Neuromuscular Electrical Stimulation Research Articles

Neuromuscular electrical stimulation for physical function maintenance during hematopoietic stem cell transplantation: Study protocol.

Hematopoietic stem cell transplantation is a common life-saving treatment for hematologic malignancies, though can lead to long-term functional impairment, fatigue, muscle atrophy, with decreased quality of life. Although traditional exercise has helped reduce these effects, it is inconsistently recommended and infrequently maintained, and most patients remain sedentary during and after treatment. There is need for alternative rehabilitation strategies, like neuromuscular electrical stimulation, that may be more amenable to the capabilities of hematopoietic stem cell transplant recipients. Patients receiving autologous HCT are being enroled in a randomized controlled trial with 1:1 (neuromuscular electrical stimulation:sham) design stratified by diagnosis and sex. Physical function, body composition, quality of life, and fatigue are assessed prior to hematopoietic stem cell transplant (prior to initiating preparatory treatment) and 24±5 days post hematopoietic stem cell transplant (Follow-up 1); physical function and quality of life are also assessed 6-months post hematopoietic stem cell transplant (Follow-up 2). The primary outcome is between-group difference in the 6-minute walk test change scores (Follow-up 1-Pre-transplant; final enrolment goal N = 23/group). We hypothesize that 1) neuromuscular electrical stimulation will attenuate hematopoietic stem cell transplant-induced adverse effects on physical function, muscle mass, quality of life, and fatigue compared to sham at Follow-up 1, and 2) Pre-transplant physical function will significantly predict fatigue and quality of life at Follow-up 2. We will also describe feasibility and acceptability of neuromuscular electrical stimulation during hematopoietic stem cell transplant. This proposal will improve rehabilitative patient care and quality of life by determining efficacy and feasibility of a currently underutilized therapeutic strategy aimed at maintaining daily function and reducing the impact of a potent and widely used cancer treatment. This trial is registered with clinicaltrials.gov (NCT04364256).

Efficiency of pulsed electromagnetic field and neuromuscular electrical stimulation on painful shoulder following stroke

Efficiency of pulsed electromagnetic field and neuromuscular electrical stimulation on painful shoulder following stroke

Fatigue Alleviation by Low-Level Laser Pre-Exposure in Ischemic Neuromuscular Electrical Stimulation.

Despite its susceptibility to muscle fatigue, combined neuromuscular electrical stimulation (NMES) and blood flow restriction (BFR) is an effective regimen for managing muscle atrophy when traditional resistance exercises are not feasible. This study investigated the potential of low-level laser therapy (LLLT) in reducing muscle fatigue after the application of combined NMES and BFR. Thirty-six healthy adults were divided into control and LLLT groups. The LLLT group received 60 J of 850 nm wavelength LLLT before a training program of combined NMES and BFR of the non-dominant extensor carpi radialis longus (ECRL). The control group followed the same protocol but received sham laser therapy. Assessments included maximal voluntary contraction (MVC), ECRL mechanical properties, and isometric force-tracking for wrist extension. The LLLT group exhibited a smaller normalized difference in MVC decrement (-4.01 ± 4.88%) than the control group (-23.85 ± 7.12%) (P < .001). The LLLT group demonstrated a smaller decrease in muscle stiffness of the ECRL compared to the control group, characterized by the smaller normalized changes in frequency (P = .002), stiffness (P = .002), and relaxation measures (P = .011) of mechanical oscillation waves. Unlike the control group, the LLLT group exhibited a smaller post-test increase in force fluctuations during force-tracking (P = .014), linked to the predominant recruitment of low-threshold MUs (P < .001) without fatigue-related increases in the discharge variability of high-threshold MUs (P > .05). LLLT pre-exposure reduces fatigue after combined NMES and BFR, preserving force generation, muscle stiffness, and force scaling. The functional benefits are achieved through fatigue-resistant activation strategies of motor unit recruitment and rate coding.

Neuromuscular Electrical Stimulation of Peroneal Longus on Balance Control Ability in Young Adults with Chronic Ankle Instability: A Randomized Controlled Trial.

