Functional Electrical Stimulation Cycling Research Articles

The Clinical Management of Electrical Stimulation Therapies in the Rehabilitation of Individuals with Spinal Cord Injuries.

Background: People with spinal cord injuries (SCIs) often have trouble remaining active because of paralysis. In the past, exercise recommendations focused on the non-paralyzed muscles in the arms, which provides limited benefits. However, recent studies show that electrical stimulation can help engage the paralyzed extremities, expanding the available muscle mass for exercise. Methods: The authors provide an evidence-based approach using expertise from diverse fields, supplemented by evidence from key studies toward the management of electrical stimulation therapies in individuals with SCIs. Literature searches were performed separately using the PubMed, Medline, and Google Scholar search engines. The keywords used for the searches included functional electrical stimulation cycling, hybrid cycling, neuromuscular electrical stimulation exercise, spinal cord injury, cardiovascular health, metabolic health, muscle strength, muscle mass, bone mass, upper limb treatment, diagnostic and prognostic use of functional electrical stimulation, tetraplegic hands, and hand deformities after SCI. The authors recently presented this information in a workshop at a major rehabilitation conference. Additional information beyond what was presented at the workshop was added for the writing of this paper. Results: Functional electrical stimulation (FES) cycling can improve aerobic fitness and reduce the risk of cardiovascular and metabolic diseases. The evidence indicates that while both FES leg cycling and neuromuscular electrical stimulation (NMES) resistance training can increase muscle strength and mass, NMES resistance training has been shown to be more effective for producing muscle hypertrophy in individual muscle groups. The response to the electrical stimulation of muscles can also help in the diagnosis and prognosis of hand dysfunction after tetraplegia. Conclusions: Electrical stimulation activities are safe and effective methods for exercise and testing for motor neuron lesions in individuals with SCIs and other paralytic or paretic conditions. They should be considered part of a comprehensive rehabilitation program in diagnosing, prognosing, and treating individuals with SCIs to improve function, physical activity, and overall health.

Exercise Responses During Outdoor Versus Virtual Reality Indoor Arm+FES-Leg Cycling in Individuals with Spinal Cord Injury.

Background: Virtual reality (VR)-enhanced indoor hybrid cycling in people with spinal cord injury (SCI) can be comparable to outdoor hybrid cycling. Method: Eight individuals with chronic thoracic-lesion SCI performed voluntary arm and electrically assisted leg cycling on a hybrid recumbent tricycle. Exercises were conducted outdoors and indoors incorporating VR technology in which the outdoor environment was simulated on a large flat screen monitor. Electrical stimulation was applied bilaterally to the leg muscle groups. Oxygen uptake (VO2), heart rate, energy expenditures, and Ratings of Perceived Exertion were measured over a 30-minute outdoor test course that was also VR-simulated indoors. Immediately after each exercise, participants completed questionnaires to document their perceptual-psychological responses. Results: Mean 30-minute VO2 was higher for indoor VR exercise (average VO2-indoor VR-exercise: 1316 ± mL/min vs. outdoor cycling: 1255 ± 53 mL/min; highest VO2-indoor VR-exercise: 1615 ± 67 mL/min vs. outdoor cycling: 1725 ± 67 mL/min). Arm and leg activity counts were significantly higher during indoor VR-assisted hybrid functional electrical stimulation (FES) cycling than outdoors; 42% greater for the arms and 23% higher for the legs (P < 0.05). Similar responses were reported for exercise effort and perceptual-psychological outcomes during both modes. Conclusion: This study proposes that combining FES and VR technology provides new opportunities for physical activity promotion or exercise rehabilitation in the SCI population, since these modes have similar "dose-potency" and self-perceived effort. Human Research Ethics Committee of the University of Sydney Ref. No. 01-2010/12385.

