Prevention of muscle disuse atrophy by low-frequency electrical stimulation in rats

When muscles lose neural drive, they atrophy rapidly. Neuromuscular electrical stimulation (NMS) has been used in attempts to prevent or reverse the atrophy, but optimal stimulation programs and parameters are not well defined. In this study, we investigated the effects of four different stimulation patterns on disuse atrophy produced in the tibialis anterior, lateral gastrocnemius, and soleus muscles of rats paralyzed with tetrodotoxin for seven days. Stimulation paradigms differed from one another by their stimulation frequency (2 or 10 pulses/s) and by their stimulation period (2 or 10 h a day). Results showed that stimulation with 2 pulses/s, paradigms were more effective at preventing disuse muscle atrophy than higher-frequency stimulation. The most marked difference was in the slow soleus muscle, which had only 10% mean atrophy when stimulated at 2 pulses/s for 10 h, compared to 26% atrophy when stimulated at 10 pulses/s for either 2 or 10 h and 32% atrophy in unstimulated, paralyzed controls. The level of atrophic change was not correlated with the levels of serum creatine kinase, used as an index of muscle damage. Results suggest that remediation of disuse atrophy may be accomplished using unphysiologically low rates of motor-unit activation despite the relatively low force produced by such unfused contractions. This may have significant implications for the design of therapies for muscle paralysis consequent to upper-motoneuron lesions.     

Predictor-based compensation for electromechanical delay during neuromuscular electrical stimulation

Electromechanical delay (EMD) is a biological artifact that arises due to a time lag between electrical excitation and tension development in a muscle. EMD is known to cause degraded performance and instability during neuromuscular electrical stimulation (NMES). Compensating for such input delay is complicated by the unknown nonlinear muscle force-length and muscle force-velocity relationships. This paper provides control development and a mathematical stability analysis of a NMES controller with a predictive term that actively accounts for EMD. The results are obtained through the development of a novel predictor-type method to address the delay in the voltage input to the muscle. Lyapunov-Krasovskii functionals are used within a Lyapunov-based stability analysis to prove semi-global uniformly ultimately bounded tracking. Experiments on able-bodied volunteers illustrate the performance and robustness of the developed controller during a leg extension trajectory following task.     

Effects of muscle immobilization at different lengths on tetrodotoxin-induced disuse atrophy

Previous studies have shown that immobilization causes muscle atrophy and that the rate of atrophy depends on the length at which the muscle is immobilized. However, most studies have been carried out in neurologically intact animals that were capable of generating at least some voluntary muscle activation. In this study, terrodotoxin was applied chronically to the rat sciatic nerve to produce complete paralysis of distal muscles for seven days, and the ankle was immobilized to hold the muscles at long or short lengths. Paralysis without immobilization resulted in relative weight losses of 36% for soleus, 19% for tibialis anterior (TA), and 17% for lateral gastrocnemius (LG) muscles. Casting the ankle in plantarflexion stretched TA and reduced its weight loss to 10%. Soleus and LG were shortened by this intervention and had increased losses of 43% and 28%, respectively. Fixing the limb in dorsiflexion resulted in a posture similar to that adopted by the unrestrained rats and had no significant effect on the amount of muscle atrophy compared to that in unrestrained paralyzed animals.     

Unilateral and bilateral subthalamic nucleus stimulation in Parkinson's disease: effects on EMG signals of lower limb muscles during walking.

The effects of subthalamic nucleus (STN) stimulation on the spatio-temporal organization of locomotor commands directed to lower limb muscles were studied in subjects with idiopathic Parkinson's Disease (PD) by recording the EMG activity produced during steady-state walking in representative thigh (rectus femoris, RF, and semimembranosus, SM) and leg (gatrocnemius medialis, GAM, and tibialis anterior, TA) muscles, under four experimental conditions: basal stimulation OFF, unilateral (right and left) stimulation ON, and bilateral stimulation ON. Locomotor profiles of all of the muscles tested were found to be substantially affected by STN stimulation, either in terms of restoration/enhancement of the main activity bursts or normalization of recruitment timing thereof. Responses showed relatively higher statistical significance in the distal groups (GAM and TA) and, within them, for the EMG components called into action over the ground-contact (ankle dorsiflexors) and midstance (ankle plantarflexors) phases of the stride cycle. In line with data obtained from clinical rating, unilateral stimulation produced less consistent EMG changes compared with bilateral stimulation. However, at variance with clinical effects, which prevailed on the side of the body contralateral to stimulation, EMG responses to unilateral stimulation were usually symmetrical. Results indicate that the impact of STN stimulation on locomotor activation of lower limb muscles in PD is characterized by: 1) substantial effects exhibiting differential topographical (distal versus proximal) and stride-phase (stance versus swing) consistency and 2) absence of the lateralized actions typically observed for the clinical signs of the disease. Interaction with the activity of functionally different executive systems might account for the observed pattern of responsiveness.     

