Development of an Isokinetic Functional Electrical Stimulation Cycle Ergometer

An isokinetic functional electrical stimulation leg cycle ergometer (iFES-LCE) was developed for individuals with spinal cord injury (SCI). The iFES-LCE was designed to allow cycle training over a broad range of pedalling cadences (5-60 rev/min) to promote both muscular strength and cardiorespiratory fitness. A commercially available motorized cycle ergometer was integrated with a custom built FES system, a laptop computer, and a specialized chair that restricted lateral leg movements. Sample biomechanical data were collected from an SCI subject performing FES cycling to demonstrate the IFES-LCE's performance characteristics. Calibration of the IFES-LCE system revealed a linear relationship between torque applied to the axle of the motorized ergometer and the braking motor current generated to maintain velocity. Performance data derived from iFES-LCE motor torque agreed closely with similar data collected using strain-gauge instrumented pedals (cross-correlations = 0.93-0.98). The iFES-LCE was shown to work well across a range of pedaling cadences. We conclude that the new iFES-LCE system may offer improved training potential by allowing cycling over a broad range of pedaling cadences, especially low cadence. This device also improves upon the accuracy of other ergometers by adjusting for the passive load of the legs

External power output changes during prolonged cycling with electrical stimulation.

This study analysed external power output and physiologic responses in 5 individuals with paraplegia during 40 minutes of electrical stimulation leg cycle exercise. Cycling was performed on a motor-driven isokinetic ergometer that enabled precise determinations of power output. Electrical stimulation was increased to 120-140 mA within the first 5 minutes and remained constant thereafter. Power output increased to 10.7 +/- 3.0 W after 2 minutes, dropped to 5.3 +/- 1.8 W after 6 minutes and subsequently recovered to 8.2 +/- 2.2 and 6.1 +/- 2.3 W after 19.5 and 40 minutes, respectively. Oxygen consumption increased to 0.47 +/- 0.09 l/min after 6 minutes and declined during the second half of the exercise bout. Gross mechanical efficiency after 19.5 minutes was elevated compared with the value after 6 minutes. Heart rate was significantly increased at the end of the trial. The time-dependent variability of power output and physiological responses question the concept of steady state for this form of exercise

A novel motion sensor-driven control system for FES-assisted walking after spinal cord injury: A pilot study

This pilot study reports the development of a novel closed-loop (CL) FES-gait control system, which employed a finite-state controller that processed kinematic feedback from four miniaturized motion sensors. This strategy automated the control of knee extension via quadriceps and gluteus stimulation during the stance phase of gait on the supporting leg, and managed the stimulation delivered to the common peroneal nerve (CPN) during swing-phase on the contra-lateral limb. The control system was assessed against a traditional open-loop (OL) system on two sensorimotor ‘complete’ paraplegic subjects. A biomechanical analysis revealed that the closed-loop control of leg swing was efficient, but without major advantages compared to OL. CL automated the control of knee extension during the stance phase of gait and for this reason was the method of preference by the subjects. For the first time, a feedback control system with a simplified configuration of four miniaturized sensors allowed the addition of instruments to collect the data of multiple physiological and biomechanical variables during FES-evoked gait. In this pilot study of two sensorimotor complete paraplegic individuals, CL ameliorated certain drawbacks of current OL systems – it required less user intervention and accounted for the inter-subject differences in their stimulation requirements

Evoked EMG versus muscle torque during fatiguing functional electrical stimulation-evoked muscle contractions and short-term recovery in individuals with spinal cord injury

This study investigated whether the relationship between muscle torque and m-waves remained constant after short recovery periods, between repeated intervals of isometric muscle contractions induced by functional electrical stimulation (FES). Eight subjects with spinal cord injury (SCI) were recruited for the study. All subjects had their quadriceps muscles group stimulated during three sessions of isometric contractions separated by 5 min of recovery. The evoked-electromyographic (eEMG) signals, as well as the produced torque, were synchronously acquired during the contractions and during short FES bursts applied during the recovery intervals. All analysed m-wave variables changed progressively throughout the three contractions, even though the same muscle torque was generated. The peak to peak amplitude (PtpA), and the m-wave area (Area) were significantly increased, while the time between the stimulus artefact and the positive peak (PosT) were substantially reduced when the muscles became fatigued. In addition, all m-wave variables recovered faster and to a greater extent than did torque after the recovery intervals. We concluded that rapid recovery intervals between FES-evoked exercise sessions can radically interfere in the use of m-waves as a proxy for torque estimation in individuals with SCI. This needs to be further investigated, in addition to seeking a better understanding of the mechanisms of muscle fatigue and recovery

FES assisted standing in people with incomplete spinal cord injury: a single case design series

Study design: Single case cross-over design with multiple baselines. Objective: To compare two functional electrical stimulation (FES) training protocols to assist sit-to-stand in people with incomplete spinal cord injury (SCI). Setting: The study was conducted in Sydney, Australia. Methods: Four subjects with incomplete SCI undertook nine sessions of FES supported cycling at either 100 or 35Hz stimulus frequency repeated. Ground reaction force and rate of generation of vertical ground reaction force during standing from sitting were measured before and after each training series. Results: Subjects improved their ability to generate greater support through the feet after training with 35Hz stimulus paradigm but increased the rate of force production after training with 100Hz stimulation. Conclusions: Different FES training paradigms appear to produce different responses; however the ability to stand up seems more responsive to training with 35Hz FES stimulation