This study aimed to investigate the effects of six weeks of peroneal longus neuromuscular electrical stimulation (NMES) on the balance control ability in young adults with chronic ankle instability (CAI). This study is a double blind randomized controlled trial. Six weeks of NMES and placebo intervention were conducted in the NMES and control groups for 20 minutes, three times a week, respectively. Thirty-eight participants successfully completed the whole intervention and single-leg standing tests. The kinetics data of the center of pressure (COP) trajectory during static single-leg stance were measured using a Kistler force platform. Two-way repeated measures ANOVA was used to analyze the electrical stimulation effects. Significant interactions were detected in CAIT scores and all balance parameters including Displacement X (Dx), Displacement Y(Dy), 95% confidence ellipse area (95%AREA), root-mean-square (RMS) and COP mean displacement velocity (MV) (p < 0.05, 0.103 ≤ η2 ≤ 0.201). Significant between-group differences were found in CAIT scores (p = 0.003, Cohen's d = 0.215), Dx (p = 0.045, Cohen's d = 0.107), RMS-ml (p = 0.019, Cohen's d = 0.143) and 95%AREA (p = 0.031, Cohen's d = 0.123) after the six weeks interventions. Six weeks of NMES on the peroneus longus can improve static balance control ability in young adults with CAI, especially the stability of ankle frontal plane.

Combined action observation and mental imagery versus neuromuscular electrical stimulation as novel therapeutics during short-term knee immobilization.

Limb immobilization causes rapid declines in muscle strength and mass. Given the role of the nervous system in immobilization-induced weakness, targeted interventions may be able to preserve muscle strength, but not mass, and vice versa. The purpose of this study was to assess the effects of two distinct interventions during 1 week of knee joint immobilization on muscle strength (isometric and concentric isokinetic peak torque), mass (bioimpedance spectroscopy and ultrasonography), and neuromuscular function (transcranial magnetic stimulation and interpolated twitch technique). Thirty-nine healthy, college-aged adults (21 males, 18 females) were randomized into one of four groups: immobilization only (n=9), immobilization + action observation/mental imagery (AOMI) (n=10), immobilization + neuromuscular electrical stimulation (NMES) (n=12), or control group (n=8). The AOMI group performed daily video observation and mental imagery of knee extensions. The NMES group performed twice daily stimulation of the quadriceps femoris. Based on observed effect sizes, it appears that AOMI shows promise as a means of preserving voluntary strength, which may be modulated by neural adaptations. Strength increased from PRE to POST in the AOMI group, with +7.2% (Cohen's d=1.018) increase in concentric isokinetic peak torque at 30°/s. However, NMES did not preserve muscle mass. Though preliminary, our findings highlight the specific nature of clinical interventions and suggest that muscle strength can be independently targeted during rehabilitation. This study was prospectively registered: ClinicalTrials.gov NCT05072652.

Effects of Exercise and Neuromuscular Electrical Stimulation on Lower Trapezius Muscle Activity in Individuals with Round Shoulder Posture

Effects of Exercise and Neuromuscular Electrical Stimulation on Lower Trapezius Muscle Activity in Individuals with Round Shoulder Posture

A RETROSPECTIVE REVIEW OF THE THERAPEUTIC MANAGEMENT OF SOFT TISSUE AND JOINT RANGE OF MOTION DURING LOWER LIMB LENGTHENING IN CHILDREN

IntroductionSheffield Children's Hospital specialises in limb lengthening for children. Soft tissue contracture and loss of range of motion at the knee and ankle are common complications. This review aims to look at therapeutic techniques used by the therapy team to manage these issues.Materials &amp; MethodsA retrospective case review of therapy notes was performed of femoral and tibial lengthening's over the last 3 years. Included were children having long bone lengthening with an iIntramedullary nail, circular frame or mono-lateral rail. Patients excluded were any external fixators crossing the knee/ankle joints.Results20 tibial and 25 femoral lengthening's met the inclusion criteria. Pathologies included, complex fractures, limb deficiency, post septic necrosis and other congenital conditions leading to growth disturbance. All patients had issues with loss of motion at some point during the lengthening process. The knee and foot/ankle were equally affected. Numerous risk factors were identified across the cohort. Treatment provided included splinting, serial casting, bolt on shoes, exercise therapy, electrical muscle stimulation and passive stretching.ConclusionsLoss of motion in lower limb joints was common. Patients at higher risk were those with abnormal anatomy, larger target lengthening's, poor compliance or lack of access to local services. Therapy played a significant role in managing joint motion during treatment. However, limitations were noted. No one treatment option gave preferential outcomes, selection of treatment needed to be patient specific. Future research should look at guidelines to aid timely input and avoid secondary complications.

