title: Consequences of ankle joint fixation on FES cycling power output: a simulation study.
abstract: BACKGROUND
  During fixed-ankle FES cycling in paraplegics, in which the leg position is completely determined by the crank angle, mechanical power output is low. This low power output limits the cardiovascular load that could be realized during FES ergometer cycling, and limits possibilities for FES cycling as a means of locomotion. Stimulation of ankle musculature in a released-ankle setup might increase power output. However, releasing the ankle joint introduces a degree of freedom in the leg that has to be controlled, which imposes constraints on the stimulation pattern.
  
  
  METHODS
  In this study, a forward dynamics modeling/simulation approach was used to assess the potential effect of releasing the ankle on the maximal mechanical power output.
  
  
  RESULTS
  For the released-ankle setup, the optimal stimulation pattern was found to be less tightly related to muscle shortening/lengthening than for the fixed-ankle setup, which indicates the importance of the constraints introduced by releasing the ankle. As a result, the maximal power output for 45-RPM cycling in the released-ankle setup was found to be about 10% lower than with a fixed ankle, despite the additional muscle mass available for stimulation. Power output for the released-ankle setup can be improved by tuning the point of contact between the foot and pedal to the relative strength of the ankle plantar flexors. For the model used, power output was 14% higher than for the fixed-ankle setup when this point of contact was moved posteriorly by 0.075 m.
  
  
  CONCLUSIONS
  Releasing the ankle joint and stimulating the triceps surae and tibialis anterior is expected to result in a modest increase in power output at best.
authors.affiliation: Faculty of Human Movement Sciences and IFKB, Institute for Fundamental and Clinical Human Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands. k.vansoest@fbw.vu.nl
authors.forename: A J
authors.initials: AJ
authors.lastname: van Soest
authors.forename: Margit
authors.initials: M
authors.lastname: Gföhler
authors.forename: L J Richard
authors.initials: LJ
authors.lastname: Casius
mesh_terms: D000054:Acceleration; D000843:Ankle Joint / Q000503:physiopathology*; D001696:Biomechanical Phenomena; D004558:Electric Stimulation; D005080:Exercise Test; D006801:Humans; D007103:Immobilization; D007537:Isometric Contraction / Q000502:physiology; D008954:Models, Biological; D018482:Muscle, Skeletal / Q000503:physiopathology*; D010264:Paraplegia / Q000503:physiopathology / Q000534:rehabilitation*; D019415:Torque