<p>Neuromuskulär elektrisk stimulering (NMES) används vid träning i syfte att förbättra muskulaturens egenskaper. Inom rehabilitering används NMES till att förbättra läkeprocessen av muskelskador. Vid elektrisk stimulans sker det en annorlunda aktivering av de motoriska enheterna jämfört med frivilliga kontraktioner. Vid frivilliga kontraktioner sker det en stimulering av de motoriska enheterna med långsamma muskelfibrer först. Därefter aktiveras snabba muskelfibrer. Vid elektrisk stimulans sker aktiveringen av olika sorters motoriska enheter i en omvänd- eller slumpmässig process. METOD: 16 personer (26 ± 4 år) deltog i studien varav 12 fullföljde hela testperioden. De delades in i två grupper. En testgrupp använde NMES tillsammans med frivilliga kontraktioner och en kontrollgrupp som enbart utförde frivilliga kontraktioner. Grupperna utförde en magövning för att se om det är någon skillnad mellan NMES kombinerat med frivilliga kontraktioner och enbart frivilliga kontraktioner. Testet utfördes innan, i mitten och i slutet av testperioden som varade i 10 veckor. Testet var ett styrkeuthållighetstest där deltagarna skulle utföra så många frivilliga kontraktioner som möjligt. RESULTAT: Testgruppen fick 4 procentenheter bättre resultat, men det var inte signifikant. Vilket resulterar till att denna studie inte kunde påvisa att NMES kombinerat med frivilliga kontraktioner ger bättre resultat än frivilliga kontraktioner.</p>

Neuromuskulär elektrisk stimulering (NMES) används vid träning i syfte att förbättra muskulaturens egenskaper. Inom rehabilitering används NMES till att förbättra läkeprocessen av muskelskador. Vid elektrisk stimulans sker det en annorlunda aktivering av de motoriska enheterna jämfört med frivilliga kontraktioner. Vid frivilliga kontraktioner sker det en stimulering av de motoriska enheterna med långsamma muskelfibrer först. Därefter aktiveras snabba muskelfibrer. Vid elektrisk stimulans sker aktiveringen av olika sorters motoriska enheter i en omvänd- eller slumpmässig process. METOD: 16 personer (26 ± 4 år) deltog i studien varav 12 fullföljde hela testperioden. De delades in i två grupper. En testgrupp använde NMES tillsammans med frivilliga kontraktioner och en kontrollgrupp som enbart utförde frivilliga kontraktioner. Grupperna utförde en magövning för att se om det är någon skillnad mellan NMES kombinerat med frivilliga kontraktioner och enbart frivilliga kontraktioner. Testet utfördes innan, i mitten och i slutet av testperioden som varade i 10 veckor. Testet var ett styrkeuthållighetstest där deltagarna skulle utföra så många frivilliga kontraktioner som möjligt. RESULTAT: Testgruppen fick 4 procentenheter bättre resultat, men det var inte signifikant. Vilket resulterar till att denna studie inte kunde påvisa att NMES kombinerat med frivilliga kontraktioner ger bättre resultat än frivilliga kontraktioner.

Background: Neuromuscular electrical stimulation (NMES) is increasingly being usedoutside the realms of physical therapy. Acknowledged as an efficient method to enhancestrength parameters, athletes are increasingly using NMES to facilitate training andstrength gains. A review was designed with a systematic approach with the mainobjective: to assess the effectiveness of transcutaneous NMES on maximal strength inphysical education students, trained and elite athletes in studies involving isometricNMES and Dynamic NMES. Method: A search for all types of trials was performed onPubmed, Sportdiscus, Web of Science Core Collection and The Cochrane ControlledTrials Register, and results were recorded according to the PRISMA recommendations.Twenty-one studies were included and judged for risk of bias and quality according tothe Cochrane guidelines and GRADE. Results: Studies were judged as having either anunclear or high risk of bias. All studies were judged as ‘very low level’ according toGRADE and were lacking bias-limiting methods, detailed information of interventionsand general standardised procedures. Conclusion: Strength gains in physical educationstudents, trained or elite athletes from a training intervention involving either isometricNMES combined with or without voluntary exercise or dynamic NMES are inconclusivedue to the very low level of the quality of the studies. Meta-analysis performed in thisarea should be interpreted with caution as the studies have been judged as eitherunclear or high risk of bias.Key words: isometric NMES (electrical stimulation applied to relaxed muscle), dynamicNMES (electrical stimulation superimposed onto voluntary contractions), strength.

