Neuromuscular 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.

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.

Safety and effectiveness of neuromuscular electrical stimulation in cardiac surgery: A systematic review.

Lack of mobilization and prolonged stay in the intensive care unit (ICU) are major factors resulting in the development of ICU-acquired muscle weakness (ICUAW). ICUAW is a type of skeletal muscle dysfunction and a common complication of patients after cardiac surgery, and may be a risk factor for prolonged duration of mechanical ventilation, associated with a higher risk of readmission and higher mortality. Early mobilization in the ICU after cardiac surgery has been found to be low with a significant trend to increase over ICU stay and is also associated with a reduced duration of mechanical ventilation and ICU length of stay. Neuromuscular electrical stimulation (NMES) is an alternative modality of exercise in patients with muscle weakness. A major advantage of NMES is that it can be applied even in sedated patients in the ICU, a fact that might enhance early mobilization in these patients. To evaluate safety, feasibility and effectiveness of NMES on functional capacity and muscle strength in patients before and after cardiac surgery. We performed a search on Pubmed, Physiotherapy Evidence Database (PEDro), Embase and CINAHL databases, selecting papers published between December 2012 and April 2023 and identified published randomized controlled trials (RCTs) that included implementation of NMES in patients before after cardiac surgery. RCTs were assessed for methodological rigor and risk of bias via the PEDro. The primary outcomes were safety and functional capacity and the secondary outcomes were muscle strength and function. Ten studies were included in our systematic review, resulting in 703 participants. Almost half of them performed NMES and the other half were included in the control group, treated with usual care. Nine studies investigated patients after cardiac surgery and 1 study before cardiac surgery. Functional capacity was assessed in 8 studies via 6MWT or other indices, and improved only in 1 study before and in 1 after cardiac surgery. Nine studies explored the effects of NMES on muscle strength and function and, most of them, found increase of muscle strength and improvement in muscle function after NMES. NMES was safe in all studies without any significant complication. NMES is safe, feasible and has beneficial effects on muscle strength and function in patients after cardiac surgery, but has no significant effect on functional capacity.

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.

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.

Therapeutic Effect and Optimal Electrode Placement of Transcutaneous Neuromuscular Electrical Stimulation in Patients with Post-Stroke Dysphagia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Background: To date, there is no conclusive evidence that transcutaneous neuromuscular electrical stimulation (TNMES) benefits patients with post-stroke dysphagia (PSD). In addition, the optimal TNMES electrode placement has not been well-established. This systematic review and meta-analysis were conducted to investigate these two research gaps. Methods: Five major databases were systematically searched for randomized controlled trials (RCTs) through January 2022. Effect sizes were computed using Hedges’ g statistic, which were then entered into the random-effects model to obtain pooled effect estimates. Results: Twenty-four RCTs met the eligibility criteria. On the improvement of swallowing function, TNMES alone was not superior to conventional swallowing therapies (CSTs); combined therapy of TNMES and CSTs significantly surpassed CSTs alone (standardized mean difference (SMD) = 0.91, 95% confidence interval (95% CI): 0.68 to 1.14, p < 0.0001; I2 = 63%). Moreover, significant pooled effect sizes were observed in subgroups with horizontal electrode placement above the hyoid bone (SMD = 0.94, 95% CI: 0.72 to 1.16; I2 = 0%) and horizontal electrode placement just above and below the hyoid bone (SMD = 0.87, 95% CI: 0.59 to 1.14; I2 = 0%). The largest pooled effect size was observed in the subgroup that individualized electrode placement according to dysphagia evaluation (SMD = 1.65, 95% CI: 0.38 to 2.91; I2 = 90%). Conclusion: TNMES should be used in combination with CSTs for PSD. Horizontal electrode placement should target suprahyoid muscles or both suprahyoid and thyrohyoid muscles.

Does adding neuromuscular electrical stimulation to rehabilitation following total knee arthroplasty lead to a better quadriceps muscle strength recovery? A systematic review.

