FES Bike Race preparation to Cybathlon 2016 by EMA team: a short case report

Abstract

FES-assisted cycling has been recommended to people struggling to emerge from a disability to more functioning life after spinal cord injury. Recommendations issued by a gowing number of scientific papershas promised toimprove body composition and physical activity levels, as well as to controlinvoluntary muscle response; favoring activity and participation which break new grounds in expanding locomotion, leisure and occupational options for people with paraplegia and tetraplegia. In this report we described our experience to select and prepare a pilot to compete in the FES Bike Race modality at Cybathlon 2016 in Kloten (Zurick). He was a man, 38 years old, with a complete spinal cord injury, level T9, three years of injury. He took part in a two preparation phases lasting respectively 18 and 12 weeks each: (1st) pre-FES-cycling and a (2nd) FES-cycling. The 1st phase aimed to explore electrical stimulation response in the quadricps, hamstrings and gluteus muscles; searching for a standard muscular recruitment enable to propel the pedals of a trike. Following, in the 2nd phase, stationary to mobile FES-cycling was performed at the same time the development of the automation and control systems were being incorporated in the trike. We adapted a commercial tadpole trycicle anda pilot controlled system. Although we had planned a three session by week protocol, for reasons of term and time to finish the trike development and be prepared to compete, in the last two weeks before the Cybatlhon an intense level of exercise was maintained. After the race, we noticedinflammatory signs on the left knee which later revealed a patella fracture. The video footage analysis confirmed ithappened during the race's first lap.

Keywords: FES cycling; electrical stimulation; harms; risk evaluation; spinal cord injury.

Fig 1.

The frequency of distribution for participants responsive or non-responsive to the NMES by injury level. A significant (p<0,05) association detected by Fisher’s exact test suggests a relative infinity risk of the level of the injury predicting the responsiveness, choosing the method of Katz when the values are zero, adding 0.5 to all cells before calculating the relative risk and its confidence interval. Prism shows a floating note on the results page when it does this. In this case, it suggests us switch to the Koopman method.

Fig 2.

The tadpole trike adapted in this work for mobile FES cycling.

Fig 3.

Photograph illustrating the inicial step of the 1st phase of progressive training in which the vastus lateralis muscle was activated together with the anterior tibialis muscle in isometric contractions during a sitting position.

Fig 4.

Photographs showing against gravity exercises by electrical stimulation of quadriceps, hamstrings and gluteus muscular groups during sit-to-stand transfer and standing maintenance position. The photograph recorded the beginning of the sitting position (left) and the end in the standing maintenance position (right).

Fig 5.

Photograph of stationary set up used during the initial training of the FES-cycling preparation.

Fig 6.

Heart rate and lactate levels before and after preparation sessions during the 12 weeks of FES-cycling preparation.

Fig 7.

The x-ray images reaveling the cleft knee showing the comminuted fracture of the patella. The left image is a front view of the knee in 90 degree flexion, and the right image is a profile view in the sagital plane.