Neuromuscular Electrical Stimulation Research Articles

Speech and language therapists' management practices, perceived effectiveness of current treatments and interest in neuromuscular electrical stimulation for acquired dysarthria rehabilitation: An international perspective.

Research is beginning to shed light on the practices employed by speech-language therapists (SLTs) for the management of acquired dysarthria. However, studies that explore SLTs' satisfaction with the effectiveness of current therapies and their interest in new treatment methods for this population have not been carried out. One potential new method is neuromuscular electrical stimulation (NMES): the pool of evidence for its use in rehabilitation is increasing, yet it has not been widely explored for use with dysarthria. To extend the understanding of acquired dysarthria management practices employed by SLTs across the globe and determine their satisfaction with current therapy options. To explore their interest in using NMES with this population. A cross-sectional international online survey was developed and disseminated to SLTs working with adults with acquired dysarthria through international professional associations. The survey collected information on demographic characteristics, dysarthria management practices, satisfaction with treatment effectiveness and interest in and knowledge of NMES. Survey responses were analysed using descriptive and inferential statistics, and quantitative content analysis. A total of 211 SLTs (North America, 48.8%; Europe, 36%; Asia, 8.1%; Oceania, 5.7%; Africa, 0.9%; South America, 0.5%) completed the survey in full. Management practices varied considerably. There was a clear preference for informal assessments, mainly oral-motor examinations, focusing on body functions and structures. The majority of respondents rejected the use of non-speech oral motor exercises as a clinical or carryover exercise. Variable satisfaction with current speech subsystem treatments was noted; however, overall, there was a general dissatisfaction. Whilst a strong interest in the use of NMES for dysarthria was evidenced, it was noted that most SLTs lacked fundamental knowledge of NMES principles and application. SLTs' management practices and satisfaction with acquired dysarthria treatments differed substantially. Investigations of the potential use of NMES for dysarthria treatment are of interest. What is already known on the subject Recent country-specific surveys have explored speech-language therapists' (SLTs') assessment and intervention practices for acquired dysarthria. These studies indicate that although clinical management for this speech disorder mainly involves informal assessment tools and impairment-focused treatment, communication beyond the impairment, such as the activity and participation domains, is also frequently assessed and treated. What this paper adds to existing knowledge The majority of SLTs are dissatisfied with the overall benefits of current acquired dysarthria treatment. Phonatory, respiration and speech rate therapies are perceived to be more effective than prosody, articulation and resonance treatments. Despite a general lack of theoretical knowledge, most SLTs are interested in neuromuscular electrical stimulation treatment for acquired dysarthria. What are the potential or actual clinical implications of this work? New, evidence-based treatments are needed for SLTs to be confident in the effectiveness of their acquired dysarthria treatment.

Topical electrostimulation for correction of respiratory disorders in spinal cord injury: A review

BACKGROUND: A spinal cord injury can lead to paralysis of the respiratory muscles, resulting in a significant reduction in breathing ability. People with a spinal cord injury face an increased risk of developing various respiratory complications. To date, existing effective technologies positively affect the long-term recovery of respiratory function and create conditions for neuroplasticity in the injured spinal cord. The high relevance and lack of systematization of these techniques in the world literature served as the basis for describing a topical approach in electrostimulation for the correction of respiratory disorders in patients with traumatic spinal cord injuries.
 AIM: To formulate an algorithm for topical electrostimulation of the spinal cord and respiratory muscles to correct respiratory dysfunction in patients with spinal cord injury based on the latest scientific literature.
 MATERIALS AND METHODS: This article presents the results of the analysis of peer-reviewed articles that investigated the effects of various electrostimulation techniques on respiratory function in patients with spinal cord injury. Searches were performed on ScienceDirect, Google Scholar, and PubMed for the period from 2000 to 2022.
 RESULTS: A spinal cord and muscle electrostimulation algorithm was formulated to personalize the treatment approach for patients with spinal cord injury depending on the level and period of traumatic spinal cord injury.
 CONCLUSIONS: Electrostimulation techniques were found to be effective in the treatment of spinal cord injuries, particularly for the correction of respiratory disorders. The choice of the appropriate neurostimulation technique depends on the severity, injury level, and period of injury. Noninvasive techniques, such as FES and TSSM, can be used from the acute period to the chronic period, whereas invasive techniques, such as epidural stimulation and respiratory pacemaker placement, are appropriate in the chronic period. Despite the positive results of these techniques, further research is needed to develop effective treatment plans and improve their effectiveness and long-term outcomes.

