Electrical Stimulation Program Research Articles

Randomized Controlled Trials for Post-COVID-19 Conditions: A Systematic Review.

Post-coronavirus disease 2019 (COVID-19) syndrome or condition (PCS) is defined as new onset symptoms for at least three months following COVID-19 infection that has persisted for at least two months. Given the global sequelae of COVID-19, there is an urgent need for effective PCS interventions. The aim of this study was to systematically review all interventions for PCS tested in randomized controlled trials.In this International Prospective Register of Systematic Reviews (PROSPERO) registered (CRD42023415835) systematic review, PubMed, Google Scholar, and ClinicalTrials.gov databases were searched between 1st January 2020 and 30th April 2023. Inclusion criteria were (1) randomized controlled trials that tested interventions for (2) PCS as defined above. Studies were independently reviewed, and final decisions regarding extracted data and risk of bias were made by consensus. Trial findings were summarized qualitatively.The review included 23 trials with 1,916 subjects (mean age 44.9, 25.8% males) from 10 countries. The predominant symptom or function targeted by the interventions were general long COVID-19 symptoms (35%), fatigue (30%), breathlessness (17%), olfactory (17%), and brain function (9%). Overall, the majority of trials (74%) were at high risk of bias. A range of interventions were identified, including physical therapies, dietary and regenerative treatments, electrical stimulation, and digital wellness programs with variable effects.While a diverse range of interventions for PCS have been tested, their effectiveness varies, with threats to validity in most studies. Trials focusing on PCS mental health disorders, musculoskeletal complaints, and children are needed. Well-designed RCTs are needed to establish definitive interventions for PCS.

Novel Technologies to Address the Lower Motor Neuron Injury and Augment Reconstruction in Spinal Cord Injury.

Lower motor neuron (LMN) damage results in denervation of the associated muscle targets and is a significant yet under-appreciated component of spinal cord injury (SCI). Denervated muscle undergoes a progressive degeneration and fibro-fatty infiltration that eventually renders the muscle non-viable unless reinnervated within a limited time window. The distal nerve deprived of axons also undergoes degeneration and fibrosis making it less receptive to axons. In this review, we describe the LMN injury associated with SCI and its clinical consequences. The process of degeneration of the muscle and nerve is broken down into the primary components of the neuromuscular circuit and reviewed, including the nerve and Schwann cells, the neuromuscular junction, and the muscle. Finally, we discuss three promising strategies to reverse denervation atrophy. These include providing surrogate axons from local sources; introducing stem cell-derived spinal motor neurons into the nerve to provide the missing axons; and finally, instituting a training program of high-energy electrical stimulation to directly rehabilitate these muscles. Successful interventions for denervation atrophy would significantly expand reconstructive options for cervical SCI and could be transformative for the predominantly LMN injuries of the conus medullaris and cauda equina.

Neuromuscular Electrical Stimulation in Conjunction with Conventional Swallowing Therapy in the Treatment of Dysphagia Caused by Multiple Sclerosis: A Single-Case Experimental Design

Introduction: Dysphagia as a consequence of multiple sclerosis (MS) puts individuals at higher risk of dehydration, malnutrition, and aspiration pneumonia. This study intended to investigate the effects of a combined program of neuromuscular electrical stimulation (NMES) and conventional swallowing therapy to improve swallow safety and efficiency, oral intake, and physical, emotional, and functional impacts of dysphagia in people with dysphagia and MS. Methods: In this single-case experimental study with ABA design, two participants with dysphagia caused by MS underwent 12 sessions therapy during 6 weeks following a baseline of 4 evaluation sessions. They were evaluated 4 more times in the follow-up phase after therapy sessions. Scores of Mann Assessment of Swallowing Ability (MASA), DYsphagia in MUltiple Sclerosis (DYMUS), and timed test of swallowing capacity were obtained at baseline, during treatment, and in the follow-up phases. The Dysphagia Outcome and Severity Scale (DOSS) based on videofluoroscopic swallow studies, Persian-Dysphagia Handicap Index (Persian-DHI), and Functional Oral Intake Scale (FOIS) were also completed before and after treatment. Visual analysis and percentage of nonoverlapping data were calculated. Results: MASA, DYMUS, FOIS, and DHI scores indicated significant improvement in both participants. Although the scores of the timed test of swallowing capacity in participant 1 (B.N.) and DOSS in participant 2 (M.A.) showed no changes, considerable improvements including reducing the amount of residue and the number of swallows required to clear bolus were seen in the posttreatment videofluoroscopic records of both participants. Conclusion: NMES in conjunction with conventional dysphagia therapy based on motor learning principles could improve the swallowing function and decrease disabling effects of dysphagia on different aspects of life in participants with dysphagia caused by MS.

