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.
DESIGN: Cross-sectional survey.
SETTING: Community, 22 countries including all World Health Organization regions.
PARTICIPANTS: Persons (N=12,591) with traumatic or nontraumatic SCI aged 18 years or older.
INTERVENTIONS: Not applicable.
MAIN OUTCOME MEASURES: We estimated the prevalence of problems in 53 areas of functioning from the Brief International Classification of Functioning, Disability and Health (ICF) core set for SCI, long-term context, or ICF rehabilitation set covering 4 domains: impairments in body functions, impairments in mental functions, independence in performing activities, and restrictions in participation. Associations between areas of functioning were identified and visualized using conditional independence graphs.
RESULTS: Participants had a median age of 52 years, 73% were male, and 63% had paraplegia. Feeling tired, bowel dysfunction, sexual functions, spasticity, pain, carrying out daily routine, doing housework, getting up off the floor from lying on the back, pushing open a heavy door, and standing unsupported had the highest prevalence of problems (>70%). Clustering of associations within the 4 functioning domains was found, with the highest numbers of associations within impairments in mental functions. For the whole International Spinal Cord Injury sample, areas with the highest numbers of associations were circulatory problems, transferring bed-wheelchair, and toileting, while for the World Health Organization European and Western Pacific regions, these were dressing upper body, transferring bed-wheelchair, handling stress, feeling downhearted and depressed, and feeling happy.
CONCLUSIONS: In each domain of functioning, high prevalence of problems and high connectivity of areas of functioning were identified. The understanding of problems and the identification of potential targets for intervention can inform decision makers at all levels of the health system aiming to improve the situation of people living with SCI.
METHODS: The model was developed to estimate knee torque from experimentally derived MMG signals and other parameters related to torque production, including the knee angle and stimulation intensity, during NMES-assisted knee extension.
RESULTS: When the relationship between the actual and predicted torques was quantified using the coefficient of determination (R2), with a Gaussian support vector kernel, the R2 value indicated an estimation accuracy of 95% for the training subset and 94% for the testing subset while the polynomial support vector kernel indicated an accuracy of 92% for the training subset and 91% for the testing subset. For the Gaussian kernel, the root mean square error of the model was 6.28 for the training set and 8.19 for testing set, while the polynomial kernels for the training and testing sets were 7.99 and 9.82, respectively.
CONCLUSIONS: These results showed good predictive accuracy for SVR modelling, which can be generalized, and suggested that the MMG signals from paralyzed knee extensors are a suitable proxy for the NMES-assisted torque produced during repeated bouts of isometric knee extension tasks. This finding has potential implications for using MMG signals as torque sensors in NMES closed-loop systems and provides valuable information for implementing this method in research and clinical settings.
METHODS: Six individuals with chronic motor-complete spinal cord injury performed 30-min of sustained FES-leg cycling exercise on two days to induce muscle fatigue. Each participant performed maximum FES-evoked isometric knee extensions before and after the 30-min cycling to determine pre- and post- extension peak torque concomitant with mechanomyography changes.
FINDINGS: Similar to extension peak torque, normalized root mean squared (RMS) and mean power frequency (MPF) of the mechanomyography signal significantly differed in muscle activities between pre- and post-FES-cycling for each quadriceps muscle (extension peak torque up to 69%; RMS up to 80%, and MPF up to 19%). Mechanomyographic-RMS showed significant reduction during cycling with acceptable between-days consistency (intra-class correlation coefficients, ICC = 0.51-0.91). The normalized MPF showed a weak association with FES-cycling duration (ICC = 0.08-0.23). During FES-cycling, the mechanomyographic-RMS revealed greater fatigue rate for rectus femoris and greater fatigue resistance for vastus medialis in spinal cord injured individuals.
INTERPRETATION: Mechanomyographic-RMS may be a useful tool for examining real time muscle function of specific muscles during FES-evoked cycling in individuals with spinal cord injury.
MATERIALS AND METHODS: Six participants with SCI were recruited for a pilot study to investigate the exercise intensity of selected exergames (Move Tennis, Move Boxing, and Move Gladiator Duel) for the potential to improve health. Issues relating to exergaming for individuals with SCI were identified, and a Move Kayaking exergame was conceived using relevant design processes in an iterative manner. These processes included the following: participant needs and requirements, system requirements (hardware), system architecture (physical and operational views), and integration and verification of the finished system. Emphasis was given to operational and physical designs of the Move Kayaking exergame.
RESULTS: Move Boxing, Move Gladiator Duel, and Move Kayaking achieved moderate intensity exercise, while Move Tennis only achieved exercise of low intensity based on participants' metabolic equivalent. However, all four exergames achieved at least moderate intensity based on individuals' ratings of perceived exertion (RPE).
CONCLUSION: The intensity classification while playing Move Boxing, Move Tennis, Move Gladiator Duel, and Move Kayaking, using RPE, reported adequate exercise intensities prescribed by exercise guidelines.
AIM: To compare the physiological responses and user preferences between conventional heavy-bag boxing against a novel form of video game boxing, known as exergaming boxing.
DESIGN: Cross-sectional study.
