Fatigue of Paralyzed and Control Thenar Muscles Induced by Variable or Constant Frequency Stimulation

2003 ◽  
Vol 89 (4) ◽  
pp. 2055-2064 ◽  
Author(s):  
Christine K. Thomas ◽  
Lisa Griffin ◽  
Sharlene Godfrey ◽  
Edith Ribot-Ciscar ◽  
Jane E. Butler
Keyword(s):  
Spinal Cord ◽  
High Frequency ◽  
Low Frequency ◽  
Constant Frequency ◽  
Time Integral ◽  
Frequency Stimulation ◽  
Force Time ◽  
And Control ◽  
Frequency Pulse ◽  
Force Time Integral

Muscles paralyzed by chronic (>1 yr) spinal cord injury fatigue readily. Our aim was to evaluate whether the fatigability of paralyzed thenar muscles ( n = 10) could be reduced by the repeated delivery of variable versus constant frequency pulse trains. Fatigue was induced in four ways. Intermittent supramaximal median nerve stimulation (300-ms-duration trains) was delivered at 1) constant high frequency (13 pulses at 40 Hz each second for 2 min); 2) variable high frequency (each second for 2 min). The first two intervals of each variable frequency train were 5 and 20 ms. The remaining pulses were evenly distributed in time across 275 ms. The number of pulses varied for each subject such that the force time integral in the unfatigued state matched that evoked by a constant 40-Hz train; 3) constant low frequency (7 pulses at 20 Hz each second for 4 min); and 4) variable low frequency (each second for 4 min). The pulse pattern was the same as that for variable high frequency except that the force-time integral was matched to that produced by the constant low-frequency stimulation. These same experiments were performed on the thenar muscles of five able-bodied control subjects. The variable high-frequency trains used to fatigue paralyzed and control muscles had an average (± SE) of 12 ± 2 and 10 ± 1 pulses, respectively. Variable low-frequency trains had 7 ± 1 and 6 ± 1 pulses, respectively. Significant mean force declines of comparable magnitude (to 20–25% initial fatigue force or to 13–21% initial 50 Hz force) were seen in paralyzed muscles with all four stimulation protocols. The force reductions in paralyzed muscles were always accompanied by significant increases in half-relaxation time and decreases in force-time integral, irrespective of the stimulation protocol. Significant force decreases also occurred in control muscles during each fatigue test. Again, these force declines were similar whether constant or variable pulse patterns were used at high or low frequencies (to 40–60% initial fatigue force or to 29–36% initial 50 Hz force). The force reductions in control muscles were significantly less than those seen in paralyzed muscles, except when constant high-frequency stimulation was used. The variations in stimulation frequency, pulse pattern, and pulse number used in this study therefore had little influence on thenar muscle fatigue in control subjects or in spinal cord–injured subjects with chronic paralysis.

scholarly journals Stimulation Pattern That Maximizes Force in Paralyzed and Control Whole Thenar Muscles

2002 ◽  
Vol 87 (5) ◽  
pp. 2271-2278 ◽  
Author(s):  
Lisa Griffin ◽  
Sharlene Godfrey ◽  
Christine K. Thomas
Keyword(s):  
Short Interval ◽  
Motor Units ◽  
Muscle Stiffness ◽  
Peak Force ◽  
Single Motor Units ◽  
Time Integral ◽  
Cord Injury ◽  
Force Time ◽  
And Control ◽  
Force Time Integral

The pattern of seven pulses that elicited maximal thenar force was determined for control muscles and those that have been paralyzed chronically by spinal cord injury. For each subject group ( n = 6), the peak force evoked by two pulses occurred at a short interval (5–15 ms; a “doublet”), but higher mean relative forces were achieved in paralyzed versus control muscles (41.4 ± 3.9% vs. 22.7 ± 2.0% maximal). Thereafter, longer intervals evoked peak force in each type of muscle (mean: 35 ± 1 ms, 36 ± 2 ms, respectively). With seven pulses, paralyzed and control muscles reached 76.4 ± 5.6% and 57.0 ± 2.6% maximal force, respectively. These force differences resulted from significantly greater doublet/twitch and doublet/tetanic force ratios in paralyzed (2.73 ± 0.08, 0.35 ± 0.03) compared with control muscles (2.07 ± 0.07, 0.25 ± 0.01). The greater force enhancement produced in paralyzed muscles with two closely spaced pulses may relate to changes in muscle stiffness and calcium metabolism. Peak force-time integrals were also achieved with an initial short interpulse interval, followed by longer intervals. The postdoublet intervals that produced peak force-time integrals in paralyzed and control muscles were longer than those for peak force, however (77 ± 3 ms, 95 ± 4 ms, respectively). These data show that the pulse patterns that maximize force and force-time integral in paralyzed muscles are similar to those that maximize these parameters in single motor units and various whole muscles across species. Thus the changes in neuromuscular properties that occur with chronic paralysis do not strongly influence the pulse pattern that optimizes muscle force or force-time integral.