High-vs medium-frequency neuromuscular electrical stimulation protocols on muscle mass in Intensive Care Unit patients, a pilot study

Aim: The aim of the present study was to investigate whether a high-frequency (HF) neuromuscular electrical stimulation (NMES) protocol could result in a smaller loss of muscle mass than a moderate-frequency (MF) protocol in ICU patients. Methods and materials: In this randomized pilot control trial, patients of the two intervention groups followed daily NMES sessions from the day of ICU admission until the tenth day. All study groups received physiotherapy in terms of usual care. Muscle layer thickness was assessed with ultrasound in the vastusintermedius (VI) and rectus femoris (RF) muscle to evaluate changes in muscle mass. Results: Totally 58 patients were allocated into three groups and 29 were finally analyzed (control: 10, MF: 12, HF: 7). Significant differences (p=0.05) between control and pooled NMES groups were observed for the right RF and VI. Significant differences in favor of HF vs MF group were observed for the left RF (3.6±15.3 vs 7.2±7.9% respectively, p=0.04). No differences were found regarding the number of sessions and presence of oedema (p>0.05), while strength of contraction during sessions tended to be somewhat higher in the HF (p=0.09). Conclusion: HF may be more effective than MF to prevent muscle mass loss in ICU patients. More studies are needed to determine the optimal NMES characteristics.

Physiotherapy in Patients with Stress Urinary Incontinence: A Systematic Review and Meta-analysis.

Physiotherapy is the most commonly used treatment for stress urinary incontinence including pelvic floor muscle training, biofeedback, and electrical stimulation. This systematic review evaluated the effects of physiotherapy in patients with stress urinary incontinence compared with no treatment, placebo, sham, surgery, or other inactive control treatments. MEDLINE (via PubMed), The Cochrane Library (CENTRAL), Embase, Scopus, Web of Science, PEDro, and Trip Database were explored using applicable vocabularies for all English and Persian language investigations released from inception to January 2021. On one side, trials including physiotherapy of pelvic floor muscle training, biofeedback, and electrical stimulation and on the other, either no treatment, placebo, sham, surgery, or other inactive control treatments were included. Studies were assessed for appropriateness and methodological excellence. Two authors extracted data. Disagreements were resolved by a third opinion. Data were processed as described in the Joanna Briggs Institute Handbook. Twenty-nine trials with 2601 participants were found, but only 16 were included because of data heterogeneity. The results showed that physiotherapy interventions are better than no treatment in terms of urine leakage, but no difference was found for urinary incontinence severity. Also, physiotherapy showed favorable results over comparison groups for International Consultation on Incontinence Questionnaire, pad test, pelvic floor muscle function, and improvement outcomes. This systematic review supports the widespread use of pelvic physiotherapy as the first-line treatment for adult patients with stress urinary incontinence.

Impact of subtetanic neuromuscular electrical stimulation on cardiac autonomic nervous system in young individuals.

Although subtetanic neuromuscular electrical stimulation (NMES) has been proposed as an exercise training and/or rehabilitation tool, the impact of NMES on the autonomic nervous system (ANS) is unclear. Thus, we hypothesized that NMES would alter ANS, i.e., increase sympathetic activity and decrease parasympathetic activity, in young individuals. Eighteen healthy young individuals (16 males, mean age: 22 [SD: 4] years, Body Mass Index: 21.7 [2.2] kg/m2) volunteered. Blood pressure (BP), heart rate (HR), and R-R intervals were recorded during 6-minute resting, NMES, and recovery conditions. Short-term heart rate variability analysis of R-R intervals was performed for the frequency and time domains during each condition. Time domain indices included the root mean square of successive R-R interval differences (RMSSD), and the percentage of successive R-R intervals differing by more than 50ms (pRR50%). Frequency domain indices (fast Fourier transform) of R-R intervals included total power (TP), low-frequency (LF) power (0.04-0.15 Hz), and high-frequency (HF) power (0.15-0.4 Hz). BP was not altered but HR was significantly increased during NMES (P<0.001), and it returned to the resting level at recovery. RMSSD and pRR50 decreased from resting to NMES and returned at recovery conditions (P<0.05, respectively). TP and HF decreased from resting to NMES and returned at recovery conditions (P<0.05, respectively). LF increased from NMES to recovery (P<0.05). The LF/HF ratio showed no significant differences between conditions (P=0.210). Cardiac ANS fluctuated by subtetanic NMES without BP elevation in healthy young individuals. Parasympathetic but not sympathetic activity was affected by NMES stimulation.

