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Background: Functional electrical stimulation (FES) cycling has been reported to enhance muscle strength and improve muscle fatigue resistance after spinal cord injury (SCI). Despite its proposed benefits, the quantification of muscle fatigue during FES cycling remains poorly documented. This study sought to quantify the relationship between the vibrational performance of electrically‐evoked muscles measured through mechanomyography (MMG) and its oxidative metabolism through near‐infrared spectroscopy (NIRS) characteristics during FES cycling in fatiguing paralyzed muscles in individuals with SCI. Methods: Six individuals with SCI participated in the study. They performed 30 min of FES cycling with MMG and NIRS sensors on their quadriceps throughout the cycling, and the signals were analyzed. Results: A moderate negative correlation was found between MMG root mean square (RMS) and oxyhaemoglobin (O2Hb) [r = −0.38, p = 0.003], and between MMG RMS and total hemoglobin (tHb) saturation [r = −0.31, p = 0.017]. Statistically significant differences in MMG RMS, O2Hb, and tHb saturation occurred during pre‐ and post‐fatigue of FES cycling (p < 0.05). Conclusions: MMG RMS was negatively associated with O2Hb and muscle oxygen derived from NIRS. MMG and NIRS sensors showed good inter‐correlations, suggesting a promising use of MMG for characterizing metabolic fatigue at the muscle oxygenation level during FES cycling in individuals with SCI. [ABSTRACT FROM AUTHOR]

Abstract During the Cybathlon Global Edition 2020, athletes compete in a Functional Electrical Stimulation (FES) bike race. In this event, athletes with a spinal cord injury cover a distance of 1200 m on an adapted bike by using electrostimulation to activate their leg muscles in order to evoke a pedalling movement. This report reviews the training regimen, as designed by the PULSE Racing team, and the experience of one athlete in preparation for the Cybathlon Global Edition 2020. The training plan was designed to vary exercise modes in order to optimize physiological adaptations and minimize monotony for the athlete. Additional constraints due to coronavirus pandemic, e.g., postponement of the Cybathon Global Edition and modification from a live cycling track to a virtual stationary race, along with the health concerns of the athlete, e.g. unwanted effects from the FES and bladder infection, required creativity to ensure an effective and safe training protocol. The individual needs of the athlete and task requirements for the FES bike race made the design of a suitable training programme challenging, emphasizing the importance of monitoring. Several objective and subjective measures to assess the athlete’s health and progress are presented, all with their own advantages and disadvantages. Despite these limitations, the athlete achieved a gold medal in the FES bike race Cybathlon Global Edition 2020 through discipline, team collaboration and the athlete’s own motivation.

Background: Due to its clinically proven safety and health benefits, functional electrical stimulation (FES) cycling has become a popular exercise modality for individuals with spinal cord injury (SCI). Since its inception in 2013, the Cybathlon championship has been a platform for publicizing the potential of FES cycling in rehabilitation and exercise for individuals with SCI. This study aimed to evaluate the contribution of the Cybathlon championship to the literature on FES cycling for individuals with SCI 3 years pre and post the staging of the Cybathlon championship in 2016. Methods: Web of Science, Scopus, ScienceDirect, IEEE Xplore, and Google Scholar databases were searched for relevant studies published between January 2013 and July 2019. The quality of the included studies was objectively evaluated using the Downs and Black checklist. Results: A total of 129 articles on FES cycling were retained for analysis. A total of 51 articles related to Cybathlon were reviewed, and 14 articles were ultimately evaluated for the quality. In 2017, the year following the Cybathlon championship, Web of Science cited 23 published studies on the championship, which was almost 5-fold more than that in 2016 (n = 5). Training was most often reported as a topic of interest in these studies, which mostly (76.7%) highlighted the training parameters of interest to participating teams in their effort to maximize their FES cycling performance during the Cybathlon championship. Conclusion: The present study indicates that the Cybathlon championship in 2016 contributed to the number of literature published in 2017 on FES cycling for individuals with SCI. This finding may contribute to the lessons that can be learned from participation in the Cybathlon and potentially provide additional insights into research in the field of race-based FES cycling.

Background: Functional electrical stimulation (FES) cycling has seen an upsurge in interest over the last decade. The present study describes the novel instrumented cycling ergometer platform designed to assess the efficiency of electrical stimulation strategies. The capabilities of the platform are showcased in an example determining the adequate stimulation patterns for reproducing a cycling movement of the paralyzed legs of a spinal cord injury (SCI) subject. Methods: Two procedures have been followed to determine the stimulation patterns: (1) using the EMG recordings of the able-bodied subject; (2) using the recordings of the forces produced by the SCI subject's stimulated muscles. Results: the stimulation pattern derived from the SCI subject's force output was found to produce 14% more power than the EMG-derived stimulation pattern. Conclusions: the cycling platform proved useful for determining and assessing stimulation patterns, and it can be used to further investigate advanced stimulation strategies. [ABSTRACT FROM AUTHOR]