Este trabalho apresentará um projeto cujo propósito foi definir um protocolo de avaliação para pacientes paraplégicos sob terapia, através do uso de estimulação elétrica neuromuscular, no ambulatório de ortopedia do Hospital das Clínicas da Universidade de Campinas. A análise proposta servirá tanto para o acompanhamento da evolução dos pacientes, quanto, principalmente, para avaliação dos sistemas de reabilitação desenvolvidos pelo laboratório de biocibernética e engenharia de reabilitação na Escola de Engenharia de São Carlos. Neste trabalho o protocolo foi aplicado especificamente para descrever a locomoção do paraplégico usando a estimulação padrão de 4 canais, que realiza a ativação dos quadríceps para extensão das pernas, necessária para o suporte do corpo, e a ativação do reflexo de retirada através da estimulação do nervo fibular para a flexão necessária para a fase de balanço. A análise usou como referência o conhecimento relacionado à descrição das fases e estratégias usadas pela locomoção do ser humano intacto. O protocolo de avaliação usou recursos do laboratório de biomecânica e reabilitação do aparelho locomotor, situado no hospital citado acima, que permitiram a descrição da cinemática dos membros superiores e inferiores, da atividade muscular realizada pelos membros superiores, e das forças de reação do solo. / This work present a case study on the use of the motion analysis laboratory resources (three-dimensional motion capture system, EMG, and force plate) with the purpose of improve the use of surface electrical stimulation to enable the locomotion in paraplegic subjects. Five trials for each of the five patients (thoracic complete spinal cord lesion) using a four channel electrical stimulator was done for synchronously acquisition of: 3D coordinates of 30 markers distributed on the whole body (to evaluate the stride\'s characteristics and three-dimensional measurements of angles of whole-body); EMG signal, on both sides, of triceps brachii long head, pectoralis major, middle deltoideus, extensor carpi radialis; and the vertical component of the ground reaction force. All data were normalized on the right gait cycle. The analysis was done braking the cycle in 11 events related with the swing phase in both sides, because it was focused firstly in the actions related with the swing limb and upper body advance, that represents a critical factor in locomotion aided by electrical stimulation. These events divided the gait cycle in 10 phases, which was used for associate the data evaluated with specifics tasks. The results showed temporal parameters similar to that reported by other authors, specific characteristics of the patient, the mechanism used by the patient for advance the body, and the periods of high activity of the muscles on the cycle.

Este trabalho apresentará um projeto cujo propósito foi definir um protocolo de avaliação para pacientes paraplégicos sob terapia, através do uso de estimulação elétrica neuromuscular, no ambulatório de ortopedia do Hospital das Clínicas da Universidade de Campinas. A análise proposta servirá tanto para o acompanhamento da evolução dos pacientes, quanto, principalmente, para avaliação dos sistemas de reabilitação desenvolvidos pelo laboratório de biocibernética e engenharia de reabilitação na Escola de Engenharia de São Carlos. Neste trabalho o protocolo foi aplicado especificamente para descrever a locomoção do paraplégico usando a estimulação padrão de 4 canais, que realiza a ativação dos quadríceps para extensão das pernas, necessária para o suporte do corpo, e a ativação do reflexo de retirada através da estimulação do nervo fibular para a flexão necessária para a fase de balanço. A análise usou como referência o conhecimento relacionado à descrição das fases e estratégias usadas pela locomoção do ser humano intacto. O protocolo de avaliação usou recursos do laboratório de biomecânica e reabilitação do aparelho locomotor, situado no hospital citado acima, que permitiram a descrição da cinemática dos membros superiores e inferiores, da atividade muscular realizada pelos membros superiores, e das forças de reação do solo. / This work present a case study on the use of the motion analysis laboratory resources (three-dimensional motion capture system, EMG, and force plate) with the purpose of improve the use of surface electrical stimulation to enable the locomotion in paraplegic subjects. Five trials for each of the five patients (thoracic complete spinal cord lesion) using a four channel electrical stimulator was done for synchronously acquisition of: 3D coordinates of 30 markers distributed on the whole body (to evaluate the stride\'s characteristics and three-dimensional measurements of angles of whole-body); EMG signal, on both sides, of triceps brachii long head, pectoralis major, middle deltoideus, extensor carpi radialis; and the vertical component of the ground reaction force. All data were normalized on the right gait cycle. The analysis was done braking the cycle in 11 events related with the swing phase in both sides, because it was focused firstly in the actions related with the swing limb and upper body advance, that represents a critical factor in locomotion aided by electrical stimulation. These events divided the gait cycle in 10 phases, which was used for associate the data evaluated with specifics tasks. The results showed temporal parameters similar to that reported by other authors, specific characteristics of the patient, the mechanism used by the patient for advance the body, and the periods of high activity of the muscles on the cycle.

