Denervated muscles in humans:: Limitations and problems of currently used functional electrical stimulation training protocols
Denervated muscles in humans:: Limitations and problems of currently used functional electrical stimulation training protocols
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DOI：
10.1046/j.1525-1594.2002.06933.x
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发表时间：
2002-03-01
影响因子：
2.4
通讯作者：
Stöhr, H
中科院分区：
文献类型：
--
作者：
Kern, H;Hofer, C;Stöhr, H
先前的临床工作表明，具有指数电流的电刺激疗法能够减缓萎缩并在非永久性弛缓性麻痹期间维持肌肉。然而，指数电流不足以长期。失神经变性肌肉（DDMs）的治疗。我们发起了一个欧洲研究项目，调查人类的康复策略，同时也研究了动物实验中卫星细胞或成肌细胞活性的肌肉再生的基本科学知识。在我们之前的研究中，我们能够证明高强度刺激DDM是可能的。在训练开始时，持续时间为120-150 ms的双相脉冲只能引起单次肌肉抽搐。随后，具有特殊刺激参数（30-50 ins的脉冲持续时间，16-25 Hz的刺激频率，高达250 mA的脉冲幅度）的肌肉强直收缩可以改善DDM的结构和代谢状态。因为没有神经末梢用于传导刺激，所以使用大尺寸的解剖学形状的电极。这确保了整个肌肉的均匀收缩。与目前的临床知识相反，我们能够在去神经支配15-20年后刺激和训练去神经支配的肌肉。估计每米需要恢复的肌纤维数量约为2-4百万纤维。四头肌重建如此大量的肌肉纤维需要长达3-4年。尽管刺激参数和训练方案恒定，但在功能性电刺激的第一年期间，肌肉的收缩力和抗疲劳性变化很大。
Prior clinical work showed that electrical stimulation therapy with exponential current is able to slow down atrophy and maintain the muscle during nonpermanent flaccid paralysis. However, exponential currents are not sufficient for long-term. therapy of denervated degenerated muscles (DDMs,). We initiated a European research project investigating the rehabilitation strategies in humans, but also studying the underlying basic scientific knowledge of muscle regeneration from satellite cells or myoblast activity in animal experiments. In our prior study, we were able to show that high-intensity stimulation of DDMs is possible. At the beginning of training, only single muscle twitches can be elicited by biphasic pulses with durations of 120-150 ms. Later, tetanic contraction of the muscle with special stimulation parameters (pulse duration of 30-50 ins, stimulation frequency of 16-25 Hz, pulse amplitudes of up to 250 mA) can improve the structural and metabolic state of the DDMs. Because there are no nerve endings for conduction of stimuli, large-size, anatomically shaped electrodes are used. This ensures an even contraction of the whole muscle. Contrary to the current clinical knowledge, we were able to stimulate and train denervated muscle 15-20 years after denervation. The estimated amount of muscle fibers that have to be restored is about 2-4 million fibers in each m. quadriceps. To rebuild such a large number of muscle fibers takes up to 3-4 years. Despite constant stimulation parameters and training protocols, there is a high variation in the developed contraction force and fatigue resistance of the muscle during the first years of functional electrical stimulation.