Neuromuscular Electrical Stimulation Training Research Articles

Combined repetitive facilitative exercise under continuous neuromuscular electrical stimulation and task-oriented training for hemiplegic upper extremity during convalescent phase after stroke: before-and-after feasibility trial.

Whereas repetitive facilitative exercise (RFE) affects primarily recovery of motor impairment after stroke, task-oriented training (TOT) focuses on facilitating daily use of the affected upper extremity. However, feasibility of combined RFE and TOT has not been reported. We originated "task-oriented RFE," as a new combination therapy for patients with hemiplegic upper extremity after subacute stroke, to examine its feasibility in convalescent rehabilitation wards. This is a before-and-after pilot study. Eight patients with hemiplegic upper extremity after subacute stroke received the task-oriented RFE program for 6 weeks at 80 min per day (20-60 min of TOT applied after 60-20 min of RFE under continuous neuromuscular electrical stimulation) in a convalescent rehabilitation ward. In the current program, we introduced the Aid for Decision-making in Occupation Choice (ADOC) iPad application as a goal-setting method for determining tasks. Feasibility was assessed with adherence to the protocol, adverse events in response to the intervention, and preliminary efficacy. Motor functions, amount of use and quality of movement in the hemiparetic upper extremity, and satisfaction of the patients were evaluated with Fugl-Meyer Assessment (FMA), the Action Research Arm Test (ARAT), the motor activity log (MAL) for the amount of use (AOU) and quality of movement (QOM) of the paralyzed hand, and ADOC. All participants accomplished the program, which was implemented as originally planned; neither nonattendance nor an adverse event occurred during the study. Favorable outcomes were obtained with all measures; mean changes in FMA, ARAT in the dominant hand, MAL-AOU, and MAL-QOM were greater than minimal clinically important differences. Mean changes in ADOC were greater than the minimal detectable change. The task-oriented RFE program was safe, well-tolerated, beneficial, and feasible within 80 min a day of occupational therapy, which means also within the procedural constraints of the Japanese health insurance system during the convalescent phase. Future studies are warranted to examine whether combined RFE and TOT enhances the efficacies of each program alone.

Effect of combined electrical stimulation and brief muscle lengthening on torque development.

This study aimed to evaluate torque production in response to the application of a brief muscle lengthening during neuromuscular electrical stimulation (NMES) applied over the posterior tibial nerve. Fifteen participants took part in three experimental sessions, where wide-pulse NMES delivered at 20 and 100 Hz (pulse duration of 1 ms applied during 15 s at an intensity evoking 5-10% of maximal voluntary contraction) was either applied alone (NMES condition) or in combination with a muscle lengthening at three distinct speeds (60, 180, or 300°/s; NMES + LEN condition). The torque-time integral (TTI) and the muscle activity following the stimulation trains [sustained electromyography (EMG)] were calculated for each condition. Results show that TTI and sustained EMG activity were higher for the NMES + LEN condition only when using 100-Hz stimulation, regardless of the lengthening speed (P = 0.029 and P = 0.007 for the two parameters, respectively). This indicates that superimposing a muscle lengthening to high-frequency NMES can enhance the total torque production, partly due to neural mechanisms, as evidenced by the higher sustained EMG activity. This finding has potential clinical relevance, especially when it comes to finding ways to enhance torque production to optimize the effectiveness of NMES training programs.NEW & NOTEWORTHY This study showed, for the first time, that the combined application of a brief muscle lengthening and wide-pulse neuromuscular electrical stimulation (NMES) delivered over the posterior tibial nerve can entail increased torque production as compared with the sole application of NMES. This observation, present only for high stimulation frequencies (100 Hz) and independently of the lengthening speed, is attributed to neural mechanisms, most probably related to increased afferents' solicitation, although muscular phenomena cannot be excluded.