Evaluation of a Combination Approach to Improving Muscle Tone and Decreasing Subcutaneous Tissue Thickness Using a Sequential, Dual-Modality, Energy-Based Device

Abstract Background The body shaping market has long been at the forefront of the aesthetic industry. With technological advances, patient demand for body sculpting in terms of reduction in subcutaneous tissue and enhancement of muscle has seen continual growth. Several devices have emerged in the space, however few that achieve both SQR (Subcutaneous Tissue Reduction) and VMI (Voluntary Muscle Increase) as measured by thickness, during the same treatment session. Objectives This article presents the results of a pilot study on a unique approach to subcutaneous tissue reduction and increasing muscle thickness using a dual modality, energy-based device. Methods 12 compliant subjects (8 female and 4 male with an average age of 40 years were enrolled in this single center, prospective study. All subjects were treated with the dual modality device (850 nm super-luminescent diode matrix and electrical muscle stimulation) with external applicators being placed over the lower abdomen. The subjects received five (5) weekly treatments. Ultrasound measurements, photos, weight and waist measurements were taken at baseline, prior to the start of the 5th treatments and at the two (2) week and two (2) month follow-up visits. Results At the two (2) month follow up visit, the average Subcutaneous Tissue Reduction (SQR) was 34.03% and the Voluntary Muscle Increase (VMI) measured 22.97% in all subjects who completed the study. All subject and physician evaluations rated results as satisfactory or better. There were no complications. Conclusions Preliminary data shows this dual-modality, Electrical Muscle Stimulation/Super Luminescent Diode Matrix (EMS/SDM) system provides both a safe and effective treatment for the reduction of subcutaneous tissue thickness and increase in muscle definition and thickness. Objective and subjective evaluations demonstrated high levels of efficacy and satisfaction in all subjects.

Case Report : Physiotherapy management of maternal obstetric palsy in a Nigerian teaching hospital

Introduction Maternal obstetric palsy is a rare nerve injury to all or part of the lumbosacral plexus with signs and symptoms becoming evident during labour or after childbirth. Motor and sensory involvement affect dermatomes and lower limb muscle group(s). Physiotherapy is indicated for the clinical presentations of maternal obstetric palsy, but research in this area is limited. The purpose of this case report was to highlight the application of physiotherapy in the management of the clinical presentations of maternal obstetric palsy. Clinical description A 38-year-old female patient presented with severe pain (verbal pain rating scale [VPRS]: 10/10), intermittent muscle spasm, loss of sensation, weakness of lower limb muscle groups (Oxford Muscle Grading [OMG]: ≤2/5) and loss of lower limb function after childbirth following prolonged obstructed labour. The patient was diagnosed with maternal obstetric palsy after detailed history and physical examinations. Interventions and outcomes Transcutaneous electrical muscle stimulation and muscle strengthening exercises were administered immediately post-delivery. Duration of treatment was eight weeks. The patient’s pain stopped (VPRS= 0/10), muscle spasm reduced, with improved muscle strength (OMG≥ 4/5) and lower limb function. Conclusion Early physiotherapy reduced pain intensity and muscle spasm, and increased muscle strength and function in a patient with maternal obstetric palsy.

Can Neuromuscular Electrical Stimulation Enhance the Effect of Sprint Interval Training?

