Early rehabilitation by electrical muscle stimulation in intensive care unit for patients with intracranial hypertension

Abstract

Japanese guidelines for the management of stroke recommend early rehabilitation for the prevention of disuse syndrome. However, there are few reports concerning the safety and risk of the rehabilitation for the patients with intracranial hypertension. The patients with intracranial hypertension cannot attempt to move their extremities, and ROM exercise without contraction of muscle tends to the main early rehabilitation in intensive care unit. It leads to disuse muscle atrophy. Therefore, we introduced belt electrode-skeletal muscle electrical stimulation (B-SES) as electrical muscle stimulation, which causes a muscle contraction, for patients with intracranial hypertension, and we assessed the safety of B-SES for the patients with intracranial hypertension. We use AUTO Tens PRO Rehabili Unit made by HOMER ION LABORATORY CO., LTD, and selected LEG DISUSE MODE, and the duration of the stimulation is 20 minutes. Physical therapist determined the output level by palpation of triceps surae muscle of each patient, and the effective intensity was usually between 20 V and 50 V. Case 1: a 43-year-old woman underwent coil embolization of the ruptured right VA-PICA aneurysm. We monitored her intracranial pressure (ICP) by external drainage, and her ICP kept 14.5–18.0 cmH 2 O during B-SES. Case 2: a 66-year-old man underwent external drainage for the acute hydrocephalus due to left thalamic hemorrhage and intraventricular hemorrhage. His ICP kept under 17.5–19.0 cmH 2 O during B-SES. Case 3: a 49-year-old man with right acute subdural hematoma underwent hematoma removal with decompressive craniotomy. His ICP kept 8–11 mmHg during B-SES. Case 4: a 41-year-old woman presented with subarachnoid hemorrhage underwent neckclipping of the left middle cerebral artery aneurysm. Her ICP kept 8–11 mmHg during B-SES. Electrical muscle stimulation with B-SES, as can be seen from these four cases, never worsened intracranial hypertension. Therefore, early rehabilitation with B-SES is safety and worth introducing for the patient with intracranial hypertension in intensive care unit.