Muscle Electrical Impedance Properties and Activation Alteration After Functional Electrical Stimulation-Assisted Cycling Training for Chronic Stroke Survivors: A Longitudinal Pilot Study

Abstract

Electrical impedance myography (EIM) is a sensitive assessment for neuromuscular diseases to detect muscle inherent properties, whereas surface electromyography (sEMG) is a common technique for monitoring muscle activation. However, the application of EIM in detecting training effects on stroke survivors is relatively few. This study aimed to evaluate the muscle inherent properties and muscle activation alteration after functional electrical stimulation (FES)-assisted cycling training to chronic stroke survivors. Fifteen people with chronic stroke were recruited for 20 sessions of FES-assisted cycling training (40 min/session, 3–5 sessions/week). The periodically stimulated and assessed muscle groups were quadriceps (QC), tibialis anterior (TA), hamstrings (HS), and medial head of gastrocnemius (MG) on the paretic lower extremity. EIM parameters [resistance (R), reactance (X), phase angle (θ), and anisotropy ratio (AR)], clinical scales (Fugl-Meyer Lower Extremity (FMA-LE), Berg Balance Scale (BBS), and 6-min walking test (6MWT)] and sEMG parameters [including root-mean square (RMS) and co-contraction index (CI) value] were collected and computed before and after the training. Linear correlation analysis was conducted between EIM and clinical scales as well as between sEMG and clinical scales. The results showed that motor function of the lower extremity, balance, and walking performance of subjects improved after the training. After training, θ value of TA (P = 0.014) and MG (P = 0.017) significantly increased, and AR of X (P = 0.004) value and AR of θ value (P = 0.041) significantly increased on TA. The RMS value of TA decreased (P = 0.022) and a significant reduction of CI was revealed on TA/MG muscle pair (P < 0.001). Significant correlation was found between EIM and clinical assessments (AR of X value of TA and FMA-LE: r = 0.54, P = 0.046; X value of TA and BBS score: 0.628, P = 0.016), and between sEMG and clinical scores (RMS of TA and BBS score: r = −0.582, P = 0.029). This study demonstrated that FES-assisted cycling training improved lower limb function by developing coordinated muscle activation and facilitating an orderly myofiber arrangement. The current study also indicated that EIM can jointly evaluate lower extremity function alteration with sEMG after rehabilitation training.Clinical Trail Registration: The study was registered on the Clinical Trial Registry (trial registration number: NCT 03208439, https://clinicaltrials.gov/ct2/show/NCT03208439).

Conjunct Effects of Supported Standing and Functional Electrical Stimulation on Strength and Functional Mobility in Acute Stroke: A Randomized Clinical Trial

“…A study conducted by Hu C et al, to find out the outcomes of FES along with cyclic training on post-stroke patients concluded significa nt effects on muscle activation and tone. 23 According to Ambrosini E et al, the loss of strength and motor coordination in the lower extremity in post-stroke patients were the prominent deficits causing long-term functional limitations. Multiple treatments along with different methods of assessment were used to assess the improvement in stroke patients, neuromechanical analysis suggests that functional electrical stimulation along with different treatments like cycles could improve the motor function and walking ability of the sub-acute stroke patient.…”

Immediate Effects of Functional Electrical Stimulation-Assisted Cycling on the Paretic Muscles of Patients With Hemiparesis After Stroke: Evidence From Electrical Impedance Myography

“…During the training sessions, subjects were seated on the chair of the system and pedaled with FES assistance. A goniometer was applied to measure the angles of both knees while adjusting the distance between the chair and the cycling system to ensure a maximum knee extension angle of approximately 140–150° when pedaling ( Hu et al, 2021 ).…”

“…The intensity of the stimulation of these 4 muscles was determined by taking the FES amplitude that induced a visible twitch on the corresponding muscles without causing any pain or discomfort to the subjects ( Figure 1B ). Detailed information about FES-assisted cycling training can be found in our previous study ( Hu et al, 2021 ).…”

Electrical impedance myography combined with quantitative assessment techniques in paretic muscle of stroke survivors: Insights and challenges

“…From a mechanistic perspective, the relationships between EIM data and EMG parameters, especially compound muscle action potentials, have been demonstrated in persons with various neuromuscular disease over the years ( Li et al, 2013 , 2014 , 2017f ; Arnold et al, 2016 , 2017 ; de Carvalho and Swash, 2016 ; Kolb et al, 2016 ; Zong et al, 2018 ). Our team has demonstrated the potential of the EIM and EMG to jointly evaluate lower-extremity muscle function and to assess the impact of rehabilitation training in a clinical setting ( Hu et al, 2021a ; Li et al, 2022 ). Both active and passive muscle properties were assessed at the same time, which could advance the understanding of muscle dysfunction.…”

“…• EIM is a promising biomarker in assessment of muscle function in neuromuscular diseases and its relationships with other electrophysiological measures have been well-established in various neuromuscular diseases. Hu et al, 2021a;Ngo et al, 2022 • Applying EIM and EMG simultaneously could provide more comprehensive information of the inherent properties and muscle activation alteration.…”