The use of neuromuscular electrical stimulation (NMES) for the treatment of swallowing disorders has become increasingly popular, yet little is known about its long-term effects on muscle physiology. This study indirectly assessed suprahyoid muscle physiology using electromyography (EMG) during a jaw-opening task that was completed before training, immediately after training, and two-weeks after training. Comparisons were made in muscle performance between control participants who engaged in effortful swallowing training and participants who received conjunctive NMES during effortful swallow training. All participants completed four weeks of swallowing exercises conducted five days a week (20 sessions) and consisting of 120 swallows each session. Results revealed that participants collectively improved their peak force production following training, but peak force and EMG median frequency did not vary as a function of training method. The observed high variability in median frequency between trials in addition to the documented improvement in function without a measured change in physiology suggests the need to consider alternate electrode placements during EMG or other tools of assessment. These findings suggests that both effortful swallow training and long-term conjunctive NMES with effortful swallowing improves jaw-opening strength of healthy adults, though adding NMES to the treatment was no more effective than training without it. Further research is necessary to determine the effects of long-term NMES training on swallowing physiology in vivo using other indirect measurements, or direct measurements such as muscle biopsy if possible.

Neuromuscular electrical stimulation (NMES) has become an increasingly popular rehabilitative treatment approach for swallowing disorders (dysphagia). However, its precise effects on swallowing biomechanics and measures of swallowing neurophysiology are unclear. Clearly defined NMES treatment protocols that have been corroborated by thorough empirical research are lacking. The primary objective of this research programme was therefore to establish optimal NMES treatment parameters for the anterior hyo-mandibular (submental) musculature, a muscle group that is critically involved in the oral and pharyngeal phases of swallowing. Based on previous research, the primary hypothesis was that various NMES treatment protocols would have differential effects of either enhancing or inhibiting the excitability of corticobulbar projections to this muscle group. The research paradigm used to test this hypothesis was an evaluation of MEP amplitude and onset latency, recorded in the functional context of volitional contraction of the submental musculature (VC) and contraction of this muscle group during the pharyngeal phase of volitional swallowing (VPS, volitional pharyngeal swallow). Outcome measures were recorded before and at several time points after each NMES treatment trial. This methodology is similar to, but improved upon, research paradigms previously reported. Changes in corticobulbar excitability in response to various NMES treatment protocols were recorded in a series of experiments. Ten healthy research participants were recruited into a study that evaluated the effects of event-related NMES, whereas 15 healthy research participants were enrolled in a study that investigated the effects of non-event-related NMES. In a third cohort of 35 healthy research participants, task-dependent differences in corticobulbar excitability were evaluated during three conditions of submental muscle contraction: VC, VPS and submental muscle contraction during the pharyngeal phase of reflexive swallowing (RPS, reflexive pharyngeal swallowing). Event-related NMES induced frequency-depended changes in corticobulbar excitability. NMES administered at 80 Hz facilitated MEP amplitude, whereas NMES at 5 Hz and 20 Hz inhibited MEP amplitude. No changes were observed after NMES at 40 Hz. Maximal excitatory or inhibitory changes occurred 60 min post-treatment. Changes in MEP amplitude in response to event-related NMES were only observed when MEPs were recorded during the VC condition, whereas MEPs recorded during the VPS condition remained unaffected. Non-event-related NMES did not affect MEP amplitude in either of the muscle contraction conditions. Similarly, MEP onset latencies remained unchanged across all comparisons. MEPs were detected most consistently during the VC contraction condition. They were less frequently detected and were smaller in amplitude for the VPS condition and they were infrequently detected during pre-activation by RPS. The documented results indicate that event-related NMES has a more substantial impact on MEP amplitude than non-event-related NMES, producing excitatory and inhibitory effects. Comparison of MEPs recorded during VC, VPS and RPS suggests that different neural networks may govern the motor control of submental muscle activation during these tasks. This research programme is the first to investigate the effects of various NMES treatment protocols on the excitability of submental corticobulbar projections. It provides important new information for the use of NMES in clinical rehabilitation practices and our understanding of the neural networks governing swallowing motor control.

