Utilizing Physiological Principles of Motor Unit Recruitment to Reduce Fatigability of Electrically-Evoked Contractions: A Narrative Review
| Autor: | Trevor S. Barss, Francisca C. Claveria-Gonzalez, M. John Luu, David F. Collins, Dylan J Miller, Emily N. Ainsley, Matheus Joner Wiest |
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| Rok vydání: | 2018 |
| Předmět: |
Recruitment
Neurophysiological medicine.medical_specialty Motor Disorders Single pair Physical Therapy Sports Therapy and Rehabilitation Electromyography 03 medical and health sciences 0302 clinical medicine Physical medicine and rehabilitation Humans Medicine Functional electrical stimulation Isotonic Contraction medicine.diagnostic_test business.industry Rehabilitation Motor impairment 030229 sport sciences Electric Stimulation Motor unit Muscle Fatigue Motor unit recruitment Physical therapy Narrative review H-reflex business 030217 neurology & neurosurgery |
| Zdroj: | Archives of Physical Medicine and Rehabilitation. 99:779-791 |
| ISSN: | 0003-9993 |
| DOI: | 10.1016/j.apmr.2017.08.478 |
| Popis: | Neuromuscular electrical stimulation (NMES) is used to produce contractions to restore movement and reduce secondary complications for individuals experiencing motor impairment. NMES is conventionally delivered through a single pair of electrodes over a muscle belly or nerve trunk using short pulse durations and frequencies between 20 and 40Hz (conventional NMES). Unfortunately, the benefits and widespread use of conventional NMES are limited by contraction fatigability, which is in large part because of the nonphysiological way that contractions are generated. This review provides a summary of approaches designed to reduce fatigability during NMES, by using physiological principles that help minimize fatigability of voluntary contractions. First, relevant principles of the recruitment and discharge of motor units (MUs) inherent to voluntary contractions and conventional NMES are introduced, and the main mechanisms of fatigability for each contraction type are briefly discussed. A variety of NMES approaches are then described that were designed to reduce fatigability by generating contractions that more closely mimic voluntary contractions. These approaches include altering stimulation parameters, to recruit MUs in their physiological order, and stimulating through multiple electrodes, to reduce MU discharge rates. Although each approach has unique advantages and disadvantages, approaches that minimize MU discharge rates hold the most promise for imminent translation into rehabilitation practice. The way that NMES is currently delivered limits its utility as a rehabilitative tool. Reducing fatigability by delivering NMES in ways that better mimic voluntary contractions holds promise for optimizing the benefits and widespread use of NMES-based programs. |
| Databáze: | OpenAIRE |
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