During the Cybathlon Global Edition 2020, athletes compete in a Functional Electrical Stimulation (FES) bike race. In this event, athletes with a spinal cord injury cover a distance of 1200 m on an adapted bike by using electrostimulation to activate their leg muscles in order to evoke a pedalling movement. This report reviews the training regimen, as designed by the PULSE Racing team, and the experience of one athlete in preparation for the Cybathlon Global Edition 2020. The training plan was designed to vary exercise modes in order to optimize physiological adaptations and minimize monotony for the athlete. Additional constraints due to coronavirus pandemic, e.g., postponement of the Cybathon Global Edition and modification from a live cycling track to a virtual stationary race, along with the health concerns of the athlete, e.g. unwanted effects from the FES and bladder infection, required creativity to ensure an effective and safe training protocol. The individual needs of the athlete and task requirements for the FES bike race made the design of a suitable training programme challenging, emphasizing the importance of monitoring. Several objective and subjective measures to assess the athlete's health and progress are presented, all with their own advantages and disadvantages. Despite these limitations, the athlete achieved a gold medal in the FES bike race Cybathlon Global Edition 2020 through discipline, team collaboration and the athlete's own motivation. [ABSTRACT FROM AUTHOR]

Abstract Background In this work, we share the enhancements made in our system to take part in the CYBATHLON 2020 Global Edition Functional Electrical Stimulation (FES) Bike Race. Among the main improvements, firstly an overhaul, an overhaul of the system and user interface developed with User-centered design principles with remote access to enable telerehabilitation. Secondly, the implementation and experimental comparison between the traditional single electrode stimulation (SES) and spatially distributed sequential stimulation (SDSS) applied for FES Cycling. Methods We report on the main aspects of the developed system. To evaluate the user perception of the system, we applied a System Usability Scale (SUS) questionnaire. In comparing SDSS and SES, we collected data from one subject in four sessions, each simulating one race in the CYBATHLON format. Results User perception measured with SUS indicates a positive outcome in the developed system. The SDSS trials were superior in absolute and average values to SES regarding total distance covered and velocity. We successfully competed in the CYBATHLON 2020 Global Edition, finishing in 6th position in the FES Bike Race category. Conclusions The CYBATHLON format induced us to put the end-user in the center of our system design principle, which was well perceived. However, further improvements are required if the intention is to progress to a commercial product. FES Cycling performance in SDSS trials was superior when compared to SES trials, indicating that this technique may enable faster and possibly longer FES cycling sessions for individuals with paraplegia. More extensive studies are required to assess these aspects.

• The Cybathlon championship was held in 2016, which contributed significantly to the literature on functional electrical stimulation cycling published in 2017, immediately following the year of the championship. • Most studies on Cybathlon reported that training was the topic of most interest. The studies highlighted training parameters that the teams focused on in order to maximize their functional electrical stimulation-cycling performance at the Cybathlon championship. • Most of the published Cybathlon studies originated in European countries, closely followed by studies from Asian countries, South American countries, the United States, and Australia. • The geographical distribution of Cybathlon studies indicates that functional electrical stimulation evoked cycling is well-researched throughout the world and is well-accepted across different cultures. Due to its clinically proven safety and health benefits, functional electrical stimulation (FES) cycling has become a popular exercise modality for individuals with spinal cord injury (SCI). Since its inception in 2013, the Cybathlon championship has been a platform for publicizing the potential of FES cycling in rehabilitation and exercise for individuals with SCI. This study aimed to evaluate the contribution of the Cybathlon championship to the literature on FES cycling for individuals with SCI 3 years pre and post the staging of the Cybathlon championship in 2016. Web of Science, Scopus, ScienceDirect, IEEE Xplore, and Google Scholar databases were searched for relevant studies published between January 2013 and July 2019. The quality of the included studies was objectively evaluated using the Downs and Black checklist. A total of 129 articles on FES cycling were retained for analysis. A total of 51 articles related to Cybathlon were reviewed, and 14 articles were ultimately evaluated for the quality. In 2017, the year following the Cybathlon championship, Web of Science cited 23 published studies on the championship, which was almost 5-fold more than that in 2016 (n = 5). Training was most often reported as a topic of interest in these studies, which mostly (76.7%) highlighted the training parameters of interest to participating teams in their effort to maximize their FES cycling performance during the Cybathlon championship. The present study indicates that the Cybathlon championship in 2016 contributed to the number of literature published in 2017 on FES cycling for individuals with SCI. This finding may contribute to the lessons that can be learned from participation in the Cybathlon and potentially provide additional insights into research in the field of race-based FES cycling. [Display omitted] [ABSTRACT FROM AUTHOR]

MotiMove is a battery‐powered general‐purpose transcutaneous functional electrical stimulator (tFES) that comes out of more than 40‐year academic research at the University of Belgrade, Serbia. MotiMove can be used for therapeutic intervention, clinical research, and support of fitness training in different application modes (cycling, rowing, grasping, walking, and exercising). Unlike other commercially available tFES devices, it allows real‐time open or closed‐loop control of stimulation parameters to 8 separate current sources from a multitude of sensors. Recent studies with MotiMove in healthy people and people with motor diseases have shown the applicability of the MotiMove stimulator for different users in various environments. Future development will focus on FES clothes with dry interface electrodes and integrated sensors that combined with MotiMove will make a compact easy‐donning testbed for real‐time FES control algorithms. [ABSTRACT FROM AUTHOR]

