Electrical Stimulation In Patients Research Articles

Safety and Feasibility of Neuromuscular Electrical Stimulation in Patients with Extracorporeal Membrane Oxygenation.

Background/Objectives: The aim of this study was to investigate the feasibility and safety of neuromuscular electrical stimulation (NMES) in patients on extracorporeal membrane oxygenation (ECMO) and thoroughly assess any potential adverse events. Methods: We conducted a prospective observational study assessing safety and feasibility, including 16 ICU patients on ECMO support who were admitted to the cardiac surgery ICU from January 2022 to December 2023. The majority of patients were females (63%) on veno-arterial (VA)-ECMO (81%), while the main cause was cardiogenic shock (81%) compared to respiratory failure. Patients underwent a 45 min NMES session while on ECMO support that included a warm-up phase of 5 min, a main phase of 35 min, and a recovery phase of 5 min. NMES was implemented on vastus lateralis, vastus medialis, gastrocnemius, and peroneus longus muscles of both lower extremities. Two stimulators delivered biphasic, symmetric impulses of 75 Hz, with a 400 μsec pulse duration, 5 sec on (1.6 sec ramp up and 0.8 sec ramp down) and 21 sec off. The intensity levels aimed to cause visible contractions and be well tolerated. Primary outcomes of this study were feasibility and safety, evaluated by whether NMES sessions were successfully achieved, and by any adverse events and complications. Secondary outcomes included indices of rhabdomyolysis from biochemical blood tests 24 h after the application of NMES. Results: All patients successfully completed their NMES session, with no adverse events or complications. The majority of patients achieved type 4 and 5 qualities of muscle contraction. Conclusions: NMES is a safe and feasible exercise methodology for patients supported with ECMO.

Morphological aspects of bedsore healing against high-frequency electrical stimulation in patients with severe brain damage

BACKGROUND: Bedsores or decubital ulcers are significant medical and social problems in patients with serious brain damage. The majority of local treatments are ineffective and do not ensure their healing. Therefore, the search for nondrug methods as part of the complex treatment of decubital ulcers is extremely relevant.
 AIM: To assess the morphological picture of bedsores against the background of an improved method of treatment using high-frequency electrical stimulation with pulsed currents in chronically immobilised patients who survived a cerebral catastrophe.
 MATERIALS AND METHODS: Biopsies of bedsores were examined in 12 patients with severe neurological disorders that developed after a cerebral catastrophe. The initial status of all patients was a ‘chronic critical condition’ (CCS). In all patients, the bedsore defect was located in the sacral region, with a length of 7–25 cm2. The depth of the bedsore corresponded to grade III according to the classification of the Agency for Health Care Policy and Research. Two groups of patients were formed: the main group of five patients (three men + two women), with an average age of 49.0 years, who were subjected to electrical stimulation with pulsed currents of the radiofrequency range. A control group of seven patients (three men + four women), with an average age of 60.1 years, who underwent traditional treatment. The duration of the chronic wound process ranged from 2 months to 1.5 years. The immediate cause of CCS was more often a massive ischaemic stroke (8), less often a severe traumatic brain injury (3) and radical operations to remove brain tumours (1) of various prescriptions from 3 months to 1.5 years. Morphological studies were conducted in both groups to assess the complicated wound process.
 RESULTS: The complex morphological study revealed that in the presence of high-frequency electrical stimulation, an earlier appearance of foci of fibroblastic proliferation, an increase in the regenerative potential of tissues due to increased production of type I and III collagens, and myofibroblastic and endothelial growth factors were noted.
 CONCLUSION: In the case of CCS of cerebral genesis, the wound process in bedsores inevitably becomes complicated and, according to morphological research, is characterised by severe endothelial dysfunction, deep microcirculation disorders, depletion of the potential of myofibroblastic cells and deficiency of their growth factors. Local high-frequency electrical stimulation in patients with severe brain damage and decubital ulcers as a component of complex ulcer therapy significantly optimises cellular and tissue reactions in the area of bedsores.

Effectiveness of neuromuscular electrical stimulation in patients with acute exacerbation of chronic obstructive pulmonary disease: A systematic review and meta-analysis.

