Journal of Applied Physiology
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J Appl Physiol (April 24, 2008). doi:10.1152/japplphysiol.00892.2007
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Submitted on August 20, 2007
Accepted on April 18, 2008

Doublet Stimulation Protocol to Minimize Musculoskeletal Stress during Paralyzed Quadriceps Muscle Testing

Shauna Dudley-Javoroski1, Andrew E. Littmann1, Masaki Iguchi1, and Richard K Shields2*

1 Graduate Program in Physical Therapy & Rehabilitation Science, The University of Iowa, Iowa City, Iowa, United States
2 Graduate Program in Physical Therapy & Rehabilitation Science, University of Iowa, Carver College of Medicine, Iowa City, Iowa, United States

* To whom correspondence should be addressed. E-mail: richard-shields{at}uiowa.edu.

With long-term electrical stimulation training, paralyzed muscle can serve as an effective load delivery agent for the skeletal system. Muscle adaptations to training, however, will almost certainly outstrip bone adaptations, exposing participants in training protocols to an elevated risk for fracture. Assessing the physiological properties of the chronically paralyzed quadriceps may transmit unacceptably high shear forces to the osteoporotic distal femur. We devised a two-pulse doublet strategy to measure quadriceps physiological properties while minimizing the peak muscle force. The purposes of the study were; 1) to determine the repeatability of the doublet stimulation protocol, and 2) to compare this protocol among individuals with and without spinal cord injury (SCI). 8 individuals with SCI and 4 individuals without SCI underwent testing. The doublet force-frequency relationship shifted to the left after SCI, likely reflecting enhancements in the twitch to tetanus ratio known to exist in paralyzed muscle. Post-tetanic potentiation occurred to a greater degree in subjects with SCI (20%) than in non-SCI subjects (7%). Potentiation of contractile rate occurred in both subject groups (14% and 23% for SCI and non-SCI, respectively. Normalized contractile speed (rate of force rise, rate of force fall) reflected well-known adaptations of paralyzed muscle toward a fast fatigable muscle. The doublet stimulation strategy provided repeatable and sensitive measurements of muscle force and speed properties that revealed meaningful differences between subjects with and without SCI. Doublet stimulation may offer a unique way to test muscle physiologic parameters of the quadriceps in subjects with uncertain musculoskeletal integrity.







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