FUNCTIONAL ELECTRICAL STIMULATION COMBINED WITH VOLUNTARY CYCLING ACCENTUATES VO2 RESPONSE IN PEOPLE WITH ADVANCED MULTIPLE SCLEROSIS: A PILOT STUDY

INTRODUCTION &amp; AIMS Lower limb muscle weakness and reduced balance due to disease progression in multiple sclerosis (MS) may make robust aerobic exercise difficult. Functional electrical stimulation (FES) cycling combined with voluntary cycling may allow people with advanced MS to enhance the intensity of aerobic exercise. The aim of this study was to investigate the cardiorespiratory, power, and participant perceptions during acute bouts of FES cycling, voluntary cycling, and FES cycling combined with voluntary cycling (FES assist cycling). METHODS Participants with advanced MS (Expanded Disability Status Scale [EDSS] ≥ 6.0) undertook three exercise trials on a leg cycle ergometer. Trial 1: 30 minutes of FES cycling; Trial 2: two 10-minute bouts of voluntary cycling separated by 10 minutes rest; and Trial 3: a combination of trials 1 and 2 (FES assist cycling). Outcome measures included VO2, cycle power output, heart rate, exertion, and post-exercise perceptions of fatigue. RESULTS Ten people with advanced MS participated (9 female; age 52.4±9.98 y; EDSS 7.1±0.6). Average VO2 during the 30-minute trials was significantly higher for FES assist cycling compared to voluntary cycling (429.7 ± 111.0 vs 388.5 ± 101.0 mL/min, 95% CI 23.4 to 113.0 mL/min, p=0.01), with a large effect size (Hedges’ g=1.04). Participants reported similar perceptions of exertion at the end of each trial (p=0.14). There was no difference in self-reported fatigue at the end of each trial (p=0.21). CONCLUSION This study found FES assist cycling produced significantly higher VO2 values than voluntary cycling, although the clinical significance of these differences is unknown. Participants performed FES assist cycling at a self-reported levels of exertion consistent with moderate to vigorous intensity, however it was considered light-intensity exercise when expressed by METS. FES assist cycling was no more fatiguing post-exercise than the other modes.

THE EFFECTS OF HYBRID FUNCTIONAL ELECTRICAL STIMULATION INTERVAL TRAINING ON AEROBIC FITNESS AND FATIGUE IN PEOPLE WITH ADVANCED MULTIPLE SCLEROSIS

INTRODUCTION &amp; AIMS Improving aerobic fitness in people with multiple sclerosis (MS) can reduce fatigue, and lower the risk of cardiovascular disease. Aerobic training can be challenging due to paresis, access to suitable equipment and fatigue. The aim was to investigate whether functional electrical stimulation (FES) cycling combined with arm crank interval exercise (hybrid FES interval training) is feasible for people with advanced MS, and its effects on aerobic fitness and fatigue. METHODS Hybrid FES interval training was performed 2 d/wk for 12 weeks. Each session consisted of 40 minutes of continuous FES cycling with arm crank intervals of 30 seconds work/30 seconds rest added concurrently for 20 minutes. The intensity target was a minimum of 60% of arm crank power and ‘hard’ measured by rate of perceived exertion (RPE) on a scale of 6-20. Feasibility was measured by attendance, compliance to intensity and time targets, adverse events, and drop outs. Aerobic fitness was assessed by an arm crank maximal test. Fatigue was measured via the Modified Fatigue Impact Scale (MFIS). RESULTS Seven participants (6 female; age 57.1±7.8y; Expanded Disability Status Scale 7.1±0.8) with advanced MS attended 80±10.4% of the scheduled sessions and there were no adverse events or drop outs. Average RPE at the end of each training session was 15±2, representing vigorous intensity exercise. Aerobic fitness did not change pre- to post-intervention [14.2±5.7 to 14.78±6.0 mL/kg/min (p=0.43)]. There was a trend towards a reduction in the MFIS score pre- to post-intervention [31.0±10.4 to 21.7±11.4 (p=0.10)]. CONCLUSION Hybrid FES interval training is feasible for people with advanced MS who need exercise equipment appropriate for their condition, and can represent vigorous intensity exercise. The positive findings support the need for future randomized control trials that can assess the aerobic fitness changes and associated health benefits of hybrid FES interval training.

