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

Abstract

We will here discuss the following points related to Home-based Functional Electrical Stimulation (h-b FES) as treatment for patients with permanently denervated muscles in their legs: 1. Upper (UMN) and lower motor neuron (LMN) damage to the lower spinal cord; 2. Muscle atrophy/hypertrophy versus processes of degeneration, regeneration, and recovery; 3. Recovery of twitch- and tetanic-contractility by h-b FES; 4. Clinical effects of h-b FES using the protocol of the “Vienna School”; 5. Limitations and perspectives. Arguments in favor of using the Vienna protocol include: 1. Increased muscle size in both legs; 2. Improved tetanic force production after 3-5 months of percutaneous stimulation using long stimulus pulses (> 100 msec) of high amplitude (> 80 mAmp), tolerated only in patients with no pain sensibility; 3. Histological and electron microscopic evidence that two years of h-b FES return muscle fibers to a state typical of two weeks denervated muscles with respect to atrophy, disrupted myofibrillar structure, and disorganized Excitation-Contraction Coupling (E-CC) structures; 4. The excitability never recovers to that typical of normal or reinnervated muscles where pulses less than 1 msec in duration and 25 mAmp in intensity excite axons and thereby muscle fibres. It is important to motivate these patients for chronic stimulation throughout life, preferably standing up against the load of the body weight rather than sitting. Only younger and low weight patients can expect to be able to stand-up and do some steps more or less independently. Some patients like to maintain the h-b FES training for decades. Limitations of the procedure are obvious, in part related to the use of multiple, large surface electrodes and the amount of time patients are willing to use for such muscle training.

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.…”

Modulation of trophism and fiber type gene expression in denervated muscle activated by different patterns of electrical stimulation. Role of muscle fiber regeneration revisited in 2017

“…There is, however, another group of patients whose problems are more difficult to treat. Persons suffering with complete Conus and Cauda Equina syndrome present with severe secondary medical problems because of the marked atrophy of denervated muscles and the associated loss of bone mass and skin dystrophy [1]. In these patients injury also results in irreversible loss of the nerve supply to some or all of the affected limbs (flaccid paralysis due to lower motor neuron lesion).…”

“…Sixty years of basic research [1,2] concerning electrostimulationdriven muscle plasticity has, in recent years, prompted clinical trials which investigate the use of long impulse biphasic electrical stimulation as a treatment for human denervated muscle intended to improve tissue trophism and to increase muscle power to a level sufficient to restore standing and step training [3][4][5][6][7][8][9]. These treatments usually start late after denervation because of clinical constraints and/or the outdated beliefs that electrical stimulation is useless in these cases and may actually interfere with eventual myofiber reinnervation.…”

The Ejtm Specials “Mobility in Elderly”

“…16 We would like to add to Clara's many merits, the pioneering electron microscopy study in the field of muscle denervation: her 1963 article "An electron microscope study of denervation atrophy in red and white skeletal muscle fibers". 17 Standing on the shoulders of these giants, two of us contributed to the EJTM Special three articles that describe history and results of an application of the concepts and discoveries of Bruce 18 Analytical tools and devices, designed and implemented to diagnose, treat and follow up the Conus Cauda complete syndrome that paralyze large muscles of human legs are also described. 18 Among the new analytical tools, Gargiulo P, Helgason T, Ramon C, Jónsson H jr, Carraro U describes "CT and MRI assessment and characterization using segmentation and 3D modeling techniques: applications to muscle, bone and brain".…”

“…17 Standing on the shoulders of these giants, two of us contributed to the EJTM Special three articles that describe history and results of an application of the concepts and discoveries of Bruce 18 Analytical tools and devices, designed and implemented to diagnose, treat and follow up the Conus Cauda complete syndrome that paralyze large muscles of human legs are also described. 18 Among the new analytical tools, Gargiulo P, Helgason T, Ramon C, Jónsson H jr, Carraro U describes "CT and MRI assessment and characterization using segmentation and 3D modeling techniques: applications to muscle, bone and brain". 19 Recently, a multi-disciplinary team of the Interdepartmental Research Center of Myology of the University of Padua is applying the Vienna principles to the apparently easier cases of peripheral incomplete denervation of limbs.…”