Background: In this work, we share the enhancements made in our system to take part in the CYBATHLON 2020 Global Edition Functional Electrical Stimulation (FES) Bike Race. Among the main improvements, firstly an overhaul, an overhaul of the system and user interface developed with User-centered design principles with remote access to enable telerehabilitation. Secondly, the implementation and experimental comparison between the traditional single electrode stimulation (SES) and spatially distributed sequential stimulation (SDSS) applied for FES Cycling.Methods: We report on the main aspects of the developed system. To evaluate the user perception of the system, we applied a System Usability Scale (SUS) questionnaire. In comparing SDSS and SES, we collected data from one subject in four sessions, each simulating one race in the CYBATHLON format.Results: User perception measured with SUS indicates a positive outcome in the developed system. The SDSS trials were superior in absolute and average values to SES regarding total distance covered and velocity. We successfully competed in the CYBATHLON 2020 Global Edition, finishing in 6th position in the FES Bike Race category.Conclusions: The CYBATHLON format induced us to put the end-user in the center of our system design principle, which was well perceived. However, further improvements are required if the intention is to progress to a commercial product. FES Cycling performance in SDSS trials was superior when compared to SES trials, indicating that this technique may enable faster and possibly longer FES cycling sessions for individuals with paraplegia. More extensive studies are required to assess these aspects. [ABSTRACT FROM AUTHOR]

Background: Functional electrical stimulation (FES) cycling has seen an upsurge in interest over the last decade. The present study describes the novel instrumented cycling ergometer platform designed to assess the efficiency of electrical stimulation strategies. The capabilities of the platform are showcased in an example determining the adequate stimulation patterns for reproducing a cycling movement of the paralyzed legs of a spinal cord injury (SCI) subject. Methods: Two procedures have been followed to determine the stimulation patterns: (1) using the EMG recordings of the able-bodied subject; (2) using the recordings of the forces produced by the SCI subject’s stimulated muscles. Results: the stimulation pattern derived from the SCI subject’s force output was found to produce 14% more power than the EMG-derived stimulation pattern. Conclusions: the cycling platform proved useful for determining and assessing stimulation patterns, and it can be used to further investigate advanced stimulation strategies.

The purpose of this observational study was to report the experience of a 1-yr home training with functional electrical stimulation cycling of a person with T4 American Impairment Scale A paraplegia for 9 yrs, homebound due to the COVID-19 health crisis. The 40-yr-old participant had a three-phase training: V1, isometric stimulation; V2, functional electrical stimulation cycling for 3 sessions/wk; and V3, functional electrical stimulation cycling for 2-4 sessions/wk. Data on general and physical tolerance, health impact, and performance were collected. Borg Scale score relating to fatigue was 10.1 before training and 11.8 after training. The average score for satisfaction at the end of sessions was 8.7. Lean leg mass increased more than 29%, although total bone mineral density dropped by 1.6%. The ventilatory thresholds increased from 19.5 to 29% and the maximum ventilatory peak increased by 9.5%. Rosenberg's Self-esteem Scale score returned to its highest level by the end of training. For the only track event on a competition bike, the pilot covered a distance of 1607.8 m in 17 mins 49 secs. When functional electrical stimulation cycling training is based on a clear and structured protocol, it offers the person with paraplegia the opportunity to practice this activity recreationally and athletically. In times of crisis, this training has proven to be very relevant. [ABSTRACT FROM AUTHOR]

Since the first Cybathlon 2016, when twelve teams competed in the FES bike race, we have witnessed a global effort towards the development of stimulation and control strategies to improve FES-assisted devices, particularly for cycling, as a means to practice a recreational physical activity. As a result, a set of technical notes and research paved the way for many other studies and the potential behind FES-assisted cycling has been consolidated. However, engineering research needs instrumented devices to support novel developments and enable precise assessment. Therefore, some researchers struggle to develop their own FES-assisted devices or find it challenging to implement their instrumentation using commercial devices, which often limits the implementation of advanced control strategies and the possibility to connect different types of sensor. In this regard, we hypothesize that it would be advantageous for some researchers in our community to enjoy access to an entire open-source FES platform that allows different control strategies to be implemented, offers greater adaptability and power capacity than commercial devices, and can be used to assist different functional activities in addition to cycling. Hence, it appears to be of interest to make our proprietary electrical stimulation system an open-source device and to prove its capabilities by addressing all the aspects necessary to implement a FES cycling system. The high-power capacity stimulation device is based on a constant current topology that allows the creation of biphasic electrical pulses with amplitude, width, and frequency up to 150 mA, 1000 µs, and 100 Hz, respectively. A mobile application (Android) was developed to set and modify the stimulation parameters of up to eight stimulation channels. A proportional-integral controller was implemented for cadence tracking with the aim to improve the overall cycling performance. A volunteer with complete paraplegia participated in the functional testing of the system. He was able to cycle indoors for 45 min, accomplish distances of more than 5 km using a passive cycling trainer, and pedal 2400 m overground in 32 min. The results evidenced the capacity of our FES cycling system to be employed as a cycling tool for individuals with spinal cord injury. The methodological strategies used to improve FES efficiency suggest the possibility of maximizing pedaling duration through more advanced control techniques.

