Sessions Of Electrical Stimulation Research Articles

Single-session cortical electrical stimulation enhances the efficacy of rehabilitative motor training after spinal cord injury in rats

Low neuronal cAMP levels in adults and a further decline following traumatic central nervous system (CNS) injury has been associated with the limited ability of neurons to regenerate. An approach to increase neuronal cAMP levels post injury is electrical stimulation. Stimulation as a tool to promote neuronal growth has largely been studied in the peripheral nervous system or in spared fibers of the CNS and this research suggests that a single session of electrical stimulation is sufficient to initiate a long-lasting axonal growth program. Here, we sought to promote plasticity and growth of the injured corticospinal tract with electrical cortical stimulation immediately after its spinal injury. Moreover, given the importance of rehabilitative motor training in the clinical setting and in translating plasticity into functional recovery, we applied training as a standard treatment to all rats (i.e., with or without electrical stimulation). Our findings show that electrical cortical stimulation did improve recovery in forelimb function compared to the recovery in unstimulated animals. This recovery is likely linked to increased corticospinal tract plasticity as evidenced by a significant increase in sprouting of collaterals above the lesion site, but not to increased regenerative growth through the lesion itself.

Effects of a Robot-Assisted Arm Training Plus Hand Functional Electrical Stimulation on Recovery After Stroke: A Randomized Clinical Trial

ObjectiveTo compare the effects of unilateral, proximal arm robot-assisted therapy combined with hand functional electrical stimulation with intensive conventional therapy for restoring arm function in survivors of subacute stroke. DesignThis was a single-blinded, randomized controlled trial. SettingInpatient rehabilitation university hospital. ParticipantsPatients (N=40) diagnosed as having ischemic stroke (time since stroke <8wk) and upper limb impairment were enrolled. InterventionsParticipants randomized to the experimental group received 30 sessions (5 sessions/wk) of robot-assisted arm therapy and hand functional electrical stimulation (RAT+FES). Participants randomized to the control group received a time-matched intensive conventional therapy. Main Outcome MeasuresThe primary outcome was arm motor recovery measured with the Fugl-Meyer Motor Assessment. Secondary outcomes included motor function, arm spasticity, and activities of daily living. Measurements were performed at baseline, after 3 weeks, at the end of treatment, and at 6-month follow-up. Presence of motor evoked potentials (MEPs) was also measured at baseline. ResultsBoth groups significantly improved all outcome measures except for spasticity without differences between groups. Patients with moderate impairment and presence of MEPs who underwent early rehabilitation (<30d post stroke) demonstrated the greatest clinical improvements. ConclusionsRAT+FES was no more effective than intensive conventional arm training. However, at the same level of arm impairment and corticospinal tract integrity, it induced a higher level of arm recovery.

A single session of brief electrical stimulation enhances axon regeneration through nerve autografts

Nerve graft reconstruction of gap defects may result in poor clinical outcomes, particularly with long regeneration distances. Electrical stimulation (ES) of nerves may improve outcomes in such patients. A single session of ES at 20 Hz for 1 h significantly enhances axon regeneration in animals and human subjects after nerve crush or nerve transection and repair. The objectives of this study were to evaluate if ES enhances axon regeneration through nerve grafts and if there is added benefit of a second, delayed session of ES (serial ES) on axon regeneration as compared to a single session only of ES. In female rats, a gap defect was created in the hindlimb common peroneal (CP) nerve and immediately reconstructed with a 10 mm nerve autograft (Experiment 1) or a 20 mm nerve autograft (Experiment 2). In Experiment 1, rats were randomized to 1 h of CP nerve ES or sham stimulation. In Experiment 2, rats were randomized to control (sham ES + sham ES), single ES (ES + sham ES), or serial ES (ES + ES), which consisted of an initial 1 h session of either ES or sham stimulation of the CP nerve, followed by a second 1 h session of ES or sham stimulation of the CP nerve 4 weeks later. In both experiments, after a 6 week period of nerve regeneration, CP neurons that had regenerated axons distal to the autograft were retrograde labelled for enumeration, and the CP nerve distal to the autograft was harvested for histomorphometry. In Experiment 1, rats that received CP nerve ES had statistically significantly more motor (p < .05) and sensory (p < .05) neurons that regenerated axons distal to the 10 mm nerve autograft, with more myelinated axons on histomorphometry (p < .001). Similarly, in Experiment 2, significantly more motor (p < .01) and sensory (p < .05) neurons regenerated axons distal to the 20 mm nerve autograft after a single session or two sessions of CP nerve ES. There was no significant difference in the number of regenerated motor or sensory neurons between rats with 20 mm CP nerve autografts receiving either one or two sessions of CP nerve ES (p > .05). In conclusion, a single session of ES enhances axon regeneration following nerve autografting with no added effect of a second, delayed session of ES. These findings support previous studies in animals and humans of the robust effect of a single session of ES in promoting nerve regeneration following injury and repair.

