Neuromuscular Stimulation Research Articles

Effect of non‐invasive neuroelectric stimulation of oral cavity for obstructive sleep apnoea: A systematic review

AbstractObjectivesWith an estimated disease burden of one billion adults aged 30–69, obstructive sleep apnea (OSA) offers considerable challenges in terms of both identification and management Neuroelectric stimulation offers benefit with studies showing improvement in both the respiratory disturbance index and apnoea‐hypopnoea index. This systematic review aims to examine the effects of non‐invasive neuroelectric stimulation of the oral cavity utilized in the treatment of OSA.MethodsA systematic search of PubMed, EBSCO CINAHL Plus, EBSCO Dentistry and Oral Sciences Source and Wiley Cochrane Library was utilized to identify articles. A total of 4 articles investigating 154 participants were included in the final synthesis. Data was extracted to by two authors (MOA and HI) working independently of each other. Any discrepancies that arose were discussed and resolved.ResultsOur results demonstrated that non‐invasive neurostimulation serves as an avenue for management that can allow for improvements in functionality as well as oxygen saturation amongst patients suffering from mild to moderate OSA.ConclusionDue to the dearth of research, it is imperative that further studies are done to investigate the efficacy of neuromuscular stimulation, as these findings cannot be generalized across different populations.

Functional Magnetic Neuromuscular Stimulation vs. Routine Physiotherapy in the Critically Ill for Prevention of ICU Acquired Muscle Loss: A Randomised Controlled Trial

Background and Objectives: Muscle loss is a known complication of ICU admission. The aim of the study was to investigate the effect of neuromuscular functional magnetic stimulation (FMS) on quadriceps muscle thickness in critically ill patients. Materials and Methods: Among ICU patients one quadriceps was randomized to FMS (Tesla Stym,Iskra Medical, Ljubljana, Slovenia) stimulation and the other to control care. Quadriceps thickness was measured by ultrasound (US) in transversal and longitudinal planes at enrolment, Days 3–5, and Days 9–12. The trial stopped early following an interim analysis comparing muscle thickness differences between groups using repeated measures ANOVA. Results: Of 18 patients randomized, 2 died before completing the trial. The final analysis reported included 16 patients (female 38%, age 68 ± 10 years, SOFA 10.8 ± 2.7). Three mild skin thermal injuries were noted initially, which were later avoided with proper positioning of FMS probe. Primary outcome comparison showed that quadriceps thickness in transversal and longitudinal planes decreased in the non-stimulated legs and, but it did not change in FMS legs (−4.1 mm (95%CI: −9.4 to −0.6) vs. −0.7 mm (95%CI: −4.1 to −0.7) (p = 0.03) and −4.4 mm (95%CI: −8.9 to −1.1) vs. −1.5 mm (95%CI: −2.6 to −2.2) (p = 0.02), respectively) (ANOVA difference between groups p = 0.036 and 0.01, respectively). Conclusions: In the critically ill, neuromuscular FMS is feasible and safe with precautions applied to avoid possible skin thermal injury. FMS decreases the loss of quadriceps muscle thickness.

The Efficacy of Integrating Neuromuscular Electerical Stimulation with Swallowing Training in the Management of Dysphagia Post-stroke Dysphagia: Meta Analysis

The Efficacy of Integrating Neuromuscular Electerical Stimulation with Swallowing Training in the Management of Dysphagia Post-stroke Dysphagia: Meta Analysis

Блокада нервов нижней конечности: показания и преимущества

An inadequate approach to the choice of anesthetic care during surgery and in the postoperative period leads to numerous complications, chronic pain, decreased quality of life, as well as to the formation of a negative patient attitude and dissatisfaction with anesthetic care. Currently, there is a constant search for optimal methods of anesthetic management, especially in high-risk patients. Objective. To summarize and present current information on lower limb nerve blockade. Materials and methods. During the research work, an analysis of dissertations on this topic for 2014–2023 was carried out, and Internet resources Elibrary, Cyberleninka, PubMed for the last 9 years were used, since there are not enough literary sources on this topic from 2018 to 2023. Results. An analysis of Russian and foreign literature for 2014–2023 was given, devoted to such a type of anesthetic management as lower limb nerve blockade. Indications, anatomical features, methods, complications in femoral, obturator and sciatic nerve blockades are described. Conclusion. Due to the use of ultrasound navigation, neuromuscular stimulation, catheter technologies, it has become possible to perform peripheral blockades with a minimal risk of complications, as well as to carry out extended peripheral blockades, which allows to speed up the postoperative recovery of patients. Due to the lack of influence of peripheral blockades on hemodynamics, a smaller number of severe complications inherent in central blockades, anesthesiologists increasingly prefer peripheral blockades when choosing a method of anesthetic support for operations on the lower extremities. This type of anesthesia is offered as an alternative to neuraxial blockades, especially in elderly patients with a high class of physical condition.