Improving walking in multiple sclerosis with FES cycling and dalfampridine: a case report

Improving walking in multiple sclerosis with FES cycling and dalfampridine: a case report

Development of a functional electrical stimulation cycling toolkit for spinal cord injury rehabilitation in acute care hospitals: a participatory action approach

Development of a functional electrical stimulation cycling toolkit for spinal cord injury rehabilitation in acute care hospitals: a participatory action approach

Functional electrical stimulation combined with voluntary cycling accentuates VO2 response in people with severe multiple sclerosis: A pilot study

BackgroundLower limb muscle weakness and reduced balance due to disease progression in multiple sclerosis (MS) may make robust aerobic exercise difficult. Functional electrical stimulation (FES) cycling combined with voluntary cycling may allow people with severe MS to enhance the intensity of aerobic exercise. The aim of this study was to investigate the cardiorespiratory, power, and participant-reported perceptions during acute bouts of FES cycling, voluntary cycling, and FES cycling combined with voluntary cycling (FES assist cycling). MethodsParticipants with severe MS (Expanded Disability Status Scale [EDSS] ≥ 6.0) undertook three exercise trials on a leg cycle ergometer. Trial 1 involved 30 min of FES cycling; Trial 2 involved two 10-minute bouts of voluntary cycling separated by 10 min rest; and Trial 3 was a combination of trials 1 and 2 (FES assist cycling). Outcome measures included VO2 (volume of oxygen consumption), cycle power output, heart rate, RPE, and post-exercise perceptions of pain and fatigue. ResultsTen people with severe MS participated (9 female; age 52.4 ± 9.98 y; EDSS 7.1 ± 0.6). The average VO2 during the 30-minute trials was significantly higher for FES assist cycling compared to voluntary cycling (429.7 ± 111.0 vs 388.5 ± 101.0 mL/min, 95% CI 23.4 to 113.0 mL/min, p = 0.01), with a large effect size (Hedges' g = 1.04). Participants reported similar rates of perceived exertion at the end of FES cycling (13 ± 2), voluntary cycling (14 ± 2), and FES assist cycling (15 ± 1); p = 0.14. Self-reported pain was higher during both FES cycling (5.4 vs 0.3; 95% CI 3.4 to 6.7, p = 0.01, Hedges’ g = 2.07) and FES assist cycling (4.2 vs. 0.3; 95% CI 2.3 to 5.5, p = 0.01, Hedges’ g = 1.71) than voluntary cycling, both with large effect sizes. There was no difference in self-reported fatigue at the end of each trial (p = 0.21). ConclusionThis study found FES assist cycling produced significantly higher VO2 values than voluntary cycling, although the clinical significance of these differences is unknown. Participants performed FES assist cycling at a self-reported RPE consistent with moderate to vigorous intensity, however it was considered light-intensity exercise when expressed by METS. FES assist cycling was no more fatiguing post-exercise than the other modes.

Effects of releasing ankle joint during electrically evoked cycling in persons with motor complete spinal cord injury.

Literature has shown that simulated power production during conventional functional electrical stimulation (FES) cycling was improved by 14% by releasing the ankle joint from a fixed ankle setup and with the stimulation of the tibialis anterior and triceps surae. This study aims to investigate the effect of releasing the ankle joint on the pedal power production during FES cycling in persons with spinal cord injury (SCI). Seven persons with motor complete SCI participated in this study. All participants performed 1min of fixed-ankle and 1min of free-ankle FES cycling with two stimulation modes. In mode 1 participants performed FES-evoked cycling with the stimulation of quadriceps and hamstring muscles only (QH stimulation), while Mode 2 had stimulation of quadriceps, hamstring, tibialis anterior, and triceps surae muscles (QHT stimulation). The order of each trial was randomized in each participant. Free-ankle FES cycling offered greater ankle plantar- and dorsiflexion movement at specific slices of 20° crank angle intervals compared to fixed-ankle. There were significant differences in the mean and peak normalized pedal power outputs (POs) [F(1,500) = 14.03, p < 0.01 and F(1,500) = 7.111, p = 0.008, respectively] between fixed- and free-ankle QH stimulation, and fixed- and free-ankle QHT stimulation. Fixed-ankle QHT stimulation elevated the peak normalized pedal PO by 14.5% more than free-ankle QH stimulation. Releasing the ankle joint while providing no stimulation to the triceps surae and tibialis anterior reduces power output. The findings of this study suggest that QHT stimulation is necessary during free-ankle FES cycling to maintain power production as fixed-ankle.