Impact of stimulation frequency on neuromuscular fatigue.

The aim of the present study was to examine the frequency effects (20Hz and 100Hz) on neuromuscular fatigue using stimulation parameters favoring an indirect motor unit recruitment through the afferent pathway. Nineteen subjects were divided into two groups: 20Hz (n = 10) and 100Hz (n = 9). The electrical stimulation session consisted of 25 stimulation trains (20s ON/20s OFF, pulse width: 1ms) applied over the tibial nerve and delivered at an intensity evoking 10% maximal voluntary isometric contraction (MVIC). Before and after these protocols, MVIC was assessed, while neural changes were evaluated by the level of activation (VAL) and muscle changes were evaluated by the twitch associated with the maximal M-wave (Pt). For all stimulation trains, the real and the theoretical values of the torque-time integral (TTIr and TTIth, respectively) were calculated. The TTIr/TTIth ratio of the first train was calculated to evaluate the presence of extra torque. The main results showed a similar decrease in MVIC torque after both protocols accompanied by neural and muscle changes, as evidenced by the decrease in VAL and Pt. TTIr values across the 20-Hz trains remained constant, whereas they significantly decreased during the 100-Hz stimulation trains. The relative MVIC decrease was negatively correlated with TTIr/TTIth. Results give evidence of an identical neuromuscular fatigue development between protocols, while lower stimulation frequency permitted preservation of a given torque level during the stimulation trains. The negative correlation between this fatigue development and TTIr/TTIth suggests that extra torque production induces greater voluntary torque losses.

Bilateral Contralaterally Controlled Functional Electrical Stimulation Reveals New Insights Into the Interhemispheric Competition Model in Chronic Stroke

Background. Upper-limb chronic stroke hemiplegia was once thought to persist because of disproportionate amounts of inhibition imposed from the contralesional on the ipsilesional hemisphere. Thus, one rehabilitation strategy involves discouraging engagement of the contralesional hemisphere by only engaging the impaired upper limb with intensive unilateral activities. However, this premise has recently been debated and has been shown to be task specific and/or apply only to a subset of the stroke population. Bilateral rehabilitation, conversely, engages both hemispheres and has been shown to benefit motor recovery. To determine what neurophysiological strategies bilateral therapies may engage, we compared the effects of a bilateral and unilateral based therapy using transcranial magnetic stimulation. Methods. We adopted a peripheral electrical stimulation paradigm where participants received 1 session of bilateral contralaterally controlled functional electrical stimulation (CCFES) and 1 session of unilateral cyclic neuromuscular electrical stimulation (cNMES) in a repeated-measures design. In all, 15 chronic stroke participants with a wide range of motor impairments (upper extremity Fugl-Meyer score: 15 [severe] to 63 [mild]) underwent single 1-hour sessions of CCFES and cNMES. We measured whether CCFES and cNMES produced different effects on interhemispheric inhibition (IHI) to the ipsilesional hemisphere, ipsilesional corticospinal output, and ipsilateral corticospinal output originating from the contralesional hemisphere. Results. CCFES reduced IHI and maintained ipsilesional output when compared with cNMES. We found no effect on ipsilateral output for either condition. Finally, the less-impaired participants demonstrated a greater increase in ipsilesional output following CCFES. Conclusions. Our results suggest that bilateral therapies are capable of alleviating inhibition on the ipsilesional hemisphere and enhancing output to the paretic limb.

