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While a number of studies have demonstrated the benefits of FES-cycling therapy for people who have had a stroke, the question Italian researchers wanted to answer is whether FES-cycling might be better than standard physiotherapy for recovering functional motion.

To answer this question, the researchers recruited 16 patients who experienced their first stroke less than 6 months prior to enrolling in the study. All patients were over 18 years old and were evaluated before and after therapy training using standard measures of function including gait analysis and volitional cycling ability.

Participants were randomly assigned to FES-cycling therapy or standard physical therapy. Both groups were compared to an age-matched healthy group. Participants underwent 75 minutes of training a day for 15 days. In the FES group, the training consisted of 25 minutes of FES-assisted cycling and 50 minutes of standard therapy. The comparison group did 75 minutes of standard physiotherapy, including strength and stretching exercises, gait training, and hand rehabilitation.

At the end of the intervention, participants underwent testing and evaluation by therapists who were unaware of the group to which the patients belonged. The tests included functional evaluation, 6-minute walk test, and a cycling test, where patients were asked to volitionally pedal at four different velocities (20, 30, 40 and 50 revolutions per minute).

A comparison of the FES-cycling and standard therapy groups showed that both obtained similar improvements in functional performance as a result of the intervention (45.2% and 47.9% improvement for the FES-cycling and standard therapy groups, respectively).

Analysis of the gait speed and double support time (how long both feet are on the ground during walking) showed that the FES-cycling group experienced greater improvements in both of these measures as compared to the standard therapy group. Specifically, the FES-cycling group experienced a 35.4% increase in gait speed and a 33.8% reduction in double support time, while the standard therapy group only had a 24.3% increase in gait speed and a 23.0% reduction in double support time.

The greatest differences between the FES-cycling and standard therapy groups were highlighted by the cycling test. Patients in the FES-cycling group could produce significantly more power with their affected leg (30.5% versus 11.1% improvement in the control group) with a more symmetrical and efficient pedaling motion.

The researchers concluded that these preliminary results suggest that FES-assisted cycling training is safe and effective for improving both cycling and walking ability in post-acute elderly stroke patients. In fact, FES-assisted cycling training is at least as effective as standard physiotherapy and, in some measures, is more effective.

The study did not look at the benefits of FES-cycling therapy that have been shown in other studies, such as improved exercise capacity, aerobic capacity and cardiopulmonary function. It also was limited to 15 sessions and the authors said the preliminary results indicated that 15 sessions may not be enough to show a significant difference between the two groups.

While FES-cycling has long been associated with benefits to people with spinal cord injury, a growing body of research is showing that people with other neurological disorders such as stroke may have as much or more to gain from FES-cycling.

If you or someone you love has had a debilitating stroke and is interested in FES-cycling, contact us today to learn how an affordable MyoCycle Home can become part of your recovery and rehabilitation program and enable you to gain the benefits of standard physical therapy from the comfort of home.

 Source: European Journal of Translational Myology, Sep. 2016

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5128967/

 

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Among people with spinal cord injury, who is most likely to benefit from functional electrical stimulation (FES) therapy? That’s a great question that many researchers are asking in regard to a wide range of spinal cord injuries.

In a small study of 14 paraplegics wishing to participate in sports, researchers found that people whose spinal cord injury occurred above T-12 were more likely to benefit from FES-cycling therapy, and those with traumatic injury as opposed to infectious injury were the most likely to respond to FES-cycling therapy.

The Brazilian and French researchers published their findings in the European Journal of Translational Myology last fall.

In the study, the researchers aimed to examine the personal, clinical, structural, and functional characteristics of people with paraplegia interested in sports. They assessed all for responsiveness to neuromuscular electrical stimulation (NMES) by applying stimulation to the subjects’ leg muscles. They divided those whose muscles visibly contracted into the responsive group and those whose did not assigned to the non-responsive group.

In all, there were 14 volunteers, 3 men and 11 women between the ages of 23 and 56, who had been living with paralysis from 2 to 50 months. All participated in 16-sessions using surface NMES applied to the quadriceps and progressing to other muscle groups. The strength of contractions in response to NMES was measured on a scale from 0 to 5, where 3/5 was considered strong enough for movement against gravity.

The researchers found that all the volunteers who responded to NMES had spinal cord injuries above T-12, while among those who did not respond, half had injuries above T-12 and half had injuries below T-12 or the lumbar area. When they distinguished between spinal injury caused by trauma versus infection, they found that only one in the non-responsive group had spinal cord injury above T-12.

