Method to Reduce Muscle Fatigue During Transcutaneous Neuromuscular Electrical Stimulation in Major Knee and Ankle Muscle Groups

BackgroundNeuromuscular electrical stimulation (NMES) can facilitate the recovery of quadriceps muscle strength after total knee arthroplasty (TKA), yet the optimal intensity (dosage) of NMES and its effect on strength after TKA have yet to be determined.ObjectiveThe primary objective of this study was to determine whether the intensity of NMES application was related to the recovery of quadriceps muscle strength early after TKA. A secondary objective was to quantify quadriceps muscle fatigue and activation immediately after NMES to guide decisions about the timing of NMES during rehabilitation sessions.DesignThis study was an observational experimental investigation.MethodsData were collected from 30 people who were 50 to 85 years of age and who received NMES after TKA. These people participated in a randomized controlled trial in which they received either standard rehabilitation or standard rehabilitation plus NMES to the quadriceps muscle to mitigate strength loss. For the NMES intervention group, NMES was applied 2 times per day at the maximal tolerable intensity for 15 contractions beginning 48 hours after surgery over the first 6 weeks after TKA. Neuromuscular electrical stimulation training intensity and quadriceps muscle strength and activation were assessed before surgery and 3.5 and 6.5 weeks after TKA.ResultsAt 3.5 weeks, there was a significant association between NMES training intensity and a change in quadriceps muscle strength (R2=.68) and activation (R2=.22). At 6.5 weeks, NMES training intensity was related to a change in strength (R2=.25) but not to a change in activation (R2=.00). Furthermore, quadriceps muscle fatigue occurred during NMES sessions at 3.5 and 6.5 weeks, whereas quadriceps muscle activation did not change.LimitationsSome participants reached the maximal stimulator output during at least 1 treatment session and might have tolerated more stimulation.ConclusionsHigher NMES training intensities were associated with greater quadriceps muscle strength and activation after TKA.

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Muscle Fatigue During Neuromuscular Electrical Stimulation is Dependent on Training: A Basis for Microgravity Musculoskeletal Countermeasure Design

ASCEND 2020 ◽

10.2514/6.2020-4010 ◽

2020 ◽

Author(s):

Thomas J. Abitante ◽

Seward B. Rutkove ◽

Kevin R. Duda ◽

Dava J. Newman

Keyword(s):

Electrical Stimulation ◽

Muscle Fatigue ◽

Neuromuscular Electrical Stimulation

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Preventing Ischial Pressure Ulcers: III. Clinical Pilot Study of Chronic Neuromuscular Electrical Stimulation

Applied Bionics and Biomechanics ◽

10.1155/2011/536583 ◽

2011 ◽

Vol 8 (3-4) ◽

pp. 345-359 ◽

Cited By ~ 3

Author(s):

Hilton M. Kaplan ◽

Lucinda L. Baker ◽

Salah Rubayi ◽

Gerald E. Loeb

Keyword(s):

Electrical Stimulation ◽

Soft Tissue ◽

Pressure Ulcers ◽

Neuromuscular Electrical Stimulation ◽

Gluteus Maximus ◽

Clinical Results ◽

Trophic Factors ◽

Wound Complications ◽

Maximum Pressure ◽

Muscle Groups

Objective:BIONs™ (BIOnic Neurons) are injectable, wireless microstimulators that make chronic BION Active Seating (BAS) possible for pressure ulcer prevention (PUP). Neuromuscular electrical stimulation (NMES) produces skeletal motion and activates trophic factors, counteracting three major etiological mechanisms leading to pressure ulcers (PUs): immobility, soft-tissue atrophy, and ischemia. Companion papers I and II reviewed prior experience with NMES for PUP, and analyzed the biomechanical considerations, respectively. This paper presents a treatment strategy derived from this analysis, and the clinical results of the first three cases.Methods:Two BIONs implanted (one on inferior gluteal nerve to gluteus maximus (GM), and other on sciatic nerve to hamstrings (HS)), in 3 spinal cord injured (SCI) subjects already undergoing gluteal rotation flaps for PUs. BAS using HS when seated, and BION Conditioning (BC) via GM+HS when non-weightbearing. Follow-up: 1 yr, including 6 mo. treatment window (interface pressure mapping; muscle perfusion scans; MRI, X-ray volume assessments).Results:Successfully implanted and activated both desired muscle groups, selectively, in all. No PU recurrences or wound complications. Two subjects completed protocol. Mean results: Interface: contact pressure −10%; maximum pressure −20%; peak pressure area −15%. Vascularity: GM +20%, HS +110%. Perfusion: GM +70%, HS +440%. Muscle volume: GM +14%, HS +31%. Buttock soft-tissue padding: +49%. 1 BION failed; 1 BION rotated under GM.Conclusions:Promising proof-of-concept data supporting the feasibility of implanted microstimulators to achieve sufficiently strong and selective activation of target muscles for PUP. Ultimate goal is prophylactic deployment through bilateral, nonsurgical injection of BIONs in chronically immobile patients.

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Wide-pulse-high-frequency neuromuscular stimulation of triceps surae induces greater muscle fatigue compared with conventional stimulation

Journal of Applied Physiology ◽

10.1152/japplphysiol.01015.2013 ◽

2014 ◽

Vol 116 (10) ◽

pp. 1281-1289 ◽

Cited By ~ 23

Author(s):

Daria Neyroud ◽

David Dodd ◽

Julien Gondin ◽

Nicola A. Maffiuletti ◽

Bengt Kayser ◽

...

