scholarly journals Home-Based Functional Electrical Stimulation of Human Permanent Denervated Muscles: A Narrative Review on Diagnostics, Managements, Results and Byproducts Revisited 2020

Diagnostics ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. 529 ◽  
Author(s):  
Helmut Kern ◽  
Ugo Carraro
Keyword(s):  
Electrical Stimulation ◽  
Functional Electrical Stimulation ◽  
Cauda Equina ◽  
Quadriceps Muscle ◽  
Ultrastructural Organization ◽  
Force Output ◽  
Case Scenario ◽  
Worst Case ◽  
Home Based ◽  
Cord Injury

Spinal cord injury (SCI) produces muscle wasting that is especially severe after complete and permanent damage of lower motor neurons, as can occur in complete conus and cauda equina syndrome. Even in this worst-case scenario, mass and function of permanently denervated quadriceps muscle can be rescued by surface functional electrical stimulation using a purpose designed home-based rehabilitation strategy. Early diagnostics is a key factor in the long-term success of this management. Function of quadriceps muscle was quantitated by force measurements. Muscle gross cross-sections were evaluated by quantitative color computed tomography (CT) and muscle and skin biopsies by quantitative histology, electron microscopy, and immunohistochemistry. Two years of treatment that started earlier than 5 years from SCI produced: (a) an increase in cross-sectional area of stimulated muscles; (b) an increase in muscle fiber mean diameter; (c) improvements in ultrastructural organization; and (d) increased force output during electrical stimulation. Improvements are extended to hamstring muscles and skin. Indeed, the cushioning effect provided by recovered tissues is a major clinical benefit. It is our hope that new trials start soon, providing patients the benefits they need.

scholarly journals Functional electrical stimulation of permanently denervated muscles, updated 2020

2020 ◽  
Vol 97 (3) ◽  
pp. 130-136 ◽  
Author(s):  
U. Carraro ◽  
H. Kern ◽  
G. Albertin G. ◽  
S. Masiero ◽  
A. Pond ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Functional Electrical Stimulation ◽  
Cauda Equina ◽  
Quadriceps Muscle ◽  
Ultrastructural Organization ◽  
Force Output ◽  
Case Scenario ◽  
Cross Sectional ◽  
Worst Case ◽  
Cord Injury

Spinal cord injury produces muscle wasting, which is especially severe after the complete and permanent damage of lower motor neurons that occurs in complete Cauda Equina Syndrome. Even in this worst-case scenario, we have shown that permanently denervated Quadriceps muscle can be rescued by surface Functional Electrical Stimulation and a purpose designed home-based rehabilitation regime. Here, our aim is to show that the effects are extended to both antagonist muscles and the skin of the thighs. Before and after 2 years of electrical stimulation, mass and structure of Quadriceps and Hamstrings muscles were quantitated by force measurements. Muscle gross cross section were evaluated using color computed tomography, muscle and skin biopsies by quantitative histology and immunohistochemistry. The treatment produced: a) an increase in cross-sectional area of stimulated muscles; b) an increase in muscle fiber mean diameter; c) improvements in ultrastructural organization; and d) increased force output during electrical stimulation. The recovery of Quadriceps muscle force was sufficient to allow 25% of the compliant subjects to perform stand-up and step-in place trainings. Improvements are extended to hamstring muscles and skin. Indeed, the cushioning effect provided by recovered tissues is a major clinical benefit. It is our hope that, with or without our advice, trials may start soon in Europe and Russia to provide persons-in-need the help they deserve.