This study aimed to investigate the effectiveness and acceptability of neuromuscular electrical stimulation (NMES) in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). We conducted a systematic review and meta-analysis to investigate the effectiveness and accessibility of NMES and compared them with usual care in patients with acute exacerbation of COPD by searching databases such as MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials published up to April 2022. Randomized controlled trials (RCTs) involving patients with COPD who were treated within 3weeks of acute exacerbation onset were included. The risk of bias was assessed using the RoB 2 tools. We pooled limb muscle strength and adverse events and performed a comparison between NMES and usual care. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation approach. Five RCTs, including 168 patients, met the eligibility criteria. The meta-analysis showed that limb muscle strength was significantly higher in the NMES group (four studies with 148 patients; standardized mean difference, 0.95; 95% confidence interval, 0.60-1.30; p<0.001). The quality of evidence was very low due to the risk of bias within the studies, imprecision of the estimates, and small number of studies. Any adverse events served as outcomes in three studies (86 patients), although no adverse events occurred. NMES is safe for patients with acute exacerbation of COPD and may maintain and improve limb muscle strength; however, the quality of evidence was very low.

Cognition-Enhancement Effect of Median Nerve Electrical Stimulation in Patients with Cognitive Impairment: A Retrospective Cohort Study

People with cognitive impairment often face quality-of-life problems and require ongoing support, which has profound consequences for caregivers and society. Noninvasive brain stimulation techniques, such as median nerve electrical stimulation (MNS), have shown promising potentials in improving cognitive ability in patients with cognitive impairment. Therefore, we aimed to investigate the positive effect and safety of MNS in cognitive impairment. Patients diagnosed with cognitive impairment from the hospital record management system of the First Affiliated Hospital of Nanchang University from April 1, 2020, to December 31, 2022, were enrolled. Data on patients' basic characteristics, treatment records, and examination results such as the Mini-Mental State Examination (MMSE), activities of daily living (ADL), and P300 event-related potentials before and after treatment were collected. Overall, 146 patients with cognitive impairment were enrolled, including 71 patients who underwent conventional therapy (standard treatment group) and 75 patients who underwent conventional therapy and MNS operation (active MNS group). Before treatment, there were no differences between the standard treatment and active MNS groups in terms of age, sex, etiology, duration of symptoms before therapy, hospital stay, whether they had undergone surgery, MMSE score, ADL score, and amplitude and latency of the P300 event-related potentials (P > 0.05). After treatment, we observed significant improvements in the MMSE score, ADL score, amplitude of P300, and decreased latency of P300 event-related potentials in both groups compared with before treatment (P < 0.05). In addition, we observed that the active MNS group showed higher MMSE and ADL scores, higher amplitude of P300 event-related potentials, and lower latency of P300 event-related potentials than the standard treatment group after treatment (P < 0.05). Furthermore, no side effects were associated with MNS operation. These preliminary data provide early evidence that MNS may be a positive effect and safe method for promoting the recovery of cognitive ability in patients with cognitive impairment.

Effect of intracranial electrical stimulation on dynamic functional connectivity in medically refractory epilepsy.

The objective of this study was to explore the distributed network effects of intracranial electrical stimulation in patients with medically refractory epilepsy using dynamic functional connectivity (dFC) and graph indicators. The time-varying connectivity patterns of dFC (state-based metrics) as well as topological properties of static functional connectivity (sFC) and dFC (graph indicators) were assessed before and after the intracranial electrical stimulation. The sliding window method and k-means clustering were used for the analysis of dFC states, which were characterized by connectivity strength, occupancy rate, dwell time, and transition. Graph indicators for sFC and dFC were obtained using group statistical tests. DFCs were clustered into two connectivity configurations: a strongly connected state (state 1) and a sparsely connected state (state 2). After electrical stimulation, the dwell time and occupancy rate of state 1 decreased, while that of state 2 increased. Connectivity strengths of both state 1 and state 2 decreased. For graph indicators, the clustering coefficient, k-core, global efficiency, and local efficiency of patients showed a significant decrease, but the brain networks of patients exhibited higher modularity after electrical stimulation. Especially, for state 1, there was a significant decrease in functional connectivity strength after stimulation within and between the frontal lobe and temporary lobe, both of which are associated with the seizure onset. Our findings demonstrated that intracranial electrical stimulation significantly changed the time-varying connectivity patterns and graph indicators of the brain in patients with medically refractory epilepsy. Specifically, the electrical stimulation decreased functional connectivity strength in both local-level and global-level networks. This might provide a mechanism of understanding for the distributed network effects of intracranial electrical stimulation and extend the knowledge of the pathophysiological network of medically refractory epilepsy.