Anatomical Registration of Implanted Sensors Improves Accuracy of Trunk Tilt Estimates with a Networked Neuroprosthesis.

For individuals with spinal cord injuries (SCIs) above the midthoracic level, a common complication is the partial or complete loss of trunk stability in the seated position. Functional neuromuscular stimulation (FNS) can restore seated posture and other motor functions after paralysis by applying small electrical currents to the peripheral motor nerves. In particular, the Networked Neuroprosthesis (NNP) is a fully implanted, modular FNS system that is also capable of capturing information from embedded accelerometers for measuring trunk tilt for feedback control of stimulation. The NNP modules containing the accelerometers are located in the body based on surgical constraints. As such, their exact orientations are generally unknown and cannot be easily assessed. In this study, a method for estimating trunk tilt that employed the Gram-Schmidt method to reorient acceleration signals to the anatomical axes of the body was developed and deployed in individuals with SCI using the implanted NNP system. An anatomically realistic model of a human trunk and five accelerometer sensors was developed to verify the accuracy of the reorientation algorithm. Correlation coefficients and root mean square errors (RMSEs) were calculated to compare target trunk tilt estimates and tilt estimates derived from simulated accelerometer signals under a variety of conditions. Simulated trunk tilt estimates with correlation coefficients above 0.92 and RMSEs below 5° were achieved. The algorithm was then applied to accelerometer signals from implanted sensors installed in three NNP recipients. Error analysis was performed by comparing the correlation coefficients and RMSEs derived from trunk tilt estimates calculated from implanted sensor signals to those calculated via motion capture data, which served as the gold standard. NNP-derived trunk tilt estimates exhibited correlation coefficients between 0.80 and 0.95 and RMSEs below 13° for both pitch and roll in most cases. These findings suggest that the algorithm is effective at estimating trunk tilt with the implanted sensors of the NNP system, which implies that the method may be appropriate for extracting feedback signals for control systems for seated stability with NNP technology for individuals who have reduced control of their trunk due to paralysis.

Impact of Geko Neuromuscular Stimulator on Preoperative Preparation in Ankle Fractures.

To explore the impact of the Geko neuromuscular stimulator on preoperative preparation in patients with ankle fractures. Quasi-experiment study. Place and Duration of the Study: Department of Foot and Ankle Surgery and Department of Orthopaedics, Beijing Tongren Hospital, Capital Medical University, Beijing, China, between December 2020 and 2021. This quasi-experiment study included patients with ankle fractures treated with Geko neuromuscular stimulator before surgical fixation. The primary outcome was limb swelling at 24, 48, and 72 hours (h) after admission, and the secondary outcomes were pain according to visual analogue scale (VAS) at 12, 24, and 48 hours after admission, preoperative waiting time, and comfort 4 and 72 h after admission. A total of 60 patients were included in the study; 30 in the conventional treatment group (mean age 41.16 ± 2.01 years) and 30 in the Geko group (mean age 40.22 ± 2.68 years). The limb swelling in patients was significantly different between the Geko and conventional treatment groups (p = 0.004). Besides, the swelling values at 48 (p < 0.001) and 72 (p < 0.001) hours were significantly lower than those at 24 hours. The pain in patients was significantly different between the Geko and conventional treatment groups (p = 0.007). Besides, the swelling values at 24 (p < 0.001) and 48 (p < 0.001) hours are significantly lower than those at 24 hours. Comfort was significantly higher at 4 h (69.54 ± 2.18 vs. 67.22 ± 3.14, p = 0.002) and 72 h [(88.50 (84.00 - 94.00) vs. 82.14 ± 3.08, p < 0.001)] after admission. The preoperative waiting time (3.52 ± 1.8 vs. 5.15 ± 2.1 hours, p = 0.002) was significantly shorter in the Geko group. The Geko neuromuscular stimulator is a useful option for preoperative preparation in patients with ankle fractures to reduce local swelling and pain and improve patients' comfort. Ankle fractures, Lower extremity, Neuromuscular stimulator, Peroneal nerve, Pain.