Towards a mechanistic understanding of brain stimulation

Repetitive TMS (rTMS) represent the front-line of innovative approaches to correct dysfunctional brain networks. rTMS is FDA-approved for patients with depression, OCD and clinical trials for PTSD and substance use are underway. Despite this increasing use, knowledge of how repetitive stimulation induces brain plasticity in humans is critically lacking and will be necessary to develop next-generation personalized brain stimulation treatments. Here, we investigate the neural mechanisms underlying rTMS using direct brain recordings with high spatiotemporal resolution. We applied a single session of 10Hz prefrontal electrical stimulation, patterned to mimic rTMS, and measured intracranial EEG in 15 patients with medically-intractable epilepsy. We found that cortical regions (1) anatomically close to the stimulated site and (2) exhibiting strong evoked potentials underwent changes in excitability following stimulation. We demonstrate high accuracy (72–95%) and discriminability (81–99%) in predicting regions exhibiting changes using individual subjects’ pre-stimulation connectivity profile. We next investigated the brain dynamics during stimulation to determine how brain plasticity is induced. In each patient, we observed a four-phase response to repetitive stimulation, consisting of acute neural changes during and directly after each stimulation train as well as a buildup of effects across stimulation trains. The neural response to just one minute of stimulation reliably predicted long-term brain changes. Together this work sheds light on the mechanism underlying plasticity induction in humans. Furthermore, utilization of pre-stimulation network attributes and intra-stimulation cortical dynamics can be utilized to optimize brain stimulation technologies.

Effect of an electrical stimulation session on the right inferior frontal gyrus on the response inhibition

Introduction: Response inhibition is an executive function. This executive function is an important mental process necessary for behavior regulation and avoidance. The role of the right inferior frontal gyrus in the frontal lobe has been highlighted in recent studies on this function.

Effects of quadriceps muscle neuromuscular electrical stimulation in living donor liver transplant recipients: phase-II single-blinded randomized controlled trial

Objective: To evaluate the efficacy of neuromuscular electrical stimulation on quadriceps muscle strength and thickness in liver transplantation patients. Design: Phase-II, randomized, parallel-group, allocation-concealed, assessor-blinded, single-center controlled trial. Setting: Inpatient rehabilitation sector. Subjects: Patients following living donor liver transplantation. Interventions: The quadriceps muscle stimulation and the control groups received bilateral muscle electrical stimulation on the quadriceps and tibialis anterior muscles, respectively. Neuromuscular electrical stimulation sessions in both groups were conducted for 30 minutes per session, once per day for five weekdays over four weeks by a physical therapist. Main measures: Quadriceps muscle strength and quadriceps muscle thickness. Results: Neuromuscular electrical stimulation was applied to the quadriceps muscles group (n = 23) or the tibialis anterior muscle in the control group (n = 22). The decrease in quadriceps muscle thickness differed significantly between both groups on postoperative day 30 (median −3 vs −8, P < 0.01). The changes in predicted quadriceps strength and 6 minutes walking distance were not significantly different between groups (quadriceps strength median −12% vs −5%, P = 0.40; 6 minutes walking distance median −18 vs −21 m, P = 0.74). Conclusion: Neuromuscular electrical stimulation of the quadriceps muscle for liver transplantation recipients was able to maintain the quadriceps muscle thickness after surgery. Future larger scale studies are needed to consider the effectiveness of neuromuscular electrical stimulation and how to incorporate this intervention in the overall strategy of the physical therapy program.

Neuromuscular Electrical Stimulation on Hemodynamic and Respiratory Response in Patients Submitted to Cardiac Surgery: Pilot Randomized Clinical Trial

Abstract Background: Neuromuscular electrical stimulation seems to be a promising option to intensify the rehabilitation and improve the exercise capacity of patients in the immediate postoperative period of cardiac surgery. Objective: This study aimed to evaluate the hemodynamic (heart rate, systolic blood pressure, diastolic blood pressure, and mean blood pressure) and respiratory (respiratory rate and oxygen saturation) responses to neuromuscular electrical stimulation in the immediate postoperative period in patients submitted to cardiac surgery and to verify its feasibility and safety. Methods: This is a pilot randomized controlled trial, wherein critical patients in the immediate postoperative period of cardiac surgery were randomly assigned to a control group, using sham neuromuscular electrical stimulation, or an experimental group, submitted to neuromuscular electrical stimulation sessions (FES), for 60 min, with a 50-Hz frequency, 200-µs pulse duration, time on: 3 s, and time off: 9 s. Data distribution was evaluated by the Shapiro-Wilk test. The analysis of variance was used and a p-value < 0.05 was considered significant. Results: Thirty patients were included in the study. The neuromuscular electrical stimulation was applied within the first 23.13 ± 5.24 h after cardiac surgery, and no changes were found regarding the hemodynamic and respiratory variables between the patients who underwent neuromuscular electrical stimulation, and those in the control group. Conclusions: In the present study, neuromuscular electrical stimulation did not promote changes in hemodynamic and respiratory responses of patients in the immediate postoperative period of cardiac surgery.

