Neuromuscular Electrical Stimulation Versus Volitional Isometric Strength Training in Children With Spastic Diplegic Cerebral Palsy: A Preliminary Study

Stackhouse, Scott K.; Binder‐Macleod, Stuart A.; Stackhouse, Carrie; McCarthy, James J.; Prosser, Laura A.; Lee, Samuel C. K.

doi:10.1177/1545968306298932

Cited by 79 publications

(114 citation statements)

References 59 publications

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“…

The primary purpose was to investigate the independent effects of current amplitude, pulse duration, and current frequency on muscle fatigue during neuromuscular electrical stimulation (NMES).

…”

mentioning

confidence: 99%

Effects of Electrical Stimulation Parameters on Fatigue in Skeletal Muscle

Gorgey¹,

Black²,

Elder³

et al. 2009

J Orthop Sports Phys Ther

124

120

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N euromuscular electrical stimulation (NMES) is a promising tool in the rehabilitation of individuals with a limited ability to activate their skeletal muscles, 13,35,36 as well as a method of strength training and short-term resistance training in athletic populations. 26,27 During NMES application, the capacity to maintain performance is compromised compared to voluntary exercise, Experimental laboratory study.The primary purpose was to investigate the independent effects of current amplitude, pulse duration, and current frequency on muscle fatigue during neuromuscular electrical stimulation (NMES). A second purpose was to determine if the ratio of the evoked torque to the activated area could explain muscle fatigue.Parameters of NMES have been shown to differently affect the evoked torque and the activated area. The efficacy of NMES is limited by the rapid onset of muscle fatigue.Seven healthy participants underwent 4 NMES protocols that were randomly applied to the knee extensor muscle group. The NMES protocols were as follows: standard protocol (Std), defined as 100-Hz, 450-μs pulses and amplitude set to evoke 75% of maximal voluntary isometric torque (MVIT); short pulse duration protocol (SP), defined as 100-Hz, 150-μs pulses and amplitude set to evoke 75% of MVIT; low-frequency protocol (LF), defined as 25-Hz, 450-μs pulses and amplitude set to evoke 75% of MVIT; and low-amplitude protocol (LA), defined as 100-Hz, 450-μs pulses and amplitude set to evoke 45% of MVIT. The peak torque was measured at the start and at the end of the 4 protocols, and percent fatigue was calculated. The outcomes of the 4 NMES protocols on the initial peak torque and activated cross-sectional area were recalculated from a companion study to measure torque per active area.Decreasing frequency from 100 to 25 Hz decreased fatigue from 76% to 39%. Decreasing the amplitude and pulse duration resulted in no change of muscle fatigue. Torque per active area accounted for 57% of the variability in percent fatigue between Std and LF protocols.Altering the amplitude of the current and pulse duration does not appear to influence the percent fatigue in NMES. Lowering the stimulation frequency results in less fatigue, by possibly reducing the evoked torque relative to the activated muscle area.

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“…

The primary purpose was to investigate the independent effects of current amplitude, pulse duration, and current frequency on muscle fatigue during neuromuscular electrical stimulation (NMES).

…”

mentioning

confidence: 99%

Effects of Electrical Stimulation Parameters on Fatigue in Skeletal Muscle

Gorgey¹,

Black²,

Elder³

et al. 2009

J Orthop Sports Phys Ther

124

120

View full text Add to dashboard Cite

show abstract

“…2,4 Force responses were elicited using trains of electrical stimuli with different stimulus patterns (i.e. CFTs, VFTs, and DFTs; Fig.…”

Section: Methodsmentioning

confidence: 99%

“…6 A recent study revealed that high-intensity electrical stimulation is more effective in producing gains in strength and walking velocity than voluntary isometric exercise. 4 Electrical stimulation generated higher forces and maintained greater average force throughout exercise than volitional effort, which is affected by impaired activation. One emerging intervention for individuals with CP is FESassisted cycling 7 to improve coordination and to increase power output and exercise intensity for cardiovascular fitness training.…”

Section: Cftmentioning

confidence: 99%

“…2,4 In brief, an anesthetic was applied to the skin over the muscles where the surface electrodes would be placed. This cream was used to reduce discomfort during electrical stimulation and to reduce the possibility for reflex responses.…”

Section: 4mentioning

confidence: 99%

“…1c) muscle groups were described in detail previously. 2,4 Both testing configurations allowed the children to watch videos when their attention was not required. All stimulation trains were delivered using a Grass S88 stimulator (Grass Instruments, West Warwick, RI, USA) equipped with a Grass Model SIU8T stimulus isolation unit controlled by a personal computer used to trigger the delivery of each stimulation pulse and to record all force data, which was analyzed off line.…”

Section: 4mentioning

confidence: 99%

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A predictive mathematical model of muscle forces for children with cerebral palsy

Lee

Ding

Prosser

et al. 2009

Develop Med Child Neuro

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Aim The purpose of this study was to determine if our previously developed muscle model could be used to predict forces of the quadriceps femoris and triceps surae muscles of children with spastic diplegic cerebral palsy (CP). Method Twenty‐two children with CP (12 males, 10 females; mean age 10y, SD 2y, range 7–13y; Gross Motor Function Classification System levels II and III) participated. A physiologically based mathematical model with four free parameters is presented. Results For individuals with CP, the model predicted well the force profile throughout each contraction and both peak force and force–time integral responses to a wide range of stimulation frequencies (5–100Hz) and different stimulation patterns (constant‐, variable‐, and doublet‐frequency trains) both for nonfatigued and fatigued muscles. Interpretation The significance of this work is the insight the model can provide into the physiology of muscle in CP. Additionally, the model can potentially be applied clinically to design optimal electrical stimulation patterns for interventions to address impairments in strength and function in individuals with CP, such as functional electrical stimulation‐assisted cycling.

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Exercise interventions for cerebral palsy

Ryan

Cassidy²,

Noorduyn

et al. 2017

Cochrane Database of Systematic Reviews

130

166

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The quality of evidence for all conclusions is low to very low. As included trials have small sample sizes, heterogeneity may be underestimated, resulting in considerable uncertainty relating to effect estimates. For children with CP, there is evidence that aerobic exercise may result in a small improvement in gross motor function, though it does not improve gait speed. There is evidence that resistance training does not improve gait speed, gross motor function, participation or quality of life among children with CP.Based on the evidence available, exercise appears to be safe for people with CP; only 55% of trials, however, reported adverse events or stated that they monitored adverse events. There is a need for large, high-quality, well-reported RCTs that assess the effectiveness of exercise in terms of activity and participation, before drawing any firm conclusions on the effectiveness of exercise for people with CP. Research is also required to determine if current exercise guidelines for the general population are effective and feasible for people with CP.

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Neuromuscular Electrical Stimulation Versus Volitional Isometric Strength Training in Children With Spastic Diplegic Cerebral Palsy: A Preliminary Study

Abstract: Background-To date, no reports have investigated neuromuscular electrical stimulation (NMES) to increase muscle force production of children with cerebral palsy (CP) using high-force contractions and low repetitions.

Cited by 79 publications

References 59 publications

Effects of Electrical Stimulation Parameters on Fatigue in Skeletal Muscle

Effects of Electrical Stimulation Parameters on Fatigue in Skeletal Muscle

A predictive mathematical model of muscle forces for children with cerebral palsy

Exercise interventions for cerebral palsy

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