A randomized trial comparing the effects of electrical stimulation of the quadriceps muscle and decreased trigger sensitivity plus exercise breathing after discharge on mechanically ventilated patients with chronic obstructive pulmonary disease to those receiving standard care in terms of 30-day mortality, hospital readmission, and health-related quality of life

Abstract Background To compare the effectiveness of ES and TS plus exercise breathing after discharge on mechanically ventilated patients with chronic obstructive pulmonary disease (COPD) to those receiving standard care in terms of 30-day mortality, hospital readmission, and health-related quality of life (HRQOL). Patients and methods The current study was a randomized controlled trial. It included 108 newly admitted patients with COPD to RICU, Chest Department, Assiut University Hospital, Egypt, between June 2018 and May 2020. They were divided into two groups: group I received the usual care plus ES and TS plus breathing exercise, and group II received the usual care alone. Thirty-day mortality, hospital readmission, and HRQOL assessed by MFR-28 were recorded and evaluated. Student t test, Mann–Whitney U test, χ 2 test, and Fisher exact test were performed to analyze the data. Results A total of 108 patients with COPD were included. Early rehabilitation program (ES and TS) plus exercise breathing for patients with COPD in the ICU showed decreased 30-day mortality, decreased hospital readmission, and improved HRQOL as compared with patients with COPD who received usual care. Conclusion Patients with COPD who were treated with an early rehabilitation program (ES and TS) combined with exercise breathing had a better prognosis and a higher QOL. Clinical trial.gov The study was registered under NCT03253380.

Effects of Gastrocnemius Neuromuscular Electrical Stimulation Training on Ankle mobility and Gait in Patients with Stroke

Effects of Gastrocnemius Neuromuscular Electrical Stimulation Training on Ankle mobility and Gait in Patients with Stroke

Method of Electrical Muscle Stimulation for Training FPS Game Players in the Timing of Shots

In first-person shooter (FPS) games, players often need to calculate the timing of their shots for moving targets in advance based on the speed and relative position of those targets. For most players, the accurate timing of shots requires extended gaming experience and training. Unlike professional players, hobby players have less time to compete and train, do not receive professional game guidance, and cannot afford expensive gaming devices. According to previous studies, wearable devices with electrical stimulation can effectively control the muscles with rapid reactions. Here, we provide a method for training the timing of gaming shooters using electrical muscle stimulation (EMS). We believe that training with EMS is feasible and effective, allowing players to quickly learn and improve their gaming experience. To test the feasibility and effectiveness of our approach, we first tested the player's reaction time when using the EMS device to ensure that it did not have a negative impact on the player. Participants were then trained in a custom FPS game with three methods: EMS, non-EMS and EMS-only. The results showed a more significant increase in the average hit rate of EMS-trained participants compared to those trained using the other two methods. Thus, our study shows the possibility of using EMS devices as a training medium for a custom FPS game.

Effect of Forearm Postures and Elbow Joint Angles on Elbow Flexion Torque and Mechanomyography in Neuromuscular Electrical Stimulation of the Biceps Brachii.