Reversal of Soleus Muscle Atrophy in Older Adults: A Non-Volitional Exercise Intervention for a Changing Climate.

The World Health Organization recommends that older adults undertake at least 150 minutes of moderate intensity physical activity over the course of each week in order to maintain physical, mental, and social health. This goal turns out to be very difficult for most community dwelling older adults to achieve, due to both actual and perceived barriers. These barriers include personal health limitations, confinement issues, and self-imposed restrictions such as fear of injury. Climate change exacerbates the confinement issues and injury fears among the elderly. To assist older adults in obtaining the benefits of increased physical activity under increasingly challenging climate conditions, we propose a targeted non-volitional intervention which could serve as a complement to volitional physical activity. Exogenous neuro-muscular stimulation of the soleus muscles is a non-invasive intervention capable of significantly increasing cardiac output in sedentary individuals. Long-term daily use has been shown to improve sleep, reduce bone loss, and reverse age-related cognitive decline, all of which are significant health concerns for older adults. These outcomes support the potential benefit of exogenous neuro-muscular stimulation as a complementary form of physical activity which older adults may find convenient to incorporate into their daily life when traditional forms of exercise are difficult to achieve due to barriers to completing traditional physical activities as a result of in-home or in-bed confinement, perceptual risks, or real environmental risks such as those arising from climate change.

Flexible Peripheral Nerve Interfacing Electrode for Joint Position Control in Closed-Loop Neuromuscular Stimulation.

Addressing peripheral nerve disorders with electronic medicine poses significant challenges, especially in replicating the dynamic mechanical properties of nerves and understanding their functionality. In the field of electronic medicine, it is crucial to design a system that thoroughly understands the functions of the nervous system and ensures a stable interface with nervous tissue, facilitating autonomous neural adaptation. Herein, we present a novel neural interface platform that modulates the peripheral nervous system using flexible nerve electrodes and advanced neuromodulation techniques. Specifically, we have developed a surface-based inverse recruitment model for effective joint position control via direct electrical nerve stimulation. Utilizing barycentric coordinates, this model constructs a three-dimensional framework that accurately interpolates inverse isometric recruitment values across various joint positions, thereby enhancing control stability during stimulation. Experimental results from rabbit ankle joint control trials demonstrate our model's effectiveness. In combination with a proportional-integral-derivative (PID) controller, it shows superior performance by achieving reduced settling time (less than 1.63 s), faster rising time (less than 0.39 s), and smaller steady-state error (less than 3 degrees) compared to the legacy model. Moreover, the model's compatibility with recent advances in flexible interfacing technologies and its integration into a closed-loop controlled functional neuromuscular stimulation (FNS) system highlight its potential for precise neuroprosthetic applications in joint position control. This approach marks a significant advancement in the management of neurological disorders with advanced neuroprosthetic solutions.

Results of functional electrical stimulation of leg muscles during walking in a patient in the early recovery period after a stroke

Acute cerebrovascular accident throughout the world remains the main cause of subsequent disability in persons who have suffered a stroke.&#x0D; One promising area is neuromuscular stimulation. Functional electrical stimulation is a subtype of neuromuscular stimulation in which stimulation promotes functional and goal-oriented movements in the individual.&#x0D; A course of functional electrical stimulation was administered while walking to a 74-year-old patient in the late recovery period of an ischemic stroke (the right middle cerebral artery). 14 procedures were performed lasting from 20 to 30 minutes. Before and after the functional electrical stimulation course, a clinical study and a study of the biomechanics of walking were conducted.&#x0D; The results obtained showed an improvement in clinical indicators, inconsistent changes in the time parameters of the step cycle, an increase in amplitudes in the hip and knee joints, as well as normalization of the function of the knee and ankle joints of the paretic side. Functional EMG research showed both an improvement in muscle activity and normalization of their activity profile, as well as processes of function restructuring that require further study.&#x0D; During functional electrical stimulation, there were no negative reactions from the patient or irritation of the skin at the locations of the electrodes.&#x0D; The method of functional electrical stimulation requires further study and reasonable application in this category of patients.