Eight-week neuromuscular electrical stimulation training produces muscle strength gains and hypertrophy, and partial muscle quality improvement in the knee extensors

ABSTRACT This study investigated the effect of an 8-week neuromuscular electrical stimulation (NMES) training programme (3 days/week) on muscle quantity and quality and single-joint performance in the knee extensors. Thirty-nine untrained young male participants were randomly assigned to NMES training (n = 21) and control (n = 18) groups. The 8-week NMES training induced significant increase in the isometric maximal voluntary contraction (MVC) torque of the knee extensors (≈9.3%), muscle volume of the individual and entire quadriceps muscles determined by magnetic resonance imaging (≈3.3%–6.4%), and a significant decrease in the ultrasound echo intensity of the vastus lateralis (≈−4.0%); however, hypertrophy of the vastus intermedius (i.e., the deep muscle) was limited (≈3.3%). In the NMES training group, the repeated measures correlations of the isometric MVC torque with the muscle volume of the entire quadriceps muscle and each quadriceps muscle were significant (r rm (20) = 0.551–0.776), whereas that of the isometric MVC torque with the ultrasound echo intensity of the vastus lateralis was not significant. These findings suggest that NMES training produces muscle strength gains, muscle hypertrophy, and partial muscle quality improvement and that the NMES training-induced muscle strength gains is caused by muscle hypertrophy in the knee extensors.

Effectiveness of neuromuscular electrical stimulation training combined with exercise on patient-reported outcomes measures in people with knee osteoarthritis: A systematic review and meta-analysis.

This study examined the effectiveness of neuromuscular electrical stimulation (NMES) added to the exercise or superimposed on voluntary contractions on patient-reported outcomes measures (PROMs) in people with knee osteoarthritis (OA). This systematic review was described according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Randomized controlled trials (RCTs) were obtained from a systematic literature search in five electronic databases (PubMed, PEDro, LILACS, EMBASE, and SPORTDiscus) in April 2022. We described the effects of intervention according to each PROMs (scores for Pain; Self-reported functional ability; Symptoms (hear clicking, swelling, catching, restricted range of motion, and stiffness); Daily living function; Sports function; and Quality of life) and used a random-effect model to examine the impact of NMES plus exercise on pain compared with exercise in people with knee OA. Six RCTs (n=367) were included. In the qualitative synthesis, the systematic literature analysis showed improvement in pain after NMES plus exercise compared with exercise alone in three studies. The other three studies revealed no difference between groups in pain, although similar improvement after treatments. In the meta-analysis, NMES at a specific joint angle combined with exercise was not superior to exercise alone in pain management (standardized mean difference=-0.33, 95% CI=-1.05 to 0.39, p=0.37). There was no additional effect of NMES on exercise on self-reported functional ability, stiffness, and physical function compared with exercise alone. In only one study, symptoms, activities of daily living, sports function, and quality of life improved after whole-body electrostimulation combined with exercise. This review found insufficient evidence for the effectiveness of NMES combined with exercise in treating knee OA considering PROMs. While pain relief was observed in some studies, more high-quality clinical trials are needed to support the use of NMES added to the exercise in clinical practice. Electrical stimulation in a whole-body configuration combined with exercise shows promise as an alternative treatment option.

Effects of Gastrocnemius Neuromuscular Electrical Stimulation Training on Ankle mobility and Gait in Patients with Stroke

Effects of Gastrocnemius Neuromuscular Electrical Stimulation Training on Ankle mobility and Gait in Patients with Stroke

Intradialytic neuromuscular electrical stimulation with optional virtual reality distraction improves not only muscle strength and functional capacity but also serum albumin level in haemodialysis patients: a pilot randomized clinical trial

