The effects of FES cycling combined with virtual reality racing biofeedback on voluntary function after incomplete SCI: a pilot study
Abstract Background Functional Electrical Stimulation (FES) cycling can benefit health and may lead to neuroplastic changes following incomplete spinal cord injury (SCI). Our theory is that greater neurological recovery occurs when electrical stimulation of peripheral nerves is combined with volunta...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2019-11-01
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| Series: | Journal of NeuroEngineering and Rehabilitation |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12984-019-0619-4 |
| _version_ | 1818539652947116032 |
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| author | Lynsey D. Duffell Sue Paddison Ahmad F. Alahmary Nick Donaldson Jane Burridge |
| author_facet | Lynsey D. Duffell Sue Paddison Ahmad F. Alahmary Nick Donaldson Jane Burridge |
| author_sort | Lynsey D. Duffell |
| collection | DOAJ |
| description | Abstract Background Functional Electrical Stimulation (FES) cycling can benefit health and may lead to neuroplastic changes following incomplete spinal cord injury (SCI). Our theory is that greater neurological recovery occurs when electrical stimulation of peripheral nerves is combined with voluntary effort. In this pilot study, we investigated the effects of a one-month training programme using a novel device, the iCycle, in which voluntary effort is encouraged by virtual reality biofeedback during FES cycling. Methods Eleven participants (C1-T12) with incomplete SCI (5 sub-acute; 6 chronic) were recruited and completed 12-sessions of iCycle training. Function was assessed before and after training using the bilateral International Standards for Neurological Classification of SCI (ISNC-SCI) motor score, Oxford power grading, Modified Ashworth Score, Spinal Cord Independence Measure, the Walking Index for Spinal Cord Injury and 10 m-walk test. Power output (PO) was measured during all training sessions. Results Two of the 6 participants with chronic injuries, and 4 of the 5 participants with sub-acute injuries, showed improvements in ISNC-SCI motor score > 8 points. Median (IQR) improvements were 3.5 (6.8) points for participants with a chronic SCI, and 8.0 (6.0) points for those with sub-acute SCI. Improvements were unrelated to other measured variables (age, time since injury, baseline ISNC-SCI motor score, baseline voluntary PO, time spent training and stimulation amplitude; p > 0.05 for all variables). Five out of 11 participants showed moderate improvements in voluntary cycling PO, which did not correlate with changes in ISNC-SCI motor score. Improvement in PO during cycling was positively correlated with baseline voluntary PO (R2 = 0.50; p < 0.05), but was unrelated to all other variables (p > 0.05). The iCycle was not suitable for participants who were too weak to generate a detectable voluntary torque or whose effort resulted in a negative torque. Conclusions Improved ISNC-SCI motor scores in chronic participants may be attributable to the iCycle training. In sub-acute participants, early spontaneous recovery and changes due to iCycle training could not be distinguished. The iCycle is an innovative progression from existing FES cycling systems, and positive results should be verified in an adequately powered controlled trial. Trial registration ClinicalTrials.gov, NCT03834324. Registered 06 February 2019 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03834324. Protocol V03, dated 06.08.2015. |
| first_indexed | 2024-12-11T21:44:55Z |
| format | Article |
| id | doaj.art-fc5755c236994927960f2e4c35f723ca |
| institution | Directory Open Access Journal |
| issn | 1743-0003 |
| language | English |
| last_indexed | 2024-12-11T21:44:55Z |
| publishDate | 2019-11-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of NeuroEngineering and Rehabilitation |