Блокада плечевого сплетения подмышечным доступом. Обзор литературы

The main tasks of an anesthesiologist during the anesthesiological support of surgical interventions are the maximum possible protection of the patient from pain with minimal effect on homeostasis, creating comfortable conditions for the work of operating surgeons. These requirements fully comply with regional paintering methods, especially during operations on the upper limb, when the anesthesiologist has a choice: to perform general anesthesia or blockade of the shoulder plexus. The regional blockade will fully ensure adequate analgesia, hyporeflexia and relaxation in the operation zone. To increase the efficiency and safety of regional blockade, ultrasonic navigation and neuromuscular stimulation are used. One of the safest and easy-to-perform is axillar access. Objective. Summarize and present modern information about the regional blockade of the shoulder plexus from axillary access. Material and methods. During the writing of the article on regional methods of upper limb anesthesia, in particular on axillary access, a literature from open electronic scientific databases of Pubmed, the US National Electronic Medical Library and Databases of the Russian Scientific Electronic Library Elibary was analyzed. Results. An analysis of domestic and foreign literature dedicated to the blockade of the shoulder plexus with axillary access was carried out. The article discusses options for the location of the nerve trunks of the shoulder plexus in the axillary region, the technique of performing the axillar blockade, indications and possible complications. Conclusions. The priority when choosing access when blocking the shoulder plexus is to ensure the safety and efficiency of anesthesia, especially in high-risk patients. Axillar access using sonoscopy and neuromuscular stimulation fully complies with these requirements.

Effectiveness of Proprioceptive Neuromuscular Facilitation Technique on Balance and Mobility in Chronic Stroke Patient

This comprehensive review explores the multifaceted impact of stroke, a cerebrovascular disorder, on individuals, emphasizing the physical, emotional, and cognitive dimensions of its aftermath. Stroke is a major global health concern, contributing significantly to mortality and disability. The immediate consequences involve neurological impairments such as paralysis, speech difficulties, and impaired vision, while the emotional toll includes coping with loss and adjusting to new realities. Long-term cognitive implications affect memory, attention, and executive function, adding complexity to the recovery journey. Communication challenges, physical limitations, and the risk of secondary complications are discussed, highlighting the importance of a continuum of care. The role of caregivers is explored, emphasizing the emotional, physical, and financial burdens they face. Technological innovations, such as virtual reality and robotics, are introduced as promising tools in stroke rehabilitation. The focus then shifts to balance and mobility issues in stroke survivors, particularly the impact of proprioceptive neuromuscular facilitation (PNF) techniques. Proprioceptive neuromuscular facilitation emerges as a dynamic and versatile therapeutic approach, offering promise for improved functional outcomes and enhanced quality of life in the evolving landscape of stroke care and rehabilitation. The review delves into the neurophysiological ballet of PNF, emphasizing neuromuscular stimulation, neuroplasticity, and motor learning. Clinical applications of PNF in orthopaedic, neurological, geriatric, and paediatric rehabilitation are discussed, highlighting its versatility.

Методы немедикаментозной терапии функциональных нарушений голосовой функции

The development of physical and rehabilitation medicine makes it possible to introduce nondrug methods of treatment more widely. Treatment of patients with hypofunctional dysphonia is aimed at improving the condition of the neuromuscular apparatus of the larynx. The number of such patients increased significantly during and after the Covid-19 pandemic. Neuromuscular electrophonopedic stimulation (NMEPS) is a modern method combining physiotherapeutic and voice therapy effects. Objectives. To study the effectiveness of various nondrug treatments methods for hypofunctional dysphonia. Materials and methods. 45 patients with hypofunctional dysphonia were examined. For the treatment of vocal function, 25 patients of the observation group used NMEPS of the larynx, and 20 patients of the comparison group used phonopedic correction. Each course consisted of 10 lessons. A point assessment of patient complaints, an analysis of videoendoscopic end videolaryngostroboscopic signs of hypofunctional dysphonia and the psychoemotional status of patients were performed. Results. Before treatment, there was no significant difference between the groups. After the course of treatment, the number of complaints from patients in the observation group decreased from 10.3±1.1 to 4.1±0.3 points, in the comparison group, from 10.5±0.8 to 6.8±0.4 points (p &lt; 0.05). When analyzing the videoendoscopic picture in the observation group, a significant improvement in most indicators was noted. Normal indicators of the videoendostroboscopic picture were diagnosed in 88% of patients in the observation group and 65% of patients in the comparison group (p &lt; 0.05). In both groups, an improvement in the psychoemotional status during treatment was revealed compared to the initial one. Conclusions. The data obtained confirm the effectiveness of the NMEРS in the treatment of patients with hypofunctional dysphonia.