Neuromuscular electrical stimulation plays a pivotal role in rehabilitating muscle function among individuals with neurological impairment. However, there remains uncertainty regarding whether the muscle's response to electrical excitation is affected by forearm posture, joint angle, or a combination of both factors. This study aimed to investigate the effects of forearm postures and elbow joint angles on the muscle torque and MMG signals. Measurements of the torque around the elbow and MMG of the biceps brachii (BB) muscle were conducted in 36 healthy subjects (age, 22.24 ± 2.94 years; height, 172 ± 0.5 cm; and weight, 67.01 ± 7.22 kg) using an in-house elbow flexion testbed and neuromuscular electrical stimulation (NMES) of the BB muscle. The BB muscle was stimulated while the forearm was positioned in the neutral, pronation, or supination positions. The elbow was flexed at angles of 10°, 30°, 60°, and 90°. The study analyzed the impact of the forearm posture(s) and elbow joint angle(s) on the root-mean-square value of the torque (TQRMS). Subsequently, various MMG parameters, such as the root-mean-square value (MMGRMS), the mean power frequency (MMGMPF), and the median frequency (MMGMDF), were analyzed along the longitudinal, lateral, and transverse axes of the BB muscle fibers. The test-retest interclass correlation coefficient (ICC21) for the torque and MMG ranged from 0.522 to 0.828. Repeated-measure ANOVAs showed that the forearm posture and elbow flexion angle significantly influenced the TQRMS (p < 0.05). Similarly, the MMGRMS, MMGMPF, and MMGMDF showed significant differences among all the postures and angles (p < 0.05). However, the combined main effect of the forearm posture and elbow joint angle was insignificant along the longitudinal axis (p > 0.05). The study also found that the MMGRMS and TQRMS increased with increases in the joint angle from 10° to 60° and decreased at greater angles. However, during this investigation, the MMGMPF and MMGMDF exhibited a consistent decrease in response to increases in the joint angle for the lateral and transverse axes of the BB muscle. These findings suggest that the muscle contraction evoked by NMES may be influenced by the interplay between actin and myosin filaments, which are responsible for muscle contraction and are, in turn, influenced by the muscle length. Because restoring the function of limbs is a common goal in rehabilitation services, the use of MMG in the development of methods that may enable the real-time tracking of exact muscle dimensional changes and activation levels is imperative.

Auto-Paizo Games: Towards Understanding the Design of Games That Aim to Unify a Player’s Physical Body and the Virtual World

Most digital bodily games focus on the body as they use movement as input. However, they also draw the player’s focus away from the body as the output occurs on visual displays, creating a divide between the physical body and the virtual world. We propose a novel approach – the "Body as a Play Material" – where a player uses their body as both input and output to unify the physical body and the virtual world. To showcase this approach, we designed three games where a player uses one of their hands (input) to play against the other hand (output) by loaning control over its movements to an Electrical Muscle Stimulation (EMS) system. We conducted a thematic analysis on the data obtained from a field study with 12 participants to articulate four player experience themes. We discuss our results about how participants appreciated the engagement with the variety of bodily movements for play and the ambiguity of using their body as a play material. Ultimately, our work aims to unify the physical body and the virtual world.

Fused Spectatorship: Designing Bodily Experiences Where Spectators Become Players

Spectating digital games can be exciting. However, due to its vicarious nature, spectators often wish to engage in the gameplay beyond just watching and cheering. To blur the boundaries between spectators and players, we propose a novel approach called "Fused Spectatorship", where spectators watch their hands play games by loaning bodily control to a computational Electrical Muscle Stimulation (EMS) system. To showcase this concept, we designed three games where spectators loan control over both their hands to the EMS system and watch them play these competitive and collaborative games. A study with 12 participants suggested that participants could not distinguish if they were watching their hands play, or if they were playing the games themselves. We used our results to articulate four spectator experience themes and four fused spectator types, the behaviours they elicited and offer one design consideration to support each of these behaviours. We also discuss the ethical design considerations of our approach to help game designers create future fused spectatorship experiences.

Effect of structured pelvic floor muscle training on pelvic floor muscle contraction and treatment of pelvic organ prolapse in postpartum women: ultrasound and clinical evaluations.

The purpose of this study is to examine the impact of structured pelvic floor muscle training (PFMT) on pelvic floor muscle (PFM) contraction and the treatment of pelvic organ prolapse (POP) in postpartum women. Sixty patients who volunteered for a PFMT assessment at 6-8weeks after delivery were included in this retrospective analysis. For 5 weeks, all patients had structured PFMT, which included supervised daily pelvic muscle contractions, biofeedback therapy, and electrical stimulation. The main outcomes were POP stage assessed by POP quantification (POP-Q), pelvic organ position and hiatus area (HA) assessed by transperineal ultrasound, PFM contraction assessed by Modified Oxford scale (MOS), surface electromyography (EMG), and sensation of PFM graded using visual analog scale (VAS). Structured PFMT was associated with better POP-Q scores in Aa, Ba, C, and D (p values were 0.01, 0.001, 0.017, and 0.001 separately). The bladder neck at rest and maximum Valsalva, the cervix position and HA at maximum Valsalva in transperineal ultrasound were significantly better than before (p values were 0.031, < 0.001, 0.043, and < 0.001 separately). PFM contraction assessed by MOS, EMG, and PFM VAS score were significantly improved (all p values were < 0.001). However, no significant improvement was observed in POP-Q stage. Structured PFMT can increase PFM function in postpartum women but cannot modify the POP-Q stage. Transperineal ultrasonography is a useful method for evaluating therapy efficacy objectively. More randomized controlled trials are needed before definitive conclusions can be drawn about the effect of structured PFMT on POP in postpartum women.