Chronicles of A.I. Pospelov Moscow Society of Dermatovenerologists and Cosmetologists (MSDC was founded on October 4, 1891). Bulletin of the MSDC meeting N 1154

On October 17, 2023, the 1154th meeting of the Moscow Society of Dermatovenerologists and Cosmetologists named after A.I. Pospelov took place.&#x0D; The meeting was held in a face-to-face format. There were 118 participants in total. 65 applications were submitted for membership in MSDC! Due to the large number of applicants for membership in the MSDC, a list vote was held: approved unanimously.&#x0D; Two reports were presented in the clinical part of the meeting: Pityriasis rubra pilaris after suffering COVID-19 (Sechenov University); A clinical case of a rare hereditary disease ― erythrokeratoderma (State Scientific Center of Dermatovenereology and Cosmetology).&#x0D; Reports were made in the scientific part of the meeting: Topical therapy for xerosis of various genesis (Sechenov University); Modern paradigms for improving the effectiveness of treatment of allergodermatoses taking into account violations of the skin microbiome (Federal Scientific and Clinical Center of Intensive Care and Rehabilitation); The use of transcranial electrical stimulation in patients with atopic dermatitis (Sechenov University).

Incidentally induced atrial fibrillation during programmed electrical stimulation in patients with depressed left ventricular systolic function after an acute myocardial infarction: a CARISMA substudy

Abstract Background The aim of this study was to investigate the clinically significant value of incidentally induced atrial fibrillation (AF) during programmed electrical stimulation (PES) in patients with left ventricular systolic dysfunction (≤40%) after an acute myocardial infarction (MI). Methods In this study we included 231 patients from the Cardiac Arrhythmias and RIsk Stratification after Myocardial InfArction (CARISMA) study. These patients were identified 3-21 days after being diagnosed with an MI, had left ventricular ejection fraction ≤40% and had no prior history of AF. They all received an implantable cardiac monitor (ICM) and were continuously monitored for cardiac arrhythmias for 2 years. A PES was performed 6 weeks post-MI with pacing from the right atrium and coronary sinus for induction of SVT and from the ventricular apex and outflow tract with up to three extra stimuli for induction of VT. Induction of AF was unwanted but reported if this incidentally occurred. Results AF was induced in 34 patients (15%) during the PES of which 10 (29%) later developed AF. A total of 61 patients (26%) developed AF within 2-years follow-up and the overall risk of AF was not significantly increased in patients with PES induced AF compared to patients without inducible AF (HR 1.6, P=0.14), however, the risk of AF ≤188 days post-MI was slightly increased (HR 3.0, P=0.01). The risk of bradyarrhythmia (HR=0.2, P=0.07), ventricular arrhythmias (HR=0.7, P=0.77) and MACE (HR 0.5, P=0.28) was reduced in patients with inducible AF compared to patients without inducible AF. Conclusions Incidentally induced AF during an electrophysiological study in post-MI patients was relatively frequent (15%) but was not associated with a higher risk of atrial fibrillation, other cardiac brady- or tachy-arrhythmias or major cardiac events. Even though the short-term risk for AF slightly increased, this does not seem to justify anticoagulation treatment or intensified follow-up in these patients.

Efficacy and safety of transdermal electrical stimulation in patients with nonarteritic anterior ischemic optic neuropathy

BackgroundNo effective treatment for NAION with strong evidence has been established till date. The aim of this investigator-led, prospective, non-randomized, open-label, uncontrolled multi-center exploratory clinical trial is to evaluate the efficacy and safety of transdermal electrical stimulation (TdES) using skin electrodes in patients with NAION.MethodsFive patients with monocular NAION underwent TdES (10-ms biphasic pulses, 1.0 mA, 20 Hz, 30 min) of the affected eye six times at 2-week intervals. The primary endpoint was the logarithm of the mini-mum angle of resolution (logMAR) visual acuity at 12 weeks compared with 0 weeks. The secondary endpoints were changes in the best-corrected logMAR visual acuity, Early Treatment of Diabetic Retinopathy Study (ETDRS) visual acuity, and mean deviation (MD) of the Humphrey field analyzer (HFA) 10–2 and HFA Esterman test scores. Additionally, the safety of TdES was evaluated.ResultsLogMAR visual acuity improved by ≥ 0.1 in two eyes, and ETDRS visual acu-ity improved by ≥ 5 characters in one eye. The mean change in logMAR visual acuity from week 0 showed an increasing trend. The mean MD of HFA 10–2 showed no obvious change, while HFA Esterman score improved in four eyes. All patients completed the study according to the protocol, and no treatment-related adverse events were observed.ConclusionsTdES treatment may have improved visual acuity and visual field in some patients. Further sham-controlled study in larger cohort is needed on its effectiveness.Trial registrationUMIN, UMIN000036220. Registered 15 March, 2019, https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000041261.

