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The aim of this study was to investigate the effect of electromyography (EMG) triggered electrical stimulation (ES) applied to multifidus and erector spinae muscles on trunk balance in patients with complete thoracic spinal cord injury (SCI).
The fundamental questions that investigators want to answer are as follows:
Spinal cord injury results in loss of sensory and motor function below the level of injury, causing difficulty with unaided sitting and activities of daily living, especially at the thoracic level in SCI patients. The paraspinal muscles that provide trunk balance are weakened in these patients. Methods such as neuromuscular electrical stimulation and EMG ES are used to improve trunk balance and restore muscle function. This study aims to investigate the effect of EMG ES applied to the multifidus and erector spinae muscles on trunk balance in patients with complete thoracic SCI.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| electromyography-triggered electrical stimulation | Experimental | EMG ES was applied to the bilateral multifidus and erector spina muscles of the experimental group 3 times a week for 10 minutes in each session for 4 weeks. At the beginning of each session, the participants were instructed to position themselves in a comfortable sitting position. EMG ES was performed using six self-adhesive electrodes (37 × 64 mm) and two Neuro Trac Myo Plus Pro devices. |
|
| trunk eccentric exercises | Active Comparator | The control group performed back eccentric exercises for 4 weeks, 3 times a week, 3 times in each session. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Neuro Trac Myo Plus Pro | Device | Electrical stimulation parameters; stimuli were monophasic, rectangular, stimulus duration 300 µs, frequency 25 Hertz, amplitude was increased up to a maximum of 100 milliampere until contraction was seen. |
| Measure | Description | Time Frame |
|---|---|---|
| Trunk control test | The trunk control test is a useful tool in determining the prognosis of independence in activities of daily living and measuring trunk balance in individuals with spinal cord injury. It was applied to all participants before and after treatment. The test consisted of 3 parts; static control, dynamic control and dynamic control with upper extremity activities. | Baseline- Week 4 |
| Modified functional reach test | The modified functional reach test is a reliable tool to assess sitting reaching in individuals with SCI and to provide immediate feedback to study personnel. It was applied to both groups before and after treatment. | Baseline- Week 4 |
| Measure | Description | Time Frame |
|---|---|---|
| Erector spinae muscle thickness | Erector spinae muscle thickness was measured with a real-time B-mode ultrasound device (General Electric Co., Wisconsin, USA). Measurements were performed bilaterally in the prone position with an 8-12 MegaHertz linear probe placed parallel to the muscle fibres. Gel was used between the probe and the skin during the measurements. The measurement site was defined as 7 cm lateral to the L3 spinous process of the lumbar erector spina muscle. |
| Measure | Description | Time Frame |
|---|---|---|
| Multifidus muscle thickness | Multifidus muscle thickness was measured with a real-time B-mode ultrasound device (GE, General Electric Co., Wisconsin, USA). Measurements were performed bilaterally in the prone position with an 8-12 MegaHertz linear probe placed parallel to the muscle fibres. Gel was used between the probe and the skin during the measurements. The measurement site was defined as 2 cm lateral to the L4 spinous process of the Multifidus muscle. |
Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Ankara Bilkent City Hospital | Ankara | Turkey (Türkiye) |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 19363574 | Background | Bjerkefors A, Carpenter MG, Cresswell AG, Thorstensson A. Trunk muscle activation in a person with clinically complete thoracic spinal cord injury. J Rehabil Med. 2009 Apr;41(5):390-2. doi: 10.2340/16501977-0336. | |
| 31546613 | Background | Bergmann M, Zahharova A, Reinvee M, Asser T, Gapeyeva H, Vahtrik D. The Effect of Functional Electrical Stimulation and Therapeutic Exercises on Trunk Muscle Tone and Dynamic Sitting Balance in Persons with Chronic Spinal Cord Injury: A Crossover Trial. Medicina (Kaunas). 2019 Sep 21;55(10):619. doi: 10.3390/medicina55100619. |
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| ID | Term |
|---|---|
| D013119 | Spinal Cord Injuries |
| ID | Term |
|---|---|
| D013118 | Spinal Cord Diseases |
| D002493 | Central Nervous System Diseases |
| D009422 | Nervous System Diseases |
| D020196 | Trauma, Nervous System |
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| ID | Term |
|---|---|
| D000071066 | Patient Reported Outcome Measures |
| ID | Term |
|---|---|
| D019538 | Health Care Surveys |
| D011795 | Surveys and Questionnaires |
| D003625 | Data Collection |
| D004812 | Epidemiologic Methods |
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In this randomized controlled and prospective study, investigators included 15 participants with complete thoracic spinal cord injury. Investigators divided the participants into two groups, where one group received the electromyography-triggered electrical stimulation applied to the erector spinae and multifidus muscles, and the control group received trunk eccentric exercises only, applied three times a week for four weeks.