BackgroundSarcopenia is highly prevalent in haemodialysis (HD) patients and linked to a poor prognosis regarding comorbidities and premature mortality. Previous studies assessed the effects of neuromuscular electrical stimulation in haemodialysis patients. This study adds to the relevance of neuromuscular electrical stimulation (NMES) applications combined with a virtual reality (VR) distraction to increase intensity, dosage, and efficiency of NMES and slow sarcopenia progression in HD patients.MethodsWe conducted a 12-week multicenter prospective randomised controlled trial. The patients were randomly assigned to one of the three groups: neuromuscular electrical stimulation with or without combined virtual reality distraction or control group.ResultsThe final analysis included 32 haemodialysis patients (mean age of 68 ± 10 years, 26 men). Interaction effects between groups and time (12 weeks) were significant regarding serum albumin levels (p = 0.008) and left quadriceps femoris muscle (QFM) force (p = 0.026). Both endpoints were increased in the NMES compared to the CO group at the end of the intervention. The NMES group increased serum albumin levels significantly after 12 weeks. The main effect of time was an increase in mean right QFM force between beginning and end of the intervention (p = 0.021). Functional capacity improved after 12 weeks in the NMES and NMES + VR but not in the control group, with a significant difference between the three groups (p = 0.022). Weight and body mass index increased in the NMES and NMES + VR groups, albeit not significantly. The effects of VR distraction on NMES efficiency were inconclusive.ConclusionIntradialytic NMES increases serum albumin level, functional capacity, muscle strength in lower limb and in tendency weight and body mass index of HD patients. Effects on VR distraction are inconclusive. Large-scaled follow-up studies on integrated sports programs with NMES and active training in combination with VR as distraction and motivation accelerator are needed.Trial registrationGerman Clinical Trial Register: DRKS00029276 (Retrospectively registered: 30/06/2022).

Neuromuscular electrical stimulation improves reaction time and execution time of roundhouse kick in highly skilled martial arts athletes

ABSTRACT The purpose of the study was to evaluate the influence of neuromuscular electrical stimulation (NMES) on a roundhouse kick (RHK) and the rate of force development (RFD) and peak force during maximal isometric contractions with the knee extensors. Sixteen martial arts athletes were randomly assigned to either a training group (NMES + martial arts) or a control group (martial arts). The RHK was performed to a fixed target located approximately 1.5 m away from the athlete. The reaction time and execution time were quantified with a light-sensor system. Participants were tested before and after completing 15 sessions of training (5 weeks, 3 sessions/week, 90 min/session). In addition, the training group performed another 15 sessions (3 sessions/week, 30 min/session) in which electrical stimulation was superimposed on maximal isometric contractions of the quadriceps (100 Hz, 450 μs). There were no statistically significant changes in either RFD or maximal isometric force for either group (p > 0.05). However, the training group experienced significant reductions (p < 0.05) in both reaction time (−9.2%) and the execution time (−5.9%). The findings indicate that supplemental NMES training can improve sport-specific movements, such as the RHK, without any changes in maximal force capabilities in skilled martial arts athletes.

Effects of Unilateral Neuromuscular Electrical Stimulation with Illusionary Mirror Visual Feedback on the Contralateral Muscle: A Pilot Study.

We aim to examine the cross-education effects of unilateral muscle neuromuscular electrical stimulation (NMES) training combined with illusionary mirror visual feedback (MVF). Fifteen adults (NMES + MVF: 5; NMES: 5, Control: 5) completed this study. The experimental groups completed a 3-week NMES training on their dominant elbow flexor muscle. The NMES + MVF group had a mirror placed in the midsagittal plane between their upper arms, so a visual illusion was created in which their non-dominant arms appeared to be stimulated. Baseline and post-training measurements included both arms' isometric strength, voluntary activation level, and resting twitch. Cross-education effects were not observed from all dependent variables. For the unilateral muscle, both experimental groups showed greater strength increases when compared to the control (isometric strength % changes: NMES + MVF vs. NMES vs. Control = 6.31 ± 4.56% vs. 4.72 ± 8.97% vs. -4.04 ± 3.85%, p < 0.05). Throughout the training, even with the maximally tolerated NMES, the NMES + MVF group had greater perceived exertion and discomfort than the NMES. Additionally, the NMES-evoked force increased throughout the training for both groups. Our data does not support that NMES combined with or without MVF induces cross-education. However, the stimulated muscle becomes more responsive to the NMES and can become stronger following the training.