Acute effects of conventional versus wide-pulse neuromuscular electrical stimulation on quadriceps evoked torque and neuromuscular function.

The effectiveness of a neuromuscular electrical stimulation (NMES) program is proportional to the level of evoked torque, which can be achieved with either conventional or wide-pulse stimulations. The aim of this study was to compare evoked torque, objective fatigability, and related peripheral and central alterations, as well as changes in central nervous system (CNS) excitability induced by an acute session of conventional versus wide-pulse NMES. Seventeen young men underwent three 20-min NMES sessions: conventional (0.2 ms/50 Hz), wide-pulse at 50 Hz (1 ms/50 Hz), and wide-pulse at 100 Hz (1 ms/100 Hz). Neuromuscular measurements (i.e., maximal voluntary contraction, voluntary activation, evoked responses to femoral nerve stimulation, and CNS excitability) were performed on the right quadriceps femoris muscle before and after each NMES session. CNS excitability was measured using transcranial magnetic, thoracic, and transcutaneous spinal cord stimulations. The level of evoked torque was not significantly different between conventional and wide-pulse protocols applied at the maximal tolerable current intensity. All NMES protocols induced objective fatigability (~14% decrease in maximal voluntary contraction torque, p < 0.001) associated with peripheral (decrease in doublet torque and potentiated M-wave amplitude, p = 0.002 and p < 0.001, respectively) but not central (unchanged voluntary activation, p = 0.79) alterations. However, these acute changes did not differ between NMES protocols and none of the NMES protocols modified markers of CNS excitability. These results may allow to conjecture that chronic effects and treatment effectiveness could be comparable between conventional and wide-pulse NMES.

Wide-pulse electrical stimulation of the quadriceps allows greater maximal evocable torque than conventional stimulation.

The effectiveness of a neuromuscular electrical stimulation (NMES) program has been shown to be proportional to the maximal evocable torque (MET), which is potentially influenced by pulse characteristics such as duration and frequency. The aim of this study was to compare MET between conventional and wide-pulse NMES at two different frequencies. MET-expressed as a percentage of maximal voluntary contraction (MVC) torque-and maximal tolerable current intensity were quantified on 71 healthy subjects. The right quadriceps was stimulated with three NMES protocols using different pulse duration/frequency combinations: conventional NMES (0.2ms/50Hz; CONV), wide-pulse NMES at 50Hz (1ms/50Hz; WP50) and wide-pulse NMES at 100Hz (1ms/100Hz; WP100). The proportion of subjects reaching the maximal stimulator output (100mA) before attaining maximal tolerable current intensity was also quantified. The proportion of subjects attaining maximal stimulator output was higher for CONV than WP50 and WP100 (p < 0.001). In subjects who did not attain maximal stimulator output in any protocol, MET was higher for both WP50 and WP100 than for CONV (p < 0.001). Maximal tolerable current intensity was lower for both WP50 and WP100 than for CONV and was also lower for WP100 than for WP50 (p < 0.001). When compared to conventional NMES, wide-pulse protocols resulted in greater MET and lower maximal tolerable current intensity. Overall, this may lead to better NMES training/rehabilitation effectiveness and less practical issues associated with maximal stimulator output limitations.

