Long-Term Prevention of Pressure Ulcers in High-Risk Patients: A Single Case Study of the Use of Gluteal Neuromuscular Electric Stimulation

Abstract

Bogie KM, Wang X, Triolo RJ. Long-term prevention of pressure ulcers in high-risk patients: a single case study of the use of gluteal neuromuscular electric stimulation. Objective To evaluate the efficacy of gluteal neuromuscular electric stimulation (NMES) using implanted percutaneous electrodes to improve regional tissue health and decrease the risk of pressure ulcer development. Design Case study of long-term use of gluteal NMES. Setting Community. Participant A patient with a C4-level American Spinal Injury Association grade A spinal cord injury, 22 years postinjury at study enrollment, and a clinical history of regular grade II and occasional IV ischial pressure ulcers. Intervention Gluteal NMES using an electric stimulation system comprising a combination of implanted percutaneous electrodes and an external stimulator (controller). Main Outcome Measures Objective measurements of tissue health comprising evaluation of gluteal muscle thickness, interface pressures, and regional blood flow. Subjective self-reported sitting tolerance. Results Increased gluteal muscle thickness and blood flow together with reduced regional interface pressures occurred. Weight-shifting because of alternating left and right gluteal NMES became more effective over time as the muscles strengthened. Sitting tolerance more than doubled. Conclusions A gluteal NMES system has been developed that provides both improved regional tissue health and dynamic weight shifting while seated in the wheelchair. In the current case, regular daily use had a positive impact on multiple indirect indicators of tissue health. Continued use was indicated as the positive effects were lost when stimulation was discontinued.