scholarly journals Stim Salvage: Case Series Reporting on the Effectiveness of Spinal Cord Stimulation Salvage

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Patrick Paullus ◽  
Erika A Petersen
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Stimulation ◽  
High Frequency ◽  
New Technologies ◽  
Case Series ◽  
Low Frequency ◽  
Low Frequency Stimulation ◽  
Trial Outcomes ◽  
Frequency Stimulation ◽  
New System

Abstract INTRODUCTION Spinal cord stimulation (SCS) has been successfully used to treat chronic pain with improved levels of pain, decreased use of narcotic medications, and increased level of function. Nevertheless, for patients SCS benefit wares over time and maximal reprogramming may not achieve improvement. However, advancing technologies, such as burst and high-frequency modulation, offer stimulation which differs from the traditional low-frequency stimulation. For those with SCS already placed, these new technologies offer a possible avenue with which to salvage SCS loss of efficacy. In patients with the an ineffective system, a salvage trial with a new system can be performed. In these cases, their current generators are externalized and then, utilizing their current epidural array, the leads are connected to a new trial system. These patients return to the OR in about 1 wk time for either permanent implantation or removal of the remainder of their old system. The results of these salvage trials are presented. METHODS We reviewed serially treated patients with previously placed SCS who were taken to the operating room for a salvage trial. All patient had their SCS leads externalized and connected to a different system. Changes in VAS, functional status, the trial outcomes led to permanent placement were collected retrospectively. RESULTS Results of 15 patient who underwent SCS externalization trial between 2016 and 2019 are summarized. Trial failure rate, salvage SCS response rate, changes in VAS, and patient satisfaction with the new system are reviewed. Successful salvage was accomplished in 93%. CONCLUSION New stimulation paradigms such as burst and high frequency offer a new avenue of effective treatment for those with an ineffective SCS systems. When a patient's device is unable to deliver these paradigms, an IPG-externalization trial may be a low risk option for salvaging therapy.

scholarly journals Human-In-The-Loop Optimization of A Wearable Robot Using Foot Pressure Sensors

2021 ◽  
Author(s):  
Micheal Jacobson ◽  
Prakyath Kantharaju ◽  
Hyeongkeun Jeong ◽  
Xingyuan Zhou ◽  
Jae-Kwan Ryu ◽  
...  
Keyword(s):  
Cost Function ◽  
Metabolic Cost ◽  
Wearable Robot ◽  
Foot Pressure ◽  
Physical Effort ◽  
Foot Force ◽  
Time Integral ◽  
Force Time ◽  
And Control ◽  
Force Time Integral

Abstract Background: Individuals with below-knee amputation (BKA) experience increased physical effort when walking, and the use of a robotic ankle-foot prosthesis (AFP) can reduce such effort. Our prior study on a robotic AFP showed that walking effort could be reduced if the robot is personalized to the wearer. The personalization is accomplished using human-in-the-loop (HIL) optimization, in which the cost function is based on a real-time physiological signal indicating physical effort. The conventional physiological measurement, however, requires a long estimation time, hampering real-time optimization due to the limited experimental time budget. In addition, the physiological sensor, based on respiration uses a mask with rigid elements that may be difficult for the wearer to use. Prior studies suggest that a symmetry measure using a less intrusive sensor, namely foot pressure, could serve as a metric of gait performance. This study hypothesized that a function of foot pressure, the symmetric foot force-time integral, could be used as a cost function to rapidly estimate the physical effort of walking; therefore, it can be used to personalize assistance provided by a robotic ankle in a HIL optimization scheme. Methods: We developed a new cost function derived from a well-known clinical measure, the symmetry index, by hypothesizing that foot force-time integral (FFTI) symmetry would be highly correlated with metabolic cost. We conducted experiments on human participants (N = 8) with simulated amputation to test the new cost function. The study consisted of a discrete trial day, an HIL optimization training day, and an HIL optimization data collection day. We used the discrete trial day to evaluate the correlation between metabolic cost and a cost function using symmetric FFTI percentage. During walking, we varied the prosthetic ankle stiffness while measuring foot pressure and metabolic rate. On the second and third days, HIL optimization was used to find the optimal stiffness parameter with the new cost function using symmetric FFTI percentage. Once the optimal stiffness parameter was found, we validated the performance with comparison to a weight-based stiffness and control-off conditions. We measured symmetric FFTI percentage during the stance phase, prosthesis push-off work, metabolic cost, and user comfort in each condition. We expected the optimized prosthetic ankle stiffness based on the newly developed cost function could reduce the energy expenditure during walking for the individuals with simulated amputation. Results: We found that the cost function using symmetric foot force-time integral percentage presents a reasonable correlation with measured metabolic cost (Pearson’s R > 0.62). When we employed the new cost function in HIL ankle-foot prosthesis parameter optimization, 8 individuals with simulated amputation reduced their cost of walking by 15.9% (p = 0.01) and 16.1% (p = 0.02) compared to the weight-based and control-off conditions, respectively. The symmetric FFTI percentage for the optimal condition tended to be closer to the ideal symmetry value (50%) compared to weight-based (p = 0.23) and control-off conditions (p = 0.04). Conclusion: This study suggests that foot force-time integral symmetry using foot pressure sensors can be used as a cost function when optimizing a wearable robot parameter.

