Relationships of oxygen uptake, heart rate, and ratings of perceived exertion in persons with paraplegia during functional neuromuscular stimulation assisted ambulation

Pl, Jacobs; Kj, Klose; Guest, Rosalind S.; Needham-Shropshire, Belinda M.; Jg, Broton; Ba, Green

doi:10.1038/sj.sc.3100435

Cited by 35 publications

(24 citation statements)

References 25 publications

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“…This value is lower than the value obtained by Brissot et al and Jacobs et al during FES assisted gait, 34,35 probably due to an increased blood pressure during Parastep ambulation. Unfortunately, we could not measure blood pressure during Parastep gait, as in our experimental protocol such procedure would have been carried out only with an invasive approach, because of the high level of the isometric contraction in upper limbs.…”

Section: Discussioncontrasting

confidence: 63%

Energy consumption of locomotion with orthosis versus Parastep-assisted gait: a single case study

et al. 2003

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Study design: Single case study. Objectives: To evaluate the energy expenditure during ambulation with the Advanced Reciprocating Gait Orthosis (ARGO), with and without functional electrical stimulation (FES), and with the Parastep system in a single subject, in order to avoid the e ect of intersubject variability. Setting: The Centre of Sport Medicine and Bioengineering Centre`Don C Gnocchi' Foundation ONLUS IRCCS, Milano, Italy. Methods: A single patient (lesion level T 5 ± T 6 ) was trained speci®cally for each walking system and was evaluated after each training period. The e ects of FES on muscle conditioning, spasticity and bone density were also evaluated. The HR/ VO 2 relationship and the energy cost of locomotion were measured during wheelchair (WHCH) use, during locomotion with ARGO (with and without FES) and Parastep system at di erent speeds. Results: The following was observed at the end of the whole training: (a) circumferences of both lower limbs and quadriceps forces were increased, whereas fatigue index was slightly decreased, spasticity and bone density were unchanged; (b) compared to WHCH locomotion, the slope of HR/ VO 2 curves with ARGO was higher (slope di erence=51.1 b 1O 2 71 ), with ARGO+FES was similar (slope di erence=75.3 b 1O 2 71 ) and with Parastep was smaller (slope di erence=755.6 b 1O 2 71 ); (c) HR increased linearly with all locomotion systems, but did not rise above 125 bpm with Parastep; (d) the cost of locomotion was higher with Parastep than with ARGO (with and without FES), tested at each velocity; (e) Parastep appears to be easier to use for the subject. Conclusions: (a) FES can improve ambulation with orthosis, but the cost of locomotion remains very high; (b) the Parastep assisted gait elicits a higher energy expenditure than other orthoses, probably due to the lower speed of locomotion and to the high isometric e ort of the stimulated muscles. Sponsorship: This work has been partially supported by the Italian Minister of Public Health (Ricerca Finalizzata IRCCS no ICS030.7/RF97.25).

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Section: Discussioncontrasting

confidence: 63%

Energy consumption of locomotion with orthosis versus Parastep-assisted gait: a single case study

et al. 2003

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“…3,4 In order to improve the physiological and psychological well-being of such patients, they are encouraged to resume their ability to stand or walk in some way. 5 Physiologically, standing and walking can prevent joint contractures, improve urinary and bowel function, reduce spasticity, and decrease the incidence of pressure sores. 6 Likewise, patients can generally improve psychologically.…”

Section: Introductionmentioning

confidence: 99%

The Physiological Cost Index of Walking with an Isocentric Reciprocating Gait Orthosis Among Patients with T12–L1 Spinal Cord Injury

Leung

Wong²,

Wong

et al. 2009

Prosthetics &Amp; Orthotics International

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Objective: The objective of this study was to compare the Physiological Cost Index of walking with a reciprocating gait orthosis to that of walking with bilateral knee-ankle-foot orthoses (KAFOs) by subjects with paraplegia resulting from T 12 -L 1 spinal cord lesions. Methodology: Six chronic paraplegic subjects who had T 12 -L 1 spinal cord lesions and who previously wore bilateral KAFOs were recruited. Each subject was fitted with an isocentric reciprocating gait orthosis (IRGO) and received a standardized training program. Subjects were then asked to walk using the two orthotic devices along a 40 m rectangular pathway at a speed that was comfortable for them. The walking speed was measured using a stop watch, and a Polar Heart Rate Monitor was used to measure the heart rate of the subjects. The Physiological Cost Index (PCI) was calculated for comparison. Results: Ambulation using the IRGO (10.46 þ/7 2.00 m/min) was significantly faster (p ¼ 0.009) than ambulation using the bilateral KAFOs (5.51 þ/7 4.30 m/min). The PCI demonstrated when walking with the IRGO (2.85 þ/7 0.77 beats/m) was significantly lower (p ¼ 0.0306) than that of the bilateral KAFOs (6.77 þ/7 3.28 beats/m). Conclusion: Paraplegic patients with T 12 -L 1 spinal cord lesions walk faster and more efficiently using the isocentric reciprocating gait orthosis as compared to using the bilateral KAFOs.