Kinematic analysis of countermovement jump performance in response to immediate neuromuscular electrical stimulation.

The purpose of this study was to examine the effect of neuromuscular electrical stimulation (NMES) immediate intervention training on the countermovement jump (CMJ) height and to explore kinematic differences in the CMJ at each instant. A total of 15 male students who had never received electrical stimulation were randomly selected as the research participants. In the first test, the CMJ performance was completed with an all-out effort. The second experiment was best performed immediately to complete the CMJ operation after NMES for 30 min. Both experiments used a high-speed camera optical capture system to collect kinematic data. The results of this experiment revealed that after im-mediate NMES training, neuromuscular activation causes post-activation potentiation, which increases the height of the center of gravity of the CMJ and affects the angular velocity of the hip joint, the velocity and acceleration of the thigh and the shank and the velocity of the soles of the feet. The use of NMES interventional training based on the improvement of technical movements and physical exercises is recommended in the future.

Isokinetic strengthening and neuromuscular electrical stimulation protocol impact on physical performances, functional status and quality of life in knee osteoarthritis overweight/obese women

BackgroundKnee muscle weakness associated with overweight/obesity can lead to impairment of vital daily function in knee osteoarthritis patients. This study investigated the effect of a knee eccentric isokinetic muscle strength (IMS) training program combined with neuromuscular electrical stimulation (NMES) on muscle strength and flexibility, joint ROM, functional status, physical performance, and quality of life in knee osteoarthritis overweight/obese women. MethodsThirty-six women were randomized into three groups, two experimental groups (EG) and a control group following a classic rehabilitation program. During 6 weeks of two sessions/week, one of the two EGs performed an IMS program (ISO.G); the other underwent combined IMS and NMES training (ISO + NMES.G). All patients were evaluated with clinical examination, isokinetic test at 60°/s and 240°/s speeds, physical performance tests related to activities of daily living, and Knee injury and Osteoarthritis Outcome Score (KOOS) quality of life questionnaire, before and after the intervention. ResultsIn the 10-m walk, chair stand, stair climb and monopodal stance tests, muscle flexibility and quality of life scores showed significant improvement for ISO.G (P = 0.000) and ISO + NMES.G (P = 0.000). Concentric strength at 240°/s was improved in ISO + NMES.G (P = 0.000) unlike the muscle strength at 60°/s (quadriceps, P = 0.104; hamstrings, P = 0.171), force asymmetry (P = 0.481) and post-intervention joint ROM (P = 0.309). ConclusionsThe combination of IMS and NMES shows significant superiority over the usual rehabilitation program for the majority of the parameters measured for optimal management of knee osteoarthritis.

Scalp-nape acupuncture as adjuvant therapy for pharyngeal dysphagia of stroke at recovery stage: a randomized controlled trial

To observe the therapeutic effect of scalp-nape acupuncture for pharyngeal dysphagia of stroke at recovery stage on the basis of neuromuscular electrical stimulation (NMES) and rehabilitation training. A total of 42 patients with pharyngeal dysphagia of stroke at recovery stage were randomized into an observation group and a control group, 21 cases in each group. Conventional medical symptomatic treatment was given in both groups. NMES and rehabilitation training were adopted in the control group, 30 min for each one. On the basis of the treatment in the control group, scalp-nape acupuncture was given in the observation group, scalp acupuncture was applied at lower 2/5 of anterior and posterior oblique lines of parietal and temporal, nape acupuncture was applied at Fengchi (GB 20), Yiming (EX-HN 14), Gongxue (Extra), Zhiqiang (Extra), Tunyan (Extra), etc. The treatment was given once a day, 5 days a week for 3 weeks in both groups. Before and after treatment, the videofluoroscopic dysphagia scale (VDS) score, the Kubota water swallowing test grade, the functional oral intake scale (FOIS) grade and the swallowing quality of life (SWAL-QOL) score were observed in both groups. After treatment, the VDS scores were decreased and the SWAL-QOL scores were increased compared before treatment (P<0.05), the Kubota water swallowing test grade and FOIS grade were improved compared before treatment (P<0.05) in both groups. The changes of VDS score and SWAL-QOL score, Kubota water swallowing test grade and FOIS grade in the observation group were superior to those in the control group (P<0.05). Based on NMES and rehabilitation training, scalp-nape acupuncture can enhance the therapeutic effect on pharyngeal dysphagia of stroke at recovery stage, and improve the patients' swallowing function and quality of life.

