Nur Azah Hamzaid

Cardiorespiratory, metabolic, and biomechanical responses during functional electrical stimulation leg exercise: health and fitness benefits.

Functional electrical stimulation (FES)-induced leg exercise offers the potential for individuals with lower-limb paralysis to otherwise gain some benefits conferred by leg exercise. Although its original intent is to reactivate the leg muscles to produce functional upright mobility, as a rehabilitation therapy, FES-evoked exercise increases the whole-body metabolism of individuals with spinal cord injury (SCI) so that they may gain general and localized health and fitness benefits. The physiological and psychosocial responses during FES-evoked cycling, standing, rowing, leg extension, or stepping have been extensively explored for over 20 years. Some of the advantages of such exercise include augmented cardiorespiratory fitness, promotion of leg blood circulation, increased activity of specific metabolic enzymes or hormones, greater muscle volume and fiber size, enhanced functional exercise capacity such as strength and endurance, and altered bone mineral density. Positive psychosocial adaptations have also been reported among SCI individuals who undergo FES exercise. This article presents a position review of the available literature on the effects of FES-evoked exercise since the earliest date until 2007, to warrant a conclusion about the current status and potential of FES-evoked exercise for paralyzed people.

Mechanomyography and muscle function assessment: A review of current state and prospects

Previous studies have explored to saturation the efficacy of the conventional signal (such as electromyogram) for muscle function assessment and found its clinical impact limited. Increasing demand for reliable muscle function assessment modalities continues to prompt further investigation into other complementary alternatives. Application of mechanomyographic signal to quantify muscle performance has been proposed due to its inherent mechanical nature and ability to assess muscle function non-invasively while preserving muscular neurophysiologic information. Mechanomyogram is gaining accelerated applications in evaluating the properties of muscle under voluntary and evoked muscle contraction with prospects in clinical practices. As a complementary modality and the mechanical counterpart to electromyogram; mechanomyogram has gained significant acceptance in analysis of isometric and dynamic muscle actions. Substantial studies have also documented the effectiveness of mechanomyographic signal to assess muscle performance but none involved comprehensive appraisal of the state of the art applications with highlights on the future prospect and potential integration into the clinical practices. Motivated by the dearth of such critical review, we assessed the literature to investigate its principle of acquisition, current applications, challenges and future directions. Based on our findings, the importance of rigorous scientific and clinical validation of the signal is highlighted. It is also evident that as a robust complement to electromyogram, mechanomyographic signal may possess unprecedented potentials and further investigation will be enlightening.

Strategies for Rapid Muscle Fatigue Reduction during FES Exercise in Individuals with Spinal Cord Injury: A Systematic Review

Background Rapid muscle fatigue during functional electrical stimulation (FES)-evoked muscle contractions in individuals with spinal cord injury (SCI) is a significant limitation to attaining health benefits of FES-exercise. Delaying the onset of muscle fatigue is often cited as an important goal linked to FES clinical efficacy. Although the basic concept of fatigue-resistance has a long history, recent advances in biomedical engineering, physiotherapy and clinical exercise science have achieved improved clinical benefits, especially for reducing muscle fatigue during FES-exercise. This review evaluated the methodological quality of strategies underlying muscle fatigue-resistance that have been used to optimize FES therapeutic approaches. The review also sought to synthesize the effectiveness of these strategies for persons with SCI in order to establish their functional impacts and clinical relevance. Methods Published scientific literature pertaining to the reduction of FES-induced muscle fatigue was identified through searches of the following databases: Science Direct, Medline, IEEE Xplore, SpringerLink, PubMed and Nature, from the earliest returned record until June 2015. Titles and abstracts were screened to obtain 35 studies that met the inclusion criteria for this systematic review. Results Following the evaluation of methodological quality (mean (SD), 50 (6) %) of the reviewed studies using the Downs and Black scale, the largest treatment effects reported to reduce muscle fatigue mainly investigated isometric contractions of limited functional and clinical relevance (n = 28). Some investigations (n = 13) lacked randomisation, while others were characterised by small sample sizes with low statistical power. Nevertheless, the clinical significance of emerging trends to improve fatigue-resistance during FES included (i) optimizing electrode positioning, (ii) fine-tuning of stimulation patterns and other FES parameters, (iii) adjustments to the mode and frequency of exercise training, and (iv) biofeedback-assisted FES-exercise to promote selective recruitment of fatigue-resistant motor units. Conclusion Although the need for further in-depth clinical trials (especially RCTs) was clearly warranted to establish external validity of outcomes, current evidence was sufficient to support the validity of certain techniques for rapid fatigue-reduction in order to promote FES therapy as an integral part of SCI rehabilitation. It is anticipated that this information will be valuable to clinicians and other allied health professionals administering FES as a treatment option in rehabilitation and aid the development of effective rehabilitation interventions.

