肌肉电刺激力量训练影响运动者肌力的Meta分析

文题释义：肌肉电刺激技术(electrical stimulation training，EMS)：是一种通过不同频率脉冲电流刺激机体神经肌肉引起肌肉收缩，从而改善肌肉力量和功能或是治疗神经肌肉系统损伤疾病的物理治疗技术。 离心收缩：肌肉在收缩产生张力的同时被拉长的收缩称为离心收缩。肌肉在阻力下逐渐被拉长，使运动环节向肌肉拉力相反的方向运动的收缩方式。是动力性收缩的一种，又称作退让性收缩，其产生的最大肌肉力量比向心收缩要大。 背景：研究显示，肌肉电刺激法对于肌肉蛋白的合成和肌肉质量的增长具有一定的改善作用，但也有不同的研究结果。 目的：通过Meta分析肌肉电刺激作为力量训练手段对运动人群肌力的影响，旨在为以后运动领域力量训练提供新的方法思路和循证依据。 方法：检索PubMed、EBSCO host、Web of Science、CNKI、万方、维普VIP等数据库，收集肌肉电刺激对运动人群肌肉力量的随机对照试验(RCT)。通过PICOS原则筛选纳入文献，试验对象为运动员及有运动经验的健康人群，分为肌肉电刺激组和对照组(不进行任何干预)。运用stata 15.1、review manager 5.3依据cochrane标准进行文章质量评价和结局指标的Meta分析、敏感性分析、亚组分析以及发表偏倚评价。 结果与结论：①与对照组相比，肌肉电刺激对运动人群向心收缩峰力矩的提高有显著性作用(合并效应值WMD=8.23，95%CI：6.71-9.76)，P < 0.0001)，在20岁<年龄≤22岁的年龄段内肌肉电刺激训练对向心收缩峰力矩的影响最有效果；②与对照组相比，肌肉电刺激对运动人群离心收缩峰力矩的提高有显著性作用(合并效应值WMD=5.58，95%CI：4.16-7.00，P < 0.000 01)；③对等长收缩峰力矩影响的纳入实验数量较少，不宜进行Meta分析；④结果说明，电刺激训练可有效促进运动人群的向心收缩峰力矩和离心收缩峰力矩，且肌肉电刺激作为训练手段对运动人群肌力训练的作用需要分指标、分年龄、分对象地进行讨论。 ORCID: 0000-0002-6616-9437(侯筱) 中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程     

神经肌肉电刺激配合口肌训练在改善流涎中的应用研究

目的 探讨神经肌肉电刺激配合口肌训练在改善流涎中的应用效果。方法 选取我院收治的流涎患儿94例为研究对象,随机单盲对照法将患儿分为对照组和研究组,各47例,对照组患儿给予神经肌肉电刺激治疗,研究组患儿在此基础上配合口肌训练。根据流涎分级（TDS）评估两组患儿治疗前后临床疗效,记录两组患儿流涎评分情况,应用Pearman相关分析口肌训练配合程度与流涎评分的关系。结果 对照组患儿总有效率为63.80%,低于研究组的85.12%,差异有统计学意义（P＜0.05）;治疗后,研究组患儿流涎评分低于对照组,差异有统计学意义（P＜0.05）;口操训练配合评分与流涎评分呈负相关（r=-0.901,P=0.000）。结论 神经肌肉电刺激配合口肌训练能有效提高流涎患儿的临床疗效,且患儿口肌训练配合程度越好,疗效越好。     

电刺激在脑瘫治疗中的应用

脑性瘫痪是中国人群疾病谱中最主要的致残因素之一,近年来的发病率呈显著上升趋势。经过40多年的研究表明,电刺激疗法能成功地恢复脑瘫患者的部分运动功能,且具有无创、操作简便、适应症广等优点,它是现代康复工程领域很有应用前景的一项新技术。本文综述了当前应用于电刺激治疗脑性瘫痪的两类电刺激即神经肌肉电刺激（NMES）和阈值电刺激（TES）的治疗原理、临床疗效、适应症及并发症等,并介绍了与之相关的治疗技术和研究进展。     

神经肌肉电刺激对躯干稳定肌影响的研究进展

该文从神经肌肉电刺激作用于躯干稳定肌的效果与参数及对不同人群的应用效能等角度,阐述了躯干稳定肌的组成与功能,以及神经肌肉电刺激招募躯干稳定肌的作用机制与参数,并分析探讨了其临床效果。未来的临床研究可能集中在健康人群的长期随访队列研究和运动损伤人群躯干稳定肌萎缩的机制与临床研究方面,同时神经肌肉电刺激联合运动康复的研究也是发展趋势。该文预判相关便携式NMES设备的研发与应用具有较大的临床意义。     

