Effect of a neuromuscular electrical stimulation muscle strength training intervention on muscle force and mass, physical health and quality of life in people with spinal cord injury

Date of Award


Degree Type


Degree Name

Doctor of Philosophy


School of Medical and Health Sciences

First Advisor

Anthony Blazevich

Second Advisor

Robert U. Newton

Third Advisor

Gabriel Trajano


Spinal cord injury (SCI) leads to significant deficits in muscle strength and mass, impacting negatively on physical health and quality of life (QoL). Physical rehabilitation techniques for people with SCI rely on constant updates and the accumulation of evidence regarding the efficacy of available and/or new physical interventions. Neuromuscular electrical stimulation (NMES) is already commonly used to activate skeletal muscles and subsequently reverse muscle atrophy, however NMES as a high-intensity “strength training” intervention appears to be a particularly promising technique for increasing muscle strength and mass and to subsequently improve physical health and quality of life (QoL) in people with SCI. Nonetheless, there are many factors limiting the use of standard NMES protocols, and further evidence pertaining to the use of high-intensity NMES strength training in clinical populations is warranted. The primary aim of the research described in this thesis was to examine the effects of NMES as a high-intensity muscle strength training intervention, specifically using wide-pulse width (1000 μs), low-to-moderate frequency (30 Hz) NMES combined with tendon vibration, on muscle strength and mass, physical health, symptoms of spasticity and QoL in people with SCI. This thesis includes two cross-sectional studies examining the effects of patellar tendon vibration (55 Hz, 7 mm amplitude) superimposed onto wide-pulse width (1000 μs) NMES (e.g. 30 Hz over 2 s) on the peak muscular (knee extensor) force and total impulse elicited by, and rate of recovery from, the intervention in healthy subjects (Study 1) and in people with chronic SCI (Study 2). The results of Study 1 revealed that superimposing tendon vibration onto wide-pulse width NMES leads to an increase in the muscle work performed before fatigue in only some individuals (i.e. positive responders, 50% of individuals in the current study), but decreases it in others (i.e. negative responders). However, it tends to reduce the voluntary force loss that was consistently experienced after a training session using high-intensity NMES, and may thus allow for additional exercise or rehabilitation work to be performed without ongoing voluntary muscle fatigue in healthy people. The results of Study 2 also identified positive and negative responders to tendon vibration in people with SCI, however the responses were less clear and a defined effect of tendon vibration superimposed onto NMES was not discerned. In Study 3, a 12-week (twice-weekly) high-intensity NMES strength training intervention was implemented in people with chronic SCI; based on results of Study 2, high-force contractions were evoked by NMES without superimposed tendon vibration. A significant increase in muscle mass (45%) and strength (tetanic evoked force; 31.8%), amelioration of spasticity symptoms, and improvement in some aspects of physical health and QoL were observed. Therefore, the use of high-intensity NMES strength training appears to be an effective rehabilitation tool to increase muscle force and mass, ameliorate symptoms of spasticity and improve physical and mental health outcomes in people with SCI.

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