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The effects of FES cycling combined with virtual reality racing biofeedback on voluntary function after incomplete SCI: A pilot study

The effects of FES cycling combined with virtual reality racing biofeedback on voluntary function after incomplete SCI: A pilot study
The effects of FES cycling combined with virtual reality racing biofeedback on voluntary function after incomplete SCI: A pilot study
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.
1743-0003
Duffell, Lynsey D.
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Paddison, Sue
366a652c-c166-47ff-aa1e-7f70d8e3a4bb
Alahmary, Ahmad, F. A.
e10967ef-1b2b-4a3b-bf76-60fd46988a4d
Donaldson, Nick
0e2d66b4-ce73-4cbb-8cad-d6d55c063d98
Burridge, Jane
0110e9ea-0884-4982-a003-cb6307f38f64
Duffell, Lynsey D.
b7dfdb9e-5085-45ef-ba69-0a90c1355e5b
Paddison, Sue
366a652c-c166-47ff-aa1e-7f70d8e3a4bb
Alahmary, Ahmad, F. A.
e10967ef-1b2b-4a3b-bf76-60fd46988a4d
Donaldson, Nick
0e2d66b4-ce73-4cbb-8cad-d6d55c063d98
Burridge, Jane
0110e9ea-0884-4982-a003-cb6307f38f64

Duffell, Lynsey D., Paddison, Sue, Alahmary, Ahmad, F. A., Donaldson, Nick and Burridge, Jane (2019) 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, [149]. (doi:10.1186/s12984-019-0619-4).

Record type: Article

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.

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The effects of FES cycling combined with virtual reality racing biofeedback on voluntary function after incomplete SCI A pilot study - Accepted Manuscript
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Accepted/In Press date: 5 November 2019
e-pub ahead of print date: 27 November 2019

Identifiers

Local EPrints ID: 435822
URI: http://eprints.soton.ac.uk/id/eprint/435822
ISSN: 1743-0003
PURE UUID: 787de994-58ac-4b0c-9ec6-05fc980d522b
ORCID for Jane Burridge: ORCID iD orcid.org/0000-0003-3497-6725

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Date deposited: 21 Nov 2019 17:30
Last modified: 26 Nov 2021 02:40

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Contributors

Author: Lynsey D. Duffell
Author: Sue Paddison
Author: Ahmad, F. A. Alahmary
Author: Nick Donaldson
Author: Jane Burridge ORCID iD

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