Closed-loop Functional Electrical Stimulation (FES) – cycling rehabilitation with phase control Fuzzy Logic for fatigue reduction control strategies for stroke patients

Functional Electrical Stimulation (FES) cycling, or FES-Cycling, holds great therapeutic potential for individuals with paralysis, such as those with Spinal Cord Injury (SCI), traumatic brain injury, or stroke, aiming to restore mobility. However, the nonlinear nature of the musculoskeletal system poses a significant challenge in controlling FES-Cycling. To address this, an integrated closed-loop phase angle fuzzy-based system was developed. This system offers real-time control by adjusting stimulation intensity (pulse width) within the range of 50 to 200μs while maintaining a constant frequency of 35Hz, thereby ensuring precise pedaling trajectory and cadence patterns. An experimental study involved three healthy individuals (Cases A, B, and C) and one individual with hemiplegia stroke (Case D). Results showed that the proposed system consistently reduced average angle trajectory errors for Cases A, B, and C, with values of 2.6945, 3.2958, and 2.9922 degrees, respectively. Case D, affected by hemiplegia stroke, faced greater challenges and exhibited a higher error of 3.4562 degrees. Fatigue resistance, evaluated through fatigue indices, showed promising results for Cases A, B, and C with values of 0.10778, 0.06866, and 0.04603, respectively. However, Case D experienced higher fatigue (0.2304) due to the unique challenges of hemiplegia stroke. These findings highlight the effectiveness of the proposed control system in optimizing FES-Cycling, particularly for healthy individuals. For individuals with paralysis, like Case D, further research is needed to adapt the system to their specific conditions and cycling patterns. This system holds the potential for enhancing FES-Cycling as a therapeutic strategy and warrants additional investigation and customization for different patient populations.

Effectiveness of functional electrical stimulation machine in managing neurological diseases - A retrospective study.

Cerebrovascular Accident (CVA) or stroke, Spinal Cord injury can lead to neurological diseases resulting in major loss in motor function causing hemiplegia or tetraplegia. In 2019, according to The Global Burden of Diseases (GBD) CVA/Stroke is the second leading cause of death and the third leading cause of death and disability combined, globally. Its prevalence vary drastically among South Asian countries. The objective of this study was to determine the effectiveness of Functional Electrical Stimulation (FES) machine on neurologically impaired patients at the Physical Therapy department at IHHN, Karachi, Pakistan. In this retrospective study data was extracted from August 2016 to February 2022 on patients with neurological symptoms i.e. hemiplegia or paraplegia with muscle power of two or less on Manual Muscle Testing (MMT). The parameters for evaluating patients progress pre and post treatment were MMT results and their mobility status. The number of sessions ranged between 40 to 100 sessions of Functional Electrical Stimulation (FES) provided on alternate days according to the patient's need. Data of 51 patients who had completed their treatment were extracted and analyzed. The mean age of patients who completed treatment was 49.62 ± 17.26 years. Out of 51(100%), 30 (58.8%) were male and 21 (41.2%) were female. Pre- and post-treatment median (IQR) showed remarkable improvement in MMT of upper limb muscle (from 1.0 to 4.0) and lower limb muscle (from 2.0 to 4.0). FES cycling is an effective treatment for patients with neurological impairments, as it resulted in improvement in both upper and lower limb muscle strength, along with mobility status.