They concluded that paraplegics with traumatic spinal injuries above T-12 were the best potential candidates for FES-cycling therapy. According to the 2015 Annual Report by the National Spinal Cord Injury Statistical Center (NSCISC), 90% of people with spinal cord injury are injured at T-12 or above, meaning that 9 out of 10 people with spinal cord injury are likely good candidates for FES-cycling therapy.

The explanation for these results is that injury below T-12, or certain types of spinal cord infections, typically damage the peripheral nerves. Without intact peripheral nerves, NMES/FES cannot cause the muscles to contract, meaning that people with damaged peripheral nerves are not good candidates for FES-cycling therapy.

If you or a loved one may be a candidate for FES-cycling therapy, the MyoCycle Home may be right for you. It is the most affordable, easiest-to-use FES bike ever made, and it empowers people with muscle weakness or paralysis to get the best workout possible from the comfort of home.

Source: European Journal of Translational Myology, Sep 2016

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5128972/

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Cerebral palsy (CP) is a broadly-defined neurological disorder that encompasses brain injury or malformation in a child’s brain that occurs before, during, or immediately after birth and results in impaired motor control [1]. Because of the broad definition of CP, people with CP can exhibit a very wide range of symptoms, and no two people with CP will exhibit the same symptoms. However, people with CP generally have difficulty moving parts of their bodies normally because of muscle weakness or paralysis, impaired muscle coordination, and/or spasticity. Impaired motor control can also be accompanied by intellectual impairment, seizures, or sensory impairment.

Physical impairment can severely limit participation in physical activity by people with CP, as is true for anyone with physical impairments. Lack of physical activity can lead to the development of any number of chronic diseases [2], especially in children with disabilities like CP [3]. Exercise is an effective method for mitigating the negative secondary health effects of neuromuscular diseases like CP [4], but how can someone with CP exercise despite their impaired motor control, especially when 31% of children with Cerebral Palsy have limited or no walking ability [5]?
Stationary cycling is an especially effective means of exercising for people with disabilities, as it’s a relatively simple task that physically engages the entire lower body but doesn’t require dynamic balancing. Unfortunately, physical impairment often prevents children with CP from cycling at workloads high enough to achieve a significant therapeutic effect. Cycling combined with functional electrical stimulation (FES-cycling) has been used for more than 30 years to help people with spinal cord injury exercise despite physical impairment [6]. Recent research is proving that an FES bike, especially FES-assisted cycling, where the patient actively participates in the cycling with help from FES, offers similar benefits for people with CP [7]-[10]. Specifically, the research has demonstrated the following benefits:
•    Improved muscle coordination and strength
•    Immediate improvements in cycling performance
•    Improved walking ability
•    Better quality of life

FES-cycling may also provide afferent sensory input to the central nervous system that enhances brain plasticity and cortical motor output, which may further improve functional outcomes in a manner similar to the effect of FES-cycling for people with multiple sclerosis, Parkinson’s disease, or stroke.
FES-cycling can significantly improve quality of life for people with CP, as it provides them a way to achieve therapeutically significant levels of physical activity despite their physical impairments. The MyoCycle is an affordable, easy-to-use FES bike that can be used by people with Cerebral Palsy to achieve the combined benefits of cycling, isokinetic exercise, and FES. The MyoCycle can specifically provide the following benefits to people with CP:
•    Relaxation of muscle spasms
•    Prevention or retardation of disuse atrophy
•    Increasing local blood circulation
•    Muscle re-education
•    Maintaining or increasing range of motion


If you or someone you love has CP and is interested in FES-cycling, contact us today to learn how the MyoCycle can meet your needs or join the waiting list now!

[1] CerebralPalsy.org

[2] Booth, F. W.; Roberts, C. K.; Laye, M. J. 2012. Lack of exercise is a major cause of chronic diseases. Compr Physiol. 2(2):1143-1211.

[3] United States Government. Healthy People 2010: Disability and Secondary Conditions. 2005.

[4] Anziska, Y. and Sternberg, A. 2013. Exercise in neuromuscular disease. Muscle Nerve. 48(1):3-20.

[5] CDC.gov

[6] Petrofsky, J. S.; Phillips, C. A.; Heaton, H. H.; Glaser, R. M. 1984. Bicycle ergometer for paralyzed muscle. Journal of Clinical Engineering. 9(1):13-19.

[7] Harrington, A. T.; McRae, C. G. A.; Lee, S. C. K. 2012. Evaluation of functional electrical stimulation to assist cycling in four adolescents with spastic cerebral palsy. International Journal of Pediatrics.

[8] McRae, C. G. A.; Johnston, T. E.; Lauer, R. T.; Tokay, A. M.; Lee, S. C. K.; Hunt, K. J. 2009. Cycling for children with neuromuscular impairments using electrical stimulation—development of tricycle-based systems. Med Eng Phys. 31(6):650-9.