Neuromuscular electrical stimulation (NMES) has become an increasingly popular rehabilitative treatment approach for swallowing disorders (dysphagia). However, its precise effects on swallowing biomechanics and measures of swallowing neurophysiology are unclear. Clearly defined NMES treatment protocols that have been corroborated by thorough empirical research are lacking. The primary objective of this research programme was therefore to establish optimal NMES treatment parameters for the anterior hyo-mandibular (submental) musculature, a muscle group that is critically involved in the oral and pharyngeal phases of swallowing. Based on previous research, the primary hypothesis was that various NMES treatment protocols would have differential effects of either enhancing or inhibiting the excitability of corticobulbar projections to this muscle group. The research paradigm used to test this hypothesis was an evaluation of MEP amplitude and onset latency, recorded in the functional context of volitional contraction of the submental musculature (VC) and contraction of this muscle group during the pharyngeal phase of volitional swallowing (VPS, volitional pharyngeal swallow). Outcome measures were recorded before and at several time points after each NMES treatment trial. This methodology is similar to, but improved upon, research paradigms previously reported. Changes in corticobulbar excitability in response to various NMES treatment protocols were recorded in a series of experiments. Ten healthy research participants were recruited into a study that evaluated the effects of event-related NMES, whereas 15 healthy research participants were enrolled in a study that investigated the effects of non-event-related NMES. In a third cohort of 35 healthy research participants, task-dependent differences in corticobulbar excitability were evaluated during three conditions of submental muscle contraction: VC, VPS and submental muscle contraction during the pharyngeal phase of reflexive swallowing (RPS, reflexive pharyngeal swallowing). Event-related NMES induced frequency-depended changes in corticobulbar excitability. NMES administered at 80 Hz facilitated MEP amplitude, whereas NMES at 5 Hz and 20 Hz inhibited MEP amplitude. No changes were observed after NMES at 40 Hz. Maximal excitatory or inhibitory changes occurred 60 min post-treatment. Changes in MEP amplitude in response to event-related NMES were only observed when MEPs were recorded during the VC condition, whereas MEPs recorded during the VPS condition remained unaffected. Non-event-related NMES did not affect MEP amplitude in either of the muscle contraction conditions. Similarly, MEP onset latencies remained unchanged across all comparisons. MEPs were detected most consistently during the VC contraction condition. They were less frequently detected and were smaller in amplitude for the VPS condition and they were infrequently detected during pre-activation by RPS. The documented results indicate that event-related NMES has a more substantial impact on MEP amplitude than non-event-related NMES, producing excitatory and inhibitory effects. Comparison of MEPs recorded during VC, VPS and RPS suggests that different neural networks may govern the motor control of submental muscle activation during these tasks. This research programme is the first to investigate the effects of various NMES treatment protocols on the excitability of submental corticobulbar projections. It provides important new information for the use of NMES in clinical rehabilitation practices and our understanding of the neural networks governing swallowing motor control.

Neuromuscular electrical stimulation (NMES) is a modality of electrotherapy which is aiming to restore and improve muscle function by injecting small levels of current into the muscle using different types of electrodes. Advantages are seen in using textile electrodes which can be integrated into wearables. Previous research has been done for the development of textile stimulation electrodes. However, the focus has not been on the electrode construction itself. Therefore, the influence of electrode construction parameters of knitted electrodes as well as of the electrode condition, i.e. wet or dry, on the skin-electrode impedance and on the perceived stimulation comfort were analysed. Further, the application of pressure to the electrode was investigated. It was found that the electrode condition is the most important parameter for the electrode performance as a wet electrode showed a lower impedance and an improved stimulation comfort with a better skin contact. Followed by this, the pressure was the second most important factor, especially for dry electrodes. A higher pressure reduced the skin-electrode impedance and improved the skin contact in dry condition. Nevertheless, dry electrodes with a high applied pressure still performed worse than wet electrodes. Regarding the electrode design, the most important factor was the electrode size. A bigger size reduced the impedance. Nevertheless, for the application in NMES, a smaller electrode size is to be preferred as it improved the stimulation selectivity and thus, a lower NMES level was required to induce a plantarflexion without affecting the stimulation comfort. The other investigated construction parameters (binding, yarn density, shape) only showed minor influences on the electrode performance. Therefore, the possibilities of applying pressure to the electrode to improve the performance of dry textile electrodes should be further investigated.

No description available.