Strength and endurance adaptations to functional electrical stimulation leg cycle ergometry in spinal cord injury

Abstract

OBJECTIVES: To describe adaptations in power output, quadriceps muscle strength, and fatigability that occur during a 13-week regimen of Functional Electrical Stimulation Leg Cycle Ergometry (FES-LCE) in Spinal Cord Injury (SCI). To identify differences in outcomes between individuals with complete and incomplete motor impairment. DESIGN: Observational and longitudinal. SETTING: Rehabilitation and biomechanics research laboratory. PARTICIPANTS: Eleven (N = 11) individuals with SCI and no previous FES-LCE experience. INTERVENTION: 40 sessions of FES-LCE at a rate of three sessions per week. Continuous exercise was performed at a pedal cadence of 45 RPM against a constant resistance for up to 60 minutes. OUTCOME MEASURES: Mean power output was recorded for each session. Before and after the training regimen, each subject performed a fatigue test in which electrically stimulated knee extension torque and Fatigue Index were measured. RESULTS: Participants demonstrated significant increases in mean power output (9.0 to 20.3 W; p < 0.001), peak isometric knee extension torque (3.8 to 16.9 Nm; p = 0.006) and sustainable isometric knee extension torque (4.9 to 14.4 Nm; p = 0.001) after FES-LCE training (95% confidence intervals). Participants with incomplete motor impairment demonstrated a decrease in Fatigue Index (p = 0.021), and improved mean power output more than those with complete motor impairment (p = 0.037). CONCLUSIONS: Significant improvements in muscle conditioning and exercise performance are possible following the 13-week regimen of FES-LCE described in this article. Individuals with incomplete motor impairment experience greater improvements in mean power output than individuals with complete motor impairment.

Effect of tendon vibration during wide-pulse neuromuscular electrical stimulation (NMES) on muscle force production in people with spinal cord injury (SCI)

“…However, muscle strength training poses an increased challenge for people with a neurological condition, such as people with SCI. Alternatively, neuromuscular electrical stimulation (NMES) is a commonly used intervention in rehabilitation programs to increase muscle recruitment and thus muscle force production, especially in individuals with a complete loss of motor function [ 10 – 12 ]. NMES has been conventionally used in clinical practice as functional electrical stimulation (FES), i.e.…”

“…NMES has been conventionally used in clinical practice as functional electrical stimulation (FES), i.e. a prolonged and low levels of evoked force NMES exercise paired simultaneously or intermittently with a functional task [ 12 ]. However, such interventions cannot optimally stimulate muscular strength and mass improvements, imposing a higher load to the muscle to obtain higher force output [ 13 , 14 ] in accordance with the overload training principle [ 15 ], to obtain musculoskeletal changes in paralysed muscles.…”

Administration of chlorogenic acid alleviates spinal cord injury via TLR4/NF‑κB and p38 signaling pathway anti‑inflammatory activity

“…There is a high incidence rate of SCI in China. As a serious nervous system injury, the majority of SCI cases result in paralysis, pain and burden to patients and their families (3). Therefore, therapeutic intervention to aid treatment of these symptoms is of primary concern (4).…”

“…There are two primary mechanisms involved in the development of SCI, including primary mechanical injury and sequential injury. The latter was proposed in 1911 and has been accepted and acts as a foundation to current research investigations (3). The self-destruction fracture degree of sequential organization involves multiple factors and exceeds even that of primary injury mechanism (5).…”

Effect of tendon vibration during wide-pulse neuromuscular electrical stimulation (NMES) on the decline and recovery of muscle force

“…a continuous, prolonged stimulation at low-to-moderate frequencies (30–50 Hz) paired simultaneously or intermittently with a functional task (e.g. cycling) [ 8 ]. FES exercise has been shown to slow muscle weakening or even increase muscle strength as well as reduce the rate of skeletal muscle atrophy and weakness and improve physical health in people with a SCI [ 9 – 12 ].…”