Patients undergoing total knee arthroplasty (TKA) show postsurgical quadriceps weakness. Neuromuscular electrical stimulation (NMES) has been shown to be an effective treatment for muscle strength recovery in a number of orthopaedic conditions. The aim of this review is to investigate whether adding NMES to TKA rehabilitation leads to a better quadriceps strength recovery in comparison with standardized rehabilitation. A second aim is to investigate which are the most commonly used NMES pulse settings and their effectiveness. A systematic review of literature was conducted on PubMed, Cochrane, Scopus and Web-of-Science. Intervention studies evaluating the effects of a rehabilitation intervention based on quadriceps NMES in patients undergoing TKA were retrieved. Methodological quality was assessed using the risk of bias-2 Cochrane tool. Features of NMES rehabilitation and technical data on NMES settings were extracted from the studies. Four studies met the inclusion criteria. Due to the limited number and the heterogeneity of the selected studies, it was not appropriate to carry out a meta-analysis. All the studies reported higher quadriceps strength in patients undergoing quadriceps NMES, particularly early after TKA. The addition of NMES or traditional strength training shows similar long-term effects. Short duration and low-intensity NMES have limited effects on quadriceps strength. Heterogeneity was found on NMES methodologies and pulse settings. In conclusion, NMES is effective for quadriceps strength recovery following TKA. NMES intensity and duration are essential for good NMES outcomes on quadriceps strength. Further studies on NMES methodologies, pulse features and settings are required to address the gaps in knowledge on NMES following TKA.

Effects of Neuromuscular Electrical Stimulation on Lower Limb Muscle Strength After Living Donor Liver Transplant: A Case-Control Study

Early mobilization after liver transplant (LT) plays an important role in postoperative recovery and complication prevention; however, patients undergoing LT cannot achieve early mobilization because of mechanical ventilation and poor preoperative physical performance. We investigated the effect of neuromuscular electrical stimulation (NMES) on lower limb muscle strength after living donor liver transplant (LDLT). Adult patients who underwent LDLT between December 2016 and January 2019 at a university hospital were recruited. A consecutive series of patients who underwent LDLT without NMES therapy before the clinical trial (April 2014-May 2016) were enrolled as the non-NMES (control) group. Patients in the NMES group received NMES on the quadriceps muscles starting 1 day post LDLT for 4 weeks. The study was conducted in accordance with the Declaration of Helsinki, and all patients provided informed consent. Twenty-four patients in the NMES group and 16 patients in the non-NMES group were analyzed. There was no significant difference between groups regarding changes in any outcome. The application of NMES in patients with LDLT did not yield greater improvement of muscle strength, functional capacity, activities of daily living, or length of hospital stay 4 weeks postoperatively compared with the control group. However, developing a novel NMES device and confirming whether additional NMES is effective for other body areas may yield different results.

Neuromuscular Electrical Stimulation in Patients With Severe COVID-19 Associated With Sepsis and Septic Shock.

BackgroundNeuromuscular electrical stimulation (NMES) can be applied to critically ill patients. However, its results on muscle strength and functionality in patients with COVID-19 are unknown.ObjectiveEvaluate the effects of intervention with NMES on muscle mass and functionality of patients with severe COVID-19 associated with sepsis and septic shock.MethodsSeven patients with COVID-19 associated with sepsis or septic shock were selected, but only 5 patients completed all days of the intervention with NMES. The intervention was performed by a single physiotherapist on 7 consecutive days in a daily session of 40 min. The outcome measures were the femoris cross-sectional area; thickness of the anterior compartment of the quadriceps muscle; rectus femoris echogenicity; International Classification of Functioning, Disability, and Health (ICF)-muscle strength; PFIT-s, DEMMI, and the SOMS; feasibility, and safety. The patients were evaluated on days 1, 5, and 8.ResultsThe rectus femoris cross-sectional area decreased significantly from days 1 to 8, but showed maintenance of the thickness of the anterior compartment of the quadriceps muscle from days 1 to 8. The MRC score increased significantly from days 1 to 5 and kept this improvement until day 8. All patients showed an increase in the MRC score and reduction of the ICF-muscle strength, meaning improved muscle strength from days 1 to 8. The PFIT-s increased significantly from days 1 to 5 and improved until day 8 compared to day 5. DEMMI and SOMS score increased significantly on day 8 compared to days 1 and 5.ConclusionRehabilitation with NMES showed improvement in muscle strength and functionality of patients in this study with a potential protective effect on muscle mass loss in patients with critical COVID-19 associated with sepsis and septic shock. This study is the first report of the potential effects of neuromuscular electrical stimulation in patients with severe COVID-19 associated with sepsis and septic shock.