[9] Johnston, T. E. and Wainwright, S. F. 2011. Cycling with functional electrical stimulation in an adult with spastic diplegic cerebral palsy. Phys Ther. 91(6):970-82.

[10] Peng, C.-W. et al. 2011. Review. Clinical Benefits of Functional Electrical Stimulation Cycling Exercise for Subjects with Central Neurological Impairments. Journal of Medical and Biological Engineering. 31(1):1-11.

[11] CerebralPalsyGuidance.com

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Tuesday, 28 February 2017 14:16

The Benefits of FES-Cycling After a Stroke

Stroke (cerebrovascular accident or CVA) is a leading cause of death in the United States, killing more than 130,000 Americans every year [1]. Moreover, stroke is a leading cause of long-term disability, especially hemiparesis (weakness or paralysis on one side of the body). In fact, roughly 80% of stroke survivors have hemiparesis [2], which can cause difficult speaking, grasping objects, or walking. Therefore, rehabilitation following a stroke resulting in hemiparesis usually involves a combination of occupational therapy, speech therapy, and physical therapy. Independence in daily living, especially independent walking, is a priority for stroke survivors, so a major objective of rehabilitation post-stroke is to recover the ability to walk normally.

Recovery walking ability after a stroke is a complicated process, as walking function depends on motor control, muscular strength/power, cardiorespiratory fitness, and other factors [3]. There are many different therapeutic interventions aimed at improving walking function that address one or more of these factors. Recently, therapists have increased their use of task-specific training using bodyweight-supported treadmills or robotic gait trainers, but such systems are often complex, expensive, and difficult to use in a timely manner. Gait training is particularly difficult for patients with severely limited walking ability, limiting its effectiveness for the people who may need it most.

Stationary cycling is a tried and true means of exercise and rehabilitation, and it may be just as effective at improving gait as bodyweight-supported or robotic gait training devices [4]. Cycling is an effective therapeutic tool for improving walking post-stroke for a number of reasons:

  • it allows for continuous, repetitive motion involving symmetric, coordinated flexion and extension of the joints with agonist/antagonist muscle activation through a greater range of motion than that in walking
  • it can be used early post-stroke, when patients may not yet be able to participate in traditional gait training
  • it can easily be continued beyond rehab and incorporated into a healthy lifestyle, minimizing the risk for subsequent strokes
  • it may be safer than gait training, as balance isn’t required, minimizing the fear and risk of falling
  • cycling outcomes are easily quantifiable, and different training effects can be achieved by altering only a few parameters (e.g., muscular strength can be trained with low cadence and high resistance, while cardiorespiratory fitness can be trained with high cadence and low resistance)

When functional electrical stimulation (FES) is added to cycling (FES-cycling), the benefits of cycling for people post-stroke can be amplified. Several studies have demonstrated the benefits of FES-cycling for people post-stroke [5]-[9], including:

  • improved aerobic capacity and cardiopulmonary function;
  • improved symmetry and smoothness of cycling;
  • improved muscle strength, tone, and power output;
  • improved postural control and motor coordination;
  • reduced muscle spasticity; and
  • increased walking speed, step length, symmetry, and balance.

FES itself adds the benefits of preventing muscle atrophy, increasing blood flow, re-educating the muscles, and maintaining/increasing joint range of motion. FES-cycling may also provide afferent sensory input to the central nervous system that enhances brain plasticity and cortical motor output, which may further improve functional outcomes in a manner similar to the effect of FES-cycling for people with Parkinson’s disease.

Clearly, combining the benefits of cycling with the benefits of FES can dramatically improve the health and functional performance of people who have suffered a stroke. The MyoCycle is an FES bike that combines the benefits of cycling, isokinetic exercise, and FES into one affordable, easy-to-use system. If you or someone you love has had a stroke and is interested in FES-cycling, contact us today to learn how the MyoCycle can meet your needs!