Functional electrical stimulation for foot drop syndrome in patients with cerebral stroke

BACKGROUND: The deterioration of walking function as a result of acute cerebrovascular accident manifested by the foot drop syndrome, leading to difficulties in maintaining balance in the standing position and increased substitution strategies, is the most important limiting factor that affects autonomy and independence. The results of short time training with functional electrical stimulation in patients with cerebral stroke in the early and late recovery periods remain unknown.&#x0D; AIM: to study the functional and clinical results of a short course of functional electrical stimulation in patients with cerebral stroke and foot drop syndrome.&#x0D; MATERIALS AND METHODS: The study involved 20 patients with early and late hemispheric acute cerebrovascular accident who received a course of single-channel 30-minute functional electrical stimulation training of the m. tibialis anterior in conjunction with the main program of motor rehabilitation (60 minutes), consisting of 12 sessions. The biomechanics of walking at a random pace before and after training was investigated. Spatial and temporal parameters of walking, movements in hip, knee and ankle joints and maximum amplitudes of electromyography of the main muscle groups responsible for walking were recorded. Classical clinical scales were also used.&#x0D; RESULTS: No negative reaction to training with functional electrical stimulation was obtained. After treatment, there was a significant improvement in the following scales was observed: "Dynamic Gait Index", "Hauser Ambulation Index", "Timed Up and Go Test" test, muscle strength assessment, "Activity and Participation" domains. Spatial and temporal parameters demonstrate a complex syndrome characteristic of post-stroke walking. Walking speed and step cycle length increased significantly after training. The kinematics of movements in the hip and knee joints do not reveal significant dynamics. The difference from the control group of contralateral side indices in knee and hip joints, indicating bilateral functional involvement in the pathologic process, draws attention. Goniograms of the ankle joints of the paretic limb revealed the following parameters characteristic of the sagging foot: increase in the circumduction parameter on the paresis side, total amplitude of hip joint movements, knee joint flexion in the transfer period (Ka3), and ankle joint flexion amplitude in the transfer period (A3). Following functional electrical stimulation training, no changes were observed in these parameters.&#x0D; CONCLUSION: All clinical parameters have improved. Objective diagnostic results of the functional electrical stimulation training showed no significant effect on ankle joint function. Taking into account the limitations of this study, a follow-up study is planned.

Comparison of Motor Evoked Potentials Neuromonitoring Following Pre- and Postoperative Transcranial Magnetic Stimulation and Intraoperative Electrical Stimulation in Patients Undergoing Surgical Correction of Idiopathic Scoliosis.

The relationships between the results of pre- and intraoperative motor evoked potential recordings during neuromonitoring and whether idiopathic scoliosis (IS) surgical correction improves the spinal efferent transmission have not been specified in detail. This study aims to compare the results of surface-recorded electromyography (EMG), electroneurography (ENG, M, and F-waves), and especially motor evoked potential (MEP) recordings from tibialis anterior muscle (TA) bilaterally in 353 girls with right idiopathic scoliosis (types 1-3 according to Lenke classification). It has not yet been documented whether the results of MEP recordings induced by transcranial single magnetic stimulus (TMS, pre- and postoperatively) and trains of electrical stimuli (TES; intraoperatively in T0-before surgery, T1-after pedicle screws implantation, and T2-after scoliosis curvature distraction and derotation following two-rod implantation) can be compared for diagnostic verification of the improvement of spinal cord neural transmission. We attempted to determine whether the constant level of optimal anesthesia during certain surgical steps of scoliosis treatment affects the parameters of MEPs recorded during neuromonitoring procedures. No neurological deficits have been observed postoperatively. The values of amplitudes but not latencies in MEP recordings evoked with TMS in IS patients compared before and after surgery indicated a slight improvement in efferent neural transmission. The results of all neurophysiological studies in IS patients were significantly asymmetrical and recorded worse on the concave side, suggesting greater neurological motor deficits at p = 0.04. The surgeries brought significant improvement (p = 0.04) in the parameters of amplitudes of sEMG recordings; however, the consequences of abnormalities in the activity of TA motor units were still reflected. ENG study results showed the symptoms of the axonal-type injury in peroneal motor fibers improving only on the concave side at p = 0.04, in parallel with F-wave parameters, which suggests that derotation and distraction might result in restoring the proper relations of the lumbar ventral roots in the spinal central canal, resembling their decompression. There were no significant differences detected in the amplitudes or latencies of MEPs induced with TMS or TES when comparing the parameters recorded preoperatively and intraoperatively in T0. The amplitudes of TES-evoked MEPs increased gradually at p = 0.04 in the subsequent periods (T1 and T2) of observation. A reduction in MEP latency at p = 0.05 was observed only at the end of the IS surgery. Studies on the possible connections between the level of anesthesia fluctuations and the required TMS stimulus strength, as well as the MEP amplitude changes measured in T0-T2, revealed a lack of relationships. These might not be the factors influencing the efferent transmission in spinal pathways beside the surgical procedures. Pre- (TMS-evoked) and intraoperative (TES-evoked) recordings are reliable for evaluating the patient's neurological status before and during surgical scoliosis correction procedures. An increase in MEP amplitude parameters recorded on both sides after scoliosis surgery proves the immediate improvement of the total efferent spinal cord transmission. Considering comparative pre- and postoperative sEMG and ENG recordings, it can be concluded that surgeries might directly result in additional lumbar ventral root decompression. We can conclude that MEP parameter changes are determined by the surgery procedures during neuromonitoring, not the anesthesia conditions if they are kept stable, which influences a decrease in the number of false-positive neuromonitoring warnings.