Investigating the Effect of Electrical Stimulation (tDCS) of the Prefrontal Cortex of the Brain on the Improvement of Behavioral and Neurological Symptoms of Children with Specific Learning Disabilities

The aim of the current research was to investigate the effect of electrical stimulation of the dorsolateral prefrontal cortex on improving behavioral and neuropsychological symptoms in children with specific learning disorders. The research method was quasi-experimental. The study population comprised all children aged 7 to 12 years with specific learning disorders attending a private psychotherapy center in Tehran during 2022. From this group, 20 individuals were selected as the statistical sample using convenient random sampling, with 10 placed in the experimental group and 10 in the control group. Research tools included an electrical stimulation program for improving behavioral and neuropsychological symptoms in children with specific learning disorders, the Symptom Checklist-90-Revised (SCL-90R), and the Conners' Neuropsychological Questionnaire (2004). Statistical data analysis was performed using SPSS software and mixed analysis of variance with repeated measurements. The findings showed significant differences between the behavioral symptom scores and neuropsychological signs of the experimental and control groups in the pre-test and post-test phases. The results indicated that electrical stimulation of the dorsolateral prefrontal cortex had a significant effect on reducing both behavioral symptoms and neuropsychological signs in the experimental group. The effectiveness of this intervention was also sustained in the follow-up phase according to the Bonferroni post-hoc test. Based on the findings, it can be concluded that electrical stimulation of the dorsolateral prefrontal cortex can be used to reduce behavioral symptoms and neuropsychological signs in students with specific learning disorders. Therefore, it is suggested that this method be used in child and adolescent counseling centers and rehabilitation facilities.

A Multicenter, Investigator-Blinded, Randomized Controlled Trial to Assess the Efficacy of Calf Neuromuscular Electrical Stimulation Program on Walking Performance in Peripheral Artery Disease: The ELECTRO-PAD Study Protocol.

This paper describes a currently on-going multicenter, randomized controlled trial designed to assess the efficacy of calf neuromuscular electrical stimulation (NMES) on changes in maximal walking distance in people with lower extremity peripheral artery disease (PAD), compared with a non-intervention control-group. This study (NCT03795103) encompasses five participating centers in France. PAD participants with a predominant claudication at the calf level and a maximal treadmill walking distance ≤300 m are randomized into one of the two groups: NMES group or Control group. The NMES program consists of a 12-week program of electrical stimulations at the calf-muscle level. The primary outcome of the study is the change in maximal treadmill walking distance at 12 weeks. Main secondary outcomes include changes in the pain-free treadmill walking distance; 6 min total walking distance; global positioning system (GPS)-measured outdoor walking capacity; daily physical activity level by accelerometry; self-reported walking impairment; self-reported quality of life; ankle-brachial index; and skin microvascular function, both at the forearm and calf levels. Recruitment started in September 2019 and data collection is expected to end in November 2022.

Home-Based Nonoperative-Side Quadriceps Neuromuscular Electrical Stimulation Prevents Muscle Weakness Following Anterior Cruciate Ligament Reconstruction

We compared the effectiveness of a home-based neuromuscular electrical stimulation (NMES) program applied to the quadriceps of the nonoperative side against sham-NMES as a complement to standard rehabilitation on knee extensor neuromuscular function in patients following anterior cruciate ligament (ACL) reconstruction. Twenty-four patients completed the 6 week NMES (n = 12) and sham-NMES (n = 12) post-operative interventions and were tested at different time points for neuromuscular function and self-reported knee function. Isometric, concentric, and eccentric strength deficits (muscle weakness) increased significantly from pre-surgery to 24 weeks post-surgery in the sham-NMES group (p < 0.05), while no significant changes were observed in the NMES group. On the stimulated (nonoperative) side, quadriceps voluntary activation and muscle thickness were respectively maintained (p > 0.05) and increased (p < 0.001) as a result of the NMES intervention, contrary to sham-NMES. Self-reported knee function improved progressively during the post-operative phase (p < 0.05), with no difference between the two groups. Compared to a sham-NMES intervention, a 6 week home-based NMES program applied to the quadriceps of the nonoperative side early after ACL reconstruction prevented the occurrence of knee extensor muscle weakness 6 months after surgery. We conclude that nonoperative-side NMES may help counteract muscle weakness after ACL reconstruction.

