The Application of Recovery Strategies for Cyclists

During training and congested competition schedules, recovery strategies are thought to alleviate post-exercise fatigue and enhance subsequent performance. Consequently, a substantial challenge is placed on athletes and coaches to ensure optimal recovery is attained, this has been one of the contributing factors for the development of acute recovery strategies aimed to enhance performance recovery. Recently, athletes have incorporated the use of Intermittent Sequential Pneumatic Compression (ISPC), a form of dynamic compression, to enhance recovery post-exercise. However, with contrasting findings and limited literature, further research is necessary to determine the value of ISPC on exercise recovery and/or subsequent performance. While ISPC has been examined in cycling settings, studies have failed to examine the effects of this strategy in trained cyclists, limiting the ecological validity of their results. Furthermore, the Omnium is a multi-race event in track cycling at the Olympic Games, with short periods of recovery (as little as 30-mins) between 6 separate races. Therefore, the objective of this investigation was to examine the impact of ISPC on trained cyclists, when implemented between a maximal 20-min cycling bout (simulated scratch race) and a 4-min maximal test (simulated individual pursuit), as experienced during an Omnium track cycling competition. Twenty-one (13 male, 8 female, mean ± SD; age: 36 ± 14 years) trained cyclists completed a familiarisation trial followed by two experimental trials in a counterbalanced, crossover design. Participants performed a fixed-intensity 20-min cycling bout on a Wattbike cycle ergometer, followed by a 30-min recovery period where ISPC recovery boots or passive recovery (CON) was implemented. At the conclusion of the recovery period, participants performed a 4-min maximal cycling bout (4-minTT). Average power (Watts) for the 4-minTT, blood lactate concentration (BLa) and perceived total quality recovery (TQR) during the recovery period were used to examine the influence of ISPC. There were no significant differences between trials for the 4-minTT (p = 0.08), with the effect deemed to be trivial (d = -0.08). There was an unclear effect (d ±90%CI = 0.26 ±0.78, p = 0.57) for ISPC vs CON in the clearance of BLa during the recovery period. There was a small but not significant difference for TQR in favour of ISPC (d ±90%CI = 0.27 ±0.27, p = 0.07). These findings suggest there is little additional benefit associated with the use of ISPC to enhance recovery and subsequent performance when used during the recovery period between two events in a simulated Omnium track cycling competition

Detecção de fadiga neuromuscular em pessoas com lesão medular completa utilizando transformada wavelet