Seasonal iron fluxes and iron cycling in sandy bioirrigated sediments

Permeable sediments, which represent more than 50% of the continental shelves, have been largely neglected as a potential source of Fe in current global estimates of benthic dissolved iron (Fed) fluxes. There are open questions regarding the effects of a range of factors on Fed fluxes from these deposits, including seasonal dynamics and the role of bioirrigation. To address these gaps, we performed laboratory-based sediment incubation experiments with muddy sands during summer (21 °C) and winter (7 °C). We used bioirrigation mimics to inject overlying water into the permeable sediment with patterns resembling the bioirrigation activity of the prolific bioturbating polychaete, Clymenella torquata. Newly developed in-line Fe accumulators were used to estimate Fe fluxes with a recirculating set-up. We found high Fed fluxes from sandy sediments, especially in benthic chambers with simulated bioirrigation. In the winter fluxes reached &amp;gt;200 µmol Fed m-2 d-1 at the onset of irrigation and then decreased over the course of a 13-day experiment while in the summer fluxes from irrigated sediments reached &amp;gt;100 µmol Fed m-2 d-1 and remained high throughout a 7-day experiment. Despite different geochemical expressions of Fe-S cycling and resulting porewater Fed concentrations in winter and summer, large Fed fluxes were sustained during both seasons. Solid-phase and porewater concentration profiles showed that maximum concentrations of key constituents, including total solid-phase reactive Fe, and porewater Fed and ammonium, were located closer to the sediment water interface (SWI) in irrigated cores than in non-irrigated cores due to the upward advective transport of dissolved porewater constituents. This upward transport also facilitated Fed fluxes out of the sediments, especially during times of active pumping. Our study demonstrates the potential for large Fed fluxes from sandy sediments in both summer and winter, despite relatively low standing stocks of labile organic matter and porewater Fed. The primary driver of these high fluxes was advective porewater transport, in our study induced by the activity of infaunal organisms. These results suggest that permeable sediments, which dominate shelf regions, must be explicitly considered in global estimates of benthic Fed fluxes, and cannot be simply extrapolated from estimates based on muddy sediments.

Inflammation and altered metabolism impede efficacy of functional electrical stimulation in critically ill patients

BackgroundCritically ill patients suffer from acute muscle wasting, which is associated with significant physical functional impairment. We describe data from nested muscle biopsy studies from two trials of functional electrical stimulation (FES) that did not shown improvements in physical function.MethodsPrimary cohort: single-centre randomized controlled trial. Additional healthy volunteer data from patients undergoing elective hip arthroplasty. Validation cohort: Four-centre randomized controlled trial. Intervention: FES cycling for 60-90min/day. Analyses: Skeletal muscle mRNA expression of 223 genes underwent hierarchal clustering for targeted analysis and validation.ResultsPositively enriched pathways between healthy volunteers and ICU participants were “stress response”, “response to stimuli” and “protein metabolism”, in keeping with published data. Positively enriched pathways between admission and day 7 ICU participants were “FOXO-mediated transcription” (admission = 0.48 ± 0.94, day 7 = − 0.47 ± 1.04 mean log2 fold change; P = 0.042), “Fatty acid metabolism” (admission = 0.50 ± 0.67, day 7 = 0.07 ± 1.65 mean log2 fold change; P = 0.042) and “Interleukin-1 processing” (admission = 0.88 ± 0.50, day 7 = 0.97 ± 0.76 mean log2 fold change; P = 0.054). Muscle mRNA expression of UCP3 (P = 0.030) and DGKD (P = 0.040) decreased in both cohorts with no between group differences. Changes in IL-18 were not observed in the validation cohort (P = 0.268). Targeted analyses related to intramuscular mitochondrial substrate oxidation, fatty acid oxidation and intramuscular inflammation showed PPARγ-C1α; (P < 0.001), SLC25A20 (P = 0.017) and UCP3 (P < 0.001) decreased between admission and day 7 in both arms. LPIN-1 (P < 0.001) and SPT1 (P = 0.044) decreased between admission and day 7. IL-18 (P = 0.011) and TNFRSF12A (P = 0.009) increased in both arms between admission and day 7. IL-1β (P = 0.007), its receptor IL-1R1 (P = 0.005) and IL-6R (P = 0.001) decreased in both arms between admission and day 7. No between group differences were seen in any of these (all p > 0.05).ConclusionsIntramuscular inflammation and altered substrate utilization are persistent in skeletal muscle during first week of critical illness and are not improved by the application of Functional Electrical Stimulation-assisted exercise. Future trials of exercise to prevent muscle wasting and physical impairment are unlikely to be successful unless these processes are addressed by other means than exercise alone.