Home-Based Functional Electrical Stimulation Rescues Permanently Denervated Muscles in Paraplegic Patients With Complete Lower Motor Neuron Lesion

2010 ◽  
Vol 24 (8) ◽  
pp. 709-721 ◽  
Author(s):  
Helmut Kern ◽  
Ugo Carraro ◽  
Nicoletta Adami ◽  
Donatella Biral ◽  
Christian Hofer ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Muscle Mass ◽  
Functional Electrical Stimulation ◽  
Cauda Equina ◽  
Ultrastructural Organization ◽  
Mass Force ◽  
Cross Sectional ◽  
Home Based ◽  
Cord Injury ◽  
Denervated Muscles

Background. Spinal cord injury causes muscle wasting and loss of function, which are especially severe after complete and permanent damage to lower motor neurons. In a previous cross-sectional study, long-standing denervated muscles were rescued by home-based functional electrical stimulation (h-bFES) training. Objective. To confirm results by a 2-year longitudinal prospective study of 25 patients with complete conus/cauda equina lesions. Methods. Denervated leg muscles were stimulated by h-bFES using a custom-designed stimulator and large surface electrodes. Muscle mass, force, and structure were determined before and after 2 years of h-bFES using computed tomography, measurements of knee torque during stimulation, and muscle biopsies analyzed by histology and electron microscopy. Results. Twenty of 25 patients completed the 2-year h-bFES program, which resulted in ( a) a 35% cross-sectional increase in area of the quadriceps muscle from 28.2 ± 8.1 to 38.1 ± 12.7 cm 2 ( P < .001), a 75% increase in mean diameter of muscle fibers from 16.6 ± 14.3 to 29.1 ± 23.3 μm ( P < .001), and improvements of the ultrastructural organization of contractile material; and ( b) a 1187% increase in force output during electrical stimulation from 0.8 ± 1.3 to 10.3 ± 8.1 N m ( P < .001). The recovery of quadriceps force was sufficient to allow 25% of the subjects to perform FES-assisted stand-up exercises. Conclusions. Home-based FES of denervated muscle is an effective home therapy that results in rescue of muscle mass and tetanic contractility. Important immediate benefits for the patients are the improved cosmetic appearance of lower extremities and the enhanced cushioning effect for seating.

scholarly journals Two years of Functional Electrical Stimulation by large surface electrodes for denervated muscles improve skin epidermis in SCI

2018 ◽  
Vol 28 (1) ◽  
Author(s):  
Giovanna Albertin ◽  
Helmut Kern ◽  
Christian Hofer ◽  
Diego Guidolin ◽  
Andrea Porzionato ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Functional Electrical Stimulation ◽  
Muscle Fibers ◽  
Cauda Equina ◽  
Skin Thickness ◽  
Surface Electrodes ◽  
Long Term Treatment ◽  
Cord Injury ◽  
Skin Biopsies

Our previous studies have shown that severely atrophic Quadriceps muscles of spinal cord injury (SCI) patients suffering with complete conus and cauda equina lesions, and thus with permanent denervation-induced atrophy and degeneration of muscle fibers, were almost completely rescued to normal size after two years of home-based Functional Electrical Stimulation (h-bFES). Since we used large surface electrodes to stimulate the thigh muscles, we wanted to know if the skin was affected by long-term treatment. Here we report preliminary data of morphometry of skin biopsies harvested from legs of 3 SCI patients before and after two years of h-bFES to determine the total area of epidermis in transverse skin sections. By this approach we support our recently published results obtained randomly measuring skin thickness in the same biopsies after H-E stain. The skin biopsies data of three subjects, taken together, present indeed a statistically significant 30% increase in the area of the epidermis after two years of h-bFES. In conclusion, we confirm a long term positive modulation of electrostimulated epidermis, that correlates with the impressive improvements of the FES-induced muscle strength and bulk, and of the size of the muscle fibers after 2-years of h-bFES.

scholarly journals Human Permanent Denervated Muscles Recovery

2020 ◽  
Author(s):  
Ugo Carraro ◽  
Paolo Gargiulo ◽  
Jorgelina Ramos ◽  
Romain Aubonnet ◽  
Helmut Kern
Keyword(s):  
Motor Neurons ◽  
Cauda Equina ◽  
Clinical Value ◽  
Case Scenario ◽  
Worst Case ◽  
Leg Muscles ◽  
Cord Injury ◽  
Life Threatening ◽  
Aging Muscle ◽  
Denervated Muscles