The aim of this study was to determine the effects of subtetanic neuromuscular electrical stimulation combined with voluntary exercise between repeated Wingate tests on sprint exercise performance and blood lactate accumulation during sprint interval training. Fifteen healthy young males volunteered. After 1-min baseline, participants underwent the Wingate test twice. They performed a 4-min intervention between tests: neuromuscular electrical stimulation with free-weight cycling or voluntary cycling alone [43.6 (8.0) watts], which matched oxygen consumption with neuromuscular electrical stimulation with free-weight cycling. The blood lactate concentration was assessed at the end of the baseline, at 3-min intervention, and on recovery at 1, 3, 5, and 10 min after the second Wingate test. Peak and mean blood lactate concentration during recovery were significantly greater with neuromuscular electrical stimulation with free-weight cycling than voluntary cycling alone (P>0.036 and P=0.011, respectively). Peak power, mean power, and rate of decline (fatigue index) were not significantly different between conditions in both Wingate tests (condition/interaction all P>0.300, partial η2<0.1). Subtetanic neuromuscular electrical stimulation combined with voluntary exercise indicated similar exercise performance and fatigue levels during Wingate tests, but enhanced blood lactate accumulation compared to oxygen consumption-matched voluntary cycling during sprint interval training.

Analysis of the Improvement Effect of Combined Application of Oral Rehabilitation Training and Neuromuscular Electrical Stimulation on Pediatric Swallowing Disorders

: Pediatric swallowing disorders are common yet often overlooked neuro-muscular system diseases that significantly impact the quality of life and development of affected children. This study aims to explore the effect of combined application of oral rehabilitation training and neuromuscular electrical stimulation on improving pediatric swallowing disorders. Children meeting the inclusion criteria for swallowing disorders were divided into control and experimental groups based on different intervention protocols. The experimental group received combined oral rehabilitation training and neuromuscular electrical stimulation, while the control group received only oral rehabilitation training. Results showed that the intervention was more effective in the experimental group, with shorter recovery time for normal swallowing function and improved nutritional status and quality of life. This study provides scientific evidence for clinical treatment of pediatric swallowing disorders. In conclusion, the combined application of oral rehabilitation training and neuromuscular electrical stimulation effectively improves pediatric swallowing disorders, with superior efficacy compared to single treatment methods. Further research is needed to elucidate the mechanism of action and optimize treatment protocols to enhance the therapeutic outcomes and prognosis of pediatric swallowing disorders.

Surface electromyography-based biofeedback can facilitate recovery from total knee arthroplasty.

Knee osteoarthritis is among the most prevalent chronic diseases. Total knee arthroplasty is a common solution that effectively addresses the continued structural degeneration of the articular cartilage. However, effective physical therapy is critical for recovery. Despite participating in physical therapy, many patients fail to recover. This study investigated the potential efficacy of a behaviorally informed approach to surface electromyographic biofeedback following total knee arthroplasty relative to the clinical standard, neuromuscular electrical stimulation. The surface electromyographic biofeedback procedure incorporated improved techniques for establishing a baseline and individualized and adjusting criteria for feedback. The findings suggest some advantages for surface electromyographic biofeedback over neuromuscular electrical stimulation in quadriceps strength, range of motion, functional recovery, and quality of life. Behaviorally informed surface electromyographic biofeedback holds promise for total knee arthroplasty recovery and these data suggest considerable room for collaboration between behavior analysts and physical therapists.

Neuromuscular electrical stimulation of humeral adductors in subjects with rotator cuff tear.

In symptomatic patients with rotator cuff tear, MRI and radiographic studies have ascribed the pain symptom to insufficient humeral head depression during arm elevations. The arm adductors such as the teres major and pectoralis major may contribute to depression of the humerus head during arm elevations. Researchers have demonstrated that neuromuscular electrical stimulation (NMES) of the serratus anterior and lower trapezius can control scapular motions and improve acromiohumeral distance. It is unknown, however, if adductor neuromuscular training could help patients with rotator cuff tear. A cross-sectional study of NMES of the teres major and pectoralis major was conducted on 30 symptomatic subjects with rotator cuff tear. We measured the acromiohumeral distance by ultrasonography and scapular kinematics during arm elevation with a three-dimensional motion tracking system. The acromiohumeral distance significantly increased during NMES of the teres major (0.73mm, p < 0.001). However, the distance significantly decreased with NMES of the pectoralis major (0.78mm, p < 0.001). Additionally, scapular upward rotation was greater during NMES of the teres major than during NMES of the pectoralis major (3.4°, p < 0.001). Scapular external rotation decreased significantly more during NMES of the pectoralis major than during NMES of the teres major (1.6°, p = 0.003). NMES of the teres major can increase acromiohumeral distance and scapular upward rotation during arm elevation. However, the decreased upward and external rotation of the scapula during arm elevation with NMES of the pectoralis major may be associated with subacromial impingement.

