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Functional Electrical Stimulation Assisted Swimming for Paraplegics


Abstract and Figures

A new method for functional electrical stimulation (FES) assisted swimming has been developed. This includes the development of waterproof electrodes, cables, and a stimulator. In preliminary experiments, an extension and flexion movement of the knee could be induced for a complete paralyzed subject. Furthermore, the developed setting stayed safe and dry during several sessions. To investigate the overall benefit of FES assisted swimming a pilot study was designed which started in 2018. During this study, up to ten complete paraplegic subjects shall be trained to swim with FES assisted leg movement while swimming speed and heart rate are compared to swimming without FES-support. Additionally, the effects of the training on spasticity, the well-being, and the usability of the technology shall be assessed.
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22. Annual IFESS Conference
Constantin Wiesener
, Jens Axelgaard
, Rachel Horton
, Andreas Niedeggen
, and Thomas Schauer
1Control Systems Group, Technische Universität Berlin, Germany
2Axelgaard Manufacturing Co., Ltd., USA
3Treatment Centre for Spinal Cord Injuries, ukb Unfallkrankenhaus Berlin, Germany
A new method for functional electrical stimu-
lation (FES) assisted swimming has been developed. This
includes the development of waterproof electrodes, cables,
and a stimulator. In preliminary experiments, an extension
and flexion movement of the knee could be induced for a
complete paralyzed subject. Furthermore, the developed
setting stayed safe and dry during several sessions. To
investigate the overall benefit of FES assisted swimming
a pilot study was designed which started in 2018. Dur-
ing this study, up to ten complete paraplegic subjects shall
be trained to swim with FES assisted leg movement while
swimming speed and heart rate are compared to swimming
without FES-support. Additionally, the effects of the train-
ing on spasticity, the well-being, and the usability of the
technology shall be assessed.
Keywords: FES, Swimming, paraplegic
A spinal cord injury (SCI) is often associated with paralysis
of the lower extremities which means a severe restriction
of physical activity and health for the affected subjects. De-
pending on the level and severity of the injury, this involves
a functional limitation of various body sensory and motor
functions below the level of lesion. In case of a traumatic
SCI, the physical inactivity is in stark contrast to the condi-
tion prior to the injury, especially for young patients.
Participation in physical and therapeutic activities following
a paraplegia is often limited due to the loss of voluntary
motor function and inefficient temperature regulation of
the affected extremities, autonomic dysfunction, and early
muscle fatigue. In addition, often specially adapted equip-
ment and assistants are needed. Despite all these obsta-
cles, sportive and therapeutic activity after paraplegia can
contribute to a reduction in concomitant diseases and to
an increase in the emotional well-being of those affected
[1, 2].
In the majority of cases, paraplegia results in complete
or incomplete paralysis of the lower extremities. There-
fore, effective and safe lower extremity training is limited
and training exercises of the upper extremities are recom-
mended such as arm-crank ergometer, wheelchair ergometer
or swimming. All these exercises can improve physical fit-
ness by up to 25 % with regular exercises [
]. Mobility
in the water is often the only experience of unaided body
movement (except for the transfer in and from the pool)
within the environment that most paralyzed patients enjoy.
In addition, there is a plurality of therapeutic effects de-
scribed in the literature as an increase of muscle strength,
improved coordination, reduction of spasticity and a reduc-
tion of contractures [4].
Functional electrical stimulation (FES) is used successfully
in FES cycling or rowing [
]. The corresponding muscles
for knee extension and flexion or hip extension and flexion
are stimulated depending on the crank or joint angle during
cycling or triggered by a pull switch while rowing. Due
to the combination of arm and leg training, a significantly
higher training effect can be achieved. In addition, an im-
provement in perfusion and lower limb bone density has
been observed in some studies [
]. In this paper, we want to
present our recent work on the combination of FES assisted
swimming in paraplegic patients.
During the relearn phase of swimming for paraplegics, the
independence in the water is first achieved on the back since
the prone position is more difficult to maintain without
muscle power at the hip joints. Furthermore, symmetri-
cal strokes are taught initially by the swimming instructor
during the relearn phase, because asymmetrical swimming
techniques cause the paralyzed limbs to roll and the patient
finds it difficult in maintaining a straight course [4].