Therapeutic perspectives of high pulse repetition rate electroporation

Electroporation, a technique that uses electrical pulses to temporarily or permanently destabilize cell membranes, is increasingly used in cancer treatment, gene therapy, and cardiac tissue ablation. Although the technique is efficient, patients report discomfort and pain. Current strategies that aim to minimize pain and muscle contraction rely on the use of pharmacological agents. Nevertheless, technical improvements might be a valuable tool to minimize adverse events, which occur during the application of standard electroporation protocols. One recent technological strategy involves the use of high pulse repetition rate. The emerging technique, also referred as “high frequency” electroporation, employs short (micro to nanosecond) mono or bipolar pulses at repetition rate ranging from a few kHz to a few MHz. This review provides an overview of the historical background of electric field use and its development in therapies over time. With the aim to understand the rationale for novel electroporation protocols development, we briefly describe the physiological background of neuromuscular stimulation and pain caused by exposure to pulsed electric fields. Then, we summarize the current knowledge on electroporation protocols based on high pulse repetition rates. The advantages and limitations of these protocols are described from the perspective of their therapeutic application.

Nerve and neuromuscular stimulation for hemiplegic shoulder pain in stroke patients – a meta-analysis

Nerve and neuromuscular stimulation for hemiplegic shoulder pain in stroke patients – a meta-analysis

A State-Space Control Approach for Tracking Isometric Grip Force During BMI Enabled Neuromuscular Stimulation

A State-Space Control Approach for Tracking Isometric Grip Force During BMI Enabled Neuromuscular Stimulation

Ehlers-Danlos syndrome in the practice of an otorhinolaryngologist: Clinical observation and literature review

The presented own clinical observation showed that functional dysphonia can be one of the clinical manifestations of EhlersDanlo syndrome: it is the deep layer of the own plate of the vocal fold, containing a large amount of collagen, that is most susceptible to changes in this pathology. The patient of the vocal voice for many years: a picture of hypotonic dysphonia was revealed during video pharyngostroboscopy – gaping of the laryngeal ventricles, non-closure of the vocal folds throughout by 1.5–2 mm. Acoustic analysis of the voice showed a decrease and instability in the amplitude of the pitch frequency, a narrowing of the dynamic range, a decrease in the intensity of the voice in the area of individual tones of the transient register, an increase in the level of noise components in the spectrum. The patient underwent a course of neuromuscular electrophonopedic stimulation No. 12 in combination with taking B vitamins for three weeks; after that, an increase in voice endurance was subjectively noted, however, according to the results of phonetography, spectrography and videolaryngostroboscopy, no visible positive dynamics was noted. The rheumatologist revealed hyperextension and increased traumatism of the skin, increased folding of the palms and flat feet. DNA sequencing revealed mutations in the genes and confirmed the diagnosis of Ehlers-Danlo syndrome.

Professional practice profile, treatment preferences, and the bases for clinical, educational, and research among Nigerian physiotherapists

BackgroundPhysiotherapy education and practice have country-specific peculiarities which may limit globalization in health care. This study aimed to characterize physiotherapy practice and treatment preferences, educational qualifications, and research in Nigeria, with a view of providing vital information for transnational integration and collaboration.MethodsA cross-sectional survey of 104 Nigerian physiotherapists was conducted. The Physical Therapy Practice Questionnaire and a self-developed proforma were used as survey tools.ResultsThe mean age of respondents was 33.5 ± 9.4 years. About two-fifth of all respondents (39.4%) had an MSc and mostly practice as clinicians (51.0%) in teaching hospitals (34.6%). The respondents were mostly involved in general practice (50.0%), with a caseload of 1–10 patients per day (67.3%). Soft tissue mobilization (83%), proprioceptive neuromuscular facilitation (76%), breathing exercises (77%), and transcutaneous electrical neuromuscular stimulation (83%) were commonly used. Respondents were familiar databases and evidence-based resources (81.2%) and mostly utilize PubMed (73.3%). Regular case conferences with professional colleagues (47.6%) and treatment planning of between 11 and 30 min (40.6%) were common. Educators spend 1–3 h planning educational work (91.8%). Clinical decision-making is mostly based on professional experience, while journals are the primary resource for educational information.ConclusionPhysiotherapy practice in Nigeria is degree based and requires registration board’s licensure. Practitioners deal with a high caseload and utilize a wide range of techniques and modalities and have tendencies to utilize personal experience and research in making clinical decisions. The parity in education and practice with advanced climes inadvertently gives physiotherapy practice in Nigeria a global purview.

