Objective

To understand the progression in parameters of functional electrical stimulation (FES) cycling dosage (including duration, velocity, stimulation amplitudes, power output), and the resulting changes in muscle mass early after acute spinal cord injury (SCI).

Methods

Three participants, 24–38 years old, with neurological injury level C4–T4, severity AIS (American Spinal Injury Association Impairment Scale) A–C, started FES cycling 16–20 days post injury while admitted at a level-1 trauma center in Canada, and continued for 8–13 weeks in a rehabilitation hospital. They performed three sessions/week of 15–45 min FES cycling, supine or sitting. FES parameters, cycling performance, and muscle cross-sectional area (CSA) in thighs and calves were measured every 2 weeks.

Results

Progression in power output, but not in session duration, was limited in two participants who experienced stimulation-associated referred pain or apprehension, requiring limitation of stimulation amplitudes for up to 65 days after the start of FES cycling. Participants started with 15 min cycling at 20 RPM with no resistance (0 W), and progressed to 30–45 min at 30 RPM producing 8.8–19.0 W average power/session after 2–3 months. Initially, muscle CSA decreased in all 3 participants (up to 16% after 6 weeks), and recovered later after a variable period of FES cycling (up to 16% at 13.3 weeks).

Conclusion

Progression of FES cycling in the first 3 months after injury required a highly individualized approach, guided by participant response, rather than standardized increments in stimulation intensity or duration. Changes in muscle CSA did not always correspond with the dose of FES cycling.

中文翻译：

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急性脊髓损伤后早期 FES 循环的时机和剂量：病例系列报告

 客观的

了解功能性电刺激 (FES) 循环剂量参数的进展（包括持续时间、速度、刺激幅度、功率输出），以及急性脊髓损伤 (SCI) 后早期肌肉质量的变化。

 方法

三名参与者，年龄 24-38 岁，神经损伤级别为 C4-T4，严重程度为 AIS（美国脊柱损伤协会损伤量表）A-C，在受伤后 16-20 天开始 FES 骑行，同时在 1 级创伤中心入院。加拿大，并在康复医院继续治疗 8-13 周。他们每周进行 3 次 15-45 分钟的 FES 骑行训练，仰卧或坐姿。每两周测量一次 FES 参数、骑行表现以及大腿和小腿的肌肉横截面积 (CSA)。

 结果

两名经历了刺激相关疼痛或忧虑的参与者的功率输出进展受到限制，但训练持续时间不受限制，需要在 FES 循环开始后长达 65 天内限制刺激幅度。参与者开始以 20 RPM 的速度骑行 15 分钟，无阻力 (0 W)，并进展到以 30 RPM 的速度骑行 30-45 分钟，2-3 个月后产生 8.8-19.0 W 的平均功率/会话。最初，所有 3 名参与者的肌肉 CSA 均下降（6 周后高达 16%），并在一段不同的 FES 循环周期后恢复（13.3 周时高达 16%）。

 结论

受伤后前 3 个月内 FES 循环的进展需要采用高度个性化的方法，以参与者反应为指导，而不是刺激强度或持续时间的标准化增量。肌肉 CSA 的变化并不总是与 FES 循环的剂量相对应。