Efficacy of contralaterally controlled functional electrical stimulation compared to cyclic neuromuscular electrical stimulation and task-oriented training for recovery of hand function after stroke: study protocol for a multi-site randomized controlled trial

BackgroundMulti-site studies in stroke rehabilitation are important for determining whether a technology and/or treatment can be successfully administered by sites other than the originating site and with similar positive outcomes. This study is the first multi-site clinical trial of a novel intervention for post-stroke upper limb rehabilitation called contralaterally controlled functional electrical stimulation (CCFES). Previous pilot and single-site studies showed positive effects of CCFES on upper limb impairment and hand dexterity in stroke survivors. The main purpose of this study is to confirm and demonstrate the efficacy of CCFES in a larger group of most likely responders across multiple clinical sites.MethodsUp to 129 stroke survivors with moderate to severe upper extremity hemiparesis at 4 clinical trial sites will be randomized to CCFES, cyclic neuromuscular electrical stimulation (cNMES), or task-oriented-training (TOT). Participants will receive 12 weeks of group-specific therapy. Blinded assessments of upper limb impairment and activity limitation, quality of life, and neurophysiology will be used to compare outcomes at baseline, after treatment, and up to 6 months post-treatment. The primary endpoint is change in dexterity from baseline to 6 months post-treatment.DiscussionLoss of hand function following stroke is a major rehabilitation problem affecting millions of people per year globally. More effective rehabilitation therapies are needed to restore hand function in these individuals. This study will determine whether CCFES therapy produces greater improvements in upper extremity function than cNMES or TOT, and will begin to elucidate the different mechanisms underlying each of the three treatments. This multi-site study is a critical step in advancing a novel method of rehabilitation toward clinical translation and widespread dissemination.Trial registrationClinicalTrials.gov NCT03574623. Registered prior to first enrollment; July 2, 2018.

Effect of neuromuscular electrical stimulation on exercise capacity in patients with severe chronic obstructive pulmonary disease: A randomised controlled trial

Objective To compare strengthening by neuromuscular electrical stimulation versus cycle ergometer training during a pulmonary rehabilitation program, in patients with severe to very severe chronic obstructive pulmonary disease. Design A prospective randomized controlled study. Setting Two inpatient pulmonary rehabilitation centers. Subjects Patients with severe to very severe chronic obstructive pulmonary disease and multidimensional index to predict risk of death ≥5, were randomly assigned to receive neuromuscular electrical stimulation or cycle ergometer training during pulmonary rehabilitation. Main measures The primary endpoint was the change in exercise capacity using 1-min sit-to-stand test Secondary endpoints were the changes in exercise capacity using 6-min walk test, quadriceps strength, quality of life and dyspnea. Results 102 patients were included. After 3 weeks, 47 patients in the neuromuscular electrical stimulation group, and 45 in the cycle ergometer training group were able to be analyzed. No significant difference was seen in the evolution of exercise capacity using 1-min sit-to-stand test (3.3 ± 3.8 and 2.6 ± 4.1) and 6-min walk test (37.8 ± 58.4 and 33.1 ± 46.7), in the evolution of quadriceps strength and endurance (9.2 ± 12.9 and 6.6 ± 16.1; 9.0 ± 13.2 and 6.2 ± 17.0), in the evolution of quality of life (St George's Respiratory Questionnaire: −11.3 ± 11.7 and −8.1 ± 11.6; COPD Assessment Test: −5.7 ± 7.1 and −4.7 ± 7.0), or in the evolution of dyspnea using Dyspnea 12 (−5.5 ± 10.2 and −5.9 ± 8.5) except using modified medical research council scale (95% confidence interval: 0.48 [0.05; 0.91], p = 0.027). Conclusion We found no significant difference between the two programs on exercise capacity, quadriceps strength and quality of life.