Dual Neural Network Control of a Hybrid Functional Electrical Stimulation Cycling System

Abstract Hybrid functional electrical stimulation (FES) cycling is a method to rehabilitate people with neurological conditions when they are not in and of themselves capable of fully controlling their extremities. To ensure smooth cycling and adequate stimulation to accomplish the rehabilitation task, admittance control is applied between the human and the robotic cycle. The cycle motor is actuated by a dual neural network control structure with an additional robust element tracking the admittance trajectory, while muscles are stimulated with a simple saturated robust controller. The dual neural network structure allows adaptation to separable functions of the dynamic system, in addition to shared adaptation through the admittance filter. A Lyapunov analysis shows that the admittance tracking controller is globally exponentially stable. A passivity analysis shows that the admittance system and cadence tracking error are output strictly passive. A combined analysis shows that the total system is passive. Experiments are performed on eight participants without neurological conditions, on 12 differing protocols including a robust controller for comparison, the addition of noise, and the addition or lack of stimulation. One participant with a neurological condition was evaluated on three different protocols, including a robust controller, a neural network controller, and a game-like mode where the participant was asked to track the trajectory as it appeared on a screen. Statistical analysis of the experiments show that the standard deviation of the tracking error is significantly improved with the adaptive dual neural network control addition when compared to the robust controller, in some instances reducing the magnitude by half.

The effect of a combination of functional electrical stimulation and cycle ergometer (FES-cycling) on physiological changes and functional ability in patients with ICU-acquired weakness

Intensive care unit-acquired weakness (ICU-AW) is the most common complication found in the intensive care unit (ICU) patients, especially those on prolonged use of mechanical ventilation (MV). It is known to cause poor long-term outcomes, and early rehabilitation (ER) intervention has been proved to be useful in improving muscle strength, physical function, and quality of life of ICU survivors. Several obstacles, such as patients’ medical condition and limited availability of equipment or trained personnel, interfere with ER. Passive ER including functional electrical stimulation (FES) and cycling were found to be effective. The combination of FES with a cycle ergometer (FES cycling) can be implemented, but research on using this modality in the ICU is still limited. This review aimed at providing information on the use of FES cycling in ICU patients to explain its effect on physiological changes and functional abilities. The physiological effects of FES cycling are obtained through local metabolic changes in muscles due to FES and increased cardiovascular responses due to muscle contraction during cycling. Its effects on muscle strength, cross-section area, days free of MV, mobilization, cognitive ability, delirium, and quality of life were positive, and only rarely adverse events occurred during the intervention. To conclude, the use of FES cycling in the prevention and treatment of ICU-AW can be considered since this modality causes positive physiological effects and has proven safe.&#x0D; Abbreviations: EM – Early Mobilization; ER- early rehabilitation; FES - functional electrical stimulation; ICU-AW - Intensive Care Unit-Acquired Weakness; MV - mechanical ventilation; NMBA - neuromuscular blocking agents; PICS - post-intensive care syndrome; NMES - neuromuscular electrical stimulation;&#x0D; Key words: Electrical Stimulation; Intensive Care Unit; Muscle Contraction; Muscle Strength; Quality of Life&#x0D; Citation: Nazir A. The effect of a combination of functional electrical stimulation and cycle ergometer (FES-cycling) on physiological changes and functional ability in patients with ICU-acquired weakness. Anaesth. pain intensive care 2023;27(5):599−606; DOI: 10.35975/apic.v27i5.2315&#x0D; Received: July 03, 2023; Reviewed &amp; Accepted: August 18, 2023

ICEP: An Instrumented Cycling Ergometer Platform for the Assessment of Advanced FES Strategies.

