title: Reducing muscle fatigue during transcutaneous neuromuscular electrical stimulation by spatially and sequentially distributing electrical stimulation sources.
abstract: OBJECTIVE
  A critical limitation with transcutaneous neuromuscular electrical stimulation is the rapid onset of muscle fatigue. We have previously demonstrated that spatially distributed sequential stimulation (SDSS) shows a drastically greater fatigue-reducing ability compared to a single active electrode stimulation (SES). The purposes of this study were to investigate (1) the fatigue-reducing ability of SDSS in more detail focusing on the muscle contractile properties and (2) the mechanism of this effect using array-arranged electromyogram (EMG).
  
  
  METHODS
  SDSS was delivered through four active electrodes applied to the plantarflexors, sending a stimulation pulse to each electrode one after another with 90° phase shift between successive electrodes. In the first experiment, the amount of exerted ankle torque and the muscle contractile properties were investigated during a 3 min fatiguing stimulation. In the second experiment, muscle twitch potentials with SDSS and SES stimulation electrode setups were compared using the array-arranged EMG.
  
  
  RESULTS
  The results demonstrated negligible torque decay during SDSS in contrast to considerable torque decay during SES. Moreover, small changes in the muscle contractile properties during the fatiguing stimulation using SDSS were observed, while slowing of muscle contraction and relaxation was observed during SES. Further, the amplitude of the M-waves at each muscle portion was dependent on the location of the stimulation electrodes during SDSS.
  
  
  CONCLUSIONS
  We conclude that SDSS is more effective in reducing muscle fatigue compared to SES, and the reason is that different sets of muscle fibers are activated alternatively by different electrodes.
authors.affiliation: Department of Neurological Surgery, University of Louisville Frazier Rehab Institute, 220 Abraham Flexner Way, Ste. 1506, Louisville, KY, 40202, USA.
authors.forename: Dimitry G
authors.initials: DG
authors.lastname: Sayenko
authors.forename: Robert
authors.initials: R
authors.lastname: Nguyen
authors.forename: Milos R
authors.initials: MR
authors.lastname: Popovic
authors.forename: Kei
authors.initials: K
authors.lastname: Masani
mesh_terms: D000328:Adult; D000842:Ankle / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D009119:Muscle Contraction; D018763:Muscle Fatigue; D018482:Muscle, Skeletal / Q000294:innervation / Q000502:physiology; D004561:Transcutaneous Electric Nerve Stimulation / Q000379:methods*