Effects of Neuromuscular Electrical Stimulation with Gastrocnemius Strengthening on Foot Morphology in Stroke Patients: A Randomized Controlled Trial.

This study aimed to investigate the effects of neuromuscular electrical stimulation (NMES) with gastrocnemius (GCM) strength exercise on foot morphology in patients with stroke. Herein, 31 patients with chronic stroke meeting the study criteria were enrolled and divided into two groups; 16 patients were randomized to the gastrocnemius neuromuscular electrical stimulation (GCMNMES) group, and 15 patients to the conventional neuromuscular electrical stimulation (CNMES) group. The GCMNMES group conducted GCM-strengthening exercise with NMES. CNMES group conducted NMES at paretic tibialis anterior muscle with ankle dorsiflexion movement. These patients underwent therapeutic interventions lasting 30 min/session, five times a week for 4 weeks. To analyze changes in foot morphology, 3D foot scanning was used, while a foot-pressure measurement device was used to evaluate foot pressure and weight-bearing area. In an intra-group comparison of 3D-foot-scanning results, the experimental group showed significant changes in longitudinal arch angle (p < 0.05), medial longitudinal arch angle (MLAA) (p < 0.01), transverse arch angle (TAA) (p < 0.01), rearfoot angle (RA) (p < 0.05), foot length (FL) (p < 0.05), foot width (FW) (p < 0.05), and arch height index (AHI) (p < 0.01) of the paretic side and in TAA (p < 0.05) and AHI (p < 0.05) of the non-paretic side. The CNMES group showed significant changes in TAA (p < 0.05) and FW (p < 0.05) of the paretic side and TAA (p < 0.05) and AHI (p < 0.05) of the non-paretic side. An inter-group comparison showed significant differences in MLAA (p < 0.05) and RA (p < 0.05) of the paretic side. In an intra-group comparison of foot pressure assessment, the experimental group showed significant differences in footprint area (FPA) (p < 0.05) of the paretic side and FPA symmetry (p < 0.05). The CNMES group showed a significant difference in only FPA symmetry (p < 0.05). An inter-group comparison showed no significant difference between the two groups (p < 0.05). Thus, NMES with GCM-strengthening exercises yielded positive effects on foot morphology in patients with stroke.

Body contouring effects of at-home beauty device equipped with suction, radiofrequency, and electrical muscle stimulation functions.

With the rise in interest and demand for body contouring, beauty devices have continuously developed. Suction can aid in increasing the rate of fat breakdown by inducing a massage-like effect, thereby increasing blood flow. Moreover, radiofrequency (RF) can boost fibroblast activity and help reduce cellulite. In addition, electrical muscle stimulation (EMS) can use electrical stimulation to induce muscle contraction, leading to an athletic, and skin elasticity-increasing effect. This study aimed to assess the effects of body contouring, such as cellulite and swelling, in healthy Korean women to objectively prove the efficacy of an at-home beauty device equipped with suction, RF, and EMS functions. For 8 weeks, 21 participants used the at-home beauty device 3 days a week on their abdomen, thighs, and left calf. Validity assessments and subjective surveys were conducted at 4 and 8 weeks, including the first visit. The results of the validity assessments revealed that cellulite, swelling, elasticity, femoral skin texture, and dermal density were significantly (p < 0.05) improved in the experimental group compared with those at the baseline. The results of this study demonstrate that the combination of suction, RF, and EMS function is effective for body skin, fat, and body shape management. For better body-contouring effects, combining the beauty device with regular exercise and healthy eating habits is recommended.