Methods to monitor accurate and consistent electrode placements in conventional transcranial electrical stimulation

BackgroundInaccurate electrode placement and electrode drift during a transcranial electrical stimulation (tES) session have been shown to alter predicted field distributions in the brain and thus may contribute to a large variation in tES study outcomes. Currently, there is no objective and independent measure to quantify electrode placement accuracy/drift in tES clinical studies. Objective/hypothesisWe proposed and tested novel methods to quantify accurate and consistent electrode placements in tES using models generated from a 3D scanner. MethodsAccurate electrode placements were quantified as Discrepancy in eight tES participants by comparing landmark distances of physical electrode locations F3/F4 to their model counterparts. Distances in models were computed using curve and linear based methods. Variability of landmark locations in a single subject was computed for multiple stimulation sessions to determine consistent electrode placements across four experimenters. Main resultsWe obtained an average of 0.4 cm in Discrepancy, which was within the placement accuracy/drift threshold (1 cm) for conventional tES electrodes (∼35 cm2) to achieve reliable tES sessions suggested in the literature. Averaged Variability was 5.2%, with F4 electrode location as the least consistent placement. ConclusionsThese methods provide objective feedback for experimenters on their performance in placing tES electrodes. Applications of these methods can be used to monitor electrode locations in tES studies of a larger cohort using F3/F4 montage and other conventional electrode arrangements. Future studies may include co-registering the landmark locations with imaging-derived head models to quantify the effects of electrode accuracy/drift on predicted field distributions in the brain.

Effect of Transcutaneous Electrical Nerve Stimulation on Postoperative Pain and Patient Satisfaction

Background and AimsThis study was conducted to investigate the effect of transcutaneous electrical nerve stimulation on postoperative pain, changes in patients’ vital signs, and patient satisfaction after inguinal herniorrhaphy. DesignThis study used a randomized controlled design. SettingA state hospital in the west of Turkey. Participants/SubjectsThe study was conducted on 52 patients who had inguinal herniorrhaphy between January and July 2015. MethodsPatients were randomly divided into two groups (intervention and control). Intervention group patients received transcutaneous electrical nerve stimulation postoperatively five times for 30 minutes each. Electrodes in control group patients were placed, but the device was not started. At each transcutaneous electrical nerve stimulation session, the patients’ vital signs and pain severity were recorded. A satisfaction scale was administered before discharge to assess patient satisfaction with nursing care. ResultsPain scores of patients in the intervention group were lower than those in the control group (p < .05). No differences were found in pre–and post–transcutaneous electrical nerve stimulation in the vital signs. Satisfaction scores were higher in the intervention group than control group (p < .05). ConclusionsAfter inguinal herniorrhaphy, transcutaneous electrical nerve stimulation reduced postoperative pain without a negative impact on vital signs and increased patient satisfaction with nursing care.

Effects of Neuromuscular Electrical Stimulation of the Quadriceps and Diaphragm in Critically Ill Patients: A Pilot Study.

Background Deep and respiratory muscle disorders are commonly observed in critically ill patients. Neuromuscular electrical stimulation (NMES) is an alternative to mobilize and to exercise that does not require active patient participation and can be used on bedridden patients. Objective Evaluate the effectiveness of the NMES therapy in quadriceps versus diaphragm subjects in mechanical ventilation (MV). Methods Sixty-seven subjects in MV were included, divided into 3 groups: (a) control group (CG, n=26), (b) stimulation of quadriceps (quadriceps group–QG, n=24), and (c) stimulation of diaphragm (diaphragm group–DG, n=17). The QG and DG patients received consecutive daily electrical stimulation sessions at specific points from the first day of randomization until ICU discharge. Respiratory and peripheral muscle strength, MV time, length of hospitalization, and functional independence score (the Functional Status Score-ICU) were recorded. Results There were studied n=24 (QG), n=17 (DG), and n=26 (CG) patients. Peripheral muscle strength improved significantly in the QG (p=0.030). Functional independence at ICU discharge was significantly better in QG (p=0.013), and the QG presented a better Barthel Index compared to DG and CG (p=0.0049) and also presented better FSS compared to CG (p=0.001). Conclusions Electrical stimulation of quadriceps had best outcomes for peripheral muscle strength compared with controls or electrical stimulation of diaphragm among mechanically ventilated critically ill subjects and promoted functional independence and decreased length of hospitalization.