• Isokinetic robotic leg extension/flexion dynamometer was designed and developed. • A feedback control system for isokinetic knee joint torque measurement has been developed. • The dynamometer is capable of moving the lower limbs in a range of motion of 72∘ and measure torque values up to 75 Nm. • This system can be used to develop and evaluate novel muscle activation strategies. The limitations of functional electrical stimulation (FES) cycling directly affect the health benefits acquired from this technology and prevents its' full potential to be realised. Experiments should be done on a test bed which can isolate and focus only on one muscle group, namely the quadriceps. The aim of this work was to design and develop an isokinetic robotic leg extension/flexion dynamometer which can mimic knee joint motion during actual cycling to be used for evaluation of novel functional electrical stimulation strategies. Although the main motivation for development of the dynamometer was for application in FES studies, it has the potential to be used for various different muscle physiology studies. A feedback control system with integrated electrical stimulation for isokinetic knee joint torque measurement has been developed and tested for safety and functionality. The leg extension/flexion device was modified and equipped with a DC motor drive system to imitate isokinetic knee joint motion during cycling when the hip joint remains fixed. Real-time bi-directional effective torque on the lever arm was measured by a magnetostrictive torque sensor and a load cell. Closed-loop motor control system was also designed to mimic the cyclical motion at desired angular velocity. A functional model of the robotic dynamometer was developed and evaluated. The dynamometer is capable of simulating the knee angle during cycling at a cadence of up to 70 rpm with range of motion of 72∘. The magnetostrictive torque sensor can measure torque values up to 75 Nm. The lever arm can be adjusted and the target knee angle was controlled with RMSE tracking error of less than 2.1∘ in tests with and without a test person, and with and without muscle stimulation. The isokinetic knee joint torque measurement system was designed and validated in this work, and subsequently used to develop and evaluate novel muscle activation strategies. This is important for fundamental research on effective stimulation patterns and novel activation strategies. This will, in turn, enhance the efficiency of FES cycling exercise and has the potential to improve the health-beneficial effects. [ABSTRACT FROM AUTHOR]

This brief examines the use of a learning control method in a passivity-based framework to control a motorized cycle-rider system with functional electrical stimulation (FES) of the quadriceps muscle groups. FES cycling with motorized assistance has been used in the rehabilitation of people with neurological conditions. The concepts of adaptation and passivity are explored to compensate for the uncertain nonlinear time-varying dynamics of the motorized FES cycle-rider system. The system is modeled as a closed-loop feedback, state-dependent switched system such that in each cycle, the quadriceps muscle groups produce the functional torque and the electric motor provides assistance as needed. The output strictly passive feature of the closed-loop system is proven by considering a learning control input. Then, an adaptive update law, based on iterative learning control, is developed to guarantee the convergence of the cadence tracking error. Experimental results from seven able-bodied participants are presented and discussed to demonstrate the effectiveness of this approach. The average cadence tracking error is 0.00 ± 2.47 rpm for the desired trajectory of 50 rpm. [ABSTRACT FROM AUTHOR]

Background Investigation of muscle fatigue during functional electrical stimulation (FES)-evoked exercise in individuals with spinal cord injury using dynamometry has limited capability to characterize the fatigue state of individual muscles. Mechanomyography has the potential to represent the state of muscle function at the muscle level. This study sought to investigate surface mechanomyographic responses evoked from quadriceps muscles during FES-cycling, and to quantify its changes between pre- and post-fatiguing conditions in individuals with spinal cord injury. Methods Six individuals with chronic motor-complete spinal cord injury performed 30-min of sustained FES-leg cycling exercise on two days to induce muscle fatigue. Each participant performed maximum FES-evoked isometric knee extensions before and after the 30-min cycling to determine pre- and post- extension peak torque concomitant with mechanomyography changes. Findings Similar to extension peak torque, normalized root mean squared (RMS) and mean power frequency (MPF) of the mechanomyography signal significantly differed in muscle activities between pre- and post-FES-cycling for each quadriceps muscle (extension peak torque up to 69%; RMS up to 80%, and MPF up to 19%). Mechanomyographic-RMS showed significant reduction during cycling with acceptable between-days consistency (intra-class correlation coefficients, ICC = 0.51–0.91). The normalized MPF showed a weak association with FES-cycling duration (ICC = 0.08–0.23). During FES-cycling, the mechanomyographic-RMS revealed greater fatigue rate for rectus femoris and greater fatigue resistance for vastus medialis in spinal cord injured individuals. Interpretation Mechanomyographic-RMS may be a useful tool for examining real time muscle function of specific muscles during FES-evoked cycling in individuals with spinal cord injury. [ABSTRACT FROM AUTHOR]