Afterward, there are several possible swimming techniques
for paraplegics with slight modifications compared to non-
paralyzed subjects. For patients with thoracic or lumbar le-
sion height [
] recommends backstroke, breaststroke, crawl
stroke and butterfly stroke in which the butterfly stroke is
the most difficult to learn.
For normal breaststroke in unimpaired subjects, the so-
called frog kick is used as leg technique, which includes
knee flexors and extensors, thigh adductors and abductors,
gluteus and the plantar-flexors. In preliminary tests, we
found out that a complex movement like the frog kick is
Figure 1: Experimental FES swimming setting including the waterproof stimulator (Hasomed RehaMove3, CHIP embedded PC, scuba diving housing)
the user interface (Pebble I smartwatch, Laptop), waterproof IMU sensors and waterproof electrodes.
not realizable with FES. For backstroke and crawl, the so-
called flutter kick can be used for the lower legs with FES
support. For this technique, the knee extensors and flexors
and the gluteus are mostly involved. In [
] the knee
angle course for healthy non-expert swimmers for crawl is
analyzed. Here, after a short and strong extension phase,
a plateau phase can be observed where the knee joint is
fully extended. During the plateau phase, the other knee
is flexed until 40-50 degrees and then directly extended
until the plateau phase. To reproduce this movement for
paraplegic patients a periodic stimulation pattern is used
which is shown in Fig 3. The pulse width is kept constant
at a level of 300-400
s while the current amplitude of the
biphasic pulses is ramped on and off.
To our best knowledge, there is no study or work on FES
in water to produce a functional movement. There are
several works on Iontophoresis for the transdermal delivery
of pharmaceuticals using low DC currents. Furthermore, in
] waterproof surface EMG electrodes are used to compare
EMG signals on land and in water. Here, standard EMG
electrodes are fixed and waterproofed using 3M Tegaderm
as a waterproof oversize backing. Due to the fact that
chlorinated water in swimming pools has a conductance of
2.5-3 mS/cm which results in resistance of 333-400 Ohm
a direct stimulation with non-waterproof electrodes would
produce a parasitic short circuit between electrodes during
Therefore, Axelgaard Manufacturing developed a water-
proof electrode with a snap connector which stays water-
proof over at least 30 minutes (see Fig. 4). To fix the snap
connector a 3M Tegaderm adhesive has been used. In tests
with healthy subjects, it has been shown that the connection
between cable and electrode must be waterproof as well.
Therefore, a tight silicone tube is used as a cover for the
connection between electrode and cable.
During preliminary tests for the STIMSWIM pilot study, an
experimental FES swimming setting was developed (Fig.1).
For the stimulator, the RehaMove3 (Hasomed GmbH, Ger-
many) is used in combination with a wireless embedded PC
which executes the stimulation pattern and collects sensor
measurements. The stimulation is controlled via a Kivy
App running on a standard laptop. In the water, the subject
can control the stimulation via a customized smartwatch
Preliminary experimental results
To find the best swimming technique and stimulation set-
ting several preliminary tests have been executed with one
paraplegic subject under medical supervision of the Un-
fallkrankenhaus Berlin
. The participant gave written in-
formed consent.
The stimulation of the gluteus was excluded due to the fact
that it is not possible to place the electrodes on a paraplegic
without help. Furthermore, the hip position of a paraplegic
in backstroke swimming technique depends on the level
of control over the waist and hip. In preliminary tests, we
found out that the lower the hip the less propulsion which
can be achieved by stimulating the knee flexors and ex-
tensors. As a result crawl stroke was decided to be used
in combination with FES for the planned study. Further-
more, during tests with floats at the ankle a default upward
movement of the ankle could be observed for crawl stroke
which results in a more streamlined position in the water.