Introduction: People with spinal cord injury (SCI) may have the paralyzed muscles activated through functional electrical stimulation (FES) on neural pathways present below the skin. These electrical stimulations are important to restore the neuromuscular trophism or during the movement control using neural prostheses. However, prolonged FES application causes fatigue, which decreases the contraction strength, mainly due the neuromuscular hypotrophy in this population. The acquisition of myofibers’ vibration is recognized by mechanomyography (MMG) system and does not suffer electrical interference from the FES system. Objective: To characterize the rectus femoris muscle vibration during electrically evoked neuromuscular fatigue protocol in complete spinal cord injury subjects. Methods: As sample, 24 limbs (right and left) from 15 male participants (age: 27±5 y.o.) and ranked as A and B according to American Spinal Injury Impairment Scale) were selected. An electrical stimulator operating as voltage source, specially developed for research, was configured as: pulse frequency set to 1 kHz (20% duty cycle) and burst (modulating) frequency set to 70 Hz (20% active period). The triaxial [X (transverse), Y (longitudinal) and Z (perpendicular)] MMG signal of rectus femoris muscle was processed with a third-order 5-50 Hz bandpass Butterworth filter. A load cell was used to register the force. The stimulator output voltage was increased (~3 V/s to avoid motoneuron adaptation/habituation) until the maximal electrically-evoked extension (MEEE) of the knee joint. After the load cell placement, the stimuli magnitude required to reach MEEE was applied and registered by the load cell as muscular F100% response. Stimuli intensity was increased during the control to keep the force in F100%. Four instants (I - IV) were selected from F100% up to the inability to keep the FES response force above 30% (F30%). The signal was processed in temporal (energy), spectral (median frequency) and wavelet (temporal-spectral with twelve band frequencies between 5 and 53 Hz) domains. All data were normalized by initial instant, creating arbitrary units (a.u.), and non-parametric tests were applied. Results: The median frequency did not show statistical significance. Regarding the MMG axes, the transverse axis showed most statistical differences. The MMG energy (temporal domain) indicates the decrease between the instants I (unfatigued) and II (pre-fatigue), as well as instants I and IV (fatigued). The wavelet domain focused on the transverse axis, especially on 13, 16, 20, 25 and 35 Hz frequency bands, for having shown significant reduction proven during neuromuscular fatigue. In focus on 25 Hz band frequency that showed a constant decrease between instants I (median value from data de 0.53 a.u.) with subsequent instants [II (0.30 a.u.), III (0.28 a.u.) and IV (0.24 a.u.). Conclusion: Neuromuscular fatigue is characterized by energy decrease in MMG X-axis (transverse) signal of vibration on the rectus femoris muscle for complete spinal cord injured subjects, in the temporal domain but mainly in the wavelet domain. The 25 Hz is the most important band frequency because its energy decreases with neuromuscular fatigue. These findings open the possibility of application in closed-loop systems during physical rehabilitation procedures using FES or in the control of neural prostheses.CNPqIntrodução: As pessoas com lesão medular (LM) podem ter seus músculos paralisados ativados por meio da estimulação elétrica funcional (FES) sobre vias neurais presentes próximas à pele. Estas estimulações elétricas são importantes para a recuperação do trofismo neuromuscular ou durante o controle de movimento por próteses neurais. No entanto, ao longo da aplicação da FES, a fadiga ocorre, diminuindo a eficiência da contração, principalmente devido à hipotrofia neuromuscular presente nessa população. A aquisição da vibração das fibras musculares como indicador de fadiga é registrada por meio da técnica de mecanomiografia (MMG), que não sofre interferências elétricas decorrentes da aplicação da FES. Objetivo: Caracterizar a vibração do músculo reto femoral durante protocolo de fadiga neuromuscular eletricamente evocada em pessoas com lesão medular completa. Método: 24 membros (direito e esquerdo) de 15 participantes (idade: 27±5 anos) do sexo masculino (A e B na American Spinal Injury Impairment Scale) foram selecionados. Um estimulador elétrico operando como fonte de tensão, desenvolvido especialmente para pesquisa, foi configurado com: freqüência de pulso em 1 kHz (20% de ciclo de trabalho) e trem de pulsos (modulação) em 70 Hz (20% período ativo). O sinal triaxial [X (transversal), Y (longitudinal) e Z (perpendicular)] da MMG foi processado com filtro Butterworth de terceira ordem e banda passante entre 5 e 50 Hz. Previamente ao protocolo, a tensão de saída do estimulador foi incrementada (~3 V/s evitando-se a adaptação/habituação dos motoneurônios) até alcançar a extensão máxima eletricamente estimulada (EMEE) da articulação do joelho. Uma célula de carga foi usada para registrar a resposta de força, onde após a sua colocação, a intensidade da FES necessária para alcançar a EMEE foi aplicada e registrada pela célula de carga como 100% da força (F100%). Durante o protocolo de fadiga neuromuscular, a intensidade do estímulo foi incrementada durante o controle para manter a força em F100%. Quatro instantes (I - IV) foram selecionados entre F100% e a incapacidade da FES manter a resposta de força acima de 30% (F30%). O sinal foi processado nos domínios temporal (energia), espectral (frequência mediana) e wavelet (temporal-espectral com doze bandas de frequência entre 5 e 53 Hz). Os dados extraídos foram normalizados pelo instante inicial (I) gerando unidades arbitrárias (u.a.), e testados com estatística não paramétrica. Resultados: A frequência mediana não apresentou significância estatística. Em relação aos eixos de deslocamento da MMG, o eixo transversal mostrou o maior número de resultados estatisticamente significantivos. A energia da vibração das fibras musculares (domínio temporal) indicou diminuição entre os instantes I (músculo fresco) e II (pré-fadiga), como também entre os instantes I e IV (fadigado) com redução significativa. O domínio wavelet teve como foco o eixo transversal, especialmente as bandas de frequência de 13, 16, 20, 25 e 35 Hz, por terem indicado redução significativa durante a fadiga neuromuscular; principalmente, a banda de 25 Hz, que indicou redução significativa entre o instante I (valor da mediana dos dados de 0,53 u.a.) e os demais instantes [II (0,30 u.a), III (0,28 u.a.) e IV (0,24 u.a.)]. Conclusão: A fadiga neuromuscular é caracterizada pela redução da energia do sinal no eixo de deslocamento transversal (X) da vibração do músculo reto femoral, em pessoas com lesão medular completa, tanto no domínio temporal quanto principalmente no domínio wavelet, sendo a banda de frequência de 25 Hz a mais relevante, porque sua energia diminui com a ocorrência da fadiga neuromuscular. Estes achados abrem a possibilidade de aplicação em sistemas de malha fechada durante procedimentos de reabilitação física utilizando FES ou no controle de próteses neurais

Development of a hybrid assist-as-need hand exoskeleton for stroke rehabilitation.

