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János Négyesi, Menno P. Veldman, Kelly M.M. Berghuis, Marie Javet, József Tihanyi and Tibor Hortobágyi

, 1999 ; Porter, Sakamoto, & Asanuma, 1990 ; Sawaki, Wu, Kaelin-Lang, & Cohen, 2006 ). In contrast, an increase in afferent input through mechanical vibration or electrical stimulation can potentiate motor skill acquisition and intermanual transfer ( Rothwell & Rosenkranz, 2005 ; Veldman, Maffiuletti

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Bernardo Requena, Jaan Ereline, Helena Gapeyeva and Mati Pääsuke

Context:

The understanding of posttetanic potentiation (PTP) in human muscles induced by percutaneous electrical stimulation (PES) is important for effective application of electrical stimulation in rehabilitation.

Objective:

To examine the effect of 7-second high-frequency (100-Hz) submaximal (25% of maximal voluntary contraction force) direct PES on contractile characteristics of the knee-extensor (KE) muscles.

Design:

Single-group repeated measures.

Setting:

Kinesiology laboratory.

Subjects:

13 healthy men age 18–27 years.

Measurement:

Peak force (PF), maximal rates of force development (RFD) and relaxation (RR) of supramaximal twitch, and PF of doublet and 10-Hz tetanic contractions before and after direct tetanic PES.

Results:

A significant potentiation of twitch, doublet, and 10-Hz tetanic-contraction PF has been observed at 1–5 minutes posttetanic. Twitch RFD and RR were markedly potentiated throughout the 10-minute posttetanic period.

Conclusions:

A brief high-frequency submaximal tetanic PES induces PTP in KE muscles associated with small increase at 1–5 minutes.

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Daria Neyroud, Jimmy Samararatne, Bengt Kayser and Nicolas Place

Neuromuscular electrical stimulation (NMES), which consists of delivering bursts of electrical current to a muscle, to depolarize terminal axonal motoneuron branches, is widely used for strength training and rehabilitation. It can be less time consuming than voluntary training, 1 and presents the

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Paul Head, Mark Waldron, Nicola Theis and Stephen David Patterson

in muscle mass during periods of immobilization 5 – 7 but to be unable to increase muscle strength and size. 5 – 8 Neuromuscular electrical stimulation (NMES) has also been shown to prevent disuse muscle atrophy, 9 but there is inconsistent evidence regarding its efficacy in enhancing muscle

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Antoine Langeard, Lucile Bigot, Gilles Loggia, Nathalie Chastan, Gaëlle Quarck and Antoine Gauthier

adults causes them to be more fearful of engaging in exercise, thus, creating a barrier for older adults to be willing to engage in exercise. 10 An interesting alternative could be home-based training by neuromuscular electrical stimulation (NMES), the application of an electrical current through

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John K. Malone, Catherine Blake and Brian Caulfield

Purpose:

To investigate the use of neuromuscular electrical stimulation (NMES) during acute recovery between 2 bouts of maximal aerobic exercise.

Methods:

On 3 separate days, 19 trained male cyclists (28 ± 7 y, 76.4 ± 10.4 kg, power output at maximal aerobic power [pVo2max] 417 ± 44 W) performed a 3-min maximal cycling bout at 105% PVo2max before a 30-min randomly assigned recovery intervention of passive (PAS: resting), active (ACT: 30% PVo2max), or NMES (5 Hz, 4 pulses at 500 μs). Immediately afterward, a cycle bout at 95% PVo2max to exhaustion (TLIM) was performed. Heart rate (HR) and blood lactate (BLa) were recorded at designated time points. Data were analyzed using repeated-measures ANOVA with a Tukey honestly significantly different post hoc test. Statistical significance threshold was P < .05.

Results:

The TLIM was significantly shorter for NMES than for ACT (199.6 ± 69.4 s vs 250.7 ± 105.5 s: P = .016) but not PAS recovery (199.6 ± 69.4 s vs 216.4 ± 77.5 s: P = .157). The TLIM was not significantly different between ACT and PAS (250.7 ± 105.5 s vs 216.4 ± 77.5 s: P = .088). The decline in BLa was significantly greater during ACT than NMES and PAS recovery (P < .001), with no difference between NMES and PAS. In addition, HR was significantly higher during ACT than NMES and PAS recovery (P < .001), with no difference between NMES and PAS.

Conclusions:

NMES was less effective than ACT and comparable to PAS recovery when used between 2 bouts of maximal aerobic exercise in trained male cyclists.