肌肉磁刺激脑诱发电位传入机制的研究

目的：研究磁刺激肌肉脑诱发电位（ＭＭＳＥＰ）的传入机制。方法：对肌松弛下腓肠肌ＭＭ－ＳＥＰ及电刺激踝部胫后神经体感诱发电位（ＳＥＰ）进行配对对比研究。结果：（１）肌松弛无肌收缩时仍可记录到ＭＭＳＥＰ；（２）配对腓肠肌ＭＭＳＥＰ与胫后神经ＳＥＰＰ４０潜伏期差值伴与不伴肌收缩相差显著；（３）伴肌收缩时，ＭＭＳＥＰ较配对ＳＥＰＰ４０潜伏期显著延长，不伴肌收时则相差不显著。结论：正常伴肌收缩时，磁刺激很可能先兴奋肌肉运动神经末梢致肌肉运动，间接兴奋肌肉Ｉａ纤维或（和）肌肉深部感受器；由此可解释ＭＭＳＥＰ较电刺激同等水平ＳＥＰＰ４０潜伏期长。     

不同刺激参数对SD大鼠肌肉收缩的影响

目的研究不同电刺激参数对SD大鼠肌肉收缩的影响,为临床应用电刺激治疗周围神经损伤提供参考。方法采用低频脉冲发射器对SD大鼠的颈项部肌群进行局部电刺激。刺激时改变频率、脉宽、电压及占空比等参数,观察参数变化对肌肉收缩及动物行为的影响。同时记录受刺激肌肉的肌电图。结果 8只SD大鼠在10~60Hz的频率范围内,随频率增加肌肉收缩率逐步增强。肌电图结果显示在刺激频率不变的前提下,随脉宽的增加（50~200μs）,肌电幅值显著上升,且肌电幅值的变化与大鼠行为改变成正相关。结论不同的刺激参数可影响肌肉的收缩状态与强度,选择合适的参数可使失神经支配肌肉发生有节律地收缩,防止肌萎缩,并有助于建立局部肌痉挛动物模型。     

重复电刺激检查在神经肌肉接头病变诊断中的临床应用研究

目的：研究神经重复电刺激检查对神经肌肉接头病变的诊断价值。方法：用Ｎｅｕｒｏｍａｔｉｃ型２０００Ｃ及Ｋｅｙｐｏｉｎｔ型肌电图／诱发电位仪，检查９３例神经科肌无力患者１８８条神经的重复电刺激，按临床诊断分为重症肌无力（ＭＧ）组（ｎ＝５９）和非重症肌无力（ｎＭＧ）组（ｎ＝３４）。结果：ＭＧ组神经重复电刺激诱发的波幅衰减阳性率（６４％）显著高于ｎＭＧ组（８８％）（Ｐ＜０００５）。９７５％的ＭＧ患者在低频刺激时即可获得阳性结果，波幅衰减最大的刺激频率为５Ｈｚ而非３Ｈｚ。测量波面积对ＭＧ的诊断价值优于测定波幅。结论：神经重复电刺激检查在神经肌肉接头病变的诊断中具有重要价值     

加压抗阻训练的肌肉效应、量效关系及生理机制

背景：加压抗阻训练是通过“加压”和“抗阻”的双重刺激达到训练效果的一种新型训练模式,但由于学者们在试验中进行加压干预时通常采用不同的加压量,因此不同的加压抗阻训练模型下肌肉功能表现不同,加压抗阻训练与肌肉功能表现的量效关系暂无定论,其中潜在的生理机制需要进一步探讨。目的：对国内外新近加压抗阻训练的试验研究进行梳理,归纳加压抗阻训练诱发的主要训练效应,厘清加压抗阻训练中的量效关系,深度剖析潜在的生理机制,为提高肌肉目标功能表现提供指导意见。方法：以“加压训练”“血流限制训练”“抗阻训练”“力量训练”“肌肉适能”“肌肉训练效应”“肌肉力量”“肌肉耐力”“神经肌肉适应”“Blood flow restricting”“Pressure training”“KAATSU training”“KAATSU volume”“Resistance training”“Anaerobic training”“Strength training”“Muscle fitness”“Muscle hypertrophy”“Muscle strength”“Muscle endurance”“Neuromus...     