Safety and Feasibility of Functional Repetitive Neuromuscular Magnetic Stimulation of the Gluteal Muscles in Children and Adolescents with Bilateral Spastic Cerebral Palsy.

Background: For children and adolescents affected by bilateral spastic cerebral palsy (BSCP), non-invasive neurostimulation with repetitive neuromuscular magnetic stimulation (rNMS) combined with physical exercises, conceptualized as functional rNMS (frNMS), represents a novel treatment approach. Methods: In this open-label study, six children and two adolescents (10.4 ± 2.5 years) with BSCP received a frNMS intervention targeting the gluteal muscles (12 sessions within 3 weeks). Results: In 77.1% of the sessions, no side effects were reported. In 16.7%, 6.3% and 5.2% of the sessions, a tingling sensation, feelings of pressure/warmth/cold or very shortly lasting pain appeared, respectively. frNMS was highly accepted by families (100% adherence) and highly feasible (97.9% of treatment per training protocol). A total of 100% of participants would repeat frNMS, and 87.5% would recommend it. The Canadian Occupational Performance Measure demonstrated clinically important benefits for performance in 28% and satisfaction in 42% of mobility-related tasks evaluated by caregivers for at least one follow-up time point (6 days and 6 weeks post intervention). Two patients accomplished goal attainment for one mobility-related goal each. One patient experienced improvement for both predefined goals, and another participant experienced improvement in one and outreach of the other goal as assessed with the goal attainment scale. Conclusions: frNMS is a safe and well-accepted neuromodulatory approach that could improve the quality of life, especially in regard to activity and participation, of children and adolescents with BSCP. Larger-scaled studies are needed to further explore the effects of frNMS in this setting.

Neuromodulation in Pediatric Migraine using Repetitive Neuromuscular Magnetic Stimulation: A Feasibility Study.

Migraine has a relevant impact on pediatric health. Non-pharmacological modalities for its management are urgently needed. This study assessed the safety, feasibility, acceptance, and efficacy of repetitive neuromuscular magnetic stimulation (rNMS) in pediatric migraine. A total of 13 patients with migraine, ≥6 headache days during baseline, and ≥1 myofascial trigger point in the upper trapezius muscles (UTM) received six rNMS sessions within 3 weeks. Headache frequency, intensity, and medication intake were monitored using headache calendars; headache-related impairment and quality of life were measured using PedMIDAS and KINDL questionnaires. Muscular involvement was assessed using pressure pain thresholds (PPT). Adherence yielded 100%. In 82% of all rNMS sessions, no side effects occurred. All participants would recommend rNMS and would repeat it. Headache frequency, medication intake, and PedMIDAS scores decreased from baseline to follow-up (FU), trending towards statistical significance (p = 0.089; p = 0.081, p = 0.055). A total of 7 patients were classified as responders, with a ≥25% relative reduction in headache frequency. PPT above the UTM significantly increased from pre- to post-assessment, which sustained until FU (p = 0.015 and 0.026, respectively). rNMS was safe, feasible, well-accepted, and beneficial on the muscular level. The potential to reduce headache-related symptoms together with PPT changes of the targeted UTM may underscore the interplay of peripheral and central mechanisms conceptualized within the trigemino-cervical complex.

Synergic Effect of Isometric Resistance Training and Subthreshold Electrical Neuromuscular Stimulation on the Excitability of Spinal Motoneurons in Humans

Synergic Effect of Isometric Resistance Training and Subthreshold Electrical Neuromuscular Stimulation on the Excitability of Spinal Motoneurons in Humans