Assessment of the Strength Parameters of the Quadriceps Femoris Muscles in Polish University Students after a 3-Week Program of Neuromuscular Electrical Stimulation Using the RSQ1 Method.

A rehabilitative program for patients who lose strength and muscle mass along with the ability to perform intensive exercises is lacking. We developed a 3-week training program based on neuromuscular electrical stimulation (NMES) using a RSQ1 device (modulated current resulting from the overlapping of two-component currents) for RSQ1 electrostimulation to improve strength parameters of the quadricep femoris muscles and compare its effectiveness to isometric training. Nineteen university students were randomly divided into the NMES group (10 sessions) and the control group who trained. We measured the circumference of the thigh, as well as peak torques of the flexor and extensor muscles before and after the start and after the end of the training program. Both tested training programs gave similar results. Differences between measured parameters were not significant except for differences in the peak torques of the knee flexors (9.9% for left limb; p = 0.2135 vs. 7.8% for rift limb; p = 0.2135) and the circumference of the left thigh—2% for both (left p = 0.5839 and right p = 0.1088). Comparable results of the tested training programs suggest that NMES is a good alternative for people who cannot perform exercises, but want to maintain or improve their physical fitness.

The Effects of Electrical Stimulation Program on Navicular Height, Balance, and Fear of Falling in Community-Dwelling Elderly.

Introduction: Intrinsic foot muscle weakness is a crucial cause of balance deficit in the elderly, which leads to a limited range of motion from the fear of falling and subsequently decreases the quality of life. Muscle strengthening via transcutaneous electrical stimulation (TENS) is an effective intervention; however, its effects on elderly people have rarely been reported. This study was conducted to investigate the effects of TENS on navicular height, balance, and fear of falling. Method: In this study, forty-eight participants aged 65–75 years were included and were randomly divided into two groups: the TENS and control groups. Before and after 4 weeks of training, navicular height, balance, and fear of falling were measured. Result: After 4 weeks of training, navicular height significantly increased in both groups (p < 0.05); however, the increase was higher in the TENS group (p = 0.035). The TENS group had a better improvement in balance in all four directions—front, back, left, and right (p < 0.05). However, postural balance improvements in the control group were observed in three directions only—front, back, and left (p < 0.05)—without any significant difference between the two groups. Furthermore, the TENS group decreased the scale of fear of falling after 4 weeks of training (p = 0.039). Conclusion: In summary, the results of this study can be used as part of the muscle strengthening via ES for decreasing the risk of falls or fear of falling in the elderly.

The Effectiveness of Matrix Rhythm Therapy in Patients with Chronic Low Back Pain.

Randomized clinical study. Our study was planned to determine the effect of matrix rhythm therapy (MRT) on pain, level of disability, and quality of life in chronic low back pain. Low back pain is a complex and heterogeneous disorder. Different therapy options can be applied in the treatment of low back pain. In the literature, there are very few studies showing the effect of MRT in patients with chronic low back pain. A total of 32 participants with a mean age of 36.41 ± 8.91 years were randomly divided into two groups (intervention group and control group). Each participant was treated with ten sessions a combined physiotherapy program (hot pack, transcutaneous electrical nerve stimulation, therapeutic ultrasound, home exercise and patient education program). Additionally, intervention group received six sessions of MRT. Pain (McGill Pain Questionnaire), level of disability (Oswestry Disability Index) and quality of life (Short Form-36) were measured before and after the treatment programme. When pre- and post-treatment results were compared in the intervention group, a statistically significant difference was found in total pain level, disability level, and all subdimensions except the "Emotional Role" subdimension of Short Form-36 (SF-36) and total SF-36 scores (P ≤ 0.05). In the control group, statistically significant differences were found in disability level, the "Vitality" and "Bodily Pain" subdimensions of SF-36 and total SF-36 scores (P ≤ 0.05). When the delta values were compared between groups, there was a statistically significant difference only in the "general health perceptions" subdimension of SF-36 (P ≤ 0.05) in favor of the intervention group. It was determined that both the combined physiotherapy program and the MRT application in addition to the combined physiotherapy program have a positive effect on pain, disability level, and quality of life in patients with chronic low back pain.Level of Evidence: 2.