In Fig. 4 three photos in the sagittal plane are displayed
which show the different states of the stimulation. During
this test, the subject was asked not to swim with his arms to
get a stable position. During the trial underwater video data
has been captured using a waterproof GoPro action cam-
era. Using the video data the left knee angle was tracked
as shown in Fig. 3 using the video processing software
Kinovea. Compared to [
] the plateau phase of the knee
1Ethical approval of Berlin Chamber of Physicians Eth-28/17
Figure 2: Photo and construction plan of Axelgaard Ultrastim
snap elec-
trode with oversize water fast backing with an electrode area of 22.9 cm2
[10, 11]
angle after the full extension is reduced. Due to the missing
arm movement, the knee moves automatically to the rest
angle of 90 degree. During swimming with arms knee an-
gle tracking was not possible due to the swimming speed
and role movement of the trunk. Furthermore, the reached
minimum flexion angles are 20 degrees higher compared to
non-paraplyzed swimmers. The stimulation setting includ-
ing the stimulator, cables, and electrodes stayed dry over
the full trial duration of 30 minutes. We found out that the
synchronization of the knee extension with the contralateral
elbow extension in the case of crawl stroke is needed to in-
crease the swimming speed and effectiveness. Furthermore,
if the arm movement is synchronized to the leg movement
then the rolling of the body around the longitudinal axis is
minimized. Therefore, we plan for the next trials to sense
the arm motion by an inertial sensor to control the stimu-
lation of the leg, or to provide a sensory stimulation to the
swimmer to inform him/her about the movement of the stim-
ulated leg as biofeedback. In addition, the influence of the
Hamstring stimulation was rated quite low compared to the
propulsion produced by the Quadriceps only. Therefore, for
the planned study either quadriceps only or the combination
of quadriceps and hamstrings shall be stimulated.
The STIMSWIM pilot study
The STIMSWIM pilot study shall investigate the technical
feasibility of FES to support swimming motions by the legs
9 10 11 12 13 14 15 16 17
Time in s
Left knee angle in degree
Current in m A
Left knee angle
Stimulation curr ent Quadriceps
Stimulation curr ent Hamstring
Figure 3: Left knee angle for three consecutive strokes during stimulation
of the Quadriceps and Hamstring muscle group.
Rest / No stimulation
Extension of right leg with FES
Extension of left leg with FES
Figure 4: Experiment with a paraplegic subject (Th5, ASIA scale A)
with floats at the feet with asynchronous stimulation of the left and right
quadriceps and hamstrings.
in up to 10 subjects with complete paralysis of the lower
extremities after spinal trauma. The subjects have to be over
18 years and must give written informed consent. There are
three main questions which shall be answered within this
trial. Does the swimming speed increase compared to non-
assisted swimming? 2. Does the general well-being of the
subject improve during the trial? 3. How is the acceptance
of the technology by the user? The trial comprises of a land
and a swimming phase. After the recruitment and initial
assessment, the subject is asked to carry out a four-week
FES cycling training. During the land training, he/she is
asked to train at least three times a week for 30 minutes
with a standard RehaMove FES cycling ergometer. At the
beginning and end of this training phase, the thigh diameter
and maximum cycling power are assessed. This preliminary
FES cycling training is needed to build up a defined baseline
for the swimming trial. During the swimming phase, the
with FES no FES no FES with FES
Pause Pause Pause
with FES with FES
Pause Pause Pause
with FES with FES
Assessment session:
Normal Training session:
25 m 25 m 25 m 25 m
Figure 5: Comparison of assessment and training session. For each as-
sessment session, the subject shall swim the same distance while the time
needed is measured. The distance of each swimming trial will be fixed to
25 m.
FES cycling shall be reduced to two times a week.
Table 1: Trial plan for the swim training during the STIMSWIM study. A
means training with FES and B without.
ID Time after assessment Assessment
Four weeks after re-
and FES cycling
training (3 times a
Execution of Modified
Ashworth Scale Test,
Measurement of swim
distance and speed with
and without FES (ABBA)
After 4-6 training ses-
sions (maximum 30
days after last assess-
Execution of Modified
Ashworth Scale Test,
Measurement of swim
distance and speed with
and without FES (ABBA)
After 8-12 training ses-
sions (maximum 30
days after last assess-
Execution of Modified
Ashworth Scale Test,
Measurement of swim
distance and speed with
and without FES (ABBA)
After 12-18 training
sessions (maximum
30 days after last
Execution of Modified
Ashworth Scale Test,
Measurement of swim
distance and speed with
and without FES (ABBA)
Afterward, the swimming training starts which follows the
trial protocol shown in Tab.1. The swimming assessment
consist of a strict ABBA pattern to eliminate the effect of
fatigue. Furthermore, the swimming trials of an assess-
ment session either with FES or without are separated by a
five-minute pause. In between the assessment, the subjects
shall train with FES only in four separate training blocks as
shown in Fig. 5. The training is supervised by a pool atten-
dant to eliminate the risk of severe events. At the beginning
and end of each assessment, the spasticity shall be speci-
fied using the Modified Ashworth Scale test. Furthermore,
the subject is asked to fill in a questionnaire about his/her
well-being and the usability of the FES swimming training.