Effects of Neuromuscular Electrical Stimulation in Patients with Post-Stroke Related Dysarthria: A Double-Blinded, Phase-II Randomized Sham-Controlled Trial Protocol - ULYSSES Trial

Introduction: Post-stroke individuals with dysarthria experience difficulties in producing speech due to muscle dysfunction. Neuromuscular electrical stimulation (NMES) can stimulate motor units and enhance their functionality. The objective of this study is to investigate the effects of NMES on speech intelligibility in patients with persistent dysarthria 3-6 months post-ischemic stroke. Methods: This study will be designed as a phase II, double-blinded, randomized, two-arm, parallel-group, superiority trial conducted at a single center. The target population will consist of post-stroke individuals with dysarthria, who will undergo randomization to receive either neuromuscular electrical stimulation (NMES) or sham-NMES. Both intervention groups will receive treatment sessions 5 days a week over a 4-week period. The sample size for this study will be 154 patients, recruited exclusively from a Rehabilitation Unit located in the United States. The primary outcome measure will focus on determining the mean difference in the FDA-2 intelligibility score between the two treatment groups. Secondary outcomes will involve evaluating the mean difference in the full FDA-2 score, as well as various subsets of the score, alongside an assessment of the participants’ health-related quality of life, utilizing the Stroke Impact Scale (SIS). Conclusion: To the best of our knowledge, this will be a comprehensive assessment of the potential benefits of NMES for post- stroke patients with dysarthria. Considering the positive impact of NMES on enhancing muscle functionality, it is plausible to anticipate its potential benefits in improving speech outcomes as well. Despite early studies indicating the safety and tolerability of NMES for various motor muscle conditions, there is limited data on its use in patients with dysarthria.

Domiciliary transcutaneous electrical stimulation in patients with obstructive sleep apnoea and limited adherence to continuous positive airway pressure therapy: a single-centre, open-label, randomised, controlled phase III trial

Hypoglossal nerve stimulation (HNS) for obstructive sleep apnoea (OSA) is a novel way to manage the condition. We hypothesised that in patients with OSA and limited adherence to continuous positive airway pressure (CPAP) therapy, domiciliary transcutaneous electrical stimulation (TESLA) would control sleep apnoea and provide health benefits. We undertook a single-centre, open-label, randomised, controlled phase III trial in patients with OSA (apnoea-hypopnoea-index [AHI] 5-35h-1), a BMI of 18.5-32kg∗m-2, and a documented lack of adherence to CPAP therapy (<4h∗night-1) at Guy's & St Thomas' NHS Foundation Trust (hospital), UK. Patients were randomly assigned (1:1) using minimisation (gender and OSA severity) to receive TESLA or usual care (CPAP) for at least 3 months; sleep study analysis was provided without knowledge of the assignment arm. The primary outcome was change in AHI at 3-months. The primary outcome and safety were analysed in the intention-to-treat population. Data are reported as median (interquartile range), unless otherwise explained. This trial is registered at ClinicalTrials.gov, NCT03160456. Between 6 June 2018 and 7 February 2023, 56 participants were enrolled and randomly assigned (29 patients in the intervention group and 27 in the usual care group). Patients were followed up for a median of 3.0 months (IQR 3.0; 10.0). The groups were similar in terms of age (55.8 (48.2; 66.0) vs 59.3 (47.8; 64.4) years), gender (male:female, 19:10 vs 18:9) and BMI (28.7 (26.4; 31.9) vs 28.4 (24.4; 31.9) kg∗m-2). The unadjusted group difference in the AHI was-11.5 (95% CI-20.7;-2.3) h-1 (p=0.016). Adjusted for the baseline value, the difference was AHI-7.0 (-15.7; 1.8) h-1 (p=0.12), in favour of the intervention. Minor adverse events were found in one of the participants who developed mild headaches related to the intervention. Domiciliary TESLA can be used safely and effectively in OSA patients with poor adherence to CPAP, with favourable impact on sleepiness and sleep fragmentation. Despite pandemic-related limitations of the amended protocol this trial provides the evidence that TESLA improves clinically meaningful outcomes over the observed follow up period, and the transcutaneous approach is likely to offer an affordable alternative for responders to electrical stimulation in clinical practice. British Lung Foundation, United Kingdom Clinical Research Collaboration-registered King's Clinical Trials Unit at King's Health Partners.