The effect of using EMS electrical stimulation on some kinematic variables of the floater serve in volleyball

The importance of this study lies in knowing the development of the basic muscles in the performance of the arm by using electrical stimulation and its effect on technical performance, and to infer it through biochemical variables, which are reflected in realistic training and what is the extent of its value and its impact on the achievment of volleyball females players from the category of advancers. The study aimed to know : &#x0D; -values of some biomechanical variables for the skill of the floater serve in the women's volleyball . &#x0D; - the extent and effectiveness of the effect of using an EMS device on the arm muscles , its development and its reflection on the performance movement of the serve through the kinematic variables and the differences between the pre and post tests. &#x0D; The descriptive approach was used by using the pre and post kinematic analysis. The research sample consisted of females players of the Qaraqosh Sports Club, who were 6 from the category of advancers. The researchers used the EMS device for the arm leading to the serve after imaging and analysis in the pre-test to extract the variables (shoulder angle at the moment of hitting the ball , maximum height of the ball at the moment of hitting the ball , ball launch velocity , ball launch angle, angular distance , time of movement, angular velocity) After completing the electrical stimulation program and sessions, over a period of five weeks, the same variables were analyzed in a post-test. &#x0D; The most important conclusions of the study were - that the use of electrical stimulation EMS helped in the development of the ball’s launch velocity - there were statistical differences in the arithmetic averages in the variables of the angular velocity and the angular distance between the two pre and post tests as a result of the effect of electrical stimulation, which achieved even partially the goal of the research according to the kinematic view

Investigation of the Effectiveness of Transcutaneous Electrical Nerve Stimulation (TENS) and Home Exercise Program Against Supervised Exercises in Subacromial Impingement Syndrome

Investigation of the Effectiveness of Transcutaneous Electrical Nerve Stimulation (TENS) and Home Exercise Program Against Supervised Exercises in Subacromial Impingement Syndrome

Electrochemical and biological performance of chronically stimulated conductive hydrogel electrodes

Objective. Evaluate electrochemical properties, biological response, and surface characterization of a conductive hydrogel (CH) coating following chronic in vivo stimulation. Approach. Coated CH or uncoated smooth platinum (Pt) electrode arrays were implanted into the cochlea of rats and stimulated over a 5 week period with more than 57 million biphasic current pulses. Electrochemical impedance spectroscopy (EIS), charge storage capacity (CSC), charge injection limit (CIL), and voltage transient (VT) impedance were measured on the bench before and after stimulation, and in vivo during the stimulation program. Electrically-evoked auditory brainstem responses were recorded to monitor neural function. Following explant, the cochleae were examined histologically and electrodes were examined using scanning electron microscopy. Main results. CH coated electrodes demonstrated a bench-top electrochemical advantage over Pt electrodes before and after the electrical stimulation program. In vivo, CH coated electrodes also had a significant advantage over Pt electrodes throughout the stimulation program, exhibiting higher CSC (p= 0.002), larger CIL (p = 0.002), and lower VT impedance (p < 0.001). The CH cohort exhibited a greater tissue response (p= 0.003) with small deposits of particulate material within the tissue capsule. There was no loss in auditory neuron density or change in neural response thresholds in any cochleae. Examination of the electrode surface revealed that most CH electrodes exhibited some coating loss; however, there was no evidence of corrosion in the underlying Pt. Significance. CH coated electrodes demonstrated significant electrochemical advantages on the bench-top and in vivo and maintained neural function despite an increased tissue response and coating loss. While further research is required to understand the cause of the coating loss, CH electrodes provide promise for use in neural prostheses.