At the moment 3 subjects could be recruited and we started
the FES cycling training. The study shall be finalized by
the end of this year.
A new concept for FES assisted swimming for paraplegics
was proposed which uses a waterproof stimulator and elec-
trodes to produce a swimming movement of the paralyzed
legs. During experiments, a periodic FES induced extension
and flexion of the knee could be shown which produced a
propulsion movement in the water. To assess the improve-
ment in speed, swimming distance and well-being a pilot
trial was set up. If it is possible to show that an effective
swimming training including the paralyzed legs can be re-
alized a completely new aqua therapy for paraplegics can
be built up. In addition, the stimulation could also be used
recreationally by paraplegics for diving. Furthermore, it
is conceivable that not only complete paraplegic patients
but also incomplete paraplegic patients or stroke patients
could benefit from an FES-assisted gait therapy in water.
An improvement in physical functions and walking ability
in manual underwater training has been shown in several
studies [12, 13].
We would like to acknowledge Axelgaard Manufacturing
Co., Ltd., USA for developing, producing and donating the
stimulation electrodes. Furthermore, we would like to thank
all participants and partners in the STIMSWIM clinical trial
for their support and commitment.
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... Nowadays the same technique is used to generate muscle contractions or tactile feedback as presented, for example, in [20]. In [21], we presented the first FES system that restored functional movements in swimming paraplegics by stimulating with special waterproof electrodes. ...
Full-text available
Participation in physical and therapeutic activities is usually severely restricted after a spinal cord injury (SCI). Reasons for this are the associated loss of voluntary motor function, inefficient temperature regulation of the affected extremities, and early muscle fatigue. Hydrotherapy or swim training offer an inherent weight relief, reduce spasticity and improve coordination, muscle strength and fitness. We present a new hybrid exercise modality that combines functional electrical stimulation (FES) of the knee extensors and transcutaneous spinal cord stimulation (tSCS) with paraplegic front crawl swimming. tSCS is used to stimulate the afferent fibers of the L2–S2 posterior roots for spasticity reduction. By activating the tSCS, the trunk musculature is recruited at a motor level. This shall improve trunk stability and straighten the upper body. Within this feasibility study, two complete SCI subjects (both ASIA scale A, lesion level Th5/6), who have been proficient front crawl swimmers, conducted a 10-week swim training with stimulation support. In an additional assessment swim session nine months after the training, the knee extension, hip extension, and trunk roll angles where measured using waterproof inertial measurement units (IMUs) and compared for different swimming conditions (no stimulation, tSCS, FES, FES plus tSCS). For both subjects, a training effect over the 10-week swim training was observed in terms of measured lap times (16 m pool) for all swimming conditions. Swimming supported by FES reduced lap times by 15.4% and 8.7% on average for Subject A and Subject B, respectively. Adding tSCS support yielded even greater mean decreases of 19.3% and 20.9% for Subjects A and B, respectively. Additionally, both subjects individually reported that swimming with tSCS for 30–45 minutes eliminated spasticity in the lower extremities for up to 4 hours beyond the duration of the session. Comparing the median as well as the interquartile range of all different settings, the IMU-based motion analysis revealed that FES as well as FES+tSCS improve knee extension in both subjects, while hip extension was only increased in one subject. Trunk roll angles were similar for all swimming conditions. tSCS had no influence on the knee and hip joint angles. Both subjects reported that stimulation-assisted swimming is comfortable, enjoyable, and they would like to use such a device for recreational training and rehabilitation in the future. Stimulation-assisted swimming seems to be a promising new form of hybrid exercise for SCI people. It is safe to use with reusable silicone electrodes and can be performed independently by experienced paraplegic swimmers except for transfer to water. The study results indicate that swimming speed can be increased by the proposed methods and spasticity can be reduced by prolonged swim sessions with tSCS and FES. The combination of stimulation with hydrotherapy might be a promising therapy for neurologic rehabilitation in incomplete SCI, stroke or multiples sclerosis patients. Therefore, further studies shall incorporate other neurologic disorders and investigate the potential benefits of FES and tSCS therapy in the water for gait and balance.
