Poster 409 Neuromuscular Electrical Stimulation is Safe in Children with Intramuscular Diaphragmatic Pacers: A Case Series

Abstract

Disclosures: K. MacDonald, No Disclosures: I Have No Relevant Financial Relationships to Disclose. Objective: Our objective is to present the first 3 known documented cases of successful use of Neuromuscular Electrical Stimulation (NMES) as an intervention with patients concurrently using Intramuscular Diaphragmatic Pacing Systems (IMDP) systems. Design: Retrospective Chart Review. Setting: Inpatient Pediatric Rehabilitation, Outpatient Rehabilitation. Participants: This case report discusses 3 patients with cervical level spinal cord injuries resulting in tetraplegia requiring respiratory support: male, age 16 years C2 AIS A; female, age 10 years C2 AIS A; male, 4 years C2 AIS not confirmed secondary to age (presented as complete). All patients were implanted with IMDP for respiratory support; they utilized a tracheostomy and intermittently utilized positive pressure ventilation as a supplement to IMDP. Interventions: All 3 patients successfully participated in intensive Activity-Based Rehabilitation (ABR). Each patient received 4 to 6 hours a day of combined occupational and physical therapy. Interventions included, but were not limited to: Neuromuscular Electrical Stimulation (NMES) and neuro re-education, functional electrical stimulation assisted cycling, functional mobility, activities of daily living skills training, and range of motion and strengthening. NMES parameters were optimized for function and customized to patients’ tolerance to achieve a muscle contraction. Patients were informed of the risks, benefits and alternatives for each intervention, including those involving NMES. Main Outcome Measures: Vital signs including pulse rate, respiratory rate, and oxygen saturation levels were monitored to track patient’s responses during interventions. Results or Clinical Course: All sessions in which NMES was utilized resulted with no adverse response, no acute change, no clinical or subjective respiratory function changes, and no interference with the IMDP device. Therefore it is determined that NMES is safe to utilize in patients with an implanted IMDP. Conclusions: It is safe to utilize NMES for rehabilitation with patients who use IMDP for respiratory support as it does not impact the functionality of the IMDP systems.