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| Trunk eccentric exercises | Other | The control group performed back eccentric exercises for 4 weeks, 3 times a week, 3 times in each session |
|
| Baseline- Week 4 |
| Baseline- Week 4 |
| 33328910 | Background | Gill M, Linde M, Fautsch K, Hale R, Lopez C, Veith D, Calvert J, Beck L, Garlanger K, Edgerton R, Sayenko D, Lavrov I, Thoreson A, Grahn P, Zhao K. Epidural Electrical Stimulation of the Lumbosacral Spinal Cord Improves Trunk Stability During Seated Reaching in Two Humans With Severe Thoracic Spinal Cord Injury. Front Syst Neurosci. 2020 Nov 19;14:79. doi: 10.3389/fnsys.2020.569337. eCollection 2020. |
| 36505070 | Background | Shima D, Nishimura Y, Hashizaki T, Minoshima Y, Yoshikawa T, Umemoto Y, Kinoshita T, Kouda K, Tajima F, Kamijo YI. Surface electromyographic activity of the erector spinae and multifidus during arm- and leg-ergometer exercises in young healthy men. Front Physiol. 2022 Nov 25;13:974632. doi: 10.3389/fphys.2022.974632. eCollection 2022. |
| 27225977 | Background | Wilson RD, Page SJ, Delahanty M, Knutson JS, Gunzler DD, Sheffler LR, Chae J. Upper-Limb Recovery After Stroke: A Randomized Controlled Trial Comparing EMG-Triggered, Cyclic, and Sensory Electrical Stimulation. Neurorehabil Neural Repair. 2016 Nov;30(10):978-987. doi: 10.1177/1545968316650278. Epub 2016 May 24. |
| 28899825 | Background | Triolo RJ, Bailey SN, Foglyano KM, Kobetic R, Lombardo LM, Miller ME, Pinault G. Long-Term Performance and User Satisfaction With Implanted Neuroprostheses for Upright Mobility After Paraplegia: 2- to 14-Year Follow-Up. Arch Phys Med Rehabil. 2018 Feb;99(2):289-298. doi: 10.1016/j.apmr.2017.08.470. Epub 2017 Sep 9. |
| 31702873 | Background | Qiu S, Draghici AE, Picard G, Taylor JA. Muscle Fatigue in Response to Electrical Stimulation Pattern and Frequency in Spinal Cord Injury. PM R. 2020 Jul;12(7):699-705. doi: 10.1002/pmrj.12282. Epub 2019 Dec 12. |
| 36672542 | Background | Tharu NS, Alam M, Ling YT, Wong AY, Zheng YP. Combined Transcutaneous Electrical Spinal Cord Stimulation and Task-Specific Rehabilitation Improves Trunk and Sitting Functions in People with Chronic Tetraplegia. Biomedicines. 2022 Dec 23;11(1):34. doi: 10.3390/biomedicines11010034. |
| 33178444 | Background | Lee HS, Akimoto T, Kim AR. Effects of trunk extensor eccentric exercise on lipid profile and glycaemic response. BMJ Open Sport Exerc Med. 2020 Oct 28;6(1):e000861. doi: 10.1136/bmjsem-2020-000861. eCollection 2020. |
| 30207875 | Background | Quinzanos-Fresnedo J, Fratini-Escobar PC, Almaguer-Benavides KM, Aguirre-Guemez AV, Barrera-Ortiz A, Perez-Zavala R, Villa-Romero AR. Prognostic validity of a clinical trunk control test for independence and walking in individuals with spinal cord injury. J Spinal Cord Med. 2020 May;43(3):331-338. doi: 10.1080/10790268.2018.1518124. Epub 2018 Sep 12. |
| 34418026 | Background | Arsh A, Darain H, Rahman MU, Ullah I, Shakil-Ur-Rehman S. Reliability of modified functional reach test in the assessment of balance function in people with spinal cord injury: A systematic review. J Pak Med Assoc. 2021 Aug;71(8):2040-2044. doi: 10.47391/JPMA.1276. |
| 28934633 | Background | Masaki M, Aoyama T, Murakami T, Yanase K, Ji X, Tateuchi H, Ichihashi N. Association of low back pain with muscle stiffness and muscle mass of the lumbar back muscles, and sagittal spinal alignment in young and middle-aged medical workers. Clin Biomech (Bristol). 2017 Nov;49:128-133. doi: 10.1016/j.clinbiomech.2017.09.008. Epub 2017 Sep 14. |
| 26058723 | Background | Masaki M, Ikezoe T, Fukumoto Y, Minami S, Tsukagoshi R, Sakuma K, Ibuki S, Yamada Y, Kimura M, Ichihashi N. Association of sagittal spinal alignment with thickness and echo intensity of lumbar back muscles in middle-aged and elderly women. Arch Gerontol Geriatr. 2015 Sep-Oct;61(2):197-201. doi: 10.1016/j.archger.2015.05.010. Epub 2015 May 28. |
| 38501227 | Background | Bayraktar HEN, Yalcin E, Sipal MS, Akyuz M, Akinci MG, U Delialioglu S. The effect of electromyography triggered electrical stimulation to abdominal muscles on sitting balance, respiratory functions, and abdominal muscle thickness in complete spinal cord injury: a randomized controlled trial. Int J Rehabil Res. 2024 Jun 1;47(2):87-96. doi: 10.1097/MRR.0000000000000620. Epub 2024 Mar 19. |
| D014947 | Wounds and Injuries |
| D008919 |
| Investigative Techniques |
| D006302 | Health Services Research |
| D006285 | Health Planning |
| D004472 | Health Care Economics and Organizations |
| D063868 | Patient Outcome Assessment |
| D017063 | Outcome Assessment, Health Care |
| D010043 | Outcome and Process Assessment, Health Care |
| D011787 | Quality of Health Care |
| D006298 | Health Services Administration |
| D017530 | Health Care Quality, Access, and Evaluation |
| D017531 | Health Care Evaluation Mechanisms |
| D011634 | Public Health |
| D004778 | Environment and Public Health |