... Due to the combination of arm and leg training, a significantly higher training effect can be achieved. In [6] we presented the world's first FES swimming system for paraplegics. The first test showed the need of synchronizing the leg motion with voluntary arm motion to We would like to acknowledge Axelgaard Manufacturing Co., Ltd., USA for developing, producing and donating the stimulation electrodes. ...
Functional electrical stimulation (FES) can be used to support walking and cycling in spinal cord injured individuals. In the current contribution, we present a new method that, for the first time, enables FES-supported swimming in paraplegics. The proposed setup includes a waterproof stimulator, cables, and electrodes. In preliminary experiments, flexion and extension movements of the knee could be generated to support the propulsion during crawling. A synchronization of the voluntary arm and leg movements showed to have a stabilizing effect on the body position of the swimmer in the water, especially on the roll angle. To enable such a synchronized swimming, an electrotactile feedback algorithm was developed that informs the swimmer about the leg movement by a stimulation of sensory unimpaired regions at the back of the subject at a sensory level. The new setup and methods are currently being tested during the STIMSWIM pilot study with paraplegics. In first preliminary results, an improvement of swimming velocity compared to non FES-assisted swimming was observed in the two first subjects.
Electrically stimulated lower limb systems contain higher order nonlinearities and uncertainties in their physical parameters. Takagi-Sugeno (TS) fuzzy models are used to model nonlinear systems. Techniques such as parallel distributed compensation (PDC) are dependent on the membership functions that constitute the TS fuzzy model. When the exact representation approach is used to electrical stimulation applications, the system’s performance under PDC control can be deteriorated, because the membership functions may be uncertain, besides a high computational cost be required to compute them. In this paper, we propose a robust switched control subject to actuator saturation and fault (RSwASF) that effectively handles system uncertainties and nonidealities, such as fatigue, spasms, tremor, and muscle recruitment. Control techniques based on TS fuzzy modeling (PDC and robust PDC), as well as other approaches, such as sliding-mode control, backstepping, super-twisting, gain-scheduling, and proportional-integral-derivative (PID) control were compared to RSwASF through the root-mean-squared error (RMSE). The results indicate that RSwASF minimizes the influence of the parametric uncertainties and presents the lowest RMSE for healthy and paraplegic individuals.
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Study design: Two studies were conducted: Study-1 was cross-sectional; and Study-2 a longitudinal repeated measures design. Objectives: To examine the influence of functional electrical stimulation (FES) rowing training on cardiac structure and function in people with spinal cord injury (SCI). Setting: A university sports science department and home-based FES-training. Methods: Fourteen participants with C4-T10 SCI (American Spinal Injury Association Impairment Scale A or B) were recruited for the studies. Cardiac structure and function, and peak: oxygen uptake ([Vdot ]O2peak), power output (POpeak) and heart rate (HRpeak), were compared between two FES-untrained groups (male n=3, female n=3) and an FES-trained group (male n=3) in Study-1 and longitudinally assessed in an FES-naive group (male n=1, female n=4) in Study-2. Main outcome measures left ventricular-dimensions, volumes, mass, diastolic and systolic function, and [Vdot ]O2peak, POpeak and HRpeak. In Study-2, in addition to peak values, the [Vdot ]O2 sustainable over 30 min and the related PO and HR were also assessed. Results: Sedentary participants with chronic SCI had cardiac structure and function at the lower limits of non-SCI normal ranges. Individuals with chronic SCI who habitually FES-row have cardiac structure and function that more closely resemble non-SCI populations. A programme of FES-rowing training improved cardiac structure and function in previously FES-naive people. Conclusion: FES-rowing training appears to be an effective stimulus for positive cardiac remodelling in people with SCI. Further work, with greater participant numbers, should investigate the impact of FES-rowing training on cardiac health in SCI. Sponsorship: We thank the INSPIRE Foundation, UK, for funding these studies.Spinal Cord advance online publication, 12 January 2016; doi:10.1038/sc.2015.228.
