Spatially distributed sequential stimulation reduces muscle fatigue during neuromuscular electrical stimulation

A critical limitation with neuromuscular electrical stimulation (NMES) approach is the rapid onset of muscle fatigue during repeated contractions, which results in the muscle force decay and slowing of muscle contractile properties. In our previous study, we demonstrated that spatially distributed sequential stimulation (SDSS) show a drastically greater fatigue-reducing ability compared to a conventional, single active electrode stimulation (SES) with an individual with spinal cord injury when applied for plantar flexors. The purpose of the present study is to explore the fatigue-reducing ability of SDSS for major lower limb muscle groups in the able-bodied population as well as individuals with spinal cord injury (SCI). SDSS was delivered through four active electrodes applied to the muscle of interest, sending a stimulation pulse to each electrode one after another with 90° phase shift between successive electrodes. For comparison, SES was delivered through one active electrode. For both modes of stimulation, the resultant frequency to the muscle as a whole was 40 Hz. Using corresponding protocols for the fatiguing stimulation, we demonstrated the fatigue-reducing ability of SDSS by higher fatigue indices as compared with single active electrode setup for major leg muscles in both subject groups. The present work verifies and extends reported findings on the effectiveness of using spatially distributed sequential stimulation in the leg muscles to reduce muscle fatigue. Application of this technique can improve the usefulness of NMES during functional movements in the clinical setup.