Standing up with denervated muscles in humans using functional electrical stimulation.
The use of electrical stimulation for denervated muscles is still considered to be a controversial issue by many rehabilitation facilities and medical professionals because prior clinical experience has shown that treating denervated muscle tissue using exponential current over a long time period constitutes an impossible task. Despite this fact, we managed to evoke tetanic contractions in denervated muscle using a long duration stimulation with anatomically shaped electrodes and sufficiently high amplitudes. The pulse amplitudes, which were being used for this purpose, exceeded by far the MED-GV and EC regulations (300 mJ/impulse). For this reason, an application has recently been submitted to have the EC regulations changed accordingly. It takes a tetanic contraction to achieve the desired muscle fiber tension, constituting a hypertrophic stimulus. It is also an appropriate means of exercise, which is capable of creating the metabolic and structural conditions needed (e.g, increased mitochondrial volume and capillary density) to obtain satisfactory muscle performance. With patients suffering from a complete spinal cord injury at level D12/L1, having motor and sensory loss in both lower extremities, we were able to train denervated muscle using long-duration stimulation, evoking single muscle contractions at first, soon followed by tetanic contractions against gravity. To increase the efficacy of this functional electrical stimulation (FES) strengthening program, we used ankle weights. With daily FES training over a period of 1-2 years, denervated muscle was exercised until it produced torques between 16 and 38 Nm in the m. quadriceps. With that muscle force, it is possible to stand up from a sitting position in parallel bars. Our results show that denervated muscle in humans is indeed trainable and can perform functional activities with FES. Furthermore, this method of stimulation can assist in decubitus prevention and significantly improve the mobility of paraplegics.
Kern
H
H
Department of Physical Medicine and Rehabilitation, Wilhelminenspital, Vienna, Austria.
Hofer
C
C
Strohhofer
M
M
Mayr
W
W
Richter
W
W
Stöhr
H
H
D002196:Capillaries / Q000648:ultrastructure; D004599:Electric Stimulation Therapy / Q000295:instrumentation / Q000379:methods*; D004566:Electrodes; D015444:Exercise / Q000502:physiology; D006112:Gravitation; D006801:Humans; D008931:Mitochondria, Muscle / Q000648:ultrastructure; D009119:Muscle Contraction / Q000502:physiology; D018485:Muscle Fibers, Skeletal / Q000378:metabolism / Q000502:physiology / Q000648:ultrastructure; D018482:Muscle, Skeletal / Q000033:anatomy & histology / Q000294:innervation* / Q000378:metabolism; D010264:Paraplegia / Q000534:rehabilitation*; D011187:Posture / Q000502:physiology*; D003668:Pressure Ulcer / Q000517:prevention & control; D013119:Spinal Cord Injuries / Q000534:rehabilitation; D019415:Torque; D014891:Weight Lifting / Q000502:physiology; D016474:Weight-Bearing / Q000502:physiology*