Development and evaluation of a BCI-neurofeedback system with real-time EEG detection and electrical stimulation assistance during motor attempt for neurorehabilitation of children with cerebral palsy.

In the realm of motor rehabilitation, Brain-Computer Interface Neurofeedback Training (BCI-NFT) emerges as a promising strategy. This aims to utilize an individual's brain activity to stimulate or assist movement, thereby strengthening sensorimotor pathways and promoting motor recovery. Employing various methodologies, BCI-NFT has been shown to be effective for enhancing motor function primarily of the upper limb in stroke, with very few studies reported in cerebral palsy (CP). Our main objective was to develop an electroencephalography (EEG)-based BCI-NFT system, employing an associative learning paradigm, to improve selective control of ankle dorsiflexion in CP and potentially other neurological populations. First, in a cohort of eight healthy volunteers, we successfully implemented a BCI-NFT system based on detection of slow movement-related cortical potentials (MRCP) from EEG generated by attempted dorsiflexion to simultaneously activate Neuromuscular Electrical Stimulation which assisted movement and served to enhance sensory feedback to the sensorimotor cortex. Participants also viewed a computer display that provided real-time visual feedback of ankle range of motion with an individualized target region displayed to encourage maximal effort. After evaluating several potential strategies, we employed a Long short-term memory (LSTM) neural network, a deep learning algorithm, to detect the motor intent prior to movement onset. We then evaluated the system in a 10-session ankle dorsiflexion training protocol on a child with CP. By employing transfer learning across sessions, we could significantly reduce the number of calibration trials from 50 to 20 without compromising detection accuracy, which was 80.8% on average. The participant was able to complete the required calibration trials and the 100 training trials per session for all 10 sessions and post-training demonstrated increased ankle dorsiflexion velocity, walking speed and step length. Based on exceptional system performance, feasibility and preliminary effectiveness in a child with CP, we are now pursuing a clinical trial in a larger cohort of children with CP.

Near-InfraRed Spectroscopy Provides a Reproducible Estimate of Muscle Aerobic Capacity, but Not Whole-Body Aerobic Power.

Near-infrared spectroscopy (NIRS) during repeated limb occlusions is a noninvasive tool for assessing muscle oxidative capacity. However, the method's reliability and validity remain under investigation. This study aimed to determine the reliability of the NIRS-derived mitochondrial power of the musculus vastus lateralis and its correlation with whole-body (cycling) aerobic power (V̇O2 peak). Eleven healthy active men (28 ± 10 y) twice (2 days apart) underwent repeated arterial occlusions to induce changes in muscle oxygen delivery after 15 s of electrical muscle stimulation. The muscle oxygen consumption (mV̇O2) recovery time and rate (k) constants were calculated from the NIRS O2Hb signal. We assessed the reliability (coefficient of variation and intraclass coefficient of correlation [ICC]) and equivalency (t-test) between visits. The results showed high reproducibility for the mV̇O2 recovery time constant (ICC = 0.859) and moderate reproducibility for the k value (ICC = 0.674), with no significant differences between visits (p > 0.05). NIRS-derived k did not correlate with the V̇O2 peak relative to body mass (r = 0.441, p = 0.17) or the absolute V̇O2 peak (r = 0.366, p = 0.26). In conclusion, NIRS provides a reproducible estimate of muscle mitochondrial power, which, however, was not correlated with whole-body aerobic capacity in the current study, suggesting that even if somewhat overlapping, not the same set of factors underpin these distinct indices of aerobic capacity at the different (peripheral and whole-body systemic) levels.