Increased muscle tone and exaggerated tendon reflexes characterize most of the individuals after a spinal cord injury (SCI). We estimated seven parameters from the pendulum test and used them to compare with the Ashworth modified scale of spasticity grades in three populations (retrospective study) to assess their spasticity. Three ASIA B SCI patients who exercised on a stationary FES bicycle formed group F, six ASIA B SCI patients who received only conventional therapy were in the group C, and six healthy individuals constituted the group H. The parameters from the pendulum test were used to form a single measure, termed the PT score, for each subject. The pendulum test parameters show differences between the F and C groups, but not between the F and H groups, however, statistical significance was limited due to the small study size. Results show a small deviation from the mean for all parameters in the F group and substantial deviations from the mean for the parameters in the C group. PT scores show significant differences between the F and C groups and the C and H groups and no differences between the F and C groups. The correlation between the PT score and Ashworth score was 0.88. [ABSTRACT FROM PUBLISHER]

This article introduces a novel approach for a functional electrical stimulation (FES) controller intended for FES-induced cycling based on inertial measurement units (IMUs). This study aims at simplifying the design of electrical stimulation timing patterns while providing a method that can be adapted to different users and devices. In most of studies and commercial devices, the crank angle is used as an input to trigger stimulation onset. We propose instead to use thigh inclination as the reference information to build stimulation timing patterns. The tilting angles of both thighs are estimated from one inertial sensor located above each knee. An IF−THEN rule algorithm detects, online and automatically, the thigh peak angles in order to start and stop the stimulation of quadriceps muscles, depending on these events. One participant with complete paraplegia was included and was able to propel a recumbent trike using the proposed approach after a very short setting time. This new modality opens the way for a simpler and user-friendly method to automatically design FES-induced cycling stimulation patterns, adapted to clinical use, for multiple bike geometries and user morphologies.

Functional Electrical Stimulation (FES) can elicit muscular contraction and restore motor function in paralyzed limbs. FES is a rehabilitation technique applied to various sensorimotor deficiencies and in different functional situations, e.g. grasping, walking, standing, transfer, cycling and rowing. FES can be combined with mechanical devices. FES-assisted cycling is mainly used in clinical environments for training sessions on cycle ergometers, but it has also been adapted for mobile devices, usually tricycles. In October 2016, twelve teams participated in the CYBATHLON competition in the FES-cycling discipline for persons with motorcomplete spinal cord injury. It was the first event of this kind and a wide variety of strategies, techniques and designs were employed by the different teams in the competition. The approaches of the teams are detailed in this special issue. We hope that the knowledge contained herein, together with recent positive results of FES for denervated degenerating muscles, will provide a solid basis to encourage improvements in FES equipment and open new opportunities for many patients in need of safe and effective FES management. We hope to see further developments and/or the benefit of new training strategies at future FES competitions, e.g. at the Cybathlon 2020 (www.cybathlon.ethz.ch). [ABSTRACT FROM AUTHOR]

FES-assisted cycling has been recommended to people struggling to emerge from a disability to more functioning life after spinal cord injury. Recommendations issued by a gowing number of scientific papershas promised toimprove body composition and physical activity levels, as well as to controlinvoluntary muscle response; favoring activity and participation which break new grounds in expanding locomotion, leisure and occupational options for people with paraplegia and tetraplegia. In this report we described our experience to select and prepare a pilot to compete in the FES Bike Race modality at Cybathlon 2016 in Kloten (Zurick). He was a man, 38 years old, with a complete spinal cord injury, level T9, three years of injury. He took part in a two preparation phases lasting respectively 18 and 12 weeks each: (1st) pre-FEScycling and a (2nd) FES-cycling. The 1st phase aimed to explore electrical stimulation response in the quadricps, hamstrings and gluteus muscles; searching for a standard muscular recruitment enable to propel the pedals of a trike. Following, in the 2nd phase, stationary to mobile FES-cycling was performed at the same time the development of the automation and control systems were being incorporated in the trike. We adapted a commercial tadpole trycicle anda pilot controlled system. Although we had planned a three session by week protocol, for reasons of term and time to finish the trike development and be prepared to compete, in the last two weeks before the Cybatlhon an intense level of exercise was maintained. After the race, we noticedinflammatory signs on the left knee which later revealed a patella fracture. The video footage analysis confirmed ithappened during the race's first lap. [ABSTRACT FROM AUTHOR]

The purpose of this study was to develop a functional electrical stimulation (FES) system based on the motor driving concept for use by spinal cord injury patients participating in the FES Cycling competition at the Cybathlon 2016. The proposed FES system consists of a low-power control system, a precise processor unit, and a 4-channel stimulation unit. Self-adhesive carbon conductive electrodes were utilized for stimulation. A 26-year-old SCI patient was qualified to participate in the competition. The pilot patient underwent training for 16 months, which included experience with FES stimulation, performing FES cycling, and reducing spasticity, to practice using the FES system. In addition, using surface electromyography (EMG) during cycling, the muscle activation pattern for generating the stimulation profile was applied and resulted in good performance. The best FES cycling performance the pilot achieved was 1000 meters translation with the cycling system during twelve minutes of using the FES system. The pilot achieved an 1000 meters translation mobility within an average of 16 minutes of cycling. Nevertheless, the system must be further investigated regarding muscle fatigue and other factors that may affect the stimulation conditions. [ABSTRACT FROM AUTHOR]

