title: Prolonged electrical stimulation-induced gluteal and hamstring muscle activation and sitting pressure in spinal cord injury: effect of duty cycle.
abstract: Pressure ulcers (PUs) are highly prevalent in people with spinal cord injury (SCI). Electrical stimulation (ES) activates muscles and might reduce risk factors. Our objectives were to study and compare the effects of two duty cycles during 3 h of ES-induced gluteal and hamstring activation on interface pressure distribution in sitting individuals with SCI and study the usability of a newly developed electrode garment (ES shorts). Ten individuals with SCI participated in this study, in which two ES protocols with different duty cycles (1:1 s vs 1:4 s on-off) were applied in counterbalanced order using a custom-made garment with built-in electrodes. Outcome variables included interface pressure of the ischial tuberosities (ITs) and pressure gradient. A questionnaire was used to determine usability of the ES shorts. In both protocols, ES caused a significant decrease in average IT pressure compared with rest (no ES); on average, 35% for protocol 1:4 and 13% for protocol 1:1. The ES on-off duty cycle of protocol 1:4 showed less muscle fatigue. In general, participants scored the usability of the ES shorts as satisfactory. In this study, the application of ES resulted in a significant decrease in IT pressure. The ES on-off duty cycle of 1:4 s is recommended because of the less fatiguing effect. ES of the hamstrings and gluteal muscles might be a promising method in preventing PUs, but further study is needed.
authors.affiliation: Reade, Spinal Cord Unit, Location Overtoom, PO Box 58271, 1040 HG Amsterdam, the Netherlands. c.smit@reade.nl.
authors.forename: Christof A J
authors.initials: CA
authors.lastname: Smit
authors.forename: Karin J A
authors.initials: KJ
authors.lastname: Legemate
authors.forename: Anja
authors.initials: A
authors.lastname: de Koning
authors.forename: Sonja
authors.initials: S
authors.lastname: de Groot
authors.forename: Janneke M
authors.initials: JM
authors.lastname: Stolwijk-Swuste
authors.forename: Thomas W J
authors.initials: TW
authors.lastname: Janssen
mesh_terms: D000328:Adult; D002081:Buttocks; D003020:Clothing; D004599:Electric Stimulation Therapy / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D007512:Ischium; D008297:Male; D008875:Middle Aged; D009119:Muscle Contraction; D018482:Muscle, Skeletal / Q000502:physiology; D011187:Posture; D011312:Pressure; D012879:Skin Physiological Phenomena; D013119:Spinal Cord Injuries / Q000534:rehabilitation*; D013848:Thigh; D013997:Time Factors; D014160:Transducers, Pressure; D016474:Weight-Bearing
keywords: duty cycle; electrical stimulation; interface pressure; ischial tuberosity; muscles; pressure 
  ulcers; pressure sores; questionnaire; sitting pressure; spinal cord injury