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Neuromuscular electrical stimulation (NMES) is a common therapeutic tool for persons with movement disorders. The manner in which NMES generates muscular contractions has traditionally been attributed to the depolarization of motor axons underneath the stimulating electrodes, a purely peripheral mechanism, which does not involve the central nervous system (CNS). During NMES however, sensory axons are also recruited, initiating an afferent volley which can affect both spinal and cortical centers. This thesis is focused on identifying how this afferent volley influences NMES-evoked contractions and CNS excitability. Four projects are described in which NMES was delivered to generate plantar-flexion contractions. The first goal was to establish the influence of stimulus pulse width on the central recruitment of motoneurons. Contrary to previous findings, changing the pulse width did not significantly alter maximal soleus H-reflex amplitudes; however, wider pulses resulted in a leftward shift of the H-reflex recruitment curve and increased H-reflex amplitudes on the ascending limb of the recruitment curve. The second goal was to examine the effect of stimulus pulse-width on electromyograpic responses and torque during NMES. During 20 Hz NMES, wide pulse widths depressed motor-waves (M-waves) and enhanced H-reflexes, generating larger contractions with a relatively greater central contribution, than when narrow pulses were used. The third project compared the torque produced during NMES-evoked contractions before and during a complete anesthetic block of the tibial and common peroneal nerves. Results from this project showed that contractions arising from a combination of central and peripheral mechanisms fatigue less than contractions that develop from the recruitment of motor axons alone. The final project investigated how spinal and corticospinal excitability associated with the soleus muscles are affected following NMES, voluntary contractions, or a combination of both. It was found that a combination of voluntary contractions and electrical stimulation induced plastic changes in the spinal circuitry of the stimulated muscle without affecting cortical circuitry or inducing any contralateral effects. Collectively, these experiments highlight that wider pulse widths induce a greater reflexive recruitment of motoneurons which contributes to the evoked torque during NMES, and that the evoked afferent volley reduces fatigue and influences spinal circuitry plasticity in the plantar-flexors. Methods to enhance the afferent volley during NMES are only beginning to be tested in clinical populations and future experiments will determine the potential efficacy for persons with movement disorders. / Neuroscience

Masters of Science / BACKGROUND: Hamstring injuries remain a growing concern within a large variety of sports from the elite athlete to the weekend warrior. A copious amount of research has been performed in an attempt to reduce these injuries. The aim of this study was to understand the changes in lengthened state eccentric strength of the hamstrings following four separate protocols. METHODS: A quantitative research approach, using a true experimental design, was adopted for this study. A convenience sample of non-sedentary, 35 male participants, between the ages of 18 and 35 within the City of Cape Town was used. Participants were randomly allocated to one of four groups namely; Control group (C), resistance training alone (RT), neuromuscular electrical stimulation alone (NMES), or NMES superimposed with RT (NMES&RT). Participant’s eccentric hamstring strength was tested in a lengthened state, on the Biodex system 4 Pro™ for the pre- and post-test. The intervention spanned over four weeks. SPSS version 25 was used for data analysis. RESULTS: All groups demonstrated a mean increase in relative peak torque. However, a repeated-measures analysis of variance (ANOVA) showed no interaction effect (p = 0.411) between the four groups. Further analysis using Magnitude-based inferences (MBI), to identify the magnitude of changes, showed a small positive effect for both the NMES and NMES&RT group when compared to the C and RT groups. CONCLUSION: Although there are no statistically significant differences between the four groups employed in this study (C, RT, NMES, NMES&RT), NMES and NMES&RT did show small positive effects compared to C and RT with a very low likelihood of negative effects. Thus, using NMES either alone or superimposed with resistance training will be beneficial for trained athletes but it is not a necessity and the use of specific resistance training may be just as effective. / 2019-04-30

Transcutaneous electrical stimulation (TNES) is a controversial treatment method for oropharyngeal dysphagia. Currently, few studies support the effectiveness of TNES for the treatment of dysphagia. This study examines the available research regarding the effectiveness of TNES for the treatment of oropharyngeal dysphagia. / text

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京都大学 / 新制・課程博士 / 博士(人間健康科学) / 甲第23829号 / 人健博第100号 / 新制||人健||7(附属図書館) / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 黒木 裕士, 教授 山田 重人, 教授 森田 智視 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM

Lesões na medula espinhal atingem um grande número de pessoas, devido a traumas, doenças congênitas ou adquiridas. Para estes tipos de lesões não há cura e os indivíduos lesados medulares dependem de tratamento através de fisioterapia ou órteses que auxiliem na recuperação de possíveis funções perdidas. A Estimulação Elétrica Neuromuscular (EENM) tem sido pesquisada com essa proposta: reabilitar pessoas portadoras de lesão medular ou disfunções do aparelho locomotor. Muitos estudos já foram desenvolvidos na área de estimulação elétrica neuromuscular, avaliando a marcha, o ato de levantar-se ou outros movimentos. Um ponto em comum entre estes estudos é a preocupação com os efeitos fisiológicos da EENM, como por exemplo o gasto energético. Diante disto, o objetivo deste projeto foi avaliar os efeitos da EENM sobre o gasto energético de lesados medulares. Foi observado o consumo de oxigênio durante o repouso, a marcha e a recuperação. A avaliação proposta foi realizada por método indireto e as análises estatísticas foram realizadas através do teste ANOVA ONE WAY. Os resultados sugerem os voluntários tiveram recuperação fisiológica. Entretanto novas pesquisas são necessárias, com outras variáveis sendo avaliadas. / Lesions in the spinal cord affect a great number of individuals, either due to traumas or to congenital or acquired diseases. Such lesions are incurable, and the injured patients depend on physiotherapy or orthosis to aid in the recovery of lost functions. The Neuromuscular Electrical Stimulation (NMES) has been researched with this purpose: rehabilitating spinal cord injured patients, or those with motor system dysfunction. Several studies have already been developed in the field of neuromuscular electrical stimulation, assessing gait, the act of getting up or other everyday movements. All these studies bear something in common: the concern with the physiologic effects of NMES, such as the energy consumption. Hence, the objective of this project was to evaluate the effects of NMES on the energy cost of spinal injured patients. The consumption of oxygen was assessed during rest, gait and the recovery period. The proposed evaluation was made through indirect method, and the statistical analyses through the ANOVA ONE WAY test. The results to suggest that the volunteers had phisyological recovery. However, news reserchs there are needs, with others variable to be estimated.

We describe the development of a cyber-physical system (Rehab Tracker) for improving patient compliance with at-home physical rehabilitation using neuromuscular electrical stimulation (NMES) therapy. Rehab Tracker consists of three components: 1) hardware modifications to sense and store use data from an FDA-approved NMES therapy device and provide Bluetooth communication capability, 2) an iOS-based smartphone/tablet application to receive and transmit NMES use data and serve as a conduit for patient-provider interactions and 3) a back-end server platform to receive device use data, display compliance data for provider review and provide automated positive and remedial push notifications to patients to improve compliance. This system allows for near real-time compliance monitoring via a secure web portal and offers a novel conduit for patient-provider communication during at-home rehabilitation to improve compliance. The system was tested in patients (n=5) who suffered anterior cruciate ligament rupture and surgical repair to provide proof-of-principal evidence for system functionality and an initial assessment of system usability. The system functioned as designed, recording 89% of rehabilitation sessions. Thus, Rehab Tracker is a functionally correct system with the potential to be used as a tool for studying NMES and mobile communication methodologies at scale and improving compliance with at-home rehabilitation programs.

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