Do Electrical Stimulation Devices Reduce Pain and Improve Function?-A Comparative Review.

Multiple forms of electrical stimulation (ES) potentially offer widely varying clinical benefits. Diminished function commonly associated with acute and chronic pain lessens productivity and increases medical costs. This review aims to compare the relative effects of various forms of ES on functional and pain outcomes. A comprehensive literature search focused on studies of commonly marketed forms of ES used for treatment of pain and improvement of function. Peer-reviewed manuscripts were categorized as "Important" (systematic review or meta-analysis, randomized controlled trial, observational cohort study) and "Minor" (retrospective case series, case report, opinion review) for each identified form of ES. Varying forms of ES have markedly different technical parameters, applications, and indications, based on clinically meaningful impact on pain perception, function improvement, and medication reduction. Despite being around for decades, there is limited quality evidence for most forms of ES, although there are several notable exceptions for treatment of specific indications. Neuromuscular electrical stimulation (NMES) has well-demonstrated beneficial effects for rehabilitation of selective spinal cord injured (SCI), post-stroke, and debilitated inpatients. Functional electrical stimulation (FES) has similarly shown effectiveness in rehabilitation of some stroke, SCI, and foot drop outpatients. H-Wave® device stimulation (HWDS) has moderate supportive evidence for treatment of acute and refractory chronic pain, consistently demonstrating improvements in function and pain measures across diverse populations. Interestingly, transcutaneous electrical nerve stimulation (TENS), the most widely used form of ES, demonstrated insignificant or very low levels of pain and functional improvement. Ten of 13 reviewed forms of ES have only limited quality evidence for clinically significant reduction of pain or improvement of function across different patient populations. NMES and FES have reasonably demonstrated effectiveness, albeit for specific clinical rehabilitation indications. HWDS was associated with the most clinically significant outcomes, in terms of functional improvement combined with reduction of pain and medication use. More rigorous long-term clinical trials are needed to further validate appropriate use and specific indications for most forms of ES. II.

Neuromuscular Electrical Stimulation for Intermittent Claudication (NESIC): multicentre, randomized controlled trial.

This was an open, multicentre, randomized controlled trial. Patients with intermittent claudication attending vascular surgery outpatient clinics were randomized (1:1) to receive either neuromuscular electrical stimulation (NMES) or not in addition to local standard care available at study centres (best medical therapy alone or plus supervised exercise therapy (SET)). The objective of this trial was to investigate the clinical efficacy of an NMES device in addition to local standard care in improving walking distances in patients with claudication. The primary outcome was change in absolute walking distance, measured by a standardized treadmill test at 3 months. Secondary outcomes included intermittent claudication (IC) distance, adherence, quality of life, and haemodynamic changes. Of 200 participants randomized, 160 were included in the primary analysis (intention to treat, Tobit regression model). The square root of absolute walking distance was analysed (due to a right-skewed distribution) and, although adjunctive NMES improved it at 3 months, no statistically significant effect was observed. SET as local standard care seemed to improve distance compared to best medical therapy at 3 months (3.29 units; 95 per cent c.i., 1.77 to 4.82; P < 0.001). Adjunctive NMES improved distance in mild claudication (2.88 units; 95 per cent c.i., 0.51 to 5.25; P = 0.02) compared to local standard care at 3 months. No serious adverse events relating to the device were reported. Supervised exercise therapy is effective and NMES may provide further benefit in mild IC.This trial was supported by a grant from the Efficacy and Mechanism Evaluation Program, a Medical Research Council and National Institute for Health and Care Research partnership. Trial registration: ISRCTN18242823.