Keyword(s):

Electrical Stimulation ◽

Muscle Fatigue ◽

Motor Unit ◽

High Frequency ◽

Neuromuscular Electrical Stimulation ◽

Triceps Surae ◽

Voluntary Activation ◽

Activation Level ◽

Paired Stimulation ◽

Voluntary Activation Level

We compared the extent and origin of muscle fatigue induced by short-pulse-low-frequency [conventional (CONV)] and wide-pulse-high-frequency (WPHF) neuromuscular electrical stimulation. We expected CONV contractions to mainly originate from depolarization of axonal terminal branches (spatially determined muscle fiber recruitment) and WPHF contractions to be partly produced via a central pathway (motor unit recruitment according to size principle). Greater neuromuscular fatigue was, therefore, expected following CONV compared with WPHF. Fourteen healthy subjects underwent 20 WPHF (1 ms-100 Hz) and CONV (50 μs-25 Hz) evoked isometric triceps surae contractions (work/rest periods 20:40 s) at an initial target of 10% of maximal voluntary contraction (MVC) force. Force-time integral of the 20 evoked contractions (FTI) was used as main index of muscle fatigue; MVC force loss was also quantified. Central and peripheral fatigue were assessed by voluntary activation level and paired stimulation amplitudes, respectively. FTI in WPHF was significantly lower than in CONV (21,717 ± 11,541 vs. 37,958 ± 9,898 N·s P<0,001). The reductions in MVC force (WPHF: −7.0 ± 2.7%; CONV: −6.2 ± 2.5%; P < 0.01) and paired stimulation amplitude (WPHF: −8.0 ± 4.0%; CONV: −7.4 ± 6.1%; P < 0.001) were similar between conditions, whereas no change was observed for voluntary activation level ( P > 0.05). Overall, our results showed a different motor unit recruitment pattern between the two neuromuscular electrical stimulation modalities with a lower FTI indicating greater muscle fatigue for WPHF, possibly limiting the presumed benefits for rehabilitation programs.

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Effect of neuromuscular electrical stimulation intensity over the tibial nerve trunk on triceps surae muscle fatigue

European Journal of Applied Physiology ◽

10.1007/s00421-013-2780-y ◽

2013 ◽

Vol 114 (2) ◽

pp. 317-329 ◽

Cited By ~ 4

Author(s):

Aude-Clémence M. Doix ◽

Boris Matkowski ◽

Alain Martin ◽

Karin Roeleveld ◽

Serge S. Colson

Keyword(s):

Electrical Stimulation ◽

Muscle Fatigue ◽

Tibial Nerve ◽

Neuromuscular Electrical Stimulation ◽

Nerve Trunk ◽

Triceps Surae ◽

Stimulation Intensity ◽

Triceps Surae Muscle

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Differential contractile response of critically ill patients to neuromuscular electrical stimulation

Critical Care ◽

10.1186/s13054-019-2540-4 ◽

2019 ◽

Vol 23 (1) ◽

Cited By ~ 6

Author(s):

Julius J. Grunow ◽

Moritz Goll ◽

Niklas M. Carbon ◽

Max E. Liebl ◽

Steffen Weber-Carstens ◽

...

Keyword(s):

Electrical Stimulation ◽

Muscle Strength ◽

Critically Ill ◽

Sofa Score ◽

Critically Ill Patients ◽

Contractile Response ◽

Neuromuscular Electrical Stimulation ◽

Electrical Current ◽

Icu Discharge ◽

Muscle Groups

Abstract Background Neuromuscular electrical stimulation (NMES) has been investigated as a preventative measure for intensive care unit-acquired weakness. Trial results remain contradictory and therefore inconclusive. As it has been shown that NMES does not necessarily lead to a contractile response, our aim was to characterise the response of critically ill patients to NMES and investigate potential outcome benefits of an adequate contractile response. Methods This is a sub-analysis of a randomised controlled trial investigating early muscle activating measures together with protocol-based physiotherapy in patients with a SOFA score ≥ 9 within the first 72 h after admission. Included patients received protocol-based physiotherapy twice daily for 20 min and NMES once daily for 20 min, bilaterally on eight muscle groups. Electrical current was increased up to 70 mA or until a contraction was detected visually or on palpation. Muscle strength was measured by a blinded assessor at the first adequate awakening and ICU discharge. Results One thousand eight hundred twenty-four neuromuscular electrical stimulations in 21 patients starting on day 3.0 (2.0/6.0) after ICU admission were included in this sub-analysis. Contractile response decreased from 64.4% on day 1 to 25.0% on day 7 with a significantly lower response rate in the lower extremities and proximal muscle groups. The electrical current required to elicit a contraction did not change over time (day 1, 50.2 [31.3/58.8] mA; day 7, 45.3 [38.0/57.5] mA). The electrical current necessary for a contractile response was higher in the lower extremities. At the first awakening, patients presented with significant weakness (3.2 [2.5/3.8] MRC score). When dividing the cohort into responders and non-responders (> 50% vs. ≤ 50% contractile response), we observed a significantly higher SOFA score in non-responders. The electrical current necessary for a muscle contraction in responders was significantly lower (38.0 [32.8/42.9] vs. 54.7 [51.3/56.0] mA, p < 0.001). Muscle strength showed higher values in the upper extremities of responders at ICU discharge (4.4 [4.1/4.6] vs. 3.3 [2.8/3.8] MRC score, p = 0.036). Conclusion Patients show a differential contractile response to NMES, which appears to be dependent on the severity of illness and also relevant for potential outcome benefits. Trial registration ISRCTN ISRCTN19392591, registered 17 February 2011

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