of the quadriceps and responds (in general) better to stimulation. In a patient with abundant adipose tissue surrounding the quadriceps, rectus femoris almost doubled the volume during the FES treatment while in the other bellies the changes measured were minimal. The analysis of the density shows clearly a restoration of the muscular structure in the growing muscle. The remarkable increase of muscle mass and the improved quality of the muscle tissue was observed and measured on whole muscle volume. The 3-dimensional approach proposed in this work allows the geometrical changes in denervated muscle to be measured. Central lines in rectus femoris are calculated during the treatment and the relative curvature indexes are used to quantify differences between data sets. The result shows a correlation between degeneration status and changes in shape; the differences in curvature between control and denervated muscle diminish with the growth. Furthermore, bone mineral density is measured on the femur to monitor the structural changes induced by the current flow and to evaluate the effect on the patella bone density due to the quadriceps contraction. Though the evidences aren't yet statistically relevant a kind of structural change in the femur is measured as secondary effect from the muscle stimulation. Beside, the force applied on the patella through the elicited contraction seems also to have a beneficial effect on bone density. Indeed the mineral loss in the pa...

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“…The rectus femoris muscle was segmented and a three dimensional (3D) computer model constructed. This was then used to track the tissue changes as therapy progressed [2,3]. After the project period the patient have not been stimulating or only very sporadically.…”

Section: Introductionmentioning

confidence: 99%

“…A SCI at the level of Th12 and L1 often result in a complete flaccid paralysis of the muscle of the thigh. To stop the degeneration or even built up volume and force of the muscles they can be treated with electrical stimulation [1,2]. Since there is no lower motor neuron the muscle fibres have to be stimulated directly demanding electrical pulses of two order of magnitude higher energy as those for nerve stimulation [1].…”

Section: Introductionmentioning

confidence: 99%

“…The increase in volume and shape changes can be seen in Fig 1. The third, P3, was not compliant due to decubitus ulcers and other complications. During the treatment time subjects were monitored in a neurological, functional way and with spiral CT imaging [2,3,4]. The spiral CT gives a complete description of the tissue in the thigh in terms of volume, tissue density and shape of the muscles.…”

Section: Introductionmentioning

confidence: 99%

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