A Case Report of Successful High-Frequency 10-kHz Spinal Cord Stimulator Trial in a Patient with Refractory Thoracic Postherpetic Neuralgia

2021 ◽  
pp. 55-58
Author(s):  
Sai P. Alla
Keyword(s):  
Spinal Cord ◽  
Case Report ◽  
Postherpetic Neuralgia ◽  
High Frequency ◽  
Low Frequency ◽  
Spinal Cord Stimulator ◽  
Effective Treatment Modality ◽  
Patient Reported ◽  
Frequency Stimulation ◽  
Key Words Postherpetic Neuralgia

Background: Spinal cord stimulation can be an effective treatment modality in patients suffering from postherpetic neuralgia who have failed first-line pharmacotherapy and continue to struggle from debilitating pain. Appropriate patient selection and having a wide array of stimulation waveforms can enhance the success of spinal cord stimulator trials. Case Report: In this article, we present a case report of a patient suffering from refractory thoracic postherpetic neuralgia who underwent a successful high-frequency 10-kHz spinal cord stimulator trial. Lead tips were successfully placed at the midline and left paramedial side of the top of T1 vertebral bodies at the source of the pain. The patient was followed up in our clinic 7 days post procedure. At the time of follow-up, our patient reported an 85% to 90% reduction in his pain symptom scores and a significant improvement in his quality of life. Conclusion: Similar successful trials for postherpetic neuralgia have been reported in small studies using traditional low-frequency stimulation waveforms. However, to our knowledge, this is the first report of a successful spinal cord stimulator trial using high-density 10 kHz. Key words: Postherpetic neuralgia, high-frequency spinal cord stimulator, acute herpes zoster

scholarly journals MONOSYNAPTIC REFLEX RESPONSE OF INDIVIDUAL MOTONEURONS AS A FUNCTION OF FREQUENCY

1957 ◽  
Vol 40 (3) ◽  
pp. 435-450 ◽  
Author(s):  
David P. C. Lloyd
Keyword(s):  
High Frequency ◽  
Temporal Summation ◽  
Low Frequency ◽  
Stimulation Frequency ◽  
Monosynaptic Reflex ◽  
Reflex Response ◽  
High Frequency Stimulation ◽  
Low Frequency Stimulation ◽  
Frequency Stimulation ◽  
Frequency Of Stimulation

An assemblage of individual motoneurons constituting a synthetic motoneuron pool has been studied from the standpoint of relating monosynaptic reflex responses to frequency of afferent stimulation. Intensity of low frequency depression is not a simple function of transmitter potentiality. As frequency of stimulation increases from 3 per minute to 10 per second, low frequency depression increases in magnitude. Between 10 and approximately 60 per second low frequency depression apparently diminishes and subnormality becomes a factor in causing depression. At frequencies above 60 per second temporal summation occurs, but subnormality limits the degree of response attainable by summation. At low stimulation frequencies rhythm is determined by stimulation frequency. Interruptions of rhythmic firing depend solely upon temporal fluctuation of excitability. At high frequency of stimulation rhythm is determined by subnormality rather than inherent rhythmicity, and excitability fluctuation leads to instability of response rhythm. In short, whatever the stimulation frequency, random excitability fluctuation is the factor disrupting rhythmic response. Monosynaptic reflex response latency is stable during high frequency stimulation as it is in low frequency stimulation provided a significant extrinsic source of random bombardment is not present. In the presence of powerful random bombardment discharge may become random with respect to monosynaptic afferent excitation provided the latter is feeble. When this occurs it does so equally at low frequency and high frequency. Thus temporal summation is not a necessary factor. There is, then, no remaining evidence to suggest that the agency for temporal summation in the monosynaptic system becomes a transmitting agency in its own right.