Effects of muscle contraction induced by electrical stimulation on fascial gliding: Evaluation by ultrasonography

PurposeThis study investigates the effects of neuromuscular electrical stimulation (NMES)-induced muscle contraction on fascial gliding between the muscle and adjacent tissues and identifies factors that affect fascial gliding. MethodsThe gliding between the epimysium of the vastus lateralis muscle and the subcutaneous tissue was measured using a diagnostic ultrasound system during the subject's knee joint was flexed passively. The deep temperature, deep blood flow, and tissue hardness of the vastus lateralis muscle were measured to identify factors contributing to the changes in fascial gliding. ResultsFascial gliding significantly increased after NMES. The deep temperature was significantly higher when NMES was not applied. There were no significant differences in deep blood flow or tissue hardness. ConclusionFascial gliding increased when NMES was applied. However, deep temperature, blood flow, and muscle hardness were not affected by NMES. Shear force caused by muscle contraction may play a role in the increase in fascial gliding due to NMES.

Interventions for Postextubation Dysphagia in Critically Ill Patients: A Systematic Review and Meta-analysis.

This review evaluates the efficacy and safety of dysphagia interventions for patients with prolonged endotracheal intubation (⩾48h) in critical care units. We systematically searched PubMed, Cochrane Library, Medline, Embase, OVID, CINAHL, Wanfang (China), CNKI (China), and ProQuest Dissertations for studies published up to December 31, 2023. Inclusion criteria encompassed randomized controlled trials (RCTs), quasi-randomized trials, and cohort studies comparing dysphagia rehabilitation - such as swallowing stimulation, swallowing and respiratory muscle exercise, and neuromuscular electrical stimulation - with standard care or no treatment. The primary outcomes assessed were dysphagia severity, time to resume oral intake, and incidence of aspiration and aspiration pneumonia. Detailed information on study design, setting, participant demographics, interventions, and outcomes was systematically extracted. Our analysis included ten studies with a total of 1031 participants. The findings demonstrate a significant reduction in dysphagia severity, time to oral intake and the risk of aspiration pneumonia, and an improvement in quality of life among patients receiving swallowing therapy. However, no substantial difference was found in nutritional status. Limited data availability necessitated a descriptive presentation of outcomes like the risk of aspiration, ICU/hospital stay duration, pharyngeal/oral residue severity, and intervention-related adverse events. The current evidence for the effectiveness of dysphagia interventions in critically ill patients with prolonged endotracheal intubation is limited. There is a pressing need for future research, particularly high-quality RCTs employing standardized outcome measures, to substantiate these findings.

Neuromuscular electrical stimulation producing low evoked force elicits the repeated bout effect on muscle damage markers of the elbow flexors

This study examined the repeated bout effect (RBE) on muscle damage markers following two bouts of neuromuscular electrical stimulation (NMES) in untrained individuals. Following familiarization, participants received 45 consecutive NMES to the biceps brachii at an intensity that produced low evoked force for the elbow flexors. Muscle damage markers (maximal voluntary isometric contraction [MVIC], elbow range of motion [ROM], muscle soreness via visual analogue scale [VAS] scores, pressure pain threshold [PPT], and muscle thickness) were measured before (PRE), after (POST), 1 day after (24 POST), and 2 days after (48 POST) NMES. Following 1 week of rest, procedures were replicated. Separate repeated measures two-way ANOVAs examined each measure. There were no interactions or bout main effects for MVIC or ROM. Time main effects indicated PRE MVIC was greater than POST (p ​= ​0.002) and 24-POST (p ​= ​0.024), and PRE ROM was greater than POST (p ​= ​0.036). There was no interaction for muscle thickness. Respective time and bout main effects indicated muscle thickness at PRE was less than POST (p ​= ​0.017), and second-bout muscle thickness (p ​= ​0.050) was less compared to the initial-bout. For PPT, there was an interaction (p ​= ​0.019). Initial-bout PRE PPT was less than POST (p ​= ​0.033). Initial-bout 48-POST PPT was less than second-bout 48-POST (p ​= ​0.037). There was a significant interaction for VAS (p ​= ​0.009). Initial-bout PRE VAS was less than POST (p ​= ​0.033) and 24-POST (p ​= ​0.015). Initial-bout POST and 24-POST VAS were greater than second-bout POST (p ​= ​0.023) and 24-POST (p ​= ​0.006), respectively. The results support RBE on muscle damage markers related to inflammation, but not MVIC and ROM.