Text Box: Before jumping into the exercising of weak or paralyzed muscles, let’s establish the importance of exercise. According to the National Center on Physical Activity and Disability, “being active is an important part of getting and staying healthy.” For persons with impairments, exercise can be a different ballgame. Accessibility issues, personal image and exercise guidelines come into play. To understand the importance of exercise, we turned to Exercise Physiologist, Dr. Patrick Jacobs, Ph.D. of Florida International University. Dr. Jacobs simply explains that exercise is “cheap” but health care is expensive. Exercise is really about the cardiovascular and circulatory systems of the body. These systems move nutrients, gases, and wastes to and from cells helping to fight diseases and stabilize the body. Dr. Jacobs starts with muscles that have voluntary movement. “If there is any voluntary movement, then exercise that muscle and slowly build it.” Assistive devices can be used but should not become a “crutch” and shed them over time. For those with paralysis but with intact peripheral nerves, electrical stimulation is an option. These devices send pulses of electricity into the user’s skin and contract the muscles. Even if they do not cause a twitch, they can help the blood flow. (Surface stimulation relies on the peripheral nerve system to activate the muscle.) Dr. Jacobs advises, “Use it or loose it.” Muscles are where we use the fuel for the body. Studies have confirmed that, during exercise, blood pressure control is dominated by peripheral neural feedback mechanisms; increasing the heart rate and moving blood throughout the circulatory system. Stimulating muscle activity through exercise can greatly benefit the circulatory system of the body, but also other systems such as the skeletal system. University of Iowa research team lead by Richard Shields reported that early intervention and long term treatments with electrical stimulation which causes muscle contractions exerting greater than body weight to bones is the best way to apply therapeutic stresses to keep the skeletal system healthy and significantly reduces the loss of bone mineral density. Dr. John McDonald of Johns Hopkins University published a paper in the 2002 Journal of Neurosurgery that demonstrated neurological restoration and functional recovery can occur even long after the nervous system is damaged. Studies have proven that active therapy improves patients’ quality of life by promoting overall physical integrity such as improving cardiovascular health; preventing skin breakdown; and reducing the incidence of osteoporosis, scoliosis and other skeletal disorders. For all those various health benefits, we have established that exercise is good for you. But that is nothing new. Now, let’s turn to tools that can help. Two areas of neurotechnology relating directly to exercise are Electrical Muscle Stimulators and Movement Enhancement Systems. Each area is described below with resources available in the other sections of this newsletter. Electrical Muscle Stimulators (EMS) Electrical stimulation of the muscles may be employed to help maintain the muscles because the motor nerve is blocked but remains anatomically intact. EMS devices use pulses of electricity to contract or excite the muscle. A “normal” muscle contracts during an exercise regime, whereas the weak or paralyzed muscle achieves a similar result with the assistance of electrical stimulation. Using EMS, it is possible to minimize the loss of muscle bulk, improve muscle size and performance, and enhance physical fitness. Investigators, who were interested in minimizing the muscle loss, have demonstrated the efficacy of electrical stimulation during the denervation, loss of nerve supply, period. Studies date back to the 1950s; the numbers of subjects or sample sizes are small but the results were applicable to clinical practice. However, the limitations of EMS systems for mimicking the effects of exercise are caused by the skin. Transcutaneous neural stimulators like surface stimulation garments and external FES (Functional Electrical Stimulation) devices are subject to a Catch-22. To achieve results, they have to push enough electricity through the skin to affect the nerve. Even with the limitations of the skin, the benefits of exercise can still be realized. FES bikes or rowing machines deliver electrical currents to activate the quadriceps, hamstring, and gluteus muscles enabling the legs to move through a regular patterned physical activity. EMS arm exercises deliver low level pulses of electrical current to paralyzed upper arm muscles and enable arm exercises. Therapeutic electrical stimulation used in conjunction with bilateral arm movement produce results for treatment of hemiparesis caused by stroke. More sophisticated devices work to improve the communication between the brain and the peripheral nervous system. This communication governs muscle activation. When a muscle contracts, there are areas in the brain activated to induce this activity. Disuse muscle atrophy results in the weakening of this area in the brain. Another form of rehabilitation for voluntary movement is to monitor the brain for activity to a muscle group. When strong muscle-movement signals are detected in the brain, a device induces movement by contracting the muscle through external electrical stimulation. These exercises are only possible provided the relevant nerves are not damaged.

Educate: Exercise Weak or Paralyzed Muscles

Educate: Exercise weak or paralyzed muscles

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Personal Experience: Susan & Matt

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On the Horizon: Updates in the World of Neurotech

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Resources for Exercising Weak or Paralyzed Muscles

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Neurotech Network Awarded Conference Grant

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Remembering the Consumer

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Work