Mechanomyographic parameter extraction methods: An appraisal for clinical applications

The research conducted in the last three decades has collectively demonstrated that the skeletal muscle performance can be alternatively assessed by mechanomyographic signal (MMG) parameters. Indices of muscle performance, not limited to force, power, work, endurance and the related physiological processes underlying muscle activities during contraction have been evaluated in the light of the signal features. As a non-stationary signal that reflects several distinctive patterns of muscle actions, the illustrations obtained from the literature support the reliability of MMG in the analysis of muscles under voluntary and stimulus evoked contractions. An appraisal of the standard practice including the measurement theories of the methods used to extract parameters of the signal is vital to the application of the signal during experimental and clinical practices, especially in areas where electromyograms are contraindicated or have limited application. As we highlight the underpinning technical guidelines and domains where each method is well-suited, the limitations of the methods are also presented to position the state of the art in MMG parameters extraction, thus providing the theoretical framework for improvement on the current practices to widen the opportunity for new insights and discoveries. Since the signal modality has not been widely deployed due partly to the limited information extractable from the signals when compared with other classical techniques used to assess muscle performance, this survey is particularly relevant to the projected future of MMG applications in the realm of musculoskeletal assessments and in the real time detection of muscle activity.

The Effectiveness of FES-Evoked EMG Potentials to Assess Muscle Force and Fatigue in Individuals with Spinal Cord Injury

The evoked electromyographic signal (eEMG) potential is the standard index used to monitor both electrical changes within the motor unit during muscular activity and the electrical patterns during evoked contraction. However, technical and physiological limitations often preclude the acquisition and analysis of the signal especially during functional electrical stimulation (FES)-evoked contractions. Hence, an accurate quantification of the relationship between the eEMG potential and FES-evoked muscle response remains elusive and continues to attract the attention of researchers due to its potential application in the fields of biomechanics, muscle physiology, and rehabilitation science. We conducted a systematic review to examine the effectiveness of eEMG potentials to assess muscle force and fatigue, particularly as a biofeedback descriptor of FES-evoked contractions in individuals with spinal cord injury. At the outset, 2867 citations were identified and, finally, fifty-nine trials met the inclusion criteria. Four hypotheses were proposed and evaluated to inform this review. The results showed that eEMG is effective at quantifying muscle force and fatigue during isometric contraction, but may not be effective during dynamic contractions including cycling and stepping. Positive correlation of up to r = 0.90 (p < 0.05) between the decline in the peak-to-peak amplitude of the eEMG and the decline in the force output during fatiguing isometric contractions has been reported. In the available prediction models, the performance index of the eEMG signal to estimate the generated muscle force ranged from 3.8% to 34% for 18 s to 70 s ahead of the actual muscle force generation. The strength and inherent limitations of the eEMG signal to assess muscle force and fatigue were evident from our findings with implications in clinical management of spinal cord injury (SCI) population.

Development of an isokinetic FES leg stepping trainer (iFES-LST) for individuals with neurological disability

An exercise device, employing functional electrical stimulation (FES) of leg muscles and a seated elliptical stepping mechanism, was developed for people with neurological disabilities. A feedback motor control system was developed to maintain constant (“isokinetic”) pedalling cadence, and the device could both assist legs with poor muscle power as well as resist a stronger stepping effort. FES was employed to recruit particular leg muscle groups in a pattern that resembled voluntary elliptical stepping. To switch the electrical stimulation on and off, the pedal cranks angular position was used to identify the foots instantaneous position throughout the movement path. Thus, key lower limb muscles (quadriceps, hamstrings, gluteals) could be exercised in this population with muscle weakness or paralysis. Stepping cadence, stimulation current level and each muscle groups stimulation angle could be modified ad-hoc, while the power output responses were monitored to fine tune the quality of leg exercise.

Estimation of Electrically-Evoked Knee Torque from Mechanomyography Using Support Vector Regression

The difficulty of real-time muscle force or joint torque estimation during neuromuscular electrical stimulation (NMES) in physical therapy and exercise science has motivated recent research interest in torque estimation from other muscle characteristics. This study investigated the accuracy of a computational intelligence technique for estimating NMES-evoked knee extension torque based on the Mechanomyographic signals (MMG) of contracting muscles that were recorded from eight healthy males. Simulation of the knee torque was modelled via Support Vector Regression (SVR) due to its good generalization ability in related fields. Inputs to the proposed model were MMG amplitude characteristics, the level of electrical stimulation or contraction intensity, and knee angle. Gaussian kernel function, as well as its optimal parameters were identified with the best performance measure and were applied as the SVR kernel function to build an effective knee torque estimation model. To train and test the model, the data were partitioned into training (70%) and testing (30%) subsets, respectively. The SVR estimation accuracy, based on the coefficient of determination (R2) between the actual and the estimated torque values was up to 94% and 89% during the training and testing cases, with root mean square errors (RMSE) of 9.48 and 12.95, respectively. The knee torque estimations obtained using SVR modelling agreed well with the experimental data from an isokinetic dynamometer. These findings support the realization of a closed-loop NMES system for functional tasks using MMG as the feedback signal source and an SVR algorithm for joint torque estimation.

