Abstract
After spinal cord injury (SCI), patients spend daily several hours in wheelchairs, sitting on their hamstring muscles. SCI causes muscle atrophy and wasting, which is especially severe after complete and permanent damage to lower motor neurons. A European Union (EU)-supported work demonstrates that electrical fields produced by large electrodes and purpose-developed electrical stimulators recover both quadriceps and hamstring muscles, producing a cushioning effect capable of benefitting SCI patients, even in the worst case of complete and long-term lower motor neuron denervation of leg muscles. We reported that 20 out of 25 patients completed a 2-year h-bFES program, which resulted in (1) a 35% increase in cross-sectional area of the quadriceps muscles (P < 0.001), (2) a 75% increase in mean diameter of quadriceps muscle fibers (P < 0.001), and (3) improvement of the ultrastructural organization of contractile machinery and of the Ca2+-handling system. Though not expected, after 2 years during which the 20 subjects performed 5 days per week h-bFES of the atrophic quadriceps muscles, the CT cross-sectional area of the hamstring muscles also augmented, increasing from 26.9+/−8.4 (cm2) to 30.7+/−9.8 (cm2), representing a significant (p ≤ 0.05) 15% increase. Here we show by quantitative muscle color computed tomography (QMC-CT) that h-bFES-induced tissue improvements are present also in the hamstring muscles: a once supposed drawback (lack of specificity of muscle activation by large surface electrodes) is responsible for a major positive clinical effect. Interestingly, 2 years of home-based FES by large surface electrodes reversed also the denervation-induced skin atrophy, increasing epidermis thickness. Finally, we would like to attract attention of the readers to quantitative muscle color computed tomography (QMC-CT), a sensitive quantitative imaging analysis of anatomically defined skeletal muscles introduced by our group to monitor atrophy/degeneration of skeletal muscle tissue. Worldwide acceptance of QMC-CT will provide physicians an improved tool to quantitate skeletal muscle atrophy/degeneration before and during rehabilitation strategies so that therapy for mobility-impaired persons can be better prescribed, evaluated, and altered where needed.
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References
Kern H, Hofer C, Loefler S, Zampieri S, Gargiulo P, Baba A, Marcante A, Piccione F, Pond A, Carraro U (2017) Atrophy, ultra-structural disorders, severe atrophy and degeneration of denervated human muscle in SCI and aging. Implications for their recovery by Functional Electrical Stimulation, updated 2017. Neurol Res. https://doi.org/10.1080/01616412.2017.1314906
Carraro U, Kern H, Gava P, Hofer C, Loefler S, Gargiulo P, Mosole S, Zampieri S, Gobbo V, Ravara B, Piccione F, Marcante A, Baba A, Schils S, Pond A, Gava F (2015) Biology of muscle atrophy and of its recovery by FES in aging and mobility impairments: roots and by-products. Eur J Transl Myol Aug 25;25(4):221–230. https://doi.org/10.4081/ejtm.2015.5272. eCollection 2015 Aug 24. Review
Carlson BM (2014) The biology of long-term denervated skeletal muscle. Eur J Transl Myol 24:3293. https://doi.org/10.4081/ejtm.2014.3293. eCollection 2014 Mar 31
Carraro U, Kern H (2016) Severely atrophic human muscle fibers with nuclear misplacement survive many years of permanent denervation. Eur J Transl Myol 26(2):5894. https://doi.org/10.4081/ejtm.2016.5894. eCollection 2016 Jun 13
Lomo T (2014) The response of denervated muscle to long-term stimulation (1985, Revisited here in 2014). Eur J Transl Myol 24:3294. doi: https://doi.org/10.4081/ejtm.2014.3294. eCollection 2014 Mar 31
Kern H, Boncompagni S, Rossini K, Mayr W, Fanò G, Zanin ME, Podhorska-Okolow M, Protasi F, Carraro U (2004) Long-term denervation in humans causes degeneration of both contractile and excitation- contraction coupling apparatus, which is reversible by functional electrical stimulation (FES). A role for myofiber regeneration? J Neuropathol Exp Neurol 63:919–931
Kern H, Carraro U (2014) Home-based functional electrical stimulation for long-term denervated human muscle: history, basics, results and perspectives of the Vienna Rehabilitation Strategy. Eur J Transl Myol 24(1):3296. https://doi.org/10.4081/ejtm.2014.3296. eCollection Mar 31.
Carraro U, Kern H, Gava P, Hofer C, Loefler S, Gargiulo P, Edmunds K, Árnadóttir ÍD, Zampieri S, Ravara B, Gava F, Nori A, Gobbo V, Masiero S, Marcante A, Baba A, Piccione F, Schils S, Pond A, Mosole S (2016) Recovery from muscle weakness by exercise and FES: lessons from Masters, active or sedentary seniors and SCI patients. Aging Clin Exp Res Sep 3. [Epub ahead of print].
Sajer S (2017) Mobility disorders and pain, interrelations that need new research concepts and advanced clinical commitments. Eur J Transl Myol 27(4):7179. https://doi.org/10.4081/ejtm.2017.7179. eCollection 2017 Dec 5.