Characteristics of responsiveness of cochlear nerve to electrical stimulation in patients with cochlear nerve deficiency

Objectives: This study aimed to evaluate the responsiveness of cochlear nerve to electrical stimulation in patients with cochlear nerve deficiency(CND), to compare their results with those measured in implanted children with normal-sized cochlear nerves, and to investigate the characteristics of the cochlear nerve injury of children with CND. Methods: Participants were children who underwent cochlear implantation at Shandong Provincial ENT Hospital from January 2012 to January 2020, including CND group and control group. The CND group included 51 subjects (male:20; female: 31) who were diagnosed with CND and had normal cochlea. For the CND group, four children had been bilaterally implanted, the mean implantation age was (2.7±1.5) years old. The control group included 21 subjects (male:10; femal:11) who had normal-sized cochlear nerve and normal cochlea. For the control group, all children had been unilaterally implanted except one, and the mean implantation age was (3.0±1.9)years old. Three subjects in the CND group used CI422 electrode arrays, and all the other subjects used CI24RECA/CI512 electrode arrays. The electrically evoked compound action potentials (ECAP) had been tried to record for each electrode using Custom Sound EP software (v. 4.3, Cochlear Ltd.) at least six months post first activation. Furthermore, ECAP amplitude growth functions (AGF) were measured at multiple electrode locations across the electrode array. Generalized linear mixed effect models with the subject group and electrode location as the fixed effects and subjects as the random effect were used to compare results of ECAP measurements. Results: In the control group, ECAP could been recorded at all electrodes (100%), but it could only be recorded in 71% (859/1 210) electrodes in the CND group. Additionally, the percentage of electrodes with measurable ECAP decreased from electrode 1 to electrode 22 in the CND group. Compared to the control group, the ECAP thresholds significantly increased, the ECAP amplitudes and AGF slopes significantly decreased, and the ECAP latency significantly increased in the CND group (P<0.01). GLMM showed that the stimulating site had a significant effect on the ECAP threshold, maximum amplitude, and AGF slope (P<0.01), but had no significant effect on the ECAP latency (P>0.05) in the CND group. However, the stimulating site had no significant effects on the ECAP measurements in the control group. Furthermore, the functional status of cochlear nerve varied greatly among CND group. From electrode 1 to electrode 22, the ECAP thresholds gradually increased, the ECAP maximum amplitudes and AGF slopes gradually decreased in the CND group. Conclusion: Compared with patients with normal-sized cochlear nerve, not only the number of residual spinal ganglion neurons reduce,but also the function of spinal ganglion neurons damages in CND patients. The degree of cochlea nerve deterioration varies greatly among CND patients. Generally, the deterioration of cochlear nerve tends to increase from the basal to the apical site of the cochlea.

Effect of Neuromuscular Electrical Stimulation in Patients Diagnosed with Varicose Vein: A Brief Review

Varicose vein is one of the common vascular abnormalities in the world. Patients with varicose veins are at high risk for developing deep vein thrombosis. Various physiotherapy modalities such as muscle stimulator, pneumatic compression, ultrasonic, TENS can help in the management of pain and Improves quality of life in these patients. Various studies have supported that neuromuscular electrical stimulation (NMES) could improve pain and quality of life (QOL) in patients with varicose vein. Purpose of this review is to know about the role of NMES in the management of varicose vein. Several studies showed that NMES helps in decreasing pain and improves QOL in patients with varicose vein. Till date there is no definitive protocol for NMES as treatment modality in varicose vein patients. In order to establish a definitive protocol in varicose vein, further research needs to be conducted. Keywords: Neuromuscular Electrical Stimulation (NMES), TENS, varicose vein