The use of surface EMG in neurorehabilitation following traumatic spinal cord injury: A scoping review

ObjectiveSurface electromyography (sEMG) is a common electrophysiological assessment used in clinical trials in individuals with spinal cord injury (SCI). This scoping review summarizes the most common sEMG techniques used to address clinically relevant neurorehabilitation questions. We focused on the role of sEMG assessments in the clinical practice and research studies on neurorehabilitation after SCI, and how sEMG reflects the changes observed with rehabilitation. Additionally, this review emphasizes the limitations and pitfalls of the sEMG assessments in the field of neurorehabilitation after SCI. MethodsA comprehensive search of Medline (Ovid), Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Embase, Emcare, Cumulative Index to Nursing & Allied Health Literature, and PubMed was conducted to find peer-reviewed journal articles that included individuals post-SCI that participated in neurorehabilitation interventions using sEMG assessments. This is a scoping review using a systematic search (hybrid review). ResultsOf 4522 references captured in the primary database searches, 100 references were selected and included in the scoping review. The main focus of the studies was on neurorehabilitation using sEMG biofeedback, brain stimulation, locomotor training, neuromuscular electrical stimulation (NMES), paired-pulse stimulation, pharmacology, posture and balance training, spinal cord stimulation, upper limb training, vibration, and photobiomodulation. ConclusionsMost studies employed sEMG amplitude to understand the effects of neurorehabilitation on muscle activation during volitional efforts or reduction of spontaneous muscle activity (e.g., spasms, spasticity, and hypertonia). Further studies are needed to understand the long-term reliability of sEMG amplitude, to circumvent normalization issues, and to provide a deeper physiological background to the different sEMG analyses. SignificanceThis scoping review reveals the potential of sEMG in exploring promising neurorehabilitation strategies following SCI and discusses the barriers limiting its widespread use in the clinic.

Assessment of neuromuscular electrical stimulation effect on contralateral quadriceps muscle

BackgroundIn the field of rehabilitation, the acute application of neuromuscular electrical stimulation (NMES) causes not only peripheral muscle contraction but also involve the central nervous system by the transient increase in spinal motor neuron and cortical activity. Therefore it has been used in several fields of rehabilitation. Previous studies used surface electromyography to assess this effect. But we conducted our study to assess the effect of NMES on contralateral quadriceps muscle in normal individuals using another method needle electromyography. MethodsA study carried out on 20 normal males, who were subjected to (i) NMES Training Program for 60 min for the right quadriceps muscle. (ii) Assessment of EMG activity for rectus femoris muscle (RF) on the contralateral side. An assessment was done for minimal volition and maximal volition or interference pattern analysis, this assessment was done twice: before the start of NMES and during the session. ResultsEMG of voluntary activity (Minimal volition) and Maximum voluntary activity analysis for RF muscles showed increased duration (in millisecond), amplitude (in millivolt) (P < 0.01), increased activity in turn per second, amplitude/turn (M) (uV) compared to the result before NMES application. ConclusionOur study provides a new evident date that the acute NMES application to the contralateral quadriceps muscles, leads to significant facilitation of the maximal voluntary power in the ipsilateral muscles through activation of efferent neural control. This facilitating effect of motor neurons in the contralateral muscles is likely due to the complex combination interaction between spinal and supraspinal control. Trial registrationTrial registration: PACTR202010887172053.