Muscle recruitment through electrical stimulation of the lumbo-sacral spinal cord.

The goal of this study was to determine the feasibility of producing graded muscle contraction in individual muscles or muscle groups by electrically stimulating motor neurons in the lumbo-sacral spinal cord. Recruitment curves were obtained for quadriceps, tibialis anterior and triceps surae/plantaris by stimulating their activation pools in the ventral horn of the feline spinal cord. Mean twitch times-to-peak for quadriceps, tibialis anterior and triceps surae/plantaris were 33.0, 41.0, and 36.0 ms, respectively. Twitch duration as a function of stimulus strength demonstrated a mixed motor unit recruitment order, distinctively different from the inverse recruitment order exhibited by conventional methods of electrical stimulation of peripheral nerve. The recruitment curve slopes (expressed as a percentage of maximum force per nanocurrent of delivered charge) were shallow: 7.9 for quadriceps, 2.6 for tibialis anterior and 8.5 for triceps surae/plantaris. These results show that graded control of force in individual muscles or muscle groups can be obtained through spinal cord stimulation, and suggest that spinal cord stimulation could be used for functional neuromuscular stimulation applications.     

<Superscript>1</Superscript>H NMR relaxation times of skeletal muscle metabolites at 3 T

This study reports proton relaxation times of water and metabolites in soleus and tibialis anterior muscles of young healthy volunteers at 3 T. The results are in agreement with data reported for 1.5 and 4 T, showing a steady increase of spin-lattice relaxation times of water, creatine and lipids with B₀ and no effect of B₀ on spin–spin relaxation. Comparison between muscles revealed a longer spin–spin relaxation time of water in soleus than in tibialis anterior muscle (31±1 ms vs. 28±1 ms, p<0.05). These data can be applied to relaxation correction for the absolute quantification of skeletal muscle metabolite concentrations and further sequence optimization.     

Effect of joint angle on EMG variables in leg and thigh muscles

It is the purpose of this article (a) to show the influence of electrode location on EMG amplitude and spectral variables for simulated and real signals for different muscles of the thigh and leg, (b) to investigate the relative movement of the muscle under the recording electrodes when the joint angle changes for the set of muscles most frequently investigated in gait analysis, and (c) to illustrate how different electrode locations may lead to different interpretations of the muscle activity investigated with amplitude and spectral analysis of the surface EMG signal. The study has been carried out on the following muscles of the leg and thigh: rectus femoris, vastus lateralis, vastus medialis, biceps femoris, semitendinosus, tibialis anterior, gastrocnemius lateralis, and gastrocnemius medialis     

Diffusion property differences of the lower leg musculature between athletes and non-athletes using 1.5T MRI

Object

To compare the differences in diffusion properties—namely fractional anisotropy (FA), three eigenvalues of the diffusion tensor (λ1, λ2, and λ3), and apparent diffusion coefficient (ADC)—between athletically-trained and untrained lower leg musculature.

Materials and methods

Twelve athletes (Group A) and 11 non-athletes (Group B) were recruited. All were females in their 20s. We scanned diffusion tensor images of both calves and compared FA, the three eigenvalues, and ADC in the gastrocnemius medialis, gastrocnemius lateralis, soleus (SOL), and anterior tibialis muscles between Groups A and B, and between the right and left sides, using two-factor fractional ANOVA.