Drop foot Post Mitral Valve Replacement and Total correction of Tetralogy of Fallot: A Two Case Report

Background: Peripheral nerve lesion after heart surgery was reported on brachial plexus, phrenic nerve, laryngeal recurrent nerve facial nerve, lumbosacral root and spinal cord. Incidence of peroneal communis nerve lesion after heart surgery was not much reported (0,19%). Diagnostic procedure of peripheral nerve lesion are including clinical sign and symptom, electrophysiology studies and MRI. Rehabilitation management of peripheral nerve lesion are not only management of pain and nerve stimulation, but also walking aid beside cardiac rehabilitation due to cardiac problem.Methods: Reporting two case of peripheral nerve lesion after heart surgery. First case is a female, 37 years old suffered from drop foot two days after mitral valve replacement with mechanic valve. She got pain management, electrical nerve stimulation and therapeutic exercise beside cardiac rehabilitation program. Second case is a female, 9 years old, after total correction of Tetralogy of Fallot, got drop foot at day two. She also got pain management, electrical nerve stimulation and therapeutic exercise beside cardiac rehabilitation.Results: First case result was the drop foot getting better after she entered phase two of cardiac rehabilitation. In the second case, the drop foot was relieved at phase two cardiac rehabilitation and back to normal condition after one year after surgery.Conclusion: In these two case of drop foot after heart surgery, the drop foot was relieved after pain and rehabilitation management beside cardiac rehabilitation.

The effect of transcutaneous electrical nerve stimulation on increasing salivary flow rate in hemodialysis patients.

To evaluate the impact of a transcutaneous electrical nerve stimulation (TENS) program for hemodialysis on patients' dry mouth and salivary flow rates. A single-blinded repeated measures study design was used. A total of 80 subjects were randomly assigned to a treatment group receiving a 250µs; 50Hz TENS program and a control group receiving a 50µs; 2Hz TENS program at acupoints ST 6 and TE17 three times a week for 3weeks. Whole salivary flow rate and dry mouth intensity were measured totally five times for both groups, at pretreatment, after three, six, nineTENS sessions, and 1week after the treatment was completed. After six TENS sessions were completed, whole salivary flow rates increased stably until the end of nine TENS sessions for the treatment group. In the follow-up week after treatment, there was significant increase as well. However, significant improvement in dry mouth intensity was observed at all post-tests than that at pretreatment in both groups. Whole salivary flow rates and improvement in dry mouth intensity were only observed during and 1week after the TENS sessions. Further studies are needed to evaluate whether this method can offer a long-term effective nonpharmacological therapy for dry mouth-disturbed hemodialysis patients.

