Purpose: Investigation of the influence of forced smooth and normal (nonsmooth) pedaling on the functional output of outdoor functional neuromuscular electrical stimulation (FES)-propelled cycling of spinal cord-injured subjects.
Subjects: Twelve subjects with complete spinal cord injury (T4-T12) and limited previous FES training.
Method: Each subject participated in two separate outdoor sessions: once while pedaling a tricycle in a fixed gear, and a second time while free pedaling the same tricycle; both times with FES. Data on distance covered until exhaustion, cadence, and pedal forces were collected. Energy balance calculations led to evaluations of jerk loss and joint-related concentric/eccentric work.
Results: First-trial and total session distances were 68 and 103% longer, respectively, in the forced smooth cycling session than in the free cycling session (P < 0.001). Significantly more additional crank work (accompanied by increased concentric work production) was generated in nonsteady cycling phases to overcome increased jerk losses during free than during fixed-gear pedaling. During fixed-gear pedaling, timing and joint location of muscle work generation were more similar to the cycling of able-bodied subjects than during freewheel pedaling, because most work was generated by knee extensors in the power phase during the former pedaling mode.
Conclusions: The superiority of forced smooth cycling to free cycling, as regards functional output distance, is based on less energy expenditure (less jerk loss and muscle tension) and on more efficient production of energy (more efficient timing and joint location of work production). Some energetic mechanisms that are advantageous for fixed-gear cycling act predominantly in unsteady phases; others work continuously during all phases of cycling.
1Center for Sensorimotor Research, Department of Neurology, Ludwig-Maximillians University, Munich, GERMANY; and 2Clinics of Neurology, Bad-Aibling, GERMANY
Address for correspondence: Johann Szecsi, M.D., Center for Sensorimotor Research, Dept. of Neurology, Ludwig-Maximillians University, Marchioninistrasse 23, 81377 Munich, GERMANY; E-mail: firstname.lastname@example.org.
Submitted for publication December 2005.
Accepted for publication December 2006.