Does adding neuromuscular electrical stimulation to rehabilitation following total knee arthroplasty lead to a better quadriceps muscle strength recovery? A systematic review.

Patients undergoing total knee arthroplasty (TKA) show postsurgical quadriceps weakness. Neuromuscular electrical stimulation (NMES) has been shown to be an effective treatment for muscle strength recovery in a number of orthopaedic conditions. The aim of this review is to investigate whether adding NMES to TKA rehabilitation leads to a better quadriceps strength recovery in comparison with standardized rehabilitation. A second aim is to investigate which are the most commonly used NMES pulse settings and their effectiveness. A systematic review of literature was conducted on PubMed, Cochrane, Scopus and Web-of-Science. Intervention studies evaluating the effects of a rehabilitation intervention based on quadriceps NMES in patients undergoing TKA were retrieved. Methodological quality was assessed using the risk of bias-2 Cochrane tool. Features of NMES rehabilitation and technical data on NMES settings were extracted from the studies. Four studies met the inclusion criteria. Due to the limited number and the heterogeneity of the selected studies, it was not appropriate to carry out a meta-analysis. All the studies reported higher quadriceps strength in patients undergoing quadriceps NMES, particularly early after TKA. The addition of NMES or traditional strength training shows similar long-term effects. Short duration and low-intensity NMES have limited effects on quadriceps strength. Heterogeneity was found on NMES methodologies and pulse settings. In conclusion, NMES is effective for quadriceps strength recovery following TKA. NMES intensity and duration are essential for good NMES outcomes on quadriceps strength. Further studies on NMES methodologies, pulse features and settings are required to address the gaps in knowledge on NMES following TKA.

The Effect of Lower Limb Neuromuscular Electrical Stimulation on Skeletal Muscle Signaling for Glucose Utilization and Systemic Inflammation After Acute Spinal Cord Injury

<h3>Research Objectives</h3> To quantify the effects of a novel combination neuromuscular electrical stimulation (Comb-NMES) training program on muscle signaling for glucose utilization and systemic inflammatory blood markers in individuals with acute spinal cord injury (SCI). <h3>Design</h3> Randomized controlled clinical trial. <h3>Setting</h3> In-patient rehabilitation setting. <h3>Participants</h3> 12 participants between 30.3 ±8.6, with an SCI between C6-L1, within 14 days of the SCI and with no history of diabetes, participated in the study. Muscle samples were collected from the Vastus Lateralis muscle within 14 days of SCI and before discharge from the Spain Rehabilitation hospital. <h3>Interventions</h3> The intervention group received Comb-NMES training program that combines dynamic contractions (resistance training) via high-frequency electrical stimulation with twitch contractions (aerobic training) via low-frequency electrical stimulation on the quadriceps muscle group on both legs. The control group received (sham treatment) passive dynamic exercise of the lower legs and transcutaneous electrical nerve stimulation (TENS). Interventions were given 3 times/week for 3-4 weeks. <h3>Main Outcome Measures</h3> Western blot analysis was performed to quantify signaling proteins (GLUT4, AMPKα, Hexokinase II, CaMKII, Akt, AS160, IRS-1, ACC, GS, and PI3 Kinase) for muscle glucose uptake. In addition, assays were performed to measure the serum proinflammatory and anti-inflammatory cytokines (IFN-γ, IL-10, IL-12p70, IL-1β, IL-6, IL-8, AND TNF-α). <h3>Results</h3> Protein expression for Akt, AMPKα, AS160, CaMKII, GLUT4, Hexokinase II, and PI3 Kinase and circulating levels of anti-inflammatory cytokine IL-10 and IFN-γ increased following Comb-NMES training program. <h3>Conclusions</h3> This preliminary data suggests that Comb-NMES training may increase the expression of proteins for glucose uptake and utilization in the paralyzed skeletal muscle. In addition, Comb-NMES training may increase circulating anti-inflammatory cytokines. This trial is ongoing, and results may change with a larger sample size. <h3>Author(s) Disclosures</h3> All authors listed in this abstract have no conflict of interest. this study is funded by NIH.