Effects of 8-week sensory electrical stimulation combined with motor training on EEG-EMG coherence and motor function in individuals with stroke

The peripheral sensory system is critical to regulating motor plasticity and motor recovery. Peripheral electrical stimulation (ES) can generate constant and adequate sensory input to influence the excitability of the motor cortex. The aim of this proof of concept study was to assess whether ES prior to each hand function training session for eight weeks can better improve neuromuscular control and hand function in chronic stroke individuals and change electroencephalography-electromyography (EEG-EMG) coherence, as compared to the control (sham ES). We recruited twelve subjects and randomly assigned them into ES and control groups. Both groups received 20-minute hand function training twice a week, and the ES group received 40-minute ES on the median nerve of the affected side before each training session. The control group received sham ES. EEG, EMG and Fugl-Meyer Assessment (FMA) were collected at four different time points. The corticomuscular coherence (CMC) in the ES group at fourth weeks was significantly higher (p = 0.004) as compared to the control group. The notable increment of FMA at eight weeks and follow-up was found only in the ES group. The eight-week rehabilitation program that implemented peripheral ES sessions prior to function training has a potential to improve neuromuscular control and hand function in chronic stroke individuals.

005 Neuromodulation for Female Sexual Dysfunction: Preliminary Pilot Clinical Trial and Patient Interest Survey

Peripheral nerve stimulation (neuromodulation) for bladder symptoms has led to improvements in sexual function for some patients. Further studies specifically into neuromodulation for female sexual dysfunction (FSD) are limited. We are performing a pilot clinical study (NCT02692417) of neuromodulation for FSD and have an online survey to assess the interests of women in receiving neuromodulation. In the clinical study, women with FSD, are sexually active, and have no bladder problems or neurological disorders receive 12 weekly 30-minute transcutaneous electrical stimulation sessions at the tibial nerve (TN; above medial ankle) or at the dorsal genital nerve (DGN; adjacent to clitoris). At start, 6, 12, and 18 weeks, sexual function is assessed with the female sexual function index (FSFI). Separately, we have an online survey (Sawtooth Software) that was shared at relevant clinics and a health research portal. The primary survey components are 12 randomly selected choice-based conjoint questions in which the participant chooses between two treatment options. Potential treatments are daily, weekly, and on-demand pills, TN and DGN weekly sessions, and sacral nerve neuromodulation (SNM). Each treatment option is listed with one of three levels (low, medium, high) for efficacy, side effects, and cost. The survey also includes the short FSFI, questions on demographics, and a bladder symptom index.

T02. Impairment of consciousness induced by electrical cortical stimulation: Under-reported phenomenon or a disease-specific condition?

Although consciousness is commonly impaired in epileptic seizures, limited literature is available on loss of consciousness induced by electrical cortical stimulation (ECS) in humans undergoing intracranial EEG evaluations for localization of epileptic focus. Case-study and review of literature. We report a case of impairment of consciousness (IOC) induced by electrical cortical stimulation (ECS) of homologous regions within the lateral frontal convexities in a patient with medically intractable epilepsy. The patient had mixed features of idiopathic generalized and focal epilepsy. On intracranial EEG recording, interictal and ictal discharges showed a high degree of synchrony across widespread bilateral fronto-parietal areas. We identified regions in the lateral frontal lobes that reliably and produced loss of consciousness by ECS. This was accompanied by evoked EEG activity of admixed frequencies over the fronto-parietal, mesial frontal and temporal regions during stimulation and was not associated with after-discharges. Symptoms were immediately reversible upon cessation of stimulation. This finding suggests that focal cortical stimulation can disrupt widespread networks that underlie consciousness. Individuals with high degrees of speculated thalamo-frontal cortical connectivity might be more susceptible to this effect, and the findings highlight the importance of standardizing the testing of level of consciousness during mapping sessions. This report highlights the importance of testing for impairment of consciousness during sessions of electrical cortical stimulation. It also underlines the possibility that localized stimulation in some cases may produce widespread changes in brain physiology and in consciousness. Future prospective studiesmay elucidate the occurrence and prognostic value of impairment of consciousness during electrical cortical stimulation for mapping function.