Non-invasive Body Contouring Technologies: An Updated Narrative Review.

Nowadays, a lot of body contouring devices and methods are introduced all over the world. The object of the present narrative review was to update and classify existing evidence on these methods and devices. We searched databases including PubMed, Cochrane, and Google Scholar for 11 essential keywords, including cryolipolysis, high-intensity focused ultrasound (HIFU), shock wave, low-level laser therapy (LLLT), radiofrequency (RF), capacitive resistive electrical transfer (TECAR), high-intensity focused electromagnetic (HIFEM), electromyostimulation (EMS), carboxytherapy, mesotherapy, and acupuncture and their abbreviations, in addition to obesity, overweight, cellulite, subcutaneous fat, and body contouring. Totally 193 references were used in 11 main topics. In order to help physicians with finding the best evidence in different methods, the data were summarised in 11 topics. Furthermore, FDA-approved devices, side effects and common protocols were described in each section. This journal requires that authors 39 assign a level of evidence to each article. For a full 40 description of these Evidence-Based Medicine ratings, 41 please refer to the Table of Contents or the online 42 Instructions to Authors www.springer.com/00266 .

Model of Electrical Stimulation of Back Muscles in the Treatment of Scoliosis

The article presents a three-dimensional model of the tissues of the human back in the ZBrush and SolidWorks software packages. Modeling of the spinal column with a bend, muscles, adipose tissue and skin was performed. Using the COMSOL Multiphysics environment, the effects of electrical stimulation on biological objects are modeled, and characteristics are determined. When modeling, in the properties of each biological tissue, the values of electrical conductivity and relative permittivity were set, the electrodes were adjusted, a grid was created to divide the models into smaller parts and elements, and the required frequency was adjusted. To verify the simulation results, a study was carried out on the patient, the calculation and analysis of the results obtained. The developed models can be used in clinical medicine to determine the strength of the stimulating current and set the parameters of electrical stimulation. When building a model, one can change the thickness of adipose tissue, skin, muscle and bone sizes, change the size of the electrodes, and thereby select the most optimal parameters for electrical stimulation. Models can be used in the development of the most effective method of electrical stimulation and the scheme for applying electrodes for a certain type of scoliosis.

Efficacy of rehabilitation initiated in the early phase after simultaneous deceased donor liver and kidney transplantation: A case report.

The purpose of this case report is to describe a case of successful early rehabilitation intervention for simultaneous liver and kidney transplantation (SLKT). A 51-year-old Japanese man was diagnosed with Caroli disease 27 years ago. Hemodialysis was introduced due to end-stage renal disease 17 years ago. After successful SLKT, the patient was extubated on postoperative day (POD) 1, liberated from dialysis on POD 4, and discharged from the intensive care unit on POD 9. Supervised rehabilitation was started on POD 2, and the patient was able to walk 100 m on POD 9. Electrical muscle stimulation therapy was started to improve muscle weakness in both legs on POD 16, and aerobic exercise using a cycle-ergometer was started on POD 24. The 6-minute walking distance improved from 324 m on POD 14 to 501 m on POD 28. The patient could walk 4000 to 5000 steps per day at hospital discharge, and was discharged home on POD 32. There were no adverse events, including worsening hepatic or renal function, during the rehabilitation period. One month after discharge, the patient was able to perform 30 to 40 minutes of aerobic exercise every day, and returned to work 5 months after discharge. This case shows that early rehabilitation intervention immediately after SLKT safely and rapidly improved physical performance without adverse events. The results in the present case suggest that regular physical assessment and appropriate interventions with a variety of exercise modalities can contribute to improved physical performance in SLKT patients.