Electrical, taste, and temperature stimulation in patients with chronic dysphagia after stroke: a randomized controlled pilot trial

The objective of present study was compare a traditional swallowing therapy program with a new combined swallowing therapy program including neuromuscular electrical stimulation in patients with oropharyngeal dysphagia after stroke. This pilot study included eight patients with chronic oropharyngeal dysphagia after stroke. These patients underwent traditional therapy with gustative-thermic-tactile stimulation (group A), or a new combined program adding neuromuscular electrical stimulation (group B). Study participants were evaluated before and after the intervention using fiberoptic endoscopic evaluation of swallowing with temporal measures of posterior oral spillage and whiteout time, functional oral intake scale and a visual analog scale classifies an individual's swallowing ability. The two groups did not differ in terms of posterior oral spillage time, whiteout time and functional oral intake scale. Subjects in group B exhibited significant increases in visual analog scale scores. However, both groups demonstrated improvement with decreases in posterior oral spillage time, increased whiteout time, and increased functional oral intake scale and visual analog scale scores. There was no difference in the parameters studied in both therapeutic programs in individuals with chronic oropharyngeal dysphagia after stroke.

Musculoskeletal disorders and the possibility of using neuromuscular electrical stimulation

Background. The study of the musculoskeletal disorders is relevant not only due to the limitation of the motor activity of patients and possible disability, but also due to the widespread prevalence of this pathology.&#x0D; Aim: to study the effect of neuromuscular electrical stimulation in patients with moderate adhesive capsulitis with subcompensated type 2 diabetes mellitus in order to develop a new comprehensive treatment.&#x0D; Methods. The study included two groups of patients with adhesive capsulitis with subcompensated type 2 diabetes mellitus, in which, before treatment, reduced spastic type electroexcitability in the infraspinatus muscle and the supraspinous muscle was predominant without qualitative changes; the group 1 (control) included 30 patients, the group 2 (main) included 120 patients. All patients had limited movement in the shoulder joint, pain syndrome, the presence of trigger points in the muscles of the shoulder girdle. To determine impaired muscle function, we used the classical electrodiagnostics method with the determination of electroexcitability of the infraspinatus and supraspinatus muscles.&#x0D; Results. The state of electroexcitability of the muscles under consideration, having trigger points, reflected the presence of spasticity in them, which was accompanied by an increase in the performance of all types of currents used. Currently, a wide range of drugs is known, which efficiency is limited by their side effects, therefore, in this work, for the group 2 of patients, the standard treatment additionally included neuromuscular electrical stimulation using the OMRON E-4 device. It has a wide range of frequencies, which creates an analgesic effect in the treatment, normalizes the electroexcitability of the neuromuscular apparatus, and increases the range of motion in the shoulder joint. A comparative analysis of the treatment efficiency in two groups of patients revealed the advantage of a course of comprehensive treatment (using the electrical stimulation indicated) with compensation in 86.7% of patients of the group 2, which was confirmed by clinical, electrodiagnostic and regression analysis, with a positive long term prognosis.&#x0D; Conclusion. The inclusion of neuromuscular electrical stimulation in the comprehensive treatment enables to reduce the pain syndrome and restore the movement pattern in the shoulder joint, as well as achieve overall compensation for the clinical condition.

