METHODS: Published scientific literature pertaining to the reduction of FES-induced muscle fatigue was identified through searches of the following databases: Science Direct, Medline, IEEE Xplore, SpringerLink, PubMed and Nature, from the earliest returned record until June 2015. Titles and abstracts were screened to obtain 35 studies that met the inclusion criteria for this systematic review.
RESULTS: Following the evaluation of methodological quality (mean (SD), 50 (6) %) of the reviewed studies using the Downs and Black scale, the largest treatment effects reported to reduce muscle fatigue mainly investigated isometric contractions of limited functional and clinical relevance (n = 28). Some investigations (n = 13) lacked randomisation, while others were characterised by small sample sizes with low statistical power. Nevertheless, the clinical significance of emerging trends to improve fatigue-resistance during FES included (i) optimizing electrode positioning, (ii) fine-tuning of stimulation patterns and other FES parameters, (iii) adjustments to the mode and frequency of exercise training, and (iv) biofeedback-assisted FES-exercise to promote selective recruitment of fatigue-resistant motor units.
CONCLUSION: Although the need for further in-depth clinical trials (especially RCTs) was clearly warranted to establish external validity of outcomes, current evidence was sufficient to support the validity of certain techniques for rapid fatigue-reduction in order to promote FES therapy as an integral part of SCI rehabilitation. It is anticipated that this information will be valuable to clinicians and other allied health professionals administering FES as a treatment option in rehabilitation and aid the development of effective rehabilitation interventions.
METHODOLOGY/PRINCIPAL FINDINGS: Five electronic databases were extensively searched for potentially eligible studies published between 2003 and 2012. Two authors independently assessed selected articles using an MS-Word based form created for this review. Several domains (name of muscle, study type, sensor type, subject's types, muscle contraction, measured parameters, frequency range, hardware and software, signal processing and statistical analysis, results, applications, authors' conclusions and recommendations for future work) were extracted for further analysis. From a total of 2184 citations 119 were selected for full-text evaluation and 36 studies of MFs were identified. The systematic results find sufficient evidence that MMG may be used for assessing muscle fatigue, strength, and balance. This review also provides reason to believe that MMG may be used to examine muscle actions during movements and for monitoring muscle activities under various types of exercise paradigms.
CONCLUSIONS/SIGNIFICANCE: Overall judging from the increasing number of articles in recent years, this review reports sufficient evidence that MMG is increasingly being used in different aspects of MF. Thus, MMG may be applied as a useful tool to examine diverse conditions of muscle activity. However, the existing studies which examined MMG for MFs were confined to a small sample size of healthy population. Therefore, future work is needed to investigate MMG, in examining MFs between a sufficient number of healthy subjects and neuromuscular patients.
METHODS: Twenty male participants performed repetitive submaximal (60% MVIC) grip muscle contractions to induce muscle fatigue and the results were analyzed during the pre- and post-fatigue MVIC. MMG signals were recorded on the extensor digitorum (ED), extensor carpi radialis longus (ECRL), flexor digitorum superficialis (FDS) and flexor carpi radialis (FCR) muscles. The cross-correlation coefficient was used to quantify the cross-talk values in forearm muscle pairs (MP1, MP2, MP3, MP4, MP5 and MP6). In addition, the MMG RMS and MMG MPF were calculated to determine force production and muscle fatigue level, respectively.
RESULTS: The fatigue effect significantly increased the cross-talk values in forearm muscle pairs except for MP2 and MP6. While the MMG RMS and MMG MPF significantly decreased (p<0.05) based on the examination of the mean differences from pre- and post-fatigue MVIC.
CONCLUSION: The presented results can be used as a reference for further investigation of cross-talk on the fatigue assessment of extensor and flexor muscles' mechanic.