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Alison R. Snyder, April L. Perotti, Kenneth C. Lam and R. Curtis Bay

Context:

Electrical stimulation is often used to control edema formation after acute injury. However, it is unknown whether its theoretical benefits translate to benefits in clinical practice.

Objectives:

To systematically review the basic-science literature regarding the effects of high-voltage pulsed stimulation (HVPS) for edema control.

Evidence Acquisition:

CINAHL (1982 to February 2010), PubMed (1966 to February 2010), Medline (1966 to February 2010), and SPORTDiscus (1980 to February 2010) databases were searched for relevant studies using the following keywords: edema, electrical stimulation, high-volt electrical stimulation, and combinations of these terms. Reference sections of relevant studies were hand-searched. Included studies investigated HVPS and its effect on acute edema formation and included outcome measures specific to edema. Eleven studies met the inclusion criteria. Methodological quality and level of evidence were assessed for each included study. Effect sizes were calculated for primary edema outcomes.

Evidence Synthesis:

Studies were critiqued by electrical stimulation treatment parameters: mode of stimulation, polarity, frequency, duration of treatment, voltage, intensity, number of treatments, and overall time of treatments. The available evidence indicates that HVPS administered using negative polarity, pulse frequency of 120 pulses/s, and intensity of 90% visual motor contraction may be effective at curbing edema formation. In addition, the evidence suggests that treatment should be administered in either four 30-min treatment sessions (30-min treatment, 30-min rest cycle for 4 h) or a single, continuous180-min session to achieve the edemasuppressing effects.

Conclusions:

These findings suggest that the basic-science literature provides a general list of treatment parameters that have been shown to successfully manage the formation of edema after acute injury in animal subjects. These treatment parameters may facilitate future research related to the effects of HVPS on edema formation in humans and guide practical clinical use.

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William R. Holcomb, Mack D. Rubley, Michael G. Miller and Tedd J. Girouard

Context:

Previous studies using neuromuscular electrical stimulation (NMES) have suggested that 30-second rest intervals are too short for sufficient recovery.

Objective:

To compare the effect of rest interval on knee-extension torque production.

Design:

Counterbalanced mixed design to test independent variable, rest interval; ANOVA to analyze dependent variable, percentage decline.

Setting:

Athletic training research laboratory.

Participants:

24 healthy men and women.

Intervention:

Participants performed knee extension under 2 contraction conditions, maximum voluntary isometric contraction (MVIC) and NMES with either 30- or 120-second rest between repetitions.

Main Outcome Measure:

Peak torque produced during each repetition of a 5-repetition set.

Results:

The main effect for rest interval was significant (F 1,23 = 30.30, P = .001), as was the main effect for condition (F 1,23 = 11.18, P = .003).

Conclusions:

A 120-second rest between repetitions is recommended when using NMES in early rehabilitation because force decline across repetitions with 30-second rest during NMES is greater than with MVIC.

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Sara B. Giordano, Richard L. Segal and Thomas A. Abelew

The purpose of this study was to investigate the end-point force trajectories of the fibularis longus (FIB), lateral gastrocnemius (LG), and medial gastrocnemius (MG) muscles. Most information about individual muscle function has come from studies that use models based on electromyographic (EMG) recordings. In this study (N = 20 subjects) we used electrical stimulation (20 Hz) to elicit activity in individual muscles, recorded the end-point forces at the foot, and verified the selectivity of stimulation by using magnetic resonance imaging. Unexpectedly, no significant differences were found between LG and MG force directions. Stimulation of LG and MG resulted in downward and medial or lateral forces depending on the subject. We found FIB end-point forces to be significantly different from those of LG and MG. In all subjects, stimulation of FIB resulted in downward and lateral forces. Based on our results, we suggest that there are multiple factors determining when and whether LG or MG will produce a medial or lateral force and FIB consistently plays a significant role in eversion/abduction and plantar flexion. We suggest that the intersubject variability we found is not simply an artifact of experimental or technical error but is functionally relevant and should be addressed in future studies and models.

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Michael E. Lynch and Christine A. Lauber

Clinical Question:

Is it beneficial to add neuromuscular electrical stimulation (NMES) to a strengthening program after anterior cruciate ligament (ACL) reconstruction surgery?

Clinical Bottom Line:

There is sufficient evidence to support the inclusion of NMES in a rehabilitation strengthening program post ACL reconstruction. All three included studies reported significant quadriceps strength gains (p < .05) in favor of the group that completed both NMES and strengthening exercises compared with a strength-only group. Two studies initiated NMES within 4 days of surgery. One study found significant quadriceps strength increases when NMES was implemented 6 months after surgery.