Protocols Targeting Afferent Pathways via Neuromuscular Electrical Stimulation for the Plantar Flexors: A Systematic Review

Anastasia Papavasileiou; Anthi Xenofondos; Stéphane Baudry; Thomas Lapole; Ioannis G Amiridis; Dimitrios Metaxiotis; Themistoklis Tsatalas; Dimitrios A Patikas

doi:10.3390/s23042347

Protocols Targeting Afferent Pathways via Neuromuscular Electrical Stimulation for the Plantar Flexors: A Systematic Review

Sensors (Basel). 2023 Feb 20;23(4):2347. doi: 10.3390/s23042347.

Authors

Anastasia Papavasileiou¹, Anthi Xenofondos², Stéphane Baudry³, Thomas Lapole⁴, Ioannis G Amiridis¹, Dimitrios Metaxiotis⁵, Themistoklis Tsatalas⁶, Dimitrios A Patikas¹

Affiliations

¹ Laboratory of Neuromechanics, School of Physical Education and Sports Science at Serres, Aristotle University of Thessaloniki, 62110 Serres, Greece.
² Physical Education and Sports Sciences, Frederick University, 1036 Nicosia, Cyprus.
³ Laboratory of Applied Biology, Research Unit in Applied Neurophysiology (LABNeuro), Université Libre de Bruxelles, 1070 Brussels, Belgium.
⁴ Université Jean Monnet Saint-Etienne, Lyon 1, Université Savoie Mont-Blanc, Laboratoire Interuniversitaire de Biologie de la Motricité, F-42023 Saint-Etienne, France.
⁵ 2nd Orthopaedic Department, Papageorgiou Hospital, 56429 Thessaloniki, Greece.
⁶ Department of Physical Education and Sport Science, University of Thessaly, 42100 Trikala, Greece.

Abstract

This systematic review documents the protocol characteristics of studies that used neuromuscular electrical stimulation protocols (NMES) on the plantar flexors [through triceps surae (TS) or tibial nerve (TN) stimulation] to stimulate afferent pathways. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement, was registered to PROSPERO (ID: CRD42022345194) and was funded by the Greek General Secretariat for Research and Technology (ERA-NET NEURON JTC 2020). Included were original research articles on healthy adults, with NMES interventions applied on TN or TS or both. Four databases (Cochrane Library, PubMed, Scopus, and Web of Science) were systematically searched, in addition to a manual search using the citations of included studies. Quality assessment was conducted on 32 eligible studies by estimating the risk of bias with the checklist of the Effective Public Health Practice Project Quality Assessment Tool. Eighty-seven protocols were analyzed, with descriptive statistics. Compared to TS, TN stimulation has been reported in a wider range of frequencies (5-100, vs. 20-200 Hz) and normalization methods for the contraction intensity. The pulse duration ranged from 0.2 to 1 ms for both TS and TN protocols. It is concluded that with increasing popularity of NMES protocols in intervention and rehabilitation, future studies may use a wider range of stimulation attributes, to stimulate motor neurons via afferent pathways, but, on the other hand, additional studies may explore new protocols, targeting for more optimal effectiveness. Furthermore, future studies should consider methodological issues, such as stimulation efficacy (e.g., positioning over the motor point) and reporting of level of discomfort during the application of NMES protocols to reduce the inherent variability of the results.

Keywords: afferent feedback; extra force; fatigue; human; neuromuscular electrical stimulation; plantar flexors; stimulation parameters; tibial nerve; training; triceps surae.

Publication types

Systematic Review

MeSH terms

Adult
Afferent Pathways
Animals
Checklist
Electric Stimulation
Fishes
Humans
Leg*
Tibial Nerve*

Grants and funding

This research was funded by the Greek General Secretariat for Research and Technology (ERA-NET NEURON JTC 2020, T12EPA5-00018).