Boncompagni S, Kern H, Rossini K, Hofer C, Mayr W, Carraro U, Protasi F (2007) Structural differentiation of skeletal muscle fibers in the absence of innervation in humans. Proceed Natl Acad Sci U S A 104:19339–19344
Kern H, Carraro U, Adami N, Hofer C, Loefler S, Vogelauer M, Mayr W, Rupp R, Zampieri S (2010) One year of home-based daily FES in complete lower motor neuron paraplegia: recovery of tetanic contractility drives the structural improvements of denervated muscle. Neurol Res 32:26–31
Kern H, Carraro U, Adami N, Biral D, Hofer C, Forstner C, Mödlin M, Vogelauer M, Pond A, Boncompagni S, Paolini C, Mayr W, Protasi F, Zampieri S (2010) Home-based functional electrical stimulation rescues permanently denervated muscles in paraplegic patients with complete lower motor neuron lesion. Neurorehabil Neural Repair 24:709–721
Available at: https://www.schuhfried.com/umbraco/Surface/AuthenticationSurface/Login?returnUrl=%2Fportal
Albertin G, Hofer C, Zampieri S, Vogelauer M, Löfler S, Ravara B, Guidolin D, Fede C, Incendi D, Porzionato A, De Caro R, Baba A, Marcante A, Piccione F, Gargiulo P, Pond A, Carraro U, Kern H (2018) In complete SCI patients, long-term functional electrical stimulation of permanent denervated muscles increases epidermis thickness. Neurol Res. https://doi.org/10.1080/01616412.2018.1436877
Gargiulo P, Reynisson PJ, Helgason B, Kern H, Mayr W, Ingvarsson P, Helgason T, Carraro U (2011) Muscle, tendons, and bone: structural changes during denervation and FES treatment. Neurol Res 33:750–758
Carraro U, Edmunds KJ, Gargiulo P (2015) 3D false color computed tomography for diagnosis and follow-up of permanent denervated human muscles submitted to home-based functional electrical stimulation. Eur J Transl Myol 25(2):5133. https://doi.org/10.4081/ejtm.2015.5133. eCollection 2015 Mar 11. Review
Edmunds KJ, Gíslason MK, Arnadottir ID, Marcante A, Piccione F, Gargiulo P (2016) Quantitative computed tomography and image analysis for advanced muscle assessment. Eur J Transl Myol 26(2):6015. https://doi.org/10.4081/ejtm.2016.6015. eCollection 2016 June 13
Edmunds K, Gíslason M, Sigurðsson S, Guðnason V, Harris T, Carraro U, Gargiulo P (2018) Advanced quantitative methods in correlating sarcopenic muscle degeneration with lower extremity function biometrics and comorbidities. PLoS One 13(3):e0193241. https://doi.org/10.1371/journal.pone.0193241. eCollection 2018
Hofer C, Loefler S, Kern H, Zampieri S, Albertin G, Carraro U (2018) Two years of FES training improves muscle fibers of thigh muscles in long-term thoracic level-complete spinal cord injury. Biol Eng Med 3(3):1–5. https://doi.org/10.15761/BEM.1000S1002
Carraro U, Albertin G, Gargiulo P, Ravara B, Piccione F, Zampieri S, Kern H (2018) Muscle and skin improve by home-based FES and fullbody in-bed gym. Biol Eng Med 3(3):1–4. https://doi.org/10.15761/BEM.1000S1003
Masiero S, Musumeci A (2018) Rehabilitation medicine for elderly patients, a further note. Biol Eng Med 3(3):1–2. https://doi.org/10.15761/BEM.1000S1006
Acknowledgments
This chapter was substantially modified from the paper published by our group in H Kern, U Carraro, S Loefler, Ch Hofer, S Zampieri, W Mayr, S Boncompagni, F Protasi, R Rizzuto, M Sandri, A Musarò, S Masiero, A Pond, F Piccione, and A Marcante. Functional Electrical Stimulation of Skeletal Muscles in Aging and Premature Aging. In: Rehabilitation Medicine for Elderly Patients, Masiero S, Carraro U, Eds. 2017; Chapter 11. pp. 93-104. DOI 10.1007/978-3-319-57406-6. The related contents are reused with permission.
The support of the European Regional Development Fund Cross Border Cooperation Program SLOVAKIA-AUSTRIA (Interreg Iva) project “Mobilität im Alter” MOBIL N_00033, Austrian Federal Ministry of Science and Research, and Ludwig Boltzmann Society (Vienna) is gratefully acknowledged, supported also by institutional funds of the Interdepartmental Research Center of Myology of the University of Padova; the IRCCS Fondazione Ospedale San Camillo, Venice; and the A&CM-C Foundation for Translational Myology, Padova, Italy.
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The authors declare no competing financial interests.
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Kern, H., Gargiulo, P., Pond, A., Albertin, G., Marcante, A., Carraro, U. (2018). To Reverse Atrophy of Human Muscles in Complete SCI Lower Motor Neuron Denervation by Home-Based Functional Electrical Stimulation. In: Xiao, J. (eds) Muscle Atrophy. Advances in Experimental Medicine and Biology, vol 1088. Springer, Singapore. https://doi.org/10.1007/978-981-13-1435-3_27
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