神经肌肉电刺激诱发的下肢运动疲劳信息检测与处理技术研究

限制神经肌肉电刺激(NMES)广泛应用的一个主要因素就是由其诱发的肌疲劳.设计NMES诱发下肢运动条件下的肌疲劳检测系统.分别进行膝关节角度的检测和表面肌电信号(sEMG)的频谱分析.研究表明,平均频率(MNF)、中值频率(MDF)及AR时变参数模型参量是评价NMES诱发肌疲劳的可靠指标,并且AR模型具有显著的高分辨灵敏度,最大变化率为90.23％,大于平均频率的43.82％和中值频率的55.49％,为NMES使用过程中诱发肌疲劳的准确评价和反馈寻找到一种可行的方法.     

多参数经皮神经肌肉电刺激仪的设计

目的：电刺激仪器是通过电流作用于目标组织，使目标组织产生相应的功能变化。刺激方式、刺激电流、波形等均会影响治疗效果。市面上现有的神经肌肉电刺激仪一般只有单一的治疗模式，局限性很大。为了有针对性地治疗不同肌肉疾病，我们设计了一个能够方便准确地控制刺激电流的多参数经皮神经肌肉电刺激仪系统：方法：设计了一个以STC12C5410AD单片机为核心控制芯片的多参数经皮神经肌肉电刺激仪系统，采用串口实现上下位机的通讯，通过软件编程，上位机发送波形、频率、脉宽、间隙时间、最大刺激电流等各项参数指令，由单片机控制D／A转换芯片DAC8532输出指定波形，经过高压开关保护电路加入恒流源电路，产生恒定的电流对目标组织进行刺激。系统加入多项安全控制措施，有效地避免了实际操作过程中的安全隐患；结果：通过对系统进行电阻测试，验证了系统为恒流型仪器，经过电阻的刺激电流由且仅由输入信号的各项参数确定，与电阻的大小无关。由临床试验证明了通过改变参数，可以改变刺激模式，并验证了该系统的安全性和有效性。结论：该系统能设置成临床上使用的经皮电神经刺激疗法的各种模式。安全有效，有利于临床实验和相关科研的开展。     

Is high-frequency neuromuscular electrical stimulation a suitable tool for muscle performance improvement in both healthy humans and athletes?

We aimed at providing an overview of the currently acknowledged benefits and limitations of neuromuscular electrical stimulation (NMES) training programs in both healthy individuals and in recreational and competitive athletes regarding muscle performance. Typical NMES resistance exercises are performed under isometric conditions and involve the application of electrical stimuli delivered as intermittent high frequencies trains (>40–50 Hz) through surface electrodes. NMES has been acknowledged as an efficient modality leading to significant improvements in isometric maximal voluntary strength. However, the resulting changes in dynamic strength, motor performance skills and explosive movements (i.e., jump performance, sprint ability) are still ambiguous and could only be obtained when NMES is combined with voluntary dynamic exercise such as plyometrics. Additionally, the effects of NMES on muscle fatigability are still poorly understood and required further investigations. While NMES effectiveness could be partially related to several external adjustable factors such as training intensity, current characteristics (e.g., intensity, pulse duration…) or the design of training protocols (number of contractions per session, number of sessions per week…), anatomical specificities (e.g., morphological organization of the axonal branches within the muscle) appear as the main factor accounting for the differences in NMES response. Overall, NMES cannot be considered as a surrogate training method, but rather as an adjunct to voluntary resistance training. The combination of these two training modalities should optimally improve muscle function.     

Motor unit recruitment during neuromuscular electrical stimulation: a critical appraisal

Neuromuscular electrical stimulation (NMES) is commonly used in clinical settings to activate skeletal muscle in an effort to mimic voluntary contractions and enhance the rehabilitation of human skeletal muscles. It is also used as a tool in research to assess muscle performance and/or neuromuscular activation levels. However, there are fundamental differences between voluntary- and artificial-activation of motor units that need to be appreciated before NMES protocol design can be most effective. The unique effects of NMES have been attributed to several mechanisms, most notably, a reversal of the voluntary recruitment pattern that is known to occur during voluntary muscle contractions. This review outlines the assertion that electrical stimulation recruits motor units in a nonselective, spatially fixed, and temporally synchronous pattern. Additionally, it synthesizes the evidence that supports the contention that this recruitment pattern contributes to increased muscle fatigue when compared with voluntary actions and provides some commentary on the parameters of electrical stimulation as well as emerging technologies being developed to facilitate NMES implementation. A greater understanding of how electrical stimulation recruits motor units, as well as the benefits and limitations of its use, is highly relevant when using this tool for testing and training in rehabilitation, exercise, and/or research.     