This article is a contribution to a special issue aiming at collecting data and documenting the different specificities of the teams which participated into Cybathlon 2016 FES-bike discipline. Our team prepared one paraplegic pilot over one year and developed a FES-cycling device based on existing commercial products. Our pilot (47 y.o, spinal cord lesion T3 AIS A since year 1995) was qualified for the final race and finished in 6th position over 12 participants in the discipline, covering a total distance of 750m at an average speed of 5.71km/h, propelled by his own quadriceps and hamstrings muscles. [ABSTRACT FROM AUTHOR]

Recumbent cycling exercise achieved by functional electrical stimulation (FES) of the paralyzed leg muscles is effective for cardiopulmonary and musculoskeletal conditioning after spinal cord injury, but its full potential has not yet been realized. Mechanical power output and efficiency is very low and endurance is limited due to early onset of muscle fatigue. The aim of this work was to compare stochastic modulation of the inter-pulse interval (IPI) to constant-frequency stimulation during an isokinetic leg extension task similar to FES-cycling. Seven able-bodied subjects participated: both quadriceps muscles were stimulated (n = 14) with two activation patterns (P1-constant frequency, P2-stochastic IPI). There was significantly higher power output with P2 during the first 30 s (p = 0.0092), the last 30 s (p = 0.018) and overall (p = 0.0057), but there was no overall effect on fatiguability when stimulation frequency was randomly modulated.

Spatially distributed sequential stimulation (SDSS) has demonstrated substantial power output and fatigue benefits compared to single electrode stimulation (SES) in the application of functional electrical stimulation (FES). This asymmetric electrode setup brings new possibilities but also new questions since precise placement of the electrodes is one critical factor for good muscle activation. The aim of this study was to compare the power output, fatigue and activation properties of proximally versus distally placed SDSS electrodes in an isokinetic knee extension task simulating knee movement during recumbent cycling. M. vastus lateralis and medialis of seven able-bodied subjects were stimulated with rectangular bi-phasic pulses of constant amplitude of 40 mA and at an SDSS frequency of 35 Hz for 6 min on both legs with both setups (i.e. n=14). Torque was measured during knee-extension movement by a dynamometer at an angular velocity of 110 deg/s. Mean power, peak power and activation time were calculated and compared for the initial and final stimulation phases, together with an overall fatigue index. Power output values (Pmean, Ppeak) were scaled to a standardised reference input pulse width of 100 μs (Pmean,s, Ppeak,s). The initial evaluation phase showed no significant differences between the two setups for all outcome measures. Ppeak and Ppeak,s were both significantly higher in the final phase for the distal setup (25.4 ± 8.1 W vs. 28.2 ± 6.2 W, p=0.0062 and 34.8 ± 9.5 W vs. 38.9 ± 6.7 W, p=0.021, respectively). With distal SDSS, there was modest evidence of higher Pmean and Pmean,s (p=0.071, p=0.14, respectively) but of longer activation time (p=0.096). The rate of fatigue was similar for both setups. For practical FES applications, distal placement of the SDSS electrodes is preferable.

Question: Does 4 weeks of active functional electrical stimulation (FES) cycling in addition to usual care improve mobility and strength more than usual care alone in people with a sub-acute acquired brain injury caused by stroke or trauma? Design: Multi centre, randomised, controlled trial. Participants: Forty patients from three Sydney hospitals with recently acquired brain injury and a mean composite strength score in the affected lower limb of 7 (SD 5) out of 20 points. Intervention: Participants in the experimental group received an incremental, progressive, FES cycling program five times a week over a 4-week period. All participants received usual care. Outcome measures: Outcome measures were taken at baseline and at 4 weeks. Primary outcomes were mobility and strength of the knee extensors of the affected lower limb. Mobility was measured with three mobility items of the Functional Independence Measure and strength was measured with a hand-held dynamometer. Secondary outcomes were strength of the knee extensors of the unaffected lower limb, strength of key muscles of the affected lower limb and spasticity of the affected plantar flexors. Results: All but one participant completed the study. The mean between-group differences for mobility and strength of the knee extensors of the affected lower limb were –0.3/21 points (95% CI –3.2 to 2.7) and 7.5 Nm (95% CI –5.1 to 20.2), where positive values favoured the experimental group. The only secondary outcome that suggested a possible treatment effect was strength of key muscles of the affected lower limb with a mean between-group difference of 3.0/20 points (95% CI 1.3 to 4.8). Conclusion: Functional electrical stimulation cycling does not improve mobility in people with acquired brain injury and its effects on strength are unclear. Trial registration: ACTRN12612001163897. [de Sousa DG, Harvey LA, Dorsch S, Leung J, Harris W (2016) Functional electrical stimulation cycling does not improve mobility in people with acquired brain injury and its effects on strength are unclear: a randomised controlled trial. Journal of Physiotherapy 62: 203–208] [ABSTRACT FROM AUTHOR]