SETTING: Exercise laboratory setting in a university medical center.
POPULATION: Seventeen participants with SCI were recruited, of which sixteen were male and only one female. Their mean age was 35.6±10.2 years.
METHODS: All of them performed a 15-minute physical exercise session of exergaming and heavy-bag boxing in a sitting position. The study assessed physiological responses in terms of oxygen consumption, metabolic equivalent (MET) and energy expenditure between exergaming and heavy-bag boxing derived from open-circuit spirometry. Participants also rated their perceived exertion using Borg's category-ratio ratings of perceived exertion.
RESULTS: Both exergaming (MET: 4.3±1.0) and heavy-bag boxing (MET: 4.4±1.0) achieved moderate exercise intensities in these participants with SCI. Paired t-test revealed no significant differences (P>0.05, Cohen's d: 0.02-0.49) in the physiological or perceived exertional responses between the two modalities of boxing. Post session user survey reported all the participants found exergaming boxing more enjoyable.
CONCLUSIONS: Exergaming boxing, was able to produce equipotent physiological responses as conventional heavy-bag boxing. The intensity of both exercise modalities achieved recommended intensities for health and fitness benefits.
CLINICAL REHABILITATION IMPACT: Exergaming boxing have the potential to provide an enjoyable, self-competitive environment for moderate-vigorous exercise even at the comfort of their homes.
AIM: To compare the effects of LLLT and HILT as adjuncts to rehabilitation exercises (LL + EX and HL + EX) on clinical outcomes in KOA.
METHODS: Thirty-four adults with mild-to-moderate KOA were randomly allocated to either LL + EX or HL + EX (n = 17 each). Both groups underwent their respective intervention weekly for twelve weeks: LL + EX (400 mW, 830 nm, 10 to 12 J/cm2, and 400 J per session) or HL + EX (5 W, 1064 nm, 19 to 150 J/cm2, and 3190 J per session). The laser probe was placed vertically in contact with the knee and moved in a slow-scan manner on the antero-medial/lateral sides of the knee joint. Participants' Knee Injury and Osteoarthritis Outcome Score (KOOS), Numerical Pain Rating Scale (NPRS), active knee flexion, and Timed Up-and-Go test (TUG) were assessed.
RESULTS: Post intervention, both groups showed improvements in their KOOS, NPRS, active knee flexion, and TUG scores compared to baseline (p < 0.01). The mean difference of change in KOOS, NPRS, and active knee flexion scores for the HL + EX group surpassed the minimal clinically important difference threshold. In contrast, the LL + EX group only demonstrated clinical significance for the NPRS scores.
CONCLUSIONS: Incorporating HILT as an adjunct to usual KOA rehabilitation led to significantly higher improvements in pain, physical function, and knee-related disability compared to LLLT applied in scanning mode.
MATERIALS AND METHODS: This is a multicentre, cross-sectional study involving 5 Health Clinics conducted by Family Medicine Specialists in Malaysia. Convenience sampling of 100 respondents with DM were selected. The International Classifi cation of Functioning, Disability and Health (ICF) based measures were collected using the Comprehensive Core Set for DM. SF-36 and self-administered forms and comorbidity questionnaire (SCQ) were also used.
RESULTS: Ninety-seven percent had Type 2 DM and 3% had Type 1 DM. The mean period of having DM was 6 years. Body functions related to physical health including exercise tolerance (b455), general physical endurance (b4550), aerobic capacity (b4551) and fatiguability (b4552) were the most affected. For body structures, the structure of pancreas (s550) was the most affected. In the ICF component of activities and participation, limitation in sports (d9201) was the highest most affected followed by driving (d475), intimate relationships (d770), handling stress and other psychological demands (d240) and moving around (d455). Only 7% (e355 and e450) in the environmental category were documented as being a relevant factor by more than 90% of the patients.
CONCLUSION: The content validity of the comprehensive ICF Core set DM for Malaysian population were identified and the results show that physical and mental functioning were impaired in contrast to what the respondents perceived as leading healthy lifestyles.
Objectives: Primary objective was to assess database variables, processes involved and web platform for their suitability with a view to provide guidance for a large scale global project. Secondary objective was to capture demographic and selected injury/safety data on patients with T-SCI with a view to formulate prevention strategies.
Setting: Nine centers from Asia.
Methods: All patients with T-SCI admitted for first time were included. International SCI Core Data Set and especially compiled Minimal Safety Data Set were used as data elements. Questionnaire was used for feedback from centers.
Results: Results showed relevance and appropriateness of processes, data variables and web platform of the study. Ease of entering and retrieval of data from web platform was confirmed. Cost of one year IDAPP study was USD 7780. 975 patients were enrolled. 790 (81%) were males. High falls (n = 513, 52%) as a cause and complete injuries (n = 547, 56%) were more common. There was a higher percentage of thoracic and lumbar injuries (n = 516, 53%).
Conclusions: The study confirms that establishing the SCI database is possible using the variables, processes and web platform of the pilot study. It also provides a low cost solution. Expansion to other centers/regions and including non-traumatic SCI would be the next step forward.