Development of computer play pedagogy intervention for children with low conceptual understanding in basic mathematics operation using the dyscalculia feature approach

This study describes the development of a basic computer-based play pedagogy intervention using a dyscalculia-remedy-oriented approach such as repetition and number orientation manipulation, and the investigation of its effect on children displaying dyscalculia characteristics. This computer play was evaluated in a group of 50 seven-year-old Malaysian children, who were low achievers in mathematics subject and were divided into control and intervention group. The intervention group engaged with the newly developed computer play for an hour per day for five consecutive days, while the control group attended normal classroom learning for the same time period. Overall post-test scores indicated that children from the intervention group performed significantly better than the control group after the five-day intervention period by 57.9%. Number disorientation and arithmetic operation confusion, which are common amongst the children displaying dyscalculia characteristics, were also significantly reduced after the intervention. This implies that the children benefitted from the computer play.

Detection of Prosthetic Knee Movement Phases via In-Socket Sensors: A Feasibility Study

This paper presents an approach of identifying prosthetic knee movements through pattern recognition of mechanical responses at the internal sockets wall. A quadrilateral double socket was custom made and instrumented with two force sensing resistors (FSR) attached to specific anterior and posterior sites of the sockets wall. A second setup was established by attaching three piezoelectric sensors at the anterior distal, anterior proximal, and posterior sites. Gait cycle and locomotion movements such as stair ascent and sit to stand were adopted to characterize the validity of the technique. FSR and piezoelectric outputs were measured with reference to the knee angle during each phase. Piezoelectric sensors could identify the movement of midswing and terminal swing, pre-full standing, pull-up at gait, sit to stand, and stair ascent. In contrast, FSR could estimate the gait cycle stance and swing phases and identify the pre-full standing at sit to stand. FSR showed less variation during sit to stand and stair ascent to sensitively represent the different movement states. The study highlighted the capacity of using in-socket sensors for knee movement identification. In addition, it validated the efficacy of the system and warrants further investigation with more amputee subjects and different sockets types.

Torque and mechanomyogram relationships during electrically-evoked isometric quadriceps contractions in persons with spinal cord injury

The interaction between muscle contractions and joint loading produces torques necessary for movements during activities of daily living. However, during neuromuscular electrical stimulation (NMES)-evoked contractions in persons with spinal cord injury (SCI), a simple and reliable proxy of torque at the muscle level has been minimally investigated. Thus, the purpose of this study was to investigate the relationships between muscle mechanomyographic (MMG) characteristics and NMES-evoked isometric quadriceps torques in persons with motor complete SCI. Six SCI participants with lesion levels below C4 [(mean (SD) age, 39.2 (7.9) year; stature, 1.71 (0.05) m; and body mass, 69.3 (12.9) kg)] performed randomly ordered NMES-evoked isometric leg muscle contractions at 30°, 60° and 90° knee flexion angles on an isokinetic dynamometer. MMG signals were detected by an accelerometer-based vibromyographic sensor placed over the belly of rectus femoris muscle. The relationship between MMG root mean square (MMG-RMS) and NMES-evoked torque revealed a very high association (R(2)=0.91 at 30°; R(2)=0.98 at 60°; and R(2)=0.97 at 90° knee angles; P<0.001). MMG peak-to-peak (MMG-PTP) and stimulation intensity were less well related (R(2)=0.63 at 30°; R(2)=0.67 at 60°; and R(2)=0.45 at 90° knee angles), although were still significantly associated (P≤0.006). Test-retest interclass correlation coefficients (ICC) for the dependent variables ranged from 0.82 to 0.97 for NMES-evoked torque, between 0.65 and 0.79 for MMG-RMS, and from 0.67 to 0.73 for MMG-PTP. Their standard error of measurements (SEM) ranged between 10.1% and 31.6% (of mean values) for torque, MMG-RMS and MMG-PTP. The MMG peak frequency (MMG-PF) of 30Hz approximated the stimulation frequency, indicating NMES-evoked motor unit firing rate. The results demonstrated knee angle differences in the MMG-RMS versus NMES-isometric torque relationship, but a similar torque related pattern for MMG-PF. These findings suggested that MMG was well associated with torque production, reliably tracking the motor unit recruitment pattern during NMES-evoked muscle contractions. The strong positive relationship between MMG signal and NMES-evoked torque production suggested that the MMG might be deployed as a direct proxy for muscle torque or fatigue measurement during leg exercise and functional movements in the SCI population.