Neuromuscular electrostimulation as an adjuvant therapy to pulmonary rehabilitation programs in chronic obstructive pulmonary disease

Introduction. Chronic obstructive pulmonary disease (COPD) is commonly associated with a vicious circle of sedentary lifestyle - deconditioning - muscular dysfunction. High-frequency neuromuscular electrostimulation has demonstrated beneficial effects among subjects with muscle weakness. This study aimed to evaluate the benefits of merging pulmonary rehabilitation program (PRP) with neuromuscular electrostimulation in patients with very severe COPD. Material and methods. The study included 38 males with clinically stable COPD, who were divided in 2 groups: group A-19 patients that underwent a PRP of 5 sessions/week for 4 weeks and group B-19 patients that underwent intercostal and lower extremity muscle electrostimulation (5 sessions/week for 4 weeks, 60 min /session) in association with the same type of PRP. Saint Georges’s Respiratory Questionnaire (SGRQ), Modified Medical Research Council (mMRC) dyspnea scale, spirometry, maximal inspiratory pressure (PImax) and maximal expiratory pressure (PEmax), six minutes walking test (6MWT) and bio-electrical impedance were examined before and after the intervention. Results. Electrostimulation applied in group B increased muscle mass (50.15 ± 0.61kg vs 53.97 ± 0.87kg, p&lt;0.001)., PEmax (5.41 ± 0.25 vs post 6.79 ± 0.22, p&lt;0.0003) and improved mMRC score (2.68 ± 0.15 vs 2.10 ± 0.15, p&lt;0.0109), 6MWT (369.6 ± 10.77m vs post: 445.6 ± 6.03 m) and SGRQ (61.32 ± 1.83 vs. 44.95 ± 1.94, p&lt;0.0001). In group B only SGRQ score (55.05 ± 1.32 vs. 50.05 ± 1.51, p=0.018) was improved after PRP. Conclusion. A protocol which combines PRP with neuromuscular electrical stimulation in patients with very severe forms of COPD, has grater beneficial effect on dyspnoea, exercise tolerance, muscle mass toning and quality of life, compared with PRP alone.

Effects of neuromuscular electrical stimulation in patients with pulmonary arterial hypertension: a randomized controlled pilot study

BackgroundPatients with pulmonary arterial hypertension (PAH) present impairments in muscle strength and exercise capacity. There is growing evidence about the benefits of neuromuscular electrical stimulation (NMES) in patients with respiratory diseases, except in patients with PAH. The aim of this study was to investigate the effects of NMES on muscle strength, and other physical and psychosocial variables in patients with PAH. MethodsPatients with PAH were randomly divided into two groups as NMES and control. The NMES was applied to the bilateral deltoid and quadriceps femoris muscles with 50 Hz for 3 days/week, 8 weeks for the NMES group. Muscle strength, muscle cross-sectional area and thickness, arterial stiffness, exercise capacity, functional mobility and balance, balance confidence, fatigue, physical activity, and quality of life were assessed at baseline and after 8 weeks by blinded assessors. ResultsThere was no significant difference in the demographic and clinical characteristics between the patient groups (p > 0.05). The improvements in muscle strength, muscle cross-sectional area and thickness, pulse wave velocity, exercise capacity, functional mobility and balance, balance confidence, fatigue, physical activity, and quality of life were significantly higher in the NMES group compared to the control group (p < 0.05). ConclusionsThis study suggests that NMES intervention is safe and effective for patients with PAH.

Effect of Core Stabilization Exercises and Neuromuscular Electrical Stimulation in Patients With Idiopathic Pulmonary Fibrosis

Effect of Core Stabilization Exercises and Neuromuscular Electrical Stimulation in Patients With Idiopathic Pulmonary Fibrosis

Neuromuscular electrical stimulation is feasible in patients with acute heart failure.

