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Electrical stimulation and blood flow restriction increase wrist extensor cross-sectional area and flow meditated dilatation following spinal cord injury

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Abstract

Purpose

To examine the effects of neuromuscular electrical stimulation (NMES) and blood flow restricted (BFR) exercise on wrist extensors cross-sectional area (CSA), torque and hand functions compared NMES only in individuals with incomplete tetraplegia. The acute effect of an acute bout of NMES with BFR on flow mediated dilation (FMD) was compared with BFR only.

Method

Nine men completed 6 weeks twice weekly of bilateral NMES training of the wrist extensor muscles. The right forearm received NMES + BFR (30 % above the resting systolic blood pressure), while the left forearm received NMES only. The CSA of the extensor carpi radialis longus (ECRL) and extensor digitorum communis (EDC) muscles was measured on ultrasound images. Torque was measured isometrically and hand function with grasp and release test. Another eight men with SCI received NMES+BFR to the right forearm, while the left forearm received BFR only. Immediately, the FMD of the brachial artery was measured.

Result

Following training, the ECRL CSA was 17 % greater in the NMES+BFR forearm (mean difference = 0.6 cm2, p = 0.003) compared with the NMES only. The NMES+BFR had a 15 % increase in ECRL CSA (mean increase = 0.58 cm2, p = 0.048). FMD increased (p = 0.05) in the exercise arm (12 ± 3 %) compared with the control arm (6.5 ± 6 %).

Conclusion

NMES training with BFR is a strategy that can increase skeletal muscle size. NMES with and without BFR can improve wrist strength and hand function. The acute effects of NMES+BFR may suggest that an increase in FMD may partially contribute to skeletal muscle hypertrophy.

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Abbreviations

ANCOVA:

Analysis of covariance

BFR:

Blood flow restricted

CSA:

Cross-sectional area

ECRL:

Extensor carpi radialis longus m

EDC:

Extensor digitorum communis m

FMD:

Flow mediated dilation

HR:

Heart rate

NMES:

Neuromuscular electrical stimulation

NMES+BFR:

Neuromuscular electrical stimulation and blood flow restricted

NO:

Nitric oxide

ROM:

Range of motion

SCI:

Spinal cord injury

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Authors and Affiliations

  1. Department of Veterans Affairs, Hunter Holmes McGuire VA Medical Center, Spinal Cord Injury and Disorders Service, 1201 Broad Rock Boulevard, Richmond, VA, 23249, USA

    Ashraf S. Gorgey, Justin Bengel & Kendall C. Fugate-Laus

  2. Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA

    Ashraf S. Gorgey

  3. School of Kinesiology, Marshall University, Huntington, WV, USA

    Mark K. Timmons

  4. College of Health and Human Performance, Virginia Commonwealth University, Richmond, VA, USA

    Justin Bengel

  5. School of Kinesiology, College of Health, University of Southern Mississippi, Hattiesburg, MS, USA

    David R. Dolbow

  6. Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA

    Lori A. Michener

  7. Department of Physical Medicine and Rehabilitation, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA

    David R. Gater

Authors
  1. Ashraf S. Gorgey
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  2. Mark K. Timmons
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  3. David R. Dolbow
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  4. Justin Bengel
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  5. Kendall C. Fugate-Laus
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  6. Lori A. Michener
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  7. David R. Gater
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Corresponding author

Correspondence to Ashraf S. Gorgey.

Additional information

Communicated by Guido Ferretti.

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Gorgey, A.S., Timmons, M.K., Dolbow, D.R. et al. Electrical stimulation and blood flow restriction increase wrist extensor cross-sectional area and flow meditated dilatation following spinal cord injury. Eur J Appl Physiol 116, 1231–1244 (2016). https://doi.org/10.1007/s00421-016-3385-z

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  • DOI: https://doi.org/10.1007/s00421-016-3385-z

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