Effects of activation frequency and force on low-frequency fatigue in human skeletal muscle

1999 ◽  
Vol 86 (4) ◽  
pp. 1337-1346 ◽  
Author(s):  
Stuart A. Binder-Macleod ◽  
David W. Russ
Keyword(s):  
Healthy Subjects ◽  
Human Skeletal Muscle ◽  
Low Frequency ◽  
Variable Frequency ◽  
Activation Pattern ◽  
Constant Frequency ◽  
Mean Frequency ◽  
Before And After ◽  
Low Frequency Fatigue ◽  
Force Time

No comparison of the amount of low-frequency fatigue (LFF) produced by different activation frequencies exists, although frequencies ranging from 10 to 100 Hz have been used to induce LFF. The quadriceps femoris of 11 healthy subjects were tested in 5 separate sessions. In each session, the force-generating ability of the muscle was tested before and after fatigue and at 2, ∼13, and ∼38 min of recovery. Brief (6-pulse), constant-frequency trains of 9.1, 14.3, 33.3, and 100 Hz and a 6-pulse, variable-frequency train with a mean frequency of 14.3 Hz were delivered at 1 train/s to induce fatigue. Immediately postfatigue, there was a significant effect of fatiguing protocol frequency. Muscles exhibited greater LFF after stimulation with the 9.1-, 14.3-, and variable-frequency trains. These three trains also produced the greatest mean force-time integrals during the fatigue test. At 2, ∼13, and ∼38 min of recovery, however, the LFF produced was independent of the fatiguing protocol frequency. The findings are consistent with theories suggesting two independent mechanisms behind LFF and may help identify the optimal activation pattern when functional electrical stimulation is used.

scholarly journals Force-time integral decreases with ejection despite constant oxygen consumption and pressure-volume area in dog left ventricle.

1987 ◽  
Vol 60 (6) ◽  
pp. 797-803 ◽  
Author(s):  
H Suga ◽  
Y Goto ◽  
T Nozawa ◽  
Y Yasumura ◽  
S Futaki ◽  
...  
Keyword(s):  
Oxygen Consumption ◽  
Left Ventricle ◽  
Time Integral ◽  
Force Time ◽  
Force Time Integral

Rate-dependent shortening of action potential duration increases ventricular vulnerability in failing rabbit heart

2011 ◽  
Vol 300 (2) ◽  
pp. H565-H573 ◽  
Author(s):  
Masahide Harada ◽  
Yukiomi Tsuji ◽  
Yuko S. Ishiguro ◽  
Hiroki Takanari ◽  
Yusuke Okuno ◽  
...  
Keyword(s):  
Action Potential ◽  
High Frequency ◽  
Rabbit Heart ◽  
Left Ventricular ◽  
High Frequency Stimulation ◽  
Electrophysiological Properties ◽  
Rate Dependent ◽  
Frequency Stimulation ◽  
And Control

Congestive heart failure (CHF) predisposes to ventricular fibrillation (VF) in association with electrical remodeling of the ventricle. However, much remains unknown about the rate-dependent electrophysiological properties in a failing heart. Action potential properties in the left ventricular subepicardial muscles during dynamic pacing were examined with optical mapping in pacing-induced CHF ( n = 18) and control ( n = 17) rabbit hearts perfused in vitro. Action potential durations (APDs) in CHF were significantly longer than those observed for controls at basic cycle lengths (BCLs) >1,000 ms but significantly shorter at BCLs <400 ms. Spatial APD dispersions were significantly increased in CHF versus control (by 17–81%), and conduction velocity was significantly decreased in CHF (by 6–20%). In both groups, high-frequency stimulation (BCLs <150 ms) always caused spatial APD alternans; spatially concordant alternans and spatially discordant alternans (SDA) were induced at 60% and 40% in control, respectively, whereas 18% and 82% in CHF. SDA in CHF caused wavebreaks followed by reentrant excitations, giving rise to VF. Incidence of ventricular tachycardia/VFs elicited by high-frequency dynamic pacing (BCLs <150 ms) was significantly higher in CHF versus control (93% vs. 20%). In CHF, left ventricular subepicardial muscles show significant APD shortenings at short BCLs favoring reentry formations following wavebreaks in association with SDA. High-frequency excitation itself may increase the vulnerability to VF in CHF.

The Effect of Muscle Lentgh on Force-Time Integral in Relation to Energy-Rich Phosphate Consumption

1985 ◽  
pp. 605-610 ◽  
Author(s):  
A. De Haan ◽  
J. E. Van Doorn ◽  
P. A. Huijing ◽  
R. D. Woittiez ◽  
H. G. Westra
Keyword(s):  
Time Integral ◽  
Force Time ◽  
Force Time Integral
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