Results

In all muscles of bilateral calves, all three eigenvalues and ADC were lower in Group A than in Group B, with statistically significant differences in all muscles for λ1, λ2, and λ3 and ADC, with a P value of <0.01. Moreover, statistical differences were also found between right and left for λ1, λ2, and λ3 (P?P?Conclusions Our results indicate that training causes a decrease of the three eigenvalues and ADC, which we hypothesize is due to an increase of density of myofilaments in the intracellular space, and deformation of the cell induced by enlargement of extracellular components.     

Effective range of electrical stimulation in brain slice preparations

In order to examine the confines of electrical stimulation in layer 2/3 of the visual cortex in brain slice preparations, we estimated the effective range of stimulation based on the excitatory postsynaptic potential (EPSP) evoked in layer V neurons that receive input from layer 2/3. For this purpose, we recorded and compared ESPS amplitudes evoked by stimulations directly over the site of the recording electrode and at a lateral site in layer 2/3. Since the EPSP increased linearly with stimulus intensity before saturation, it was considered that the EPSP correlates with the number of projecting neurons in an area directly excited by stimulation. Then we formed a region model by which we can obtain the ratios between the neuron numbers in areas excited by different site stimulations against the stimulus effective ranges. In the stimulus intensity for the action potential threshold of layer 5 neurons, we evaluated the effective range for the relative values of EPSP produced by stimulations 250‐μm lateral sites and directly over the site. In the model, the ratio increased monotonically with the effective range and in the case of 250 μm for the effective range, the ratio between these EPSP was less than the value in the model. These results led to the conclusion that the effective range of the intensity for layer 5 neurons to generate an output is confined within 250 μm of a point directly over the site, that is, within layer 2/3. © 1999 Scripta Technica, Electr Eng Jpn, 127(1): 56–63, 1999     

Medial Gastrocnemius Myoelectric Control of a Robotic Ankle Exoskeleton

A previous study from our laboratory showed that when soleus electromyography was used to control the amount of plantar flexion assistance from a robotic ankle exoskeleton, subjects significantly reduced their soleus activity to quickly return to normal gait kinematics. We speculated that subjects were primarily responding to the local mechanical assistance of the exoskeleton rather than directly attempting to reduce exoskeleton mechanical power via decreases in soleus activity. To test this observation we studied ten healthy subjects walking on a treadmill at 1.25 m/s while wearing a robotic exoskeleton proportionally controlled by medial gastrocnemius activation. We hypothesized that subjects would primarily decrease soleus activity due to its synergistic mechanics with the exoskeleton. Subjects decreased medial gastrocnemius recruitment by 12% (${ p}≪ 0.05$ ) but decreased soleus recruitment by 27% ( ${ p}≪ 0.05$). In agreement with our hypothesis, the primary reduction in muscle activity was not for the control muscle (medial gastrocnemius) but for the anatomical synergist to the exoskeleton (soleus). These findings indicate that anatomical morphology needs to be considered carefully when designing software and hardware for robotic exoskeletons.      

The relationship between electrical stimulus and joint torque: a dynamic model.

The knowledge of the behavior of electrically activated muscles is an important requisite for the development of functional electrical stimulation (FES) systems to restore mobility to persons with paralysis. The aim of this work was to develop a model capable of relating electrical parameters to dynamic joint torque for FES applications. The knee extensor muscles, stimulated using surface electrodes, were used for the experimental preparation. Both healthy subjects and people with paraplegia were tested. The dynamics of the lower limb were represented by a nonlinear second order model, which took account of the gravitational and inertial characteristics of the anatomical segments as well as the damping and stiffness properties of the knee joint. The viscous-elastic parameters of the system were identified experimentally through free pendular movements of the leg. Leg movements induced by quadriceps stimulation were acquired too, using a motion analysis system. Results showed that, for the considered experimental conditions, a simple one-pole transfer function is able to model the relationship between stimulus pulsewidth (PW) and active muscle torque. The time constant of the pole was found to depend on the stimulus pattern (ramp or step) while gain was directly dependent on stimulation frequency.     