Effect of Neuromuscular Electrical Stimulation in Patients With Critical Illness: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Neuromuscular electrical stimulation (NMES) is used in the rehabilitation of patients with critical illness. However, it is unclear whether NMES prevents ICU-acquired weakness (ICU-AW). For this purpose, we conducted an updated systematic review and meta-analysis. We searched the MEDLINE, Cochrane Central Register of Controlled Trials, and Igaku Chuo Zasshi databases from April 2019 to November 2022 to identify new randomized controlled trials to the previous meta-analysis. We systematically searched the literature for all randomized controlled trials on the effect of NMES in patients with critical illness. Two authors independently selected the studies and extracted data. They calculated the pooled effect estimates associated with the occurrence of ICU-AW and adverse events as primary outcomes and muscle mass change, muscle strength, length of ICU stay, mortality, and quality of life as secondary outcomes. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach. Overall, eight studies were added to the previous 10 studies. Evidence suggests that the use of NMES reduces the occurrence of ICU-AW (six trials; risk ratio [RR], 0.48; 95% CI, 0.32-0.72); however, NMES may have little to no effect on pricking sensation in patients (eight trials; RR, 6.87; 95% CI, 0.84-56.50). NMES is likely to reduce the change in muscle mass (four trials; mean difference, -10.01; 95% CI, -15.54 to -4.48) and may increase muscle strength (six trials; standardized mean difference, 0.43; 95% CI, 0.19-0.68). Further, NMES may result in little to no difference in the length of ICU stay, and the evidence is uncertain about the effect on mortality and quality of life. This updated meta-analysis revealed that the use of NMES may result in a lower occurrence of ICU-AW in patients with critical illness, but its use may have little to no effect on pricking sensation in patients.

N°53 – Clinical applicability of intra-epidermal electrical stimulation in patients with degenerative cervical myelopathy

N°53 – Clinical applicability of intra-epidermal electrical stimulation in patients with degenerative cervical myelopathy

Is Electrical Stimulation Useful for Patients with Duchenne Muscular Dystrophy? A Mini-review

Duchenne muscular dystrophy (DMD) is a hereditary progressive neuromuscular disease of childhood. The survival rate of DMD patients is extremely low. In physiotherapy, electrical stimulation is frequently applied to rehabilitate these patients. The present study aimed to evaluate the effects of electrical stimulation on the muscles of patients with DMD. In this regard limited relevant studies were found, some of which reported the positive effects of low-frequency electrical stimulation on improving muscle strength. Conversely, there were reports of the detrimental effects of electrical stimulation on muscle fibers. Overall, there is no standard guideline for electrical stimulation in patients with DMD, and further research is required with adequate sample size and follow-up.&#x0D;

Application of noninvasive hardware technique of transcranial electrical stimulation (TES) in patients with atopic dermatitis

BACKGROUND: Transcranial electrostimulation (TES therapy) is a physiotherapeutic non-invasive technology that allows painlessly, selectively and strictly dosed activation of certain brain structures producing endogenous opioid peptides by modulating activity in these brain regions that are involved in the processing of pain and itching signals. Originally, this technique was used as an electronarcosis, then the scope of TES therapy in medicine expanded and began to be used in neurology, gynecology, urology, gastroenterology. The efficacy of its use in dermatology as an antipruritic action remain poorly understood.&#x0D; AIM: the purpose of the pilot study was to evaluate the effectiveness and acceptability of the use of non-invasive TES therapy in patients with atopic dermatitis.&#x0D; MATERIAL AND METHODS: According to the existing concept, itching is considered as a kind of pain sensation caused by an altered threshold level of nerve endings in the skin that perceive pain. Given this similarity of the mechanisms of pain and itching, noninvasive brain stimulation can simultaneously reduce itching, which opens up broad prospects for its further use in itchy dermatoses.&#x0D; A pilot controlled study was conducted, the object of the study was patients with moderate atopic dermatitis (9 women and 6 men) aged 19 to 48 years. TES therapy was carried out by a pulsed bipolar electrical stimulator with acoustic effect "TRANSAIR-07" according to the standard method. All patients who received a course of TES monotherapy underwent 10 procedures, 1 time a day, lasting 3040 minutes, with a current of 13 mA. To assess the dynamics of clinical manifestations of atopic dermatitis and the severity of the disease, the following scales were used: SCORAD, EASI, IGA, DLQI, HADS, BDI. The assessment was carried out twice: the first time on the day of diagnosis verification and again on the 10th day of treatment.&#x0D; RESULTS: As a result of the treatment, there was a decrease in itching from 5 to 2 points, an improvement in mood from 5 to 1 point, an increase in performance from 4 to 1 point, a decrease in anxiety and depression from 4 to 2 points. With a general assessment of the dynamics of the indicators of the applied clinical scales (SCORAD, EASI, IGA, DLQI, HADS, BDI), the total average effectiveness in the form of parameter improvement amounted to 66.25% reduction by the end of the 10-day course.&#x0D; CONCLUSION: The work presents the modern aspects of the application of non-invasive hardware transcranial electrical stimulation technique. The positive results of our own pilot study are presented and data confirming the clinical efficacy of transcranial electrical stimulation in patients with atopic dermatitis are presented, which determines the prospect of developing a combined application of TES therapy for this persistent disease.

