title: Interleaved neuromuscular electrical stimulation after spinal cord injury.
abstract: BACKGROUND
  Neuromuscular electrical stimulation (NMES) over a muscle belly (mNMES) recruits superficial motor units (MUs) preferentially, whereas NMES over a nerve trunk (nNMES) recruits MUs evenly throughout the muscle. We performed tests to determine whether "interleaving" pulses between the mNMES and nNMES sites (iNMES) reduces the fatigability of contractions for people experiencing paralysis because of chronic spinal cord injury.
  
  
  METHODS
  Plantar flexion torque and soleus electromyography (M-waves) were recorded from 8 participants. A fatigue protocol (75 contractions; 2 s on/2 s off for 5 min) was delivered by iNMES. The results were compared with previously published data collected with mNMES and nNMES in the same 8 participants.
  
  
  RESULTS
  Torque declined ∼40% more during mNMES than during nNMES or iNMES. M-waves declined during mNMES but not during nNMES or iNMES.
  
  
  CONCLUSIONS
  To reduce fatigability of electrically evoked contractions of paralyzed plantar flexors, iNMES is equivalent to nNMES, and both are superior to mNMES. Muscle Nerve 56: 989-993, 2017.
authors.affiliation: Rehabilitation Engineering Laboratory, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.
authors.forename: Austin J
authors.initials: AJ
authors.lastname: Bergquist
authors.affiliation: Human Neurophysiology Laboratory, Faculty of Physical Education and Recreation, E-488 Van Vliet Centre, University of Alberta, Edmonton, Alberta, Canada, T6G 2H9.
authors.forename: Matheus J
authors.initials: MJ
authors.lastname: Wiest
authors.affiliation: Human Neurophysiology Laboratory, Faculty of Physical Education and Recreation, E-488 Van Vliet Centre, University of Alberta, Edmonton, Alberta, Canada, T6G 2H9.
authors.forename: Yoshino
authors.initials: Y
authors.lastname: Okuma
authors.affiliation: Human Neurophysiology Laboratory, Faculty of Physical Education and Recreation, E-488 Van Vliet Centre, University of Alberta, Edmonton, Alberta, Canada, T6G 2H9.
authors.forename: David F
authors.initials: DF
authors.lastname: Collins
mesh_terms: D000328:Adult; D001703:Biophysics; D004558:Electric Stimulation / Q000379:methods*; D004576:Electromyography; D005221:Fatigue / Q000209:etiology / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009119:Muscle Contraction / Q000502:physiology; D009469:Neuromuscular Junction / Q000502:physiology*; D011999:Recruitment, Neurophysiological / Q000502:physiology; D013119:Spinal Cord Injuries / Q000150:complications / Q000628:therapy*; D019415:Torque; D016896:Treatment Outcome
keywords: H-reflex; M-wave; electrical stimulation; fatigue; recruitment