足底动静脉脉冲系统的设计与实现

足底动静脉（arteriovenous，AV）脉冲系统模拟人行走时腿部血液循环的生理过程，促进血液流动，针对下肢不能行走的病人，对足底动静脉间歇加压，减少静脉淤滞，可有效的预防下肢深静脉栓塞的形成，降低血栓症及其并发症的风险。本文重点讨论了足底动静脉脉冲系统的硬件和软件的设计与实现方法。根据下肢静脉血流的典型生理值，给出了硬件设计原理和主要电路的设计方法，阐述了脉冲压力的控制方法。完成了全部样机设计与实验。实验表明，本文给出的设计方法是合理正确的。     

Development of an indoor rowing machine with manual FES controller for total body exercise in paraplegia

Concept 2 indoor rowing machine (Concept 2 Inc., USA) was modified for functional electrical stimulation (FES) rowing exercise in paraplegia. A new seating system provides trunk stability and constrains the leg motion to the sagittal plane. A 4-channel electrical stimulator activates the quadriceps and hamstrings in Drive and Recovery phases of the rowing cycle, respectively. Two force-sensing resistors (FSR) on the handle measure the thumb press as the command signal to the electrical stimulator. Optical encoders measure the positions of the seat and handle during rowing. To synchronize the voluntarily controlled upper body movement with the FES controlled leg movement, a novel manual control system was developed. It uses the voluntary thumb presses to control the timing of the stimulation to the paralyzed leg muscles. The manual control system was intuitive and easy to learn and resulted in well-coordinated rowing. Evaluation of the modified rower by paraplegic volunteers showed that it is effective, safe, and affordable exercise alternative for paraplegics.     

Evaluation of a suture electrode for direct bladder stimulation in a lower motor neuron lesioned animal model.

The purpose of this study was to evaluate a "suture" type electrode for direct bladder stimulation in an animal model of a lower motor neuron lesion. During an initial surgery, five male cats were instrumented under anesthesia using multistranded, 316 LVM, stainless-steel, wire electrodes implanted on the bladder wall serosa above the trigone area. Electrodes were constructed with a needle attached to the end that was removed after suturing the electrode in place. Additional instrumentation included urinary bladder catheters (tubes) for pressure recording and filling, and hook type electrodes for leg and pelvic floor electromyography recording. Chronic bladder filling and stimulation studies were conducted in tethered animals three to four weeks following surgery. To test these electrodes in a spinal cord injury model, a lower motor neuron lesion was performed including the sacral cord and complete nerve roots at L6 and below. These animals were evaluated during weeks 3 and 10 after injury. Direct bladder stimulation induced active contractions and voiding both before and after spinal cord injury. Effective stimulation parameters consisted of 40 pulses per s, 300 micros to 1 ms pulse duration, a stimulation period from 3 to 4 s, and a stimulation current from 10 to 40 mA. Fluoroscopy revealed an open membranous urethra during stimulation and following stimulation. A small diameter penile urethra was observed to limit flow. Postmortem evaluation of the suture electrode revealed no abnormalities such as corrosion, migration into the bladder lumen or displacement. These findings indicate that suture electrodes are suitable and effective for short-term implantation in the lower motor neuron animal model.     

Inotropic effects of the K+ channel blocker 3,4-diaminopyridine: differential responses of rat soleus and extensor digitorum longus.

The K+ channel blocker 3,4-diaminopyrindine (DAP) increases diaphragm force, use of which could potentially improve muscle performance during functional neuromuscular stimulation. To determine the extent of hindlimb muscle force augmentation, and delineate whether DAP effects vary in muscles comprised of mainly slow versus fast fibers, rat soleus, extensor digitorum longus (EDL) and diaphragm muscle samples were studied in vitro. DAP increased force of all three muscles, but at high concentrations the force increases were transient and were followed by declines in force below baseline. The maximum DAP-induced twitch force increase was smaller for soleus (38 +/-7%) than both EDL (94+/-12%) (P < 0.05) and diaphragm (93+/-13%) (P < 0.01). During fatigue-inducing 20 Hz stimulation (tested at an intermediate DAP concentration), force of soleus muscle remained significantly elevated by DAP for the entire testing period, force of DAP-treated EDL muscle rapidly declined to values in untreated muscle, and force of DAP-treated diaphragm had an intermediate force-time profile. Muscles varied in extent to which isometric contractile kinetics were altered by DAP. Thus, the K+ channel blocker DAP improves contractile performance of limb muscles, but the profile of improvement is distinct between the soleus and EDL muscles.     