| spelling | doaj.art-fc5755c236994927960f2e4c35f723ca2022-12-22T00:49:40ZengBMCJournal of NeuroEngineering and Rehabilitation1743-00032019-11-0116111510.1186/s12984-019-0619-4The effects of FES cycling combined with virtual reality racing biofeedback on voluntary function after incomplete SCI: a pilot studyLynsey D. Duffell0Sue Paddison1Ahmad F. Alahmary2Nick Donaldson3Jane Burridge4Department of Medical Physics & Biomedical Engineering, University College LondonLondon Spinal Cord Injury Centre, Royal National Orthopaedic HospitalFaculty of Environmental and Life Sciences, University of SouthamptonDepartment of Medical Physics & Biomedical Engineering, University College LondonFaculty of Environmental and Life Sciences, University of SouthamptonAbstract Background Functional Electrical Stimulation (FES) cycling can benefit health and may lead to neuroplastic changes following incomplete spinal cord injury (SCI). Our theory is that greater neurological recovery occurs when electrical stimulation of peripheral nerves is combined with voluntary effort. In this pilot study, we investigated the effects of a one-month training programme using a novel device, the iCycle, in which voluntary effort is encouraged by virtual reality biofeedback during FES cycling. Methods Eleven participants (C1-T12) with incomplete SCI (5 sub-acute; 6 chronic) were recruited and completed 12-sessions of iCycle training. Function was assessed before and after training using the bilateral International Standards for Neurological Classification of SCI (ISNC-SCI) motor score, Oxford power grading, Modified Ashworth Score, Spinal Cord Independence Measure, the Walking Index for Spinal Cord Injury and 10 m-walk test. Power output (PO) was measured during all training sessions. Results Two of the 6 participants with chronic injuries, and 4 of the 5 participants with sub-acute injuries, showed improvements in ISNC-SCI motor score > 8 points. Median (IQR) improvements were 3.5 (6.8) points for participants with a chronic SCI, and 8.0 (6.0) points for those with sub-acute SCI. Improvements were unrelated to other measured variables (age, time since injury, baseline ISNC-SCI motor score, baseline voluntary PO, time spent training and stimulation amplitude; p > 0.05 for all variables). Five out of 11 participants showed moderate improvements in voluntary cycling PO, which did not correlate with changes in ISNC-SCI motor score. Improvement in PO during cycling was positively correlated with baseline voluntary PO (R2 = 0.50; p < 0.05), but was unrelated to all other variables (p > 0.05). The iCycle was not suitable for participants who were too weak to generate a detectable voluntary torque or whose effort resulted in a negative torque. Conclusions Improved ISNC-SCI motor scores in chronic participants may be attributable to the iCycle training. In sub-acute participants, early spontaneous recovery and changes due to iCycle training could not be distinguished. The iCycle is an innovative progression from existing FES cycling systems, and positive results should be verified in an adequately powered controlled trial. Trial registration ClinicalTrials.gov, NCT03834324. Registered 06 February 2019 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03834324. Protocol V03, dated 06.08.2015.http://link.springer.com/article/10.1186/s12984-019-0619-4BiofeedbackCyclingFunctional electrical stimulationISNC-SCI motor scoreSpinal cord injuryVirtual reality |
| spellingShingle | Lynsey D. Duffell Sue Paddison Ahmad F. Alahmary Nick Donaldson Jane Burridge The effects of FES cycling combined with virtual reality racing biofeedback on voluntary function after incomplete SCI: a pilot study Journal of NeuroEngineering and Rehabilitation Biofeedback Cycling Functional electrical stimulation ISNC-SCI motor score Spinal cord injury Virtual reality |
| title | The effects of FES cycling combined with virtual reality racing biofeedback on voluntary function after incomplete SCI: a pilot study |
| title_full | The effects of FES cycling combined with virtual reality racing biofeedback on voluntary function after incomplete SCI: a pilot study |
| title_fullStr | The effects of FES cycling combined with virtual reality racing biofeedback on voluntary function after incomplete SCI: a pilot study |
| title_full_unstemmed | The effects of FES cycling combined with virtual reality racing biofeedback on voluntary function after incomplete SCI: a pilot study |
| title_short | The effects of FES cycling combined with virtual reality racing biofeedback on voluntary function after incomplete SCI: a pilot study |
| title_sort | effects of fes cycling combined with virtual reality racing biofeedback on voluntary function after incomplete sci a pilot study |
| topic | Biofeedback Cycling Functional electrical stimulation ISNC-SCI motor score Spinal cord injury Virtual reality |
| url | http://link.springer.com/article/10.1186/s12984-019-0619-4 |
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