Safety and effectiveness of electromyography-induced rehabilitation treatment after epidural electrical stimulation for spinal cord injury: study protocol for a prospective, randomized, controlled trial.

Epidural electrical stimulation is a new treatment method for spinal cord injury (SCI). Its efficacy and safety have previously been reported. Rehabilitation treatment after epidural electrical stimulation is important to ensure and improve the postoperative efficacy of epidural electrical stimulation in patients with SCI. Considering that electromyography (EMG)-induced rehabilitation treatment can accurately match the muscle contraction of patients with SCI, we designed a study protocol for a prospective, randomized controlled trial. In this trial, on the premise of adjusting the spinal cord electrical stimulator to obtain the maximum EMG signal of the target muscle, patients with SCI receiving epidural electrical stimulation will undergo EMG-induced rehabilitation treatment. Recovery of muscle strength of key muscles, quality of life, safety and therapeutic effects will be monitored. Twenty patients with SCI who are scheduled to undergo epidural electrical stimulation in Shanghai Ruijin Rehabilitation Hospital will be randomly divided into two groups with 10 patients per group. The control group will receive conventional rehabilitation treatment. The EMG-induced rehabilitation group will receive EMG-induced rehabilitation treatment of the target muscles of the upper and lower limbs based on conventional rehabilitation treatment. After rehabilitation treatment, follow up for all patients will occur at 2 weeks and 1, 3 and 6 months. The primary outcome measure of this trial will be evaluation of target muscle recovery using the Manual Muscle Testing grading scale. Secondary outcome measures will include modified Barthel Index scores, integrated EMG values, the visual analogue scale, Spinal Cord Independence Measure scores, and modified Ashworth scale scores. The safety indicator will be the incidence of adverse events. This trial will collect data regarding the therapeutic effects of EMG-induced rehabilitation in patients with SCI receiving epidural electrical stimulation for 6 months after rehabilitation treatment. Findings from this trial will help develop rehabilitation methods in patients with SCI after epidural electrical stimulation. This study protocol was approved by Ethics Committee of Shanghai Ruijin Rehabilitation Hospital (Approval No. RKIRB2022-12) on February 15, 2022 and was registered with Chinese Clinical Trial Registry (registration number: ChiCTR2200061674; date: June 30, 2022). Study protocol version: 1.0.

Effects of transcranial direct current stimulation in dysphagic patients

To determine the effects and effectiveness of transcranial direct current electrical stimulation in patients with complaints of gluttony. RESEARCH STRATEGIES: This is a systematic review and meta-analysis, qualitative and quantitative article. PubMed, ScienceDirect, and BVS Regional Portal were used as databases. They were only clinically controlled and/or randomized clinical trials from 2011 to 2020. SELECTION CRITERIA: Descriptors were used in a combined way: [(dysphagia AND tDCS) OR (dysphagia AND "transcranial stimulation") OR (tDCS AND swallowing)]. DATA ANALYSIS: Meta-analysis was performed using R statistical software version 4.0.2. When grouping effect sizes in Meta-analysis, two approaches were used: the Fixed Effects Model and the Random Effects model. RESULTS: After applying the selection criteria, 5 articles met the requirements for qualitative analysis and 3 for quantitative analysis (meta-analysis). The studies included had a mean of 5.2 years ± 2.38 years of publication and population obtained from patients with changes in gluttony after stroke. A stimulation modality chosen for intervention was the anodic type (n = 5; 100%), prioritizing a representation of the pharynx in the cortex engine, ranging from 4 to 30 combined tDCS. CONCLUSION: There was clinical improvement in the patients, with therapeutic advances being important in the medium term. It is noteworthy that the importance of conducting clinical studies with a greater number of participants is to carry out possible greater sedimentation of the technique in rehabilitating motor, sensory, and/or mixed swallowing genesis disorders.