AimsIn acute heart failure (AHF), immobilization is caused because of unstable haemodynamics and dyspnoea, leading to protein wasting. Neuromuscular electrical stimulation (NMES) has been reported to preserve muscle mass and improve functional outcomes in chronic disease. NMES may be effective against protein wasting frequently manifested in patients with AHF; however, whether NMES can be implemented safely without any adverse effect on haemodynamics has remained unknown. This study aimed to examine the feasibility of NMES in patients with AHF.Methods and resultsPatients with AHF were randomly assigned to the NMES or control group. The intensity of the NMES group was set at 10–20% maximal voluntary contraction level, whereas the control group was limited at a visible or palpable level of muscle contraction. The sessions were performed 5 days per week since the day after admission. Before the study implementation, we set the feasibility criteria with following items: (i) change in systolic blood pressure (BP) > ±20 mmHg during the first session; (ii) increase in heart rate (HR) > +20 b.p.m. during the first session; (iii) development of sustained ventricular arrhythmia, atrial fibrillation (AF), and paroxysmal supraventricular tachycardia during all sessions; (iv) incidence of new‐onset AF during the hospitalization period < 40%; and (v) completion of the planned sessions by >70% of patients. The criteria of feasibility were set as follows; the percentage to fill one of (i)–(iii) was <20% of the total subjects, and both (iv) and (v) were satisfied. A total of 73 patients (median age 72 years, 51 men) who completed the first session were analysed (NMES group, n = 34; control group, n = 39). Systolic BP and HR variations were not significantly different between two groups (systolic BP, P = 0.958; HR, P = 0.665). Changes in BP > ±20 mmHg or HR > +20 b.p.m. were observed in three cases in the NMES group (8.8%) and five in the control group (12.8%). New‐onset arrhythmia was not observed during all sessions in both groups. During hospitalization, one patient newly developed AF in the NMES group (2.9%), and one developed AF (2.6%) and two lethal ventricular arrhythmia in the control group. Thirty‐one patients in the NMES group (91%) and 33 patients in the control group (84%) completed the planned sessions during hospitalization. This study fulfilled the preset feasibility criteria.ConclusionsNMES is feasible in patients with AHF from immediately after admission.

The Effect of Four-Channel Neuromuscular Electrical Stimulation on Swallowing Kinematics and Pressures

The purpose of this study was to evaluate the effectiveness of the sequential four-channel neuromuscular electrical stimulation system. As a prospective case-control study, ten healthy subjects and ten patients with dysphagia were prospectively enrolled. Swallowing with and without sequential four-channel neuromuscular electrical stimulation (suprahyoid, infrahyoid muscles) was evaluated via videofluoroscopic swallowing study and high-resolution manometry. Results showed that the sequential four-channel neuromuscular electrical stimulation significantly improved the videofluoroscopic dysphagia scale during thick-fluid swallowing in patients with dysphagia. Furthermore, the kinematic analysis of videofluoroscopic swallowing study showed a tendency that neuromuscular electrical stimulation reduced duration of hyoid bone movement during thin- or thick-fluid swallowing. The high-resolution manometry parameters-maximal pressure of velopharynx, tongue base, cricopharyngeal pressure, minimal upper esophageal sphincter pressure, area of velopharynx, upper esophageal sphincter activity time, and duration of nadir upper esophageal sphincter-during thin-fluid swallowing were significantly improve in both groups compared with the high-resolution manometry parameters without neuromuscular electrical stimulation. The sequential four-channel neuromuscular electrical stimulation may help improve the parameters of videofluoroscopic swallowing study, kinematic analysis of the hyoid bone movement, and high-resolution manometry during swallowing. Further investigations are needed to better examine the effects of neuromuscular electrical stimulation in patients with dysphagia.

Home-based training using neuromuscular electrical stimulation in patients on continuous ambulatory peritoneal dialysis: A pilot study.

There is ample evidence that maintenance of basic physical fitness through exercise training is crucial for patients with chronic renal insufficiency. Rehabilitation based on neuromuscular electrical stimulation (NMES) of thigh muscles has been shown to have many beneficial effects in patients with chronic diseases. It is likely that NMES could have beneficial effects also in patients on chronic ambulatory peritoneal dialysis (CAPD). NMES was applied for 20weeks to 14 patients on CAPD, mean age 61.9 (8.7) years, using battery-powered stimulators (CEFAR-REHAB X2; Sweden) and self-adhesive electrodes 80×130 mm (PALS Platinum; Denmark). Stimulation characteristics: biphasic current, pulse width 400μs, 8seconds contraction-12seconds relaxation, frequency modulation 40-60Hz, and maximal intensity 60mA. NMES was home-based and applied simultaneously to quadriceps muscles of both legs (2 × 30min/day). Functional performance, muscle power (Fmax ), arterial stiffness (assessed by cardio-ankle vascular index-CAVI), and quality of life by KDQOL-SF evaluation was done at baseline and at the end of program. Home NMES improved significantly the main functional parameters: VO2peak /kg increased by +2.2 (1.6) mL O2 /kg/min (P<0.002), peak workload by +0.1 (0.1) W/kg (P<0.005), and distance walked in 6MWT by +44.7 (58.4) m (P<0.008). Only insignificant changes were observed in CAVI and Fmax . KDQOL-SF analysis showed significant improvement in seven parameters of QoL (P<0.012-0.049). This pilot study is the first clinical report dealing with the use of NMES in patients on CAPD. The results demonstrate that an improvement of exercise capacity and QoL can be achieved by home-based NMES in CAPD patients.