Brain-machine Interface (BMI)-based Neurorehabilitation for Post-stroke Upper Limb Paralysis.

Because recovery from upper limb paralysis after stroke is challenging, compensatory approaches have been the main focus of upper limb rehabilitation. However, based on fundamental and clinical research indicating that the brain has a far greater potential for plastic change than previously thought, functional restorative approaches have become increasingly common. Among such interventions, constraint-induced movement therapy, task-specific training, robotic therapy, neuromuscular electrical stimulation (NMES), mental practice, mirror therapy, and bilateral arm training are recommended in recently published stroke guidelines. For severe upper limb paralysis, however, no effective therapy has yet been established. Against this background, there is growing interest in applying brain-machine interface (BMI) technologies to upper limb rehabilitation. Increasing numbers of randomized controlled trials have demonstrated the effectiveness of BMI neurorehabilitation, and several meta-analyses have shown medium to large effect sizes with BMI therapy. Subgroup analyses indicate higher intervention effects in the subacute group than the chronic group, when using movement attempts as the BMI-training trigger task rather than using motor imagery, and using NMES as the external device compared with using other devices. The Keio BMI team has developed an electroencephalography-based neurorehabilitation system and has published clinical and basic studies demonstrating its effectiveness and neurophysiological mechanisms. For its wider clinical application, the positioning of BMI therapy in upper limb rehabilitation needs to be clarified, BMI needs to be commercialized as an easy-to-use and cost-effective medical device, and training systems for rehabilitation professionals need to be developed. A technological breakthrough enabling selective modulation of neural circuits is also needed.

Neuromuscular Electrical Stimulation Training vs. Conventional Strength Training: A Systematic Review and Meta-Analysis of the Effect on Strength Development.

Happ, KA, and Behringer, M. Neuromuscular electrical stimulation Training vs. conventional strength training: a systematic review and meta-analysis of the effect on strength development. J Strength Cond Res 36(12): 3527-3540, 2022-A systematic review of the current state of literature and a meta-analysis were conducted to compare the strength development between neuromuscular electrical stimulation (NMES) and conventional strength training when training volume is matched. Searches of PubMed and several other databases were conducted for studies that met the following primary inclusion criteria: randomized studies of >20 days duration with a sample size of >4 subjects in each group ("voluntary contraction" [VC] and "electrically stimulated" [ES]) conducted with percutaneous stimulation only in healthy individuals at equal training volume. Finally, a total of 19 studies were included in the analysis. When comparing strength gains between groups (ES-VC), no favorable effect toward a training method could be observed (0.023 hg [95% CI: -0.198 to 0.246, p = 0.836]). Subgroup analyses were performed based on the application type (NMES evoked and NMES onto voluntary contractions) and stimulation frequency. Both analyses revealed no favorable effect and significant difference of groups (significance level set at 0.05). A meta-regression evaluated the relationship between stimulation frequency and effect size difference. The regression showed a tendency of higher stimulation frequencies being associated with higher study effect size differences (predicted effect size = -0.599 + 0.008 (Hz) ( p = 0.176)). The findings indicate that training with NMES results in virtually identical strength gains compared with conventional strength training when training volume is matched. If training with NMES is preferred, the stimulation frequency type (regular or Burst Mode Alternating Current) can be chosen according to preference without loss of effectiveness.

Enhancing Adaptations to Neuromuscular Electrical Stimulation Training Interventions.

Neuromuscular electrical stimulation (NMES) applied to skeletal muscles is an effective rehabilitation and exercise training modality. However, the relatively low muscle force and rapid muscle fatigue induced by NMES limit the stimulus provided to the neuromuscular system and subsequent adaptations. We hypothesize that adaptations to NMES will be enhanced by the use of specific stimulation protocols and adjuvant interventions.