Stroke is one of the leading causes of disability globally and can significantly impair a patient’s ability to function on a daily basis. Through physical rehabilitative measures a patient may regain a level of functional independence. However, required therapy dosages are often not met. Rehabilitation is typically implemented through manual one-to-one assistance with a physiotherapist, which quickly becomes labour intensive and costly. Hybrid application of functional electrical stimulation (FES) and robotic support can access the physiological benefits of direct muscle activation while providing controlled and repeatable motion assistance. Furthermore, patient engagement can be heightened through the integration of a volitional intent measure, such as electromyography (EMG). Current hybrid hand-exoskeletons have demonstrated that a balanced hybrid support profile can alleviate FES intensity and motor torque requirements, whilst improving reference tracking errors. However, these support profiles remain fixed and patient fatigue is not addressed. The aim of this thesis was to develop a proof-of-concept assist-as-need hybrid exoskeleton for post-stroke hand rehabilitation, with fatigue monitoring to guide the balance of support modalities. The device required the development and integration of a constant current (CC) stimulator, stimulus-resistant EMG device, and hand-exoskeleton. The hand exoskeleton in this work was formed from a parametric Watt I linkage model that adapts to different finger sizes. Each linkage was optimised with respect to angular precision and compactness using Differential Evolution (DE). The exoskeleton’s output trajectory was shown to be sensitive to parameter variation, potentially caused by finger measurement error and shifts in coupler placement. However, in a set of cylindrical grasping trials it was observed that a range of movement strategies could be employed towards a successful grasp. As there are many possible trajectories that result in a successful grasp, it was deduced that the exoskeleton can still provide functional assistance despite its sensitivity to parameter variation. The CC stimulator developed in this work has a part cost of USD $145 and allows flexible adjustment of waveform parameters through an on-board micro-controller. The device is designed to output current up to ±30mA given a voltage compliance of ±50V. When applied across a 2kΩ load, the device exhibited a linear output transfer function, with a maximum ramp tracking error of 5 The stimulus-resistant EMG device builds on current designs by using a novel Schmitt trigger based artefact detection channel to adaptively blank stimulation artefacts without stimulator synchronisation. The design has a part cost of USD$150 and has been made open-source. The device demonstrated its ability to record EMG over its predominant energy spectrum during stimulation, through the stimulation electrodes or through separate electrodes. Pearson’s correlation coefficients greater than 0.84 were identified be- tween the normalised spectra of volitional EMG (vEMG) estimates during stimulation and of stimulation-free EMG recordings. This spectral similarity permits future research into applications such as spectral-based monitoring of fatigue and muscle coherence, posing an advantage over current same-electrode stimulation and recording systems, which can- not sample the lower end of the EMG spectrum due to elevated high-pass filter cut-off frequencies. The stimulus-resistant EMG device was used to investigate elicited EMG (eEMG)-based fatigue metrics during vEMG-controlled stimulation and hybrid support profiles. During intermittent vEMG-controlled stimulation, the eEMG peak-to-peak amplitude (PTP) index was the median frequency (MDF) had a negative correlation for all subjects with R > 0:62 during stimulation-induced wrist flexion and R > 0:55 during stimulation-induced finger flexion. During hybrid FES-robotic support trials, a 40% reduction in stimulus intensity resulted in an average 21% reduction in MDF gradient magnitudes. This reflects lower levels of fatigue during the hybrid support profile and indicates that the MDF gradient can provide useful information on the progression of muscle fatigue. A hybrid exoskeleton system was formed through the integration of the CC stimulator, stimulus-resistant EMG device, and the hand exoskeleton developed in this work. The system provided assist-as-need functional grasp assistance through stimulation and robotic components, governed by the user’s vEMG. The hybrid support profile demonstrated consistent motion assistance with lowered stimulation intensities, which in-turn lowered the subjects’ perceived levels of fatigue

Muscle activation patterns in shoulder impingement patients

Introduction: Shoulder impingement is one of the most common presentations of shoulder joint problems 1. It appears to be caused by a reduction in the sub-acromial space as the humerus abducts between 60o -120o – the 'painful arc'. Structures between the humeral head and the acromion are thus pinched causing pain and further pathology 2. Shoulder muscle activity can influence this joint space but it is unclear whether this is a cause or effect in impingement patients. This study aimed to observe muscle activation patterns in normal and impingement shoulder patients and determine if there were any significant differences. Method: 19 adult subjects were asked to perform shoulder abduction in their symptomatic arm and non-symptomatic. 10 of these subjects (age 47.9 ± 11.2) were screened for shoulder impingement, and 9 subjects (age 38.9 ± 14.3) had no history of shoulder pathology. Surface EMG was used to collect data for 6 shoulder muscles (Upper, middle and lower trapezius, serratus anterior, infraspinatus, middle deltoids) which was then filtered and fully rectified. Subjects performed 3 smooth unilateral abduction movements at a cadence of 16 beats of a metronome set at 60bpm, and the mean of their results was recorded. T-tests were used to indicate any statistical significance in the data sets. Significance was set at P<0.05. Results: There was a significant difference in muscle activation with serratus anterior in particular showing a very low level of activation throughout the range when compared to normal shoulder activation patterns (<30%). Middle deltoid recruitment was significantly reduced between 60-90o in the impingement group (30:58%).Trends were noted in other muscles with upper trapezius and infraspinatus activating more rapidly and erratically (63:25%; 60:27% respectively), and lower trapezius with less recruitment (13:30%) in the patient group, although these did not quite reach significance. Conclusion: There appears to be some interesting alterations in muscle recruitment patterns in impingement shoulder patients when compared against their own unaffected shoulders and the control group. In particular changes in scapula control (serratus anterior and trapezius) and lateral rotation (infraspinatus), which have direct influence on the sub-acromial space, should be noted. It is still not clear whether these alterations are causative or reactionary, but this finding gives a clear indication to the importance of addressing muscle reeducation as part of a rehabilitation programme in shoulder impingement patients