  1. https://www.cdc.gov/stroke/facts.htm
  2. http://www.stroke.org/we-can-help/survivors/stroke-recovery/post-stroke-conditions/physical/hemiparesis
  3. Bowden, M. G.; Embry, A. E.; and Gregory, C. M. 2011. Physical Therapy Adjuvants to Promote Optimization of Walking Recovery After Stroke. Stroke Research and Treatment.
  4. Barbosa, D.; Santos, C. P.; and Martins, M. 2015. The Application of Cycling and Cycling Combined with Feedback in the Rehabilitation of Stroke Patients: A Review. Journal of Stroke and Cerebrovascular Disease. 24(2):253-273.
  5. Peng, C.-W. et al. 2011. Review. Clinical Benefits of Functional Electrical Stimulation Cycling Exercise for Subjects with Central Neurological Impairments. Journal of Medical and Biological Engineering. 31(1):1-11.
  6. Lee, S. Y. et al. 2013. The effects of assisted ergometer training with a functional electrical stimulation on exercise capacity and functional ability in sub-acute stroke patients. Ann Rehabil Med. 37:619.
  7. Ambrosini, E. et al. 2011. Cycling induced by electrical stimulation improves motor recovery in postacute hemiparetic patients: a randomized controlled trial. Stroke. 42:1068-1073.
  8. Lo, H.-C. et al. 2012. Cycling exercise with functional electrical stimulation improves postural control in stroke patients. Gait Posture. 35:506-510.
  9. Ambrosini, E. et al. 2012. Cycling induced by electrical stimulation improves muscle activation and symmetry during pedaling in hemiparetic patients. IEEE Trans Neural Syst Rehabil Eng. 20:320-330.
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Parkinson’s disease (PD) is a progressive neurological disorder that can have a profound impact on the way people move. Damage to brain cells inhibits the brains' ability to produce dopamine – a neurotransmitter necessary for communication between different parts of the brain. Without enough dopamine, the symptoms of Parkinson’s disease appear, which may include tremor, slow movements (bradykinesia), stiff muscles, weakness, loss of coordination, and other effects on movement.

Exercise is medicine, and exercise is especially therapeutic for people with PD [1]. The leading theory is that exercise triggers the release of neurotrophic factors in the brain, which help to protect the brain cells from further degeneration. Exercise may even improve the brain’s ability to produce dopamine, further slowing the degenerative effects of PD. This would explain the success of programs like Pedaling for Parkinson’s. Researchers have discovered that forced exercise, as opposed to voluntary exercise, can have an even greater therapeutic effect for people with PD [2].

Forced exercise usually involves a tandem bicycle with fixed gears, upon which an able-bodied person and a person with PD sit. The able-bodied person pedals faster than the person with Parkinson's can pedal on their own (usually around 90 rpm), effectively forcing the person with PD to pedal faster. This same effect can be achieved with a motorized exercise bike [3]. It has been demonstrated that forced exercise has a positive effect on PD symptoms, likely because both the quantity (pedaling faster) and quality (pedaling smoother) of the exercise is enhanced in forced pedaling when compared to voluntary pedaling by people with PD. Cueing (e.g., auditory cueing like a metronome) can have a similar effect by helping someone with Parkinson's improve the quality of their movements [1].

To summarize, Parkinson's causes stiffness, weakness, loss of coordination, tremors, and other effects on movement that can be treated by motor-assisted cycling, especially if cueing is provided.

It makes perfect sense, then, that motor-assisted cycling with functional electrical stimulation (FES-cycling) would be a great therapy option for people with PD. However, surprisingly, only MYOLYN’s co-founder, Matthew Bellman, PhD, together with Chris Hass, PhD, have investigated the potential benefits of FES-cycling for people with Parkinson's [4]. Their pilot data suggests that a person with Parkinson's can pedal faster and more smoothly when assisted by FES, likely because the added FES can enhance muscle force production and provide cueing via the sensation of the stimulation during cycling.

Therefore, FES-cycling, especially isokinetic FES-cycling with electric motor assistance, can provide a person with PD all the benefits of forced exercise, in addition to the traditional benefits of FES, which are:

  • Relaxation of muscle spasms
  • Prevention or retardation of disuse atrophy
  • Increasing local blood circulation
  • Muscle re-education
  • Maintaining or increasing range of motion

MYOLYN is working to understand further the potential benefits of FES-cycling for people with PD. If you or someone you love has Parkinson's and is interested in FES-cycling, contact us today to learn how the MyoCycle Home can meet your needs!

References

[1] Earhart, G. M. and Falvo, M. J. 2013. Parkinson Disease and Exercise. Comprehensive Physiology. 3:833–848.

[2] Ridgel, A. L.; Vitek, J. L.; and Alberts, J. L. 2009. Forced, Not Voluntary, Exercise Improves Motor Function in Parkinson’s Disease Patients. Neurorehabilitation and Neural Repair. 23(6):600-608.

[3] Ridgel, A. L. et al. 2012. Active-Assisted Cycling Improves Tremor and Bradykinesia in Parkinson’s Disease. Archives of Physical Medicine and Rehabilitation. 93(11):2049-2054.

[4] Bellman, M. J. et al. 2016. Switched Control of Cadence During Stationary Cycling Induced by Functional Electrical Stimulation. IEEE Transactions on Neural Systems and Rehabilitation Engineering. 24(12):1373-1383.

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