Recumbent cycling exercise achieved by functional electrical stimulation (FES) of the paralyzed leg muscles is effective for cardiopulmonary and musculoskeletal conditioning after spinal cord injury, but its full potential has not yet been realized. Mechanical power output and efficiency is very low and endurance is limited due to early onset of muscle fatigue. The aim of this work was to compare stochastic modulation of the inter-pulse interval (IPI) to constant-frequency stimulation during an isokinetic leg extension task similar to FES-cycling. Seven able-bodied subjects participated: both quadriceps muscles were stimulated (n = 14) with two activation patterns (P1-constant frequency, P2-stochastic IPI). There was significantly higher power output with P2 during the first 30 s (p = 0.0092), the last 30 s (p = 0.018) and overall (p = 0.0057), but there was no overall effect on fatiguability when stimulation frequency was randomly modulated. [ABSTRACT FROM AUTHOR]

Spatially distributed sequential stimulation (SDSS) has demonstrated substantial power output and fatigue benefits compared to single electrode stimulation (SES) in the application of functional electrical stimulation (FES). This asymmetric electrode setup brings new possibilities but also new questions since precise placement of the electrodes is one critical factor for good muscle activation. The aim of this study was to compare the power output, fatigue and activation properties of proximally versus distally placed SDSS electrodes in an isokinetic knee extension task simulating knee movement during recumbent cycling. M. vastus lateralis and medialis of seven able-bodied subjects were stimulated with rectangular bi-phasic pulses of constant amplitude of 40 mA and at an SDSS frequency of 35 Hz for 6 min on both legs with both setups (i.e. n=14). Torque was measured during knee-extension movement by a dynamometer at an angular velocity of 110 deg/s. Mean power, peak power and activation time were calculated and compared for the initial and final stimulation phases, together with an overall fatigue index. Power output values (Pmean, Ppeak) were scaled to a standardised reference input pulse width of 100 µs (Pmean,s, Ppeak,s). The initial evaluation phase showed no significant differences between the two setups for all outcome measures. Ppeak and Ppeak,s were both significantly higher in the final phase for the distal setup (25.4 ± 8.1 W vs. 28.2 ± 6.2 W, p=0.0062 and 34.8 ± 9.5 W vs. 38.9 ± 6.7 W, p=0.021, respectively). With distal SDSS, there was modest evidence of higher Pmean and Pmean,s (p=0.071, p=0.14, respectively) but of longer activation time (p=0.096). The rate of fatigue was similar for both setups. For practical FES applications, distal placement of the SDSS electrodes is preferable. [ABSTRACT FROM AUTHOR]

Background: Spinal cord injury (SCI) leads to a profound muscular atrophy, bone loss and bone fragility. While there is evidence that exercising paralysed muscles may lead to reversal of muscle atrophy in the chronic period after SCI, there is little evidence that exercise can prevent muscle changes early after injury. Moreover, whether exercise can prevent bone loss and microarchitectural decay is not clear. Methods/Design: A multi-centre, parallel group, assessor-blinded randomised controlled trial will be conducted. Fifty participants with acute spinal cord injury will be recruited from four SCI units in Australia and New Zealand. Participants will be stratified by site and AIS status and randomised to an experimental or control group. Experimental participants will receive a 12-week programme of functional electrical stimulation (FES)-assisted cycling. Control participants will receive a 12-week programme of passive cycling. The primary outcome is muscle cross-sectional area of the thigh and calf measured using magnetic resonance images (MRI) of the leg. Secondary outcomes include serum biomarkers of SCI osteoporosis (sclerostin, P1NP and β-CTX), markers of immune function (IL-6, IL-10, FGF2, INF-γ, TNF-α), neurological function, body composition, depression and quality of life. Leg MRIs will be measured by a single blinded assessor based in Melbourne. Serum samples will be analysed in a central laboratory. All other characteristics will be measured at baseline and 12 weeks by blinded and trained assessors at each site. The first participant was randomised on 27 November 2012. Discussion: The results of this trial will determine the relative effectiveness of a 12-week programme of FES-assisted cycling versus passive cycling in preventing muscle atrophy and maintaining skeletal integrity after spinal cord injury. [ABSTRACT FROM AUTHOR]

Abstract: Functional electrical stimulation (FES) is a well established method in the rehabilitation of stroke patients. Indeed, a bilateral movement such as cycling induced by FES would be crucial for these patients who had an unilateral motor impairment and had to recover an equivalent use of limbs. The aim of this study was to develop a low-cost metrologically qualified cycle-ergometer, optimized for patients with stroke. A commercial ergometer was instrumented with resistive strain gauges and was able to provide the torque produced at the right and left crank, independently. The developed system was integrated with a stimulator, obtaining a novel FES cycling device able to control in real-time the movement unbalance. A dynamic calibration of the sensors was performed and a total torque uncertainty was computed. The system was tested on a healthy subject and on a stroke patient. Results demonstrated that the proposed sensors could be successfully used during FES cycling sessions where the maximum torque produced is about 9Nm, an order of magnitude less than the torque produced during voluntary cycling. This FES cycling system will assist in future investigations on stroke rehabilitation by means of FES and in new exercise regimes designed specifically for patients with unilateral impairments. [Copyright &y& Elsevier]

