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Permanent LMN denervation of human skeletal muscle and recovery by h-b FES: management and monitoring

Helmut Kern, Roberto Stramare, Leonora Martino, Riccardo Zanato, Paolo Gargiulo, Ugo Carraro
  • Helmut Kern
    Ludwig Boltzmann Institute of Electrical Stimulation and Physical Rehabilitation, Department of Physical Medicine and Rehabilitation, Wilhelminenspital Wien, Austria
  • Roberto Stramare
    Department of Diagnostics and Special Therapy, University of Padova, Italy
  • Leonora Martino
    Department of Diagnostics and Special Therapy, University of Padova, Italy
  • Riccardo Zanato
    Department of Diagnostics and Special Therapy, University of Padova, Italy
  • Paolo Gargiulo
    Clinical Engineering and Information Technology, Landspitali - University Hospital, Reykjavik, Iceland
  • Ugo Carraro
    Laboratory of Translational Myology, Department of Biomedical Sciences, Interdepartmental Research Center of Myology, University of Padova, Italy | ugo.carraro@unipd.it

Abstract

Denervation of a defined skeletal muscle is due to lower motor neuron (LMN) or peripheral nerve lesions that have major consequences on the muscle tissue. After early atrophy, the mid- and late-phases presents two very contrasting myofibers populations: beside those severely atrophic with internalized groups of myonuclei, large fast-type muscle fibers continue to be present 4 to 6 years after Spinal Cord Injury (SCI). Recent results of rat experiments provides the rational basis for understanding the residual functional characteristics of the long-term denervated muscle and the molecular explanation of its ability to respond to home-base functional electrical stimulation (h-b FES) using custom-designed electrodes and stimulators. Further outcomes of the Vienna-Padova ten-year collaboration are: 1. a world-unique Myo- Bank of muscle biopsies and 2. improved imaging procedures (Color Computer Tomography (CT) scan and Functional Echomyography), all demonstrating that h-b FES induces improvements in muscle contractility, tissue composition and mass, despite permanent LMN denervation. The benefits of h-b FES could be extended from patents suffering with complete Conus-Cauda Syndrome to the numerous patients with incomplete LMN denervation of skeletal muscles to determine whether h-b FES reduces secondary complications related to disuse and impaired blood perfusion (reduction in bone density, risk of bone fracture, decubitus ulcers, and pulmonary thromboembolism). We are confident that translation of the results of a clinical experiment, the EU Project RISE, to the larger cohort of incomplete LMN denervated muscles will provide the wanted results.

Keywords

LMN denervation, human skeletal muscle, managements, monitorings, h-b FES, Color CT scan, ultra sonography, Functional Echomyography

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Submitted: 2013-07-03 13:29:41
Published: 2010-09-03 00:00:00
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Copyright (c) 2010 Helmut Kern, Roberto Stramare, Leonora Martino, Riccardo Zanato, Paolo Gargiulo, Ugo Carraro

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