Military antishock trousers

The military antishock trouser (MAST) is an inflatable garment that surrounds the lower portion of the body (legs and abdomen). It is primarily used as an emergency garment to stop bleeding in the lower extremities, increase peripheral resistance to better perfuse the upper body, and increase blood flow to the brain and other vital organs. The MAST garment consists of three chambers, which can be inflated separately or together with a simple foot pump to 100 mmHg. MAST garments are designed to be applied rapidly in the field, and they use Velcro straps to secure the leg and abdominal chambers on a patient. MAST is most often used for rapid transport of patients with hypovolemia resulting from shock or trauma.     

BIONic WalkAide for correcting foot drop.

The goal of this study was to test the feasibility and efficacy of using microstimulators (BIONs) to correct foot drop, the first human application of BIONs in functional electrical stimulation (FES). A prototype BIONic foot drop stimulator was developed by modifying a WalkAide2 stimulator to control BION stimulation of the ankle dorsiflexor muscles. BION stimulation was compared with surface stimulation of the common peroneal nerve provided by a normal WalkAide2 foot drop stimulator. Compared to surface stimulation, we found that BION stimulation of the deep peroneal nerve produces a more balanced ankle flexion movement without everting the foot. A three-dimensional motion analysis was performed to measure the ankle and foot kinematics with and without stimulation. Without stimulation, the toe on the affected leg drags across the ground. The BIONic WalkAide elevates the foot such that the toe clears the ground by 3 cm, which is equivalent to the toe clearance in the unaffected leg. The physiological cost index (PCI) was used to measure effort during walking. The PCI is high without stimulation (2.29 +/- 0.37; mean +/- S.D.) and greatly reduced with surface (1.29 +/- 0.10) and BION stimulation (1.46 +/- 0.24). Also, walking speed is increased from 9.4 +/- 0.4 m/min without stimulation to 19.6 +/- 2.0 m/min with surface and 17.8 +/- 0.7 m/min with BION stimulation. We conclude that functional electrical stimulation with BIONs is a practical alternative to surface stimulation and provides more selective control of muscle activation.     

Gait analysis of people walking on tactile ground surface indicators.

Tactile ground surface indicators installed on sidewalks help visually impaired people walk safely. The visually impaired distinguish the indicators by stepping into its convexities and following them. However, these indicators sometimes cause the nonvisually impaired to stumble. This study examines the effects of these indicators by comparing the kinematic and kinetic variables of walking on paths with and without indicators. The results suggest that walking on the indicators causes extra movements of the lower extremities such as increased minimum toe heights during the midswing phase, increased peak hip flex moments, and increased peak hip heights. This study also suggests that a functional leg length discrepancy while walking on the indicators is one of the reasons for the extra movements of the lower extremities. Therefore, we designed a new recessed tactile surface to offset the differences of surface depth while walking on the path containing indicators, and found that the newly designed recessed tactile surface was effective in reducing the extra movements while walking on the path in which indicators were installed. These indicators may help both the visually impaired and elderly people with normal vision to walk safely.     

Detection of gait impairment in the elderly using patch‐GEI

We propose a novel method for estimating physical impairment of elderly people using gait. To achieve this, we first investigate which gait feature is effective for this purpose among gait energy image (GEI), duration time, and phase fluctuation as dynamic features. GEI is a popular appearance‐based feature showing high performance in human authentication. By comparison, we find that it is the most reasonable feature. In real situations, however, GEI is easily affected by clothes variations or carrying conditions, so that the use of whole body results in decreasing performance. Considering this problem, we thus propose to use only the GEI features of the most discriminative body patches. From the experiments that evaluate the contribution of various sizes of body patches, we find that head and chest regions perform better than the whole body with the classification accuracy improved from 80.93% to 83.17% for the visual impairment discrimination case. As for the leg impairment detection case, the leg region performs better than the whole body by an accuracy increased from 69.30 to 75.05%. These results confirm the effectiveness of patch‐GEI for impairment detection. © 2015 Institute of Electrical Engineers of Japan. Published by John Wiley & Sons, Inc.