Neuromuscular electrical stimulation: implications of the electrically evoked sensory volley

Neuromuscular electrical stimulation (NMES) generates contractions by depolarising axons beneath the stimulating electrodes. The depolarisation of motor axons produces contractions by signals travelling from the stimulation location to the muscle (peripheral pathway), with no involvement of the central nervous system (CNS). The concomitant depolarisation of sensory axons sends a large volley into the CNS and this can contribute to contractions by signals travelling through the spinal cord (central pathway) which may have advantages when NMES is used to restore movement or reduce muscle atrophy. In addition, the electrically evoked sensory volley increases activity in CNS circuits that control movement and this can also enhance neuromuscular function after CNS damage. The first part of this review provides an overview of how peripheral and central pathways contribute to contractions evoked by NMES and describes how differences in NMES parameters affect the balance between transmission along these two pathways. The second part of this review describes how NMES location (i.e. over the nerve trunk or muscle belly) affects transmission along peripheral and central pathways and describes some implications for motor unit recruitment during NMES. The third part of this review summarises some of the effects that the electrically evoked sensory volley has on CNS circuits, and highlights the need to identify optimal stimulation parameters for eliciting plasticity in the CNS. A goal of this work is to identify the best way to utilize the electrically evoked sensory volley generated during NMES to exploit mechanisms inherent to the neuromuscular system and enhance neuromuscular function for rehabilitation.     

Muscle plasticity of aged subjects in response to electrical stimulation training and inversion and/or limitation of the sarcopenic process

This review addresses the possible structural and functional adaptations of the muscle function to neuromuscular electrical stimulation (NMES) training in frail and/or aged (without advanced chronic disease) subjects. Evidence suggests that the sarcopenic process and its structural and functional effects would be limited and/or reversed through NMES training using excito-motor currents (or direct currents). From a structural viewpoint, NMES helps reduce muscle atrophy. From a functional viewpoint, NMES enables the improvement of motor output (i.e., muscle strength), gait, balance and activities of daily living which enhances the quality of life of aged subjects. Muscle plasticity of aged subjects in response to NMES training turns out to be undeniable, although many mechanisms are not yet explained and deserve to be explore further. Mechanistic explanations as well as conceptual models are proposed to explain how muscle plasticity operates in aged subjects through NMES training. NMES could be seen as a clinically applicable training technique, safe and efficient among aged subjects and could be used more often as part of prevention of sarcopenia. Therapists and physical conditioners/trainers could exploit this new knowledge in their professional practice to improve life conditions (including the risk of fall) of frail and/or aged subjects.     

Effect of electrostimulation training–detraining on neuromuscular fatigue mechanisms

The aim of this study was to evaluate the effects of neuromuscular electrical stimulation (NMES) training and subsequent detraining on neuromuscular fatigue mechanisms. Ten young healthy men completed one NMES fatigue protocol before and after a NMES training program of 4 weeks and again after 4 weeks of detraining. Muscle fatigue (maximal voluntary torque loss), central fatigue (activation failure), and peripheral fatigue (transmission failure and contractile failure) of the plantar flexor muscles were assessed by using a series of electrically evoked and voluntary contractions with concomitant electromyographic and torque recordings. At baseline, maximal voluntary torque decreased significantly with fatigue (P < 0.001), due to both activation and transmission failure. After detraining, maximal voluntary torque loss was significantly reduced (P < 0.05). In the same way, the relative decrease in muscle activation after training and detraining was significantly lower compared to baseline values (P < 0.05). Short-term NMES training–detraining of the plantar flexor muscles significantly reduced the muscle fatigue associated to one single NMES exercise session. This was mainly attributable to a reduction in activation failure, i.e., lower central fatigue, probably as a result of subject's accommodation to pain and discomfort during NMES.     