Low-Level Laser Therapy and the Recovery of Muscle Function After a Single Session of Neuromuscular Electrical Stimulation: A Crossover Trial

Abstract Introduction. Neuromuscular electrical stimulation is applied in muscle atrophy and in muscle strength and endurance training in athletes. Muscle soreness and temporary reduction in muscle strength may occur as adverse effects. Laser therapy has been used as a method of counteracting delayed onset muscle soreness following volitional exercise, but not following electrical stimulation. The aim of the study was to determine whether low-level laser therapy applied prior to electrical stimulation accelerates the recovery of muscle strength and decreases the duration and intensity of muscle soreness at rest after intensive isometric neuromuscular electrical stimulation of the quadriceps femoris muscle. Material and methods. A randomised crossover trial was carried out on 24 healthy, recreationally active men aged 22-24 years. Low-level laser therapy or sham laser therapy was applied prior to a single session of neuromuscular electrical stimulation of the quadriceps femoris muscle with typical technical and training-related parameters. Irradiations were performed immediately prior to and shortly after electrical stimulation as well as 24, 48, 72, and 96 hours after this procedure. Muscle soreness was examined using the VAS scale in the same time periods. Quadriceps moments of force were recorded with the use of a Biodex 4 Pro device during maximum voluntary static contraction and during electrical stimulation that triggered a tetanic contraction of the quadriceps femoris muscle reaching the level of maximum tolerance. Results. No significant differences were noted in the severity of quadriceps soreness and in the magnitude of the decrease in the moments of force of maximum voluntary contractions after stimulation preceded by laser therapy and that preceded by sham irradiations. Conclusions. In the group studied, laser therapy applied before single electrical stimulation with typical parameters did not bring about a faster recovery of muscle strength or a more rapid decrease in soreness than sham laser therapy used prior to electrical stimulation. Further research on larger groups of subjects with the application of various procedures as well as research on training programmes is needed.

Effects of Intrahippocampal Injections of Melipramin on EEG, Brain Self-Stimulation, and Behavioral Indices of Rats under Conditions of Neurogenic Stress

In young (3-month-old) male Wistar rats, we studied the effects of intrahippocampal microinjections of melipramin under conditions of emotional stress induced by sessions of electrical nociceptive stimulation of the limbs. In most cases, seven-day-long stressing resulted in suppression of electrical activity of the hippocampus, exerted ambivalent effects on the frequency of brain self-stimulation (BSS) events, decreased the communicability of animals in the two-chamber test, and increased the latencies of going of the animal from the arena center and grooming episodes in the open field test. Injections of melipramin interfered with the development of stress-induced disorders in the hippocampus, decreased the normalized content of beta oscillations in the neocortex and the theta-index in the hypothalamus, increased the BSS frequency, and decreased the level of negativation of the behavioral manifestations of this phenomenon. The duration of stay of a rat near the partition in the two-chamber test increased, the mobility and number of grooming episodes in the open field enhanced, but the latency of leaving the arena center also increased (similarly to what was observed in the control). On the 8th–9th day of the poststress period, behavioral disorders of rats of the control group in the two-chamber test were smoothed to a significant extent. The stability of the examined indices or the reverse development of stress-induced disorders within the above period in animals injected with melipramin were indicative of a significant role of the hippocampus in the formation of central effects of this antidepressant and also of adaptogenic and stress-protective properties of this drug.

Evaluation of the Effectiveness of Neuromuscular Electrical Stimulation After Total Knee Arthroplasty: A Meta-Analysis.

The aim of the study was to evaluate the efficacy of the use of the neuromuscular electrical stimulation after total knee arthroplasty. The study used a systematic review of randomized controlled trials (MEDLINE, PubMed, Cochrane Library, and PEDro) using Patient Population or Problem, Intervention, Comparison, Outcomes, Setting approach to formulate the research question, controlled terms, and Boolean operators. Inclusion and exclusion criteria were defined in advance. "Neuromuscular electrical stimulation" and "total knee arthroplasty" were used as keywords. The overall risk of bias was determined according to the following: random sequence generation, concealment, blinding mass of participants and staff, commissioning blind assessment results, incomplete data, and loans received. Of the 36 identified studies, six were included in the review (496 participants). In these studies, one group of patients followed a rehabilitation protocol (control group) and the other followed a rehabilitation program plus a session of neuromuscular electrical stimulation (neuromuscular electrical stimulation group). Patients of neuromuscular electrical stimulation groups got the best scores (timed up and go test, stair climbing test, and walk test). Neuromuscular electrical stimulation benefits were strong in the first postoperative weeks/months and gradually diminished. Neuromuscular electrical stimulation allows a slightly better functional recovery after total knee arthroplasty, especially in the first period, with more evident benefits in patients with a severe lack of muscular activation. Nevertheless, there is no difference at medium-long term.