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Objective To document the effects of underwater treadmill training (UTT) on leg strength, balance, and walking performance in adults with incomplete spinal cord injury (iSCI). Design Pre-test and post-test design. Setting Exercise physiology laboratory. Participants Adult volunteers with iSCI (n = 11). Intervention Participants completed 8 weeks (3 × /week) of UTT. Each training session consisted of three walks performed at a personalized speed, with adequate rest between walks. Body weight support remained constant for each participant and ranged from 29 to 47% of land body weight. Increases in walking speed and duration were staggered and imposed in a gradual and systematic fashion. Outcome measures Lower-extremity strength (LS), balance (BL), preferred and rapid walking speeds (PWS and RWS), 6-minute walk distance (6MWD), and daily step activity (DSA). Results Significant (P < 0.05) increases were observed in LS (13.1 ± 3.1 to 20.6 ± 5.1 N·kg(-1)), BL (23 ± 11 to 32 ± 13), PWS (0.41 ± 0.27 to 0.55 ± 0.28 m·s(-1)), RWS (0.44 ± 0.31 to 0.71 ± 0.40 m·s(-1)), 6MWD (97 ± 80 to 177 ± 122 m), and DSA (593 ± 782 to 1310 ± 1258 steps) following UTT. Conclusion Physical function and walking ability were improved in adults with iSCI following a structured program of UTT featuring individualized levels of body weight support and carefully staged increases in speed and duration. From a clinical perspective, these findings highlight the potential of UTT in persons with physical disabilities and diseases that would benefit from weight-supported exercise.
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Spinal cord injury is a catastrophic event that immeasurably alters activity and health. Depending on the level and severity of injury, functional and homeostatic decline of many body systems can be anticipated in a large segment of the paralyzed population. The level of physical inactivity and deconditioning imposed by SCI profoundly contrasts the preinjury state in which most individuals are relatively young and physically active. Involvement in sports, recreation, and therapeutic exercise is commonly restricted after SCI by loss of voluntary motor control, as well as autonomic dysfunction, altered fuel homeostasis, inefficient temperature regulation, and early-onset muscle fatigue. Participation in exercise activities also may require special adaptive equipment and, in some instances, the use of electrical current either with or without computerized control. Notwithstanding these limitations, considerable evidence supports the belief that recreational and therapeutic exercise improves the physical and emotional well-being of participants with SCI. This article will examine multisystem decline and the need for exercise after SCI. It will further examine how exercise might be used as a tool to enhance health by slowing multisystem medical complications unique to those with SCI. As imprudent exercise recommendations may pose avoidable risks of incipient disability, orthopedic deterioration, or pain, the special risks of exercise misuse in those with SCI will be discussed.
Full-text available
Spinal cord injury (SCI) leads to a partial or complete disruption of motor, sensory, and autonomic nerve pathways below the level of the lesion. In paraplegic patients, functional electrical stimulation (FES) was originally widely considered as a means to restore walking function but this was proved technically very difficult because of the numerous degrees of freedom involved in walking. FES cycling was developed for people with SCI and has the advantages that cycling can be maintained for reasonably long periods in trained muscles and the risk of falls is low. In the article, we review research findings relevant to the successful application of FES cycling including the effects on muscle size, strength and function, and the cardiovascular and bone changes. We also describe important practical considerations in FES cycling regarding the application of surface electrodes, training and setting up the stimulator limitations, implanted stimulators and FES cycling including FES cycling in groups and other FES exercises such as FES rowing.
Objective: Although no data are available on the effects of water environment on the gait of subjects with spinal cord injury (SCI), hydrotherapy is used in the rehabilitation protocols of SCI patients. The aim of this study was to characterize gait features of subjects with incomplete SCI walking in water and on land in comparison with healthy controls (CTRLs) to identify the specificity of water environment on influencing gait in SCI subjects. Design: This is a matched case-control study. Results: Kinematic gait parameters and range of motion of joint angles of 15 SCI subjects and 15 CTRLs were analyzed. Compared with gait on land, gait in water of the SCI patients was characterized by speed and stance phase reduction, gait cycle time increment, and invariance of stride length and range of motion values. Comparison with CTRL data remarked that walking in water reduces gait differences between the groups. Furthermore, in water, the SCI subjects presented a reduction in variability of the hip and knee joint angles, whereas in the CTRLs, a larger variability was observed. Conclusions: Gait in water of the SCI subjects is associated with kinematic parameters more similar to those of the CTRLs, particularly regarding speed, stride length, and stance phase, supporting the idea that walking in a water environment may be of rehabilitative significance for SCI subjects.
