Development and assessment of methods for arm-cranking exercise assisted by functional electrical stimulation (FES) in tetraplegia
In this pilot study, a new avenue for exercise in tetraplegia, involving FES applied to upper limb muscles, is suggested. The main motivation for developing methods for FES-assisted arm-cranking exercise is to provide an exercise modality specifically designed for tetraplegia that might address cardiopulmonary issues, as well as work with remaining voluntary control of upper body musculature. One primary aim of this thesis was to determine the feasibility of using these systems in tetraplegia. To investigate this, standard protocols for exercise training, and incremental and constant-load exercise testing, were adapted to make them suitable for this population and this exercise modality. These novel protocols are described here, and represent one of the contributions of the thesis. The implementation of these protocols for an experimental evaluation of the proposed systems for FES-assisted arm-cranking exercise makes up the main part of the thesis. Five volunteers with tetraplegia participated in this experimental evaluation, and their data are presented as two main case studies, and additional case reports. The first outcome of thesis evaluation is that it shows the feasibility of the proposed methods for FES-assisted arm-cranking exercise training and testing in tetraplegia. Secondly, benefits of regular use of the systems are illustrated for some individuals with tetraplegia, based on key indicators of cardiopulmonary fitness and measures of upper limb strength. Thirdly, the limitations of the current set-up for FES-assisted arm-cranking exercise in higher level tetraplegia are identified. In summary, this thesis describes new systems and protocols for FES-assisted arm-cranking exercise in tetraplegia, and provides a preliminary assessment of these methods.