Ocena skuteczności wybranych zabiegów fizykoterapeutycznych u pacjentów ze zmianami zwyrodnieniowymi stawów kolanowych

Wstęp: Choroba zwyrodnieniowa stawów kolanowych (chzsk) jest jednym z najczęściej występujących schorzeń układu ruchu. Zaliczana jest do chorób przewlekłych i postępujących. Objawia się dolegliwościami bólowymi w przedniej lub przyśrodkowej części kolana, obrzękiem oraz ograniczeniem zakresu ruchomości.Celem badań było porównanie skuteczności prądu TENS i fali ultradźwiękowej oraz samodzielnie wykonywanego zabiegu falą ultradźwiękową u pacjentów z dolegliwościami bólowymi oraz ograniczeniem zakresu ruchu spowodowanym chzsk.Materiały i metody: W badaniu wzięło udział 84 pacjentów z chzsk manifestującą się przewlekłymi dolegliwościami bólowymi oraz ograniczeniem ruchomości. W sposób losowy dokonano podziału na dwie 42-osobowe grupy. W grupie I (23 kobiety i 19 mężczyzn) wykonano 10 zabiegów prądami TENS oraz 10 zabiegów falą ultradźwiękową. W grupie II (25 kobiet i 17 mężczyzn) wykonano 10 zabiegów falą ultradźwiękową. Przed przystąpieniem do badań oraz po skończonej serii zabiegów w obu grupach wykonano pomiar zakresu ruchomości stawu kolanowego oraz zebrano wywiad dotyczący dolegliwości bólowych (VAS).Wyniki: W grupie, w której wykonano zabieg prądami TENS i falą ultradźwiękową, wykazano lepsze efekty terapii niż u osób, u których zastosowano tylko zabieg falą ultradźwiękową. Istotne statystycznie różnice obejmowały zakres ruchu zgięcia, wyprostu oraz natężenia bólu. Wanalizie pomiędzy kobietami a mężczyznami w obydwu grupach nie wykazano różnic istotnych statystycznie.Wnioski: Lepsze efekty rehabilitacji u pacjentów ze zmianami zwyrodnieniowymi stawów kolanowych przynosi zastosowanie prądów TENS i fali ultradźwiękowej niż zastosowanie samej fali ultradźwiękowej. Kobiety i mężczyźni uzyskują podobne efekty po seriach zabiegów.

Longevity of visual improvements following transcorneal electrical stimulation and efficacy of retreatment in three individuals with retinitis pigmentosa.

A small-scale randomized controlled trial conducted by our group found that four of seven retinitis pigmentosa (RP) subjects who received six weekly Transcorneal Electrical Stimulation (TES) sessions developed significant improvements in visual acuity (VA), quick contrast sensitivity function (qCSF), and/or Goldmann visual fields (GVF). We longitudinally monitored three of these participants for declining visual function due to natural RP progression to determine the duration of their responses and administered retreatments. Over a period of 29-35months, repeated ETDRS VA, qCSF and/or GVF tests and three to six TES treatment courses consisting of six weekly sessions were administered in each eye of three RP participants every four to 16months in an unmasked, prospective case series study. For two participants, there were significant VA improvements of 44-52 letters (0.88-1.04 logMAR) and 15-23 letters (0.3-0.46 logMAR) in the worse eye at baseline after each of three or four treatment courses of TES compared to initial baseline. They had no significant decreases from baseline for VA or qCSF over 29 to 35months, The third participant had a significant mean improvement in VA in the eye with better baseline vision (p= 0.004) and binocularly (p< 0.001) following six treatment courses over the 29-month period. For the first two participants, mean annual rates of GVF change for each eye ranged from -5% to 0% with the V4e stimulus, and -26% to +33% the III4e stimulus. The third participant's mean annual GVF changes were +14 to +35%, with a statistically significant improvement across 29months for both the V4e and III4e stimuli in the right eye (p= 0.045; p= 0.015) and the V4e stimulus in the left eye (p= 0.047). Following encouraging visual improvements after TES that lasted for several months, it appears it may be possible to restore and prevent slowly diminishing vision over time with retreatments, which requires confirmation in a large-scale randomized controlled trial.