Isokinetic strengthening and neuromuscular electrical stimulation protocol impact on physical performances,functional status and quality of life in knee osteoarthritis overweight/obese women

BackgroundKnee muscle weakness associated with overweight/obesity can lead to impairment of vital daily function in knee osteoarthritis patients. This study investigated the effect of a knee eccentric isokinetic muscle strength (IMS) training program combined with neuromuscular electrical stimulation (NMES) on muscle strength and flexibility, joint ROM, functional status, physical performance, and quality of life in knee osteoarthritis overweight/obese women.MethodsThirty-six women were randomized into three groups, two experimental groups (EG) and a control group following a classic rehabilitation program. During 6 weeks of two sessions/week, one of the two EGs performed an IMS program (ISO.G); the other underwent combined IMS and NMES training (ISO + NMES.G). All patients were evaluated with clinical examination, isokinetic test at 60°/s and 240°/s speeds, physical performance tests related to activities of daily living, and Knee injury and Osteoarthritis Outcome Score (KOOS) quality of life questionnaire, before and after the intervention.ResultsIn the 10-m walk, chair stand, stair climb and monopodal stance tests, muscle flexibility and quality of life scores showed significant improvement for ISO.G (P = 0.000) and ISO + NMES.G (P = 0.000). Concentric strength at 240°/s was improved in ISO + NMES.G (P = 0.000) unlike the muscle strength at 60°/s (quadriceps, P = 0.104; hamstrings, P = 0.171), force asymmetry (P = 0.481) and post-intervention joint ROM (P = 0.309).ConclusionsThe combination of IMS and NMES shows significant superiority over the usual rehabilitation program for the majority of the parameters measured for optimal management of knee osteoarthritis.     

Ability of electrical stimulation therapy to improve the effectiveness of robotic training for paretic upper limbs in patients with stroke

We investigated whether untriggered neuromuscular electrical stimulation (NMES) can increase the effectiveness of shoulder and elbow robotic training in patients with hemiparesis. Thirty subacute stroke patients were randomly equally allocated to robot only (RO) and robot and electrical stimulation (RE) groups. During training, shoulder and elbow movements were trained by operating the robotic arm with the paretic arm, and the robotic device helped to move the arm. In the RE group, the anterior deltoid and triceps brachii muscles were electrically stimulated at sub-motor threshold intensity. Training was performed (approximately 1 h/day, 5 days/week for 2 weeks) in addition to regular rehabilitation. Active range of motion (ROM) values of shoulder flexion and abduction, and Fugl-Meyer assessment (FMA) scores were measured before and after training. Active shoulder ROM was significantly better after than before training in the RE group; however, no such improvement was noted in the RO group. FMA scores were significantly better in both groups, and there was no significant difference between the groups. Untriggered NMES might increase the effectiveness of shoulder and elbow robotic training in patients with hemiparesis. Additionally, NMES at a sub-motor threshold during robotic training might facilitate activation of paretic muscles, resulting in paralysis improvement.     

Physiological and methodological considerations for the use of neuromuscular electrical stimulation

The main aim of this review is to discuss some evidence-based physiological and methodological considerations for optimal use of neuromuscular electrical stimulation (NMES) in healthy and impaired skeletal muscles. After a quick overview of the main applications, interests and limits of NMES use, the first section concentrates on two crucial aspects of NMES physiology: the differences in motor unit recruitment pattern between NMES and voluntary contractions, and the involvement of the nervous system during peripheral NMES. The second section of the article focuses on the most common NMES parameters, which entail the characteristics of both the electrical current (the input) and the evoked contraction (the output).     

A new paradigm of neuromuscular electrical stimulation for the quadriceps femoris muscle

Purpose

Neuromuscular electrical stimulation (NMES) with large electrodes and multiple current pathways (m-NMES) has recently been proposed as a valid alternative to conventional NMES (c-NMES) for quadriceps muscle (re)training. The main aim of this study was to compare discomfort, evoked force and fatigue between m-NMES and c-NMES of the quadriceps femoris muscle in healthy subjects.

Methods

Ten healthy subjects completed two experimental sessions (c-NMES and m-NMES), that were randomly presented in a cross-over design. Maximal electrically evoked force at pain threshold, self-reported discomfort at different levels of evoked force, and fatigue-induced force declines during and following a series of 20 NMES contractions were compared between c-NMES and m-NMES.

Results

m-NMES resulted in greater evoked force (P < 0.05) and lower discomfort in comparison to c-NMES (P < 0.05–0.001), but fatigue time course and magnitude did not differ between the two conditions.

Conclusions

The use of quadriceps m-NMES appears legitimate for (re)training purposes because it generated stronger contractions and was less discomfortable than c-NMES (due to multiple current pathways and/or lower current density with larger electrodes).