Functional electrical stimulation (FES) cycling has seen an upsurge in interest over the last decade. The present study describes the novel instrumented cycling ergometer platform designed to assess the efficiency of electrical stimulation strategies. The capabilities of the platform are showcased in an example determining the adequate stimulation patterns for reproducing a cycling movement of the paralyzed legs of a spinal cord injury (SCI) subject. Two procedures have been followed to determine the stimulation patterns: (1) using the EMG recordings of the able-bodied subject; (2) using the recordings of the forces produced by the SCI subject's stimulated muscles. the stimulation pattern derived from the SCI subject's force output was found to produce 14% more power than the EMG-derived stimulation pattern. the cycling platform proved useful for determining and assessing stimulation patterns, and it can be used to further investigate advanced stimulation strategies.

ACTIVE STRIDES-CP: protocol for a randomised trial of intensive rehabilitation (combined intensive gait and cycling training) for children with moderate-to-severe bilateral cerebral palsy

IntroductionFor children with cerebral palsy (CP), who are marginally ambulant, gross motor capacity peaks between 6 and 7 years of age with a subsequent clinical decline, impacting their ability to...

The effects of functional electrical stimulation cycling on gait parameters in diplegic cerebral palsy: a single-blind randomized controlled trial

Purpose To investigate the effects of functional electrical stimulation cycling (FES-C) training in addition to conventional physical therapy on gait, muscle strength, gross motor function, and energy expenditure in ambulatory children with spastic diplegic cerebral palsy. Materials and methods Twenty children with diplegic cerebral palsy were randomly assigned to FES-C group (n = 10) or control group (n = 10). Subjects trained 3 days/week for 8 weeks. Control group received conventional physical therapy. The FES-C group additionally received FES-C training. The functional muscle test was used for muscle strength assessment. Vicon-3D system was used for gait analysis. Gross Motor Function Measure (GMFM-88) was used for motor function assessment and calorimeter was used for energy expenditure. Measurements were performed at the baseline, at the eight week and at the sixteenth week. Results Functional muscle strength, gross motor function, and energy expenditure improved more in the FES-C group after training and follow up (p < 0.05). There was no significant difference found between the changes in gait parameters of the two groups after treatment and follow up (p > 0.05). Pelvic tilt while walking decreased after training in the FES-C group (p < 0.05). Conclusions FES-C applied in addition to conventional physical therapy in children with diplegic cerebral palsy is more effective than conventional physical therapy for increasing functional muscle strength, improving gross motor function functions, and reducing energy expenditure. Highlights FES-C improves lower extremity functional muscle strength, gross motor function, and energy expenditure in ambulatory children with spastic dCP. The use of FES-C in combination with conventional physiotherapy methods may be beneficial in outpatients with spastic dCP.

Robust Cadence and Power Tracking on a Switched FES Cycle With an Unknown Electromechanical Delay

Functional electrical stimulation (FES) is commonly used to facilitate cycling tasks for people with lower-limb movement disorders. In this work, FES and motor controllers are designed to track a desired power and cadence, respectively, and a Lyapunov-based switched systems analysis is performed to guarantee uniformly ultimately bounded power tracking and global exponential cadence tracking for a switched, delayed, nonlinear, and uncertain FES-cycling system. A unique challenge in this problem is that there is an unknown time-varying input delay to produce force, and a different unknown time-varying residual input delay where force is still produced after stimulation is removed. These delays impact the dwell-time conditions that dictate stimulation timing, and if not properly accounted for can lead to undesired effects such as antagonistic muscles exerting force at the same time or potential instabilities. The proposed controllers were validated by experimental analysis of four participants with neurological conditions (NCs) and five able-bodied participants, and yielded average power and cadence tracking errors of 0.01 ± 0.09 W and −0.05 ± 0.65 revolutions per minute (RPM), respectively, for the able-bodied participants and 0.01 ± 1.11 W and −0.07 ± 1.17 RPM, respectively, for the participants with NCs.

Neurophysiological and clinical outcome measures of the impact of electrical stimulation on spasticity in spinal cord injury: Systematic review and meta-analysis.