APLICACIÓN DE UN PROGRAMA DE ELECTROESTIMULACIÓN PARA LA PÉRDIDA DE GRASA CORPORAL EN MUJERES

&lt;div&gt;Actualmente M&amp;eacute;xico encabeza el listado de pa&amp;iacute;ses con sobrepeso y obesidad en su poblaci&amp;oacute;n adulta, de modo que 7 de cada 10 adultos presentan este padecimiento, por lo que es considerado un problema de salud p&amp;uacute;blica dif&amp;iacute;cil de combatir a pesar de las estrategias implementadas para ello1. Es importante&lt;/div&gt;&lt;div&gt;el papel del profesional de enfermer&amp;iacute;a hacia esta poblaci&amp;oacute;n, ya que se encarga del control y seguimiento de los pacientes con esta enfermedad, siendo capaz&lt;/div&gt;&lt;div&gt;de dise&amp;ntilde;ar e implementar programas de nutrici&amp;oacute;n y actividad f&amp;iacute;sica que permitan mejorar la calidad de vida del paciente. El objetivo fue aplicar un programa&lt;/div&gt;&lt;div&gt;de electroestimulaci&amp;oacute;n encaminado a favorecer la p&amp;eacute;rdida de grasa corporal en mujeres de 30 a 40 a&amp;ntilde;os. Es una investigaci&amp;oacute;n de tipo experimental (experimental puro), prospectiva, longitudinal y anal&amp;iacute;tica. El nivel de la investigaci&amp;oacute;n es aplicativo. Se seleccionaron dos grupos de mujeres entre 30&lt;/div&gt;&lt;div&gt;y 40 a&amp;ntilde;os que realizan actividad f&amp;iacute;sica: Grupo experimental con 9 mujeres y grupo control con 10&lt;/div&gt;&lt;div&gt;mujeres. Las mediciones se realizaron diariamente a&lt;/div&gt;&lt;div&gt;trav&amp;eacute;s de los instrumentos para valoraci&amp;oacute;n y de una&lt;/div&gt;&lt;div&gt;c&amp;eacute;dula de cotejo. Se aplic&amp;oacute; el programa durante 7&lt;/div&gt;&lt;div&gt;semanas, obteniendo mediciones basales (2 semanas)&lt;/div&gt;&lt;div&gt;y mediciones experimentales (5 semanas) aplicando 3&lt;/div&gt;&lt;div&gt;sesiones por semana con una duraci&amp;oacute;n de 30 minutos.&lt;/div&gt;&lt;div&gt;Los resultados demostraron una disminuci&amp;oacute;n&lt;/div&gt;&lt;div&gt;significativa en el porcentaje de grasa corporal, &amp;iacute;ndice&lt;/div&gt;&lt;div&gt;cintura-cadera y el pliegue cut&amp;aacute;neo de la pantorrilla,&lt;/div&gt;&lt;div&gt;es decir, 3 de las 12 variables estudiadas. Lo que&lt;/div&gt;&lt;div&gt;resulta favorecedor en el bienestar biol&amp;oacute;gico y f&amp;iacute;sico&lt;/div&gt;&lt;div&gt;de las participantes.&lt;/div&gt;&lt;div&gt;&lt;br /&gt;&lt;/div&gt;

Home-based Neuromuscular Electrical Stimulation as an Add-on to Pulmonary Rehabilitation Does Not Provide Further Benefits in Patients With Chronic Obstructive Pulmonary Disease: A Multicenter Randomized Trial

ObjectiveTo assess the additional effect of a home-based neuromuscular electrical stimulation (NMES) program as an add-on to pulmonary rehabilitation (PR), on functional capacity in subjects with chronic obstructive pulmonary disease (COPD). DesignSingle-blind, multicenter randomized trial. SettingThree PR centers. ParticipantsSubjects with severe to very severe COPD (N=73; median forced expiratory volume in 1 second, 1L (25th–75th percentile, 0.8–1.4L) referred for PR. Twenty-two subjects discontinued the study, but only 1 dropout was related to the intervention (leg discomfort). InterventionSubjects were randomly assigned to either PR plus quadricipital home-based NMES (35Hz, 30min, 5 time per week) or PR without NMES for 8 weeks. Main Outcome MeasureThe 6-minute walk test (6MWT) was used to assess functional capacity. ResultsEighty-two percent of the scheduled NMES sessions were performed. In the whole sample, there were significant increases in the distance walked during the 6MWT (P<.01), peak oxygen consumption (P=.02), maximal workload (P<.01), modified Medical Research Council dyspnea scale (P<.01), and Saint George’s Respiratory Questionnaire total score (P=.01). There was no significant difference in the magnitude of change for any outcome between groups. ConclusionsHome-based NMES as an add-on to PR did not result in further improvements in subjects with severe to very severe COPD; moreover, it may have been a burden for some patients.

