Metabolic and cardiorespiratory responses of tetraplegic subjects during treadmill walking using neuromuscular electrical stimulation and partial body weight support

Abstract

Study design: Determination of differences in the cardiorespiratory responses of tetraplegic subjects with incomplete and complete lesions during treadmill gait and endurance exercise provided by neuromuscular electrical stimulation (NMES). Differences between rest and exercise phases were also examined. Objectives: To compare the cardiorespiratory responses in tetraplegic individuals during endurance exercise in the sitting position and treadmill gait with 30-50% body weight relief, both provided by NMES. Setting: Rehabilitation Ambulatory at University Hospital, Brazil. Methods: A total of 31 tetraplegic subjects were evaluated. Individuals were separated into two groups: gait group and endurance exercise group. In the gait group (n ¼ 17), the exercise protocol consisted of three different phases: 8 min of rest, 10 min of treadmill walking using NMES and 10 min of recovery. In the endurance exercise group (n ¼ 14), the cardiorespiratory test consisted of 8 min of rest, 15 min of quadriceps endurance exercise in the sitting position by NMES and 10 min of recovery. Oxygen uptake (VO 2 ), carbon dioxide production (VCO 2 ), respiratory exchange ratio (RER), pulmonary ventilation (V E ) and heart rate (HR) were measured. Results: All parameters increased considerably in the gait group from rest to the walking phase, although individuals with incomplete lesions presented a more pronounced increase than those with complete lesion. In the gait group, for incomplete tetraplegics, the mean VO 2 peak was 0.81670.314 l/min, corresponding to 11.4173.11 ml/kg/min; the mean value for VCO 2 was 0.66070.24 l/min, mean HR was 124.54728.72 bpm and mean V E was 28.3876.28 l/min. In the endurance exercise group, for incomplete tetraplegics, the mean VO 2 peak was 0.24670.07 l/ min, corresponding to 3.8470.92 ml/kg/min; the mean value for VCO 2 was 0.20570.06 l/min, mean HR was 71.45715.51 bpm and mean V E was 11.8372.72 l/min. In the endurance exercise group, smaller differences were observed in all variables from rest to the exercise phase, compared with the large increases observed in the gait group. Conclusions: These preliminary results have shown that gait training probably improves physical capacity in tetraplegic individuals more than the endurance exercise. www.nature.com/sc injured subjects, increases the ability to perform daily activities and reduces medical complications. Neuromuscular electrical stimulation (NMES) in spinal cord injured subjects allows the activation of paralyzed muscles through electrical stimulation of intact periphery motoneurons. 3 Thus, NMES has been used extensively in order to provide walking function 4 and to study the action of the spinal cord in the control of movement, using the concept of task-oriented training, which suggests that sensory input can produce the basic motor pattern. 5 Gait training on the treadmill provides a constant rate of movement and rhythm, which stimulates the reciprocal coordination of the lower limbs. 6 Moreover, NMES activates the large muscle mass, increases str...

Clinical and radiographic evaluation of the shoulder of spinal cord injured patients undergoing rehabilitation program

“…For the paraplegic, the same stimulation pattern is applied but they use walkers, as they can have trunk control alone. 5,6 Sixteen patients from the Spinal Cord Injuries' Rehabilitation Ambulatory (outpatient clinic) participated in this study and 16 normal subjects voluntarily composed the control group. The study was approved by the local ethics committee.…”

Electrical Stimulation During Gait Promotes Increase of Muscle Cross-sectional Area in Quadriplegics: A Preliminary Study

“…Muscle atrophy is one of many alterations occurring after spinal cord injury; it contributes to various medical complications, such as fractures, deep venous thrombosis [1], cardiovascular deconditioning [5], and early fatigability during neuromuscular electrical stimulation (NMES) [15]. Decrease in average muscle cross-sectional area (CSA) [8], replacement of Type I muscle fibers by Type II fibers [4], infiltration of adipose tissue inside muscles, reduction in the oxidative enzyme level, mitochondria concentration, and number of capillaries are observed in muscles located below the injury level [3,18,21].…”

“…The positive muscle alterations provided by NMES also can benefit the oxygen consumption [5,10,12,17] and bone mass of individuals with spinal cord injury [2,6,19].…”

Electrical stimulation and treadmill gait in tetraplegic patients: assessment of its effects on the knee with magnetic resonance imaging

“…It would be rather relevant to take a closer look on the knees of tetraplegic patients through magnetic resonance image (MRIs), in order to obtain a broader picture of their rehabilitation program, following previous studies showing the benefits obtained with treadmill gait and NMES. 1,6,18 …”

“…The classical rehabilitation protocol that is used below the level of lesion in tetraplegic patients underwent several changes during the last decades, because a 'cure' for SCI started to be possible in the foreseeable future [1][2][3][4][5][6] owing to the increasing number of incomplete lesions, the rising life expectancy in SCI patients and the promising therapeutical modalities brought by the fast technological and medical development. [7][8][9][10] This change made necessary the development of therapeutical means to keep the neuromuscular system under conditioning below the level of lesion, keeping it able to respond properly to challenge brought by new interventions, such as locomotor training with harness support, treadmill apparatus and neuromuscular electrical stimulation (NMES).…”