This systematic review and meta-analysis aims to determine whether non-invasive electrical stimulation (ES) is effective at reducing spasticity in people living with spinal cord injury (SCI). PubMed, Web of Science, Scopus and Cochrane Central Register of Controlled Trials databases were searched in April 2022. Primary outcome measures were the Ashworth scale (AS), Modified Ashworth scale (MAS), Pendulum test and the Penn spasm frequency scale (PSFS). Secondary outcomes were the Hoffman (H)- reflex, motor-evoked potentials (MEPs) and posterior-root reflexes (PRRs). A random-effects model, using two correlation coefficients, ( , ) determined the difference between baseline and post-intervention measures for RCTs. A quantitative synthesis amalgamated data from studies with no control group (non-RCTs). Twenty-nine studies were included: five in the meta-analysis and 17 in the amalgamation of non-RCT studies. Twenty studies measured MAS or AS scores, 14 used the Pendulum test and one used the PSFS. Four measured the H-reflex and no studies used MEPs or PRRs. Types of ES used were: transcutaneous electrical nerve stimulation (TENS), transcutaneous spinal cord stimulation (TSCS), functional electrical stimulation (FES) cycling and FES gait. Meta-analyses of 3 studies using the MAS and 2 using the Pendulum test were carried out. For MAS scores, non-invasive ES was effective at reducing spasticity compared to a control group (p = 0.01, ; p = 0.002, ). For Pendulum test outcomes, there was no statistically significant difference between intervention and control groups. Quantitative synthesis of non-RCT studies revealed that 22 of the 29 studies reported improvement in at least one measure of spasticity following non-invasive ES, 13 of which were statistically significant (p < 0.05). Activation of the muscle was not necessary to reduce spasticity. Non-invasive ES can reduce spasticity in people with SCI, according to MAS scores, for both RCT and non-RCT studies, and Pendulum test values in non-RCT studies. This review could not correlate between clinical and neurophysiological outcomes; we recommend the additional use of neurophysiological outcomes for future studies. The use of TSCS and TENS, which did not induce a muscle contraction, indicate that activation of afferent fibres is at least required for non-invasive ES to reduce spasticity.

Perceptions of Occupational Therapy Students Regarding Functional Electrical Stimulation Technology

<h3>Research Objectives</h3> To examine occupational therapy (OT) students' knowledge and perceptions of Functional Electrical Stimulation (FES) cycle technology. <h3>Design</h3> This mixed methods survey explored OT students' experiences with FES cycle technology. Quantitative data were analyzed using descriptive statistics. Qualitative data were hand-coded and themes were identified. The survey consisted of 18 quantitative questions using descriptive and ordinal data and 3 qualitative questions with open-ended responses. <h3>Setting</h3> The participants were recruited via virtual forums in fall 2021. <h3>Participants</h3> Twenty participants met inclusion criteria. Ten participants were familiar with FES cycle technology and completed the survey. <h3>Interventions</h3> No interventions. <h3>Main Outcome Measures</h3> Analyze OT students' knowledge and perceptions of FES cycle technology. Identify areas of limited exposure to and knowledge of FES cycle technology in OT students in the US. <h3>Results</h3> Of the 20 participants, 50% were unfamiliar (n=10) and 50% familiar. Of the 10 participants who were familiar with FES cycle technology, 60% (n=6) of participants reported FES education was implemented in their curriculum. Additionally, 70% (n=7) of participants reported hands-on interaction with an FES cycle. When asked what types of experiences they had, participants reported the following experiences: 60% (n=6) PowerPoint presentation, 70% (n=7) hands-on experience, 60% (n=6) lecture, 10% (n=1) no experience, and 20% (n=2) other. Ten percent (n=1) of participants reported they were extremely comfortable and 60% (n=6) somewhat comfortable using FES cycle technology. <h3>Conclusions</h3> Results of the survey indicate a lack of awareness regarding FES cycle technology in participants. Half of the participants were not familiar with FES cycle technology. Of familiar participants, only one felt extremely comfortable and six felt somewhat comfortable with the technology. Of clinical relevance, 70% (n=7) of the participants who were familiar with FES technology also reported hands on experience with an FES cycle. This study demonstrates a lack of US OT student knowledge of and exposure to FES cycle technology despite its proven effectiveness. Lack of OT student training may have a negative impact on clients' ability to access this technology. <h3>Author(s) Disclosures</h3> No financial disclosures to report.