Effects of Electrical Muscle Stimulation on Waist Circumference in Adults with Abdominal Obesity: A Randomized, Double-blind, Sham-controlled Trial

We investigated the effects of electrical muscle stimulationon waist circumference as compared with an identical device providing transcutaneous electrical nerve stimulation as control in adults with abdominal obesity. This was a randomized, double-blind, sham-controlled trial. Sixty patients with abdominal obesity received electrical muscle stimulation or transcutaneous electrical nerve stimulation randomly five times a week for 12 weeks. The electrical muscle stimulationgroup achieved a mean 5.2±2.8 cm decrease in waist circumference while the transcutaneous electrical nerve stimulation group showed only a 2.9±3.3 cm decrease (P=0.005). About 20 (70.0%) of the electrical muscle stimulation group lost more than 4 cm of waist circumference but that only 8 (33.3%) of the transcutaneous electrical nerve stimulation group did so (P=0.008). Furthermore, fasting free fasting acid levels were significantly higher in the electrical muscle stimulation than in the transcutaneous electrical nerve stimulationgroup at week 12 (P=0.006). In the electrical muscle stimulation group, slight decreases in visceral abdominal fat and total abdominal fat areas by computer tomography were observed at 12 weeks, but these decreases were not significant. In addition, patients' self-rated satisfaction scores with this program were significantly higher in the electrical muscle stimulation group. The 12-week electrical muscle stimulation program modestly reduced waist circumference in abdominally obese adults without side effects.

Is Home Biofeedback Training Useful for Fecal Incontinence: Preliminary Fesults of RCT With New Home Device

Introduction: Biofeedback therapy (BT) is useful in fecal incontinence (FI), but it is labor intensive, not widely available and reimbursement is problematic. We tested the efficacy of home device assisted BT against standard office BT. Methods: Patients with FI (at least 1 episode / week) were randomized to office BT or home BT using a novel biofeedback device (InToneMV, InControl Medical, WI, USA). Home device consists of a probe with balloon, a pump for balloon inflation, a hand held monitor with voice guided therapy, and both mechanical and electrical stimulation of anal sphincters. Home BT patients were asked to use home device twice daily for 20 minute session. Office BT patients practiced Kegel exercise twice daily at home and had 6, one hour, weekly office BT consisting of anal strengthening, endurance training and coordination training for 6 weeks. All participants kept daily stool diaries. Bowel symptoms, fecal incontinence severity index (FISI), fecal incontinence and constipation assessment (FICA), subject's global assessment (SGA) and physiological changes (anorectal manometry) were assessed at baseline and post-treatment period. Responder was defined as ≥50% decrease in weekly FI episodes compared to baseline. Results: Eighteen (16 females, 63.6±13.4 years old) FI patients were enrolled: 11 (home BT) and 7 (office BT). There were 6/11 (55%) responders in Home BT and 3/7(43%) in Office BT (p=1.000). In Home BT, FI symptom severity (visual analog scale, VAS) improved in 10 (91%) and unchanged in 1 (9%), compared to 3 (43%) improved in Office BT and was unchanged in 1 (17%) and worse in 3 (43%). Similarly, 9% reported completely relief and 64% reported considerable relief with Home BT compared to 29% reported considerable relief with Office BT (Table 1). The mean FISI score increased and FICA score decreased in Home BT when compared to baseline (3.6 and 3.3, p=0.016 and p=0.033) and in Office BT (1.0 and 1.2 p=0.435 and p=0.330). The mean anal resting, maximal squeeze and sustained squeeze pressure increases were comparable (6.8, 25.3 and 5.21 mmHg in Home BT and 21.3, 37.6 and 14.4mmHg in Office BT respectively).Table: Table. Patients' self-assessment of the treatment effectConclusion: Home BT using a voice guided program of mechanical and electrical stimulation is a promising approach for treatment of FI, and provides comparable physiologic and somewhat better symptomatic benefit when compared to office BT. The convenience of home BT may prove beneficial in long term and reduce health care burden.