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“…The use of ES has been traditionally employed for muscle strengthening, maintenance of muscle mass and strength, and restoring neuromuscular functions after stroke or spinal cord injury (28). ES can also cause cardiorespiratory activation (4,7,20,44). Furthermore, there is substantial evidence concerning the effects of ES on metabolic responses and fuel utilization in skeletal muscle (12,19,26,27,44).…”

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confidence: 99%

Enhancement of whole body glucose uptake during and after human skeletal muscle low-frequency electrical stimulation

Hamada

Sasaki

Hayashi

et al. 2003

Journal of Applied Physiology

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. Enhancement of whole body glucose uptake during and after human skeletal muscle low-frequency electrical stimulation. J Appl Physiol 94: 2107-2112, 2003. First published January 31, 2003 10.1152/japplphysiol.00486.2002There is considerable evidence to suggest that electrical stimulation (ES) activates glucose uptake in rodent skeletal muscle. It is, however, unknown whether ES can lead to similar metabolic enhancement in humans. We employed low-frequency ES through surface electrodes placed over motor points of quadriceps femoris muscles. In male subjects lying in the supine position, the highest oxygen uptake was obtained by a stimulation pattern with 0.2-ms biphasic square pulses at 20 Hz and a 1-s on-off duty cycle. Oxygen uptake was increased by approximately twofold throughout the 20-min stimulation period and returned to baseline immediately after stimulation. Concurrent elevation of the respiratory exchange ratio and blood lactate concentration indicated anaerobic glycogen breakdown and utilization during ES. Whole body glucose uptake determined by the glucose disposal rate during euglycemic clamp was acutely increased by 2.5 mg ⅐ kg Ϫ1 ⅐ min Ϫ1 in response to ES and, moreover, remained elevated by 3-4 mg ⅐ kg Ϫ1 ⅐ min Ϫ1 for at least 90 min after cessation of stimulation. Thus the stimulatory effect of ES on whole body glucose uptake persisted not only during, but also after, stimulation. Low-frequency ES may become a useful therapeutic approach to activate energy and glucose metabolism in humans. glucose transport; euglycemic clamp; exercise; insulin sensitivity; oxygen uptake PHYSICAL EXERCISE HAS PROFOUND effects on energy and fuel metabolism in contracting skeletal muscle. It is well established that exercise can directly activate glucose uptake in skeletal muscle by inducing translocation of GLUT-4 glucose transporters to the cell surface via an insulin-independent mechanism (contraction-stimulated glucose transport) (10,11,31,37,49). This phenomenon is considered responsible for the acute effect of exercise on glucose transport, with the majority of glucose being taken up by contracting skeletal muscle. In fact, contraction-stimulated GLUT-4 translocation is not impaired in insulin-resistant conditions such as Type 2 diabetes and obesity (25). Furthermore, the period after exercise is also characterized by a substantial increase in insulin sensitivity that leads to insulin-dependent GLUT-4 translocation and glucose transport as a local phenomenon restricted to exercised muscles (9, 13, 39, 40, 48a). Thus these insulin-independent and -dependent mechanisms of exercise have been widely utilized to prevent individuals from developing glucose intolerance and to improve glycemic control in patients with Type 2 diabetes.Clinically, electrical stimulation (ES) of muscle is useful as a modality of assisting muscle contraction for those who have difficulties in performing voluntary exercise. The use of ES has been traditionally employed for muscle strengthening, maintenance of muscle mass and strength, a...

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Relationships of oxygen uptake, heart rate, and ratings of perceived exertion in persons with paraplegia during functional neuromuscular stimulation assisted ambulation

Cited by 35 publications

References 25 publications

Energy consumption of locomotion with orthosis versus Parastep-assisted gait: a single case study

Energy consumption of locomotion with orthosis versus Parastep-assisted gait: a single case study

The Physiological Cost Index of Walking with an Isocentric Reciprocating Gait Orthosis Among Patients with T12–L1 Spinal Cord Injury

Enhancement of whole body glucose uptake during and after human skeletal muscle low-frequency electrical stimulation

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