Effect of Perioperative Neuromuscular Electrical Stimulation in Patients Undergoing Cardiovascular Surgery: A Pilot Randomized Controlled Trial

A randomized, controlled trial was conducted to examine the effects of perioperative neuromuscular electrical stimulation on muscle proteolysis and physical function using blinded assessment of physical function. Consecutive patients undergoing cardiovascular surgery were screened for eligibility as study subjects. Participants were randomly assigned to receive either neuromuscular electrical stimulation or the usual postoperative mobilization program. The intervention group received neuromuscular electrical stimulation on bilateral legs 8 times before and after surgery. The primary outcomes were the mean 3-methylhistidine concentration corrected for urinary creatinine content from baseline to postoperative day 6, and knee extensor isometric muscle strength on postoperative day 7. Secondary outcomes were usual walking speed and grip strength. Physical therapists blinded to patient allocation performed measurements of physical function. Of 498 consecutive patients screened for eligibility, 119 participants (intervention group, n = 60; control group, n = 59) were enrolled. In the overall subjects, there were no differences in any outcomes between the intervention and control groups. The results demonstrated no significant effects of neuromuscular electrical stimulation on muscle proteolysis and physical function after cardiovascular surgery, suggesting the need to explore indications for neuromuscular electrical stimulation and to clarify the effects in terms of the dose-response relationship.

Comparison of the Efficacy of Neuromuscular Electrostimulation and Interval Exercise Training in Early Rehabilitation of Patients Hospitalized with Decompensation of Chronic Heart Failure

Neuromuscular electrical stimulation (NMES) of large muscle groups in patients with stable chronic heart failure (CHF) increases physical work capacity and muscle strength. The safety and efficacy of short courses of NMES in patients with decompensated CHF has not been studied. The aim of the study was to compare the impact of leg NMES, interval bicycle training, and conventional treatment on the functional capacity and quality of life in patients hospitalized with decompensation of CHF. A total of 51 patients (84.3% of men; mean age, 62.5 ± 3.3 years) hospitalized with decompensated CHF were divided into three groups: optimal pharmacological therapy (OPT) + three weeks of NMES of thigh and shin muscles starting within the first three days after admission (n = 10), OPT + three weeks of bicycle exercise training (BET) starting on the fifth to seventh day (n = 20), and the control group of OPT only (n = 21). At baseline and after the three-week symptom-limited cardiopulmonary exercise test, 6-min walk test, Duke Activity Status Index (DASI) and quality of life assessment by the Minnesota Living with Heart Failure Questionnaire (MLHFQ) were performed. Patients in the NMES and BET groups presented with similar increases in the 6-min walk distance, plus 65.0 (50.0; 112.5) and 53.0 (51.0; 78; 0) m; DASI, plus 8.6 (5.5; 11.8) and 8.0 (4.5; 9.0) points; and VO2peak, plus 1.9 (0.3; 3.2) and 2.2 (0.7; 3.2) mL/(min kg), respectively. In the control group, only the 6-min walk distance increased significantly (+21 m). The improvement in the MLHFQ score was observed in all the three groups: maximal in the BET group and minimal in the NMES group. Three weeks of leg muscle electrical stimulation and bicycle training provide similar improvement in physical capacity, daily activity, and the quality of life in patients hospitalized for severe CHF. The efficacy of NMES is comparable with low to moderate intensity interval bicycle training and well tolerated by patients.