Functional electrical stimulation on paraplegic patients

Abstract

Functional Electrical Stimulation on Paraplegic Patients. We report on clinical and physiological effects of 8 months Functional Electrical Stimulation (FES) of quadriceps femoris muscle on 16 paraplegic patients. Each patient had muscle biopsies, CT-muscle diameter measurements, knee extension strength testing carried out before and after 8 months FES training. Skin perfusion was documented through infrared telethermography and xenon clearance, muscle perfusion was recorded through thallium scintigraphy. After 8 months FES training baseline skin perfusion showed 86 % increase, muscle perfusion was augmented by 87 %. Muscle fiber diameters showed an average increase of 59 % after 8 months FES training. Muscles in patients with spastic paresis as well as in patients with denervation showed an increase in aerob and anaerob muscle enzymes up to the normal range. Even without axonal neurotropic substances FES was able to demonstrate fiberhypertrophy, enzyme adaptation and intracellular structural benefits in denervated muscles. The increment in muscle area as visible on CT-scans of quadriceps femoris was 30 % in spastic paraplegia and 10 % in denervated patients respectively. FES induced changes were less in areas not directly underneath the surface electrodes. We strongly recommend the use of Kern`s current for FES in denervated muscles to induce tetanic muscle contractions as we formed a very critical opinion of conventional exponential current. In patients with conus-cauda-lesions FES must be integrated into modern rehabilitation to prevent extreme muscle degeneration and decubital ulcers. Using FES we are able to improve metabolism and induce positive trophic changes in our patients lower extremities. In spastic paraplegics the functions "rising and walking" achieved through FES are much better training than FES ergometers. Larger muscle masses are activated and an increased heart rate is measured, therefore the impact on cardiovascular fitness and metabolism is much greater. This effectively addresses and prevents all problems which result from inactivity in paraplegic patients.

Functional electrical stimulation as a safe and effective treatment for equine epaxial muscle spasms: Clinical evaluations and histochemical morphometry of mitochondria in muscle biopsies

“…[6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] The benefits of this technology are being expanded into other areas, and FES has been recently utilized for injury rehabilitation and performance enhancement in horses. [24][25][26][27] The ability of FES to obtain precise, controlled functional movement, when compared to other electrotherapy approaches, is intriguing.…”

“…The increases in mitochondrial density and distribution could be the result of the adaptive mechanisms of the muscle fibers to the increased number of contractions per week and of the associated increase in muscle perfusion. 6,7 In conclusion, the present data from the histological evaluation of the equine longissimus lumborum muscle pre and post 22 treatments of FES over a period of 8 weeks shows that: 1) As expected for the type of FES treatment used in this study, only a couple of horses showed significant increases in mean muscle fiber size when Pre-vs Post-FES biopsies were compared; 2) In the older horses, there were sparse (or many in one horse) very atrophic and angulated muscle fibers in both Pre-and Post-FES samples, whose attributes and distribution suggests that they were denervated due to a distal neuropathy; 3) The hypothesis of generalized FES-induced muscle fiber damage during epaxial muscle training is not supported by our data since: 3.1) Denervated muscle fibers were also present in the Pre-FES biopsies and 3.2) Only one horse presented many long-term denervated muscles fibers Post-FES; 4) Preliminary data indicate an increased density and distribution of mitochondria in Post-FES biopsies, suggesting that the clinical improvements in the FES treated horses may be related to daily increased muscle contraction and perfusion induced by FES training. Finally, we stress that FES treatment, as here provided, is a safe rehabilitation strategy in the management of equine epaxial muscle spasms and provides clinical improvements and some structural changes of the muscle tissue at the histological level.…”

Functional electrical stimulation as a safe and effective treatment for equine epaxial muscle spasms: Clinical evaluations and histochemical morphometry of mitochondria in muscle biopsies

“…The increases in mitochondrial density and distribution could be the result of the adaptive mechanisms of the muscle fibers to the increased number of contractions per week and of the associated increase in muscle perfusion. 6 , 7 …”

Home-based Functional Electrical Stimulation for long-term denervated human muscle: History, basics, results and perspectives of the Vienna Rehabilitation Strategy

“…The thesis is now reprinted in the special issues “The long-term denervated muscle”. 48 The English abstract is provided in the following paragraph.…”