Abstract: Persons with spinal cord injury (SCI) are at a heightened risk of developing type II diabetes and cardiovascular disease. The purpose of this investigation was to conduct an analysis of metabolic, body composition, and neurological factors before and after 10weeks of functional electrical stimulation (FES) cycling in persons with SCI. Eighteen individuals with SCI received FES cycling 2–3 times per week for 10weeks. Body composition was analyzed by dual X-ray absorptiometry. The American Spinal Injury Association (ASIA) neurological classification of SCI test battery was used to assess motor and sensory function. An oral glucose tolerance (OGTT) and insulin-response test was performed to assess blood glucose control. Additional metabolic variables including plasma cholesterol (total-C, HDL-C, LDL-C), triglyceride, and inflammatory markers (IL-6, TNF-α, and CRP) were also measured. Total FES cycling power and work done increased with training. Lean muscle mass also increased, whereas, bone and adipose mass did not change. The ASIA motor and sensory scores for the lower extremity significantly increased with training. Blood glucose and insulin levels were lower following the OGTT after 10weeks of training. Triglyceride levels did not change following training. However, levels of IL-6, TNF-α, and CRP were all significantly reduced. [Copyright &y& Elsevier]

Since the first Cybathlon 2016, when twelve teams competed in the FES bike race, we have witnessed a global effort towards the development of stimulation and control strategies to improve FES-assisted devices, particularly for cycling, as a means to practice a recreational physical activity. As a result, a set of technical notes and research paved the way for many other studies and the potential behind FES-assisted cycling has been consolidated. However, engineering research needs instrumented devices to support novel developments and enable precise assessment. Therefore, some researchers struggle to develop their own FES-assisted devices or find it challenging to implement their instrumentation using commercial devices, which often limits the implementation of advanced control strategies and the possibility to connect different types of sensor. In this regard, we hypothesize that it would be advantageous for some researchers in our community to enjoy access to an entire open-source FES platform that allows different control strategies to be implemented, offers greater adaptability and power capacity than commercial devices, and can be used to assist different functional activities in addition to cycling. Hence, it appears to be of interest to make our proprietary electrical stimulation system an open-source device and to prove its capabilities by addressing all the aspects necessary to implement a FES cycling system. The high-power capacity stimulation device is based on a constant current topology that allows the creation of biphasic electrical pulses with amplitude, width, and frequency up to 150 mA, 1000 µs, and 100 Hz, respectively. A mobile application (Android) was developed to set and modify the stimulation parameters of up to eight stimulation channels. A proportional-integral controller was implemented for cadence tracking with the aim to improve the overall cycling performance. A volunteer with complete paraplegia participated in the functional testing of the system. He was able to cycle indoors for 45 min, accomplish distances of more than 5 km using a passive cycling trainer, and pedal 2400 m overground in 32 min. The results evidenced the capacity of our FES cycling system to be employed as a cycling tool for individuals with spinal cord injury. The methodological strategies used to improve FES efficiency suggest the possibility of maximizing pedaling duration through more advanced control techniques. [ABSTRACT FROM AUTHOR]

Abstract: Background: Cycling is a safe and functionally effective exercise for patients with early post-stroke and poor balance. Such exercise is considered even more effective when functional electrical stimulation is added. Our principal aim was to determine the biomechanically quantifiable parameters of cycling that can be improved in patients with subacute hemiparesis by incorporating functional electrical stimulation. These parameters were defined as objective goals that can be achieved in clinical applications. A secondary aim was to determine whether they could be used to identify subjects who would benefit from such therapy. Methods: Using a tricycle testbed, we tested 39 subacute (mean 10.9 weeks post-stroke (SD 5.9)), hemiplegic subjects. During isometric measurements we recorded volitional and electrically evoked crank torques, the latter at maximal tolerable intensity. During ergometric measurements, volitional pedaling was alternated with combined pedaling (volitional supported by stimulation), performed at 30-s intervals. Power, smoothness, and symmetry of cycling were evaluated. Findings: Twenty-six percent of the subjects significantly improved the smoothness of their cycling with functional electrical stimulation. Only 8% and 10% significantly increased their power and symmetry, respectively. The improvement in smoothness significantly correlated with the capability of the individual to generate electrical torque (Spearman’s rank correlation coefficient=0.66 at P =0.001). Interpretation: The smoothness of cycling was the most sensitive parameter improved by functional electrical stimulation. This improvement depended on the amount of torque evoked, and the torque achieved, in turn, correlated with the tolerated intensity of stimulation. [Copyright &y& Elsevier]

The article presents a case study on testing the effect of high-volume functional electrical stimulated (FES) cycle training on cardiopulmonary fitness and bone parameters in a tetraplegic patient. It was found out that it is possible to increase the cardiopulmonary fitness, bone parameters and power output of the paralyzed limbs in tetraplegia by means of high-volume cycle training.