The objectives of this study were to: (1) compare the sEMG recordings from maximal voluntary contractions (MVC), and (2) examine the reproducibility of sEMG recordings from MVCs for selected lower extremity muscles derived from manual muscle testing (MMT) on dry land, and in water prior to and following aquatic treadmill running. Twelve healthy recreational male runners participated. The selected muscles were: M. quadriceps-vastus medialis (VM) and rectus femoris (RF), M. biceps femoris (BF), M. tibialis anterior (TA) and the M. gastrocnemius caput mediale (GAS) of the right leg. The MVC testing conditions were: dry land, underwater prior to (Water 1) and following an aquatic exercise trial (Water 2). For each muscle, a one-way analysis of variance with repeated measures was used to compare MVC scores between testing conditions, and the intra-class correlation coefficient (ICC) and typical error (CV%) were calculated to determine the reproducibility and precision of MVC scores, respectively, between conditions. For all muscles, no significant differences were observed between land and water MVC scores (p=0.88-0.97), and high reliability (ICC=0.96-0.98) and precision (CV%=7.4-12.6%) were observed between MVC conditions. Under MMT conditions it appears that comparable MVC sEMG values were achieved on land and in water and the integrity of the EMG recordings were maintained during water immersion. Future studies using sEMG waterproofing procedures should conduct MVC testing in water for data normalization and perform post-exercise verification of sEMG signal integrity.
The aim of this study was to examine the effects of swimming speed and skill level on inter-limb coordination and its intra-cyclic variability. The elbow-knee continuous relative phase (CRP) was used as the order parameter to analyze upper-lower limbs coupling during a complete breaststroke cycle. Twelve recreational and 12 competitive female swimmers swam 25m at a slow speed and 25m at maximal speed. Underwater and aerial side views were mixed and genlocked with an underwater frontal view. The angle, angular velocity, and phase were calculated for the knee and elbow by digitizing body marks on the side view. Three cycles were analyzed, filtered, averaged, and normalized in percentage of the total cycle duration. The competitive swimmers showed greater intra-cyclic CRP variability, indicating a combination of intermediate phase and in-phase knee-elbow coupling within a cycle. This characteristic was more marked at slow speed because more time was spent in the glide period of the stroke cycle, with the body completely extended. Conversely, because they spent less time in the glide, the recreational swimmers showed lower intra-cyclic CRP variability (which is mostly in the in-phase coordination mode), resulting in superposition of contradictory actions (propulsion of one limb during the recovery of the other limb).
This was a prospective cross-sectional study for people with chronic spinal cord injury (SCI). To (1) evaluate the intensity level and nature of physical activity in community-dwelling individuals living with SCI, and (2) explore the relation between descriptive individual variables (for example, lesion level), secondary complications and participation in physical activity. Urban community setting. A total of 49 subjects with SCI who used a manual wheelchair for primary mode of mobility (mean years since injury, 11.8; mean age, 43.7 years; 67% paraplegia) completed the physical activity recall assessment for people with SCI (PARA-SCI). Approximately 50% of reported physical activity among individuals with SCI is due to activities of daily living. The amount of physical activity was not related to lesion level, age, body mass index or waistline size. Greater heavy-intensity activity was related to lower levels of pain and fatigue and higher levels of self-efficacy, whereas higher amounts of mild-intensity activity and total activity were related to less depressive symptoms. Activities of daily living are a large component for physical activity among individuals with SCI. It appears that greater physical activity is associated with less secondary complications (pain, fatigue and depression) in individuals with SCI.
Tetraplegia and paraplegia : a guide for physiotherapists
  • I Bromley
I. Bromley, Tetraplegia and paraplegia : a guide for physiotherapists. Churchill Livingstone, 2006.
Use of Inertial Central to Analyse Skill of Inter-Limb Coordination in Sport Activities
  • L Seifert
  • M L'hermette
  • L Wattebled
  • J Komar
  • F Mell
  • D Gomez
  • Y Caritu
L. Seifert, M. L'Hermette, L. Wattebled, J. Komar, F. Mell, D. Gomez, and Y. Caritu, "Use of Inertial Central to Analyse Skill of Inter-Limb Coordination in Sport Activities," BIO Web of Conferences, vol. 1, pp. 1-4, dec 2011.