Effectiveness of neuromuscular electrical stimulation in severe acute pancreatitis complicated patients with acute respiratory distress syndrome: study protocol for a randomized controlled trial

BackgroundSevere acute pancreatitis complicated by acute respiratory distress is a common cause of intensive care unit (ICU) admission. These patients are at risk of a decline in physical activity due to bed rest. Neuromuscular electrical stimulation (NMES) has been recommended for ICU patients to strengthen muscles, but its effects on muscle atrophy, respiratory function, multiple organ dysfunction, and functional status of these patients remain to be proven.MethodsPatients (n = 80) will be prospectively randomized into an NMES group and a control group. The NMES group will receive NMES for 1 h per day for 7 days, and both the control and NMES groups will receive usual care. The efficacy will be assessed by an experienced physiotherapist and sonographer who will be blinded to the patient’s group assignment. Muscle power assessment (MRC scale), lower extremity circumference, grip strength, activities of daily living (Barthel index), and Marshall scores will be measured at baseline and posttreatment. The functions of the diaphragm assessments will be measured daily. Barthel index measurements will be followed up in the 1st month, 3rd month, and 6th month after discharge.DiscussionThe trial will explore the effectiveness of NMES in functional status and diaphragm function in patients with SAP complicated with ARDS. The results of this trial will provide strong evidence of the efficacy of NMES in treating SAP patients with ARDS.Trial registrationThis trial has been registered at the Chinese Clinical Trial Registry, and the registry name is “Effectiveness of neuromuscular electrical stimulation in severe acute pancreatitis complicated patients with acute respiratory distress syndrome: study protocol for a randomized controlled trial,” URL: https://www.chictr.org.cn, numbered ChiCTR2300068995. Date of Registration: 2023-03-03.

Temporal Dynamics of Brain Activity Predicting Sense of Agency over Muscle Movements.

Our muscles are the primary means through which we affect the external world, and the sense of agency (SoA) over the action through those muscles is fundamental to our self-awareness. However, SoA research to date has focused almost exclusively on agency over action outcomes rather than over the musculature itself, as it was believed that SoA over the musculature could not be manipulated directly. Drawing on methods from human-computer interaction and adaptive experimentation, we use human-in-the-loop Bayesian optimization to tune the timing of electrical muscle stimulation so as to robustly elicit a SoA over electrically actuated muscle movements in male and female human subjects. We use time-resolved decoding of subjects' EEG to estimate the time course of neural activity which predicts reported agency on a trial-by-trial basis. Like paradigms which assess SoA over action consequences, we found that the late (post-conscious) neural activity predicts SoA. Unlike typical paradigms, however, we also find patterns of early (sensorimotor) activity with distinct temporal dynamics predicts agency over muscle movements, suggesting that the "neural correlates of agency" may depend on the level of abstraction (i.e., direct sensorimotor feedback versus downstream consequences) most relevant to a given agency judgment. Moreover, fractal analysis of the EEG suggests that SoA-contingent dynamics of neural activity may modulate the sensitivity of the motor system to external input.SIGNIFICANCE STATEMENT The sense of agency, the feeling of "I did that," when directing one's own musculature is a core feature of human experience. We show that we can robustly manipulate the sense of agency over electrically actuated muscle movements, and we investigate the time course of neural activity that predicts the sense of agency over these actuated movements. We find evidence of two distinct neural processes: a transient sequence of patterns that begins in the early sensorineural response to muscle stimulation and a later, sustained signature of agency. These results shed light on the neural mechanisms by which we experience our movements as volitional.

Effect of Device-Assisted Therapy in Children With Oropharyngeal Dysphagia: A Rapid Review

Purpose: The purpose of this study was to determine the state of the evidence regarding device-assisted therapy for swallowing physiology and functional feeding outcomes in children with oropharyngeal dysphagia. Method: This rapid review methodology identified relevant literature through a narrow search strategy applied to three relevant databases using search strategies specific to the electronic database and searching the following keywords and their variations: “pediatric,” “dysphagia,” “device-assisted,” and “therapy.” Searches took place between February and March 2023. Device-assisted therapy was defined as therapy that utilized instruments capable of providing objective data about patient performance and/or providing mechanically controlled external stimulation to the client during therapy. Results: This rapid review identified seven peer-reviewed journal articles relating to device-assisted dysphagia therapy in pediatric patients, 1–18 years of age. Most of the included articles were observational in nature and reported on the impact of neuromuscular electrical stimulation on swallowing physiology in children. Critical appraisal of the experimental articles revealed generally small sample size and low methodological quality. Conclusions: This rapid review indicates that there is limited empirical evidence to support the use of device-assisted therapeutic modalities in children with oropharyngeal dysphagia 1–18 years of age. Further research into the effect of device-assisted therapeutic modalities on swallowing physiology and functional feeding outcomes in pediatric populations is immediately required.