We demonstrated the long-term clinical value of co-activating thigh muscles through hbFES strategy using high currents and large surface electrodes. This Vienna Strategy is able to reverse, at clinically relevant levels, the adverse effects of Spinal Cord Injury (SCI), even in the worst-case scenario of complete lesion of lower motor neurons, as it may occur in complete conus and cauda equina syndrome. Continued regularly, hbFES for denervated, degenerating muscles helps to maintain healthier leg muscles and skin, reducing the risks of life-threatening SCI complications. By products of these studies are new approaches for counteracting aging muscle atrophy, new color clinical imaging of muscle tissue and Machine Learning Predictive Systems for skeletal muscle diagnostics and managements.

Exercise Adherence During Home-Based Functional Electrical Stimulation Cycling by Individuals with Spinal Cord Injury

2012 ◽  
Vol 91 (11) ◽  
pp. 922-930 ◽  
Author(s):  
David R. Dolbow ◽  
Ashraf S. Gorgey ◽  
Jessica M. Ketchum ◽  
Jewel R. Moore ◽  
Laurel A. Hackett ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Electrical Stimulation ◽  
Functional Electrical Stimulation ◽  
Exercise Adherence ◽  
Home Based ◽  
Cord Injury

scholarly journals Myokines in Home-Based Functional Electrical Stimulation-Induced Recovery of Skeletal Muscle in Elderly and Permanent Denervation

2018 ◽  
Vol 28 (4) ◽  
Author(s):  
Sascha Sajer ◽  
Giulio Sauro Guardiero ◽  
Bianca Maria Scicchitano
Keyword(s):  
Skeletal Muscle ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Electrical Stimulation ◽  
Muscle Atrophy ◽  
Functional Electrical Stimulation ◽  
Neuromuscular Disorders ◽  
Muscle Fibers ◽  
Home Based ◽  
Cord Injury

Neuromuscular disorders, disuse, inadequate nutrition, metabolic diseases, cancer and aging produce muscle atrophy and this implies that there are different types of molecular triggers and signaling pathways for muscle wasting. Exercise and muscle contractions may counteract muscle atrophy by releasing a group of peptides, termed myokines, to protect the functionality and to enhance the exercise capacity of skeletal muscle. In this review, we are looking at the role of myokines in the recovery of permanent denervated and elderly skeletal muscle tissue. Since sub-clinical denervation events contribute to both atrophy and the decreased contractile speed of aged muscle, we saw a parallel to spinal cord injury and decided to look at both groups together. The muscle from lifelong active seniors has more muscle bulk and more slow fiber-type groupings than those of sedentary seniors, demonstrating that physical activity maintains slow motoneurons that reinnervate the transiently denervated muscle fibers. Furthermore, we summarized the evidence that muscle degeneration occur with irreversible Conus and Cauda Equina syndrome, a spinal cord injury in which the human leg muscles may be permanently disconnected from the peripheral nervous system. In these patients, suffering with an estreme case of muscle disuse, a complete loss of muscle fibers occurs within five to ten years after injury. Their recovered tetanic contractility, induced by home-based Functional Electrical Stimulation, can restore the muscle size and function in compliant Spinal Cord Injury patients, allowing them to perform electrical stimulation-supported stand-up training. Myokines are produced and released by muscle fibers under contraction and exert both local and systemic effects. Changes in patterns of myokine secretion, particularly of IGF-1 isoforms, occur in long-term Spinal Cord Injury persons and also in very aged people. Their modulation in Spinal Cord Injury and late aging are also key factors of home-based Functional Electrical Stimulation - mediated muscle recovery. Thus, Functional Electrical Stimulation should be prescribed in critical care units and nursing facilities, if persons are unable or reluctant to exercise. This will result in less frequent hospitalizations and a reduced burden on patients’ families and public health services.

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