scholarly journals Preventing Ischial Pressure Ulcers: III. Clinical Pilot Study of Chronic Neuromuscular Electrical Stimulation

2011 ◽  
Vol 8 (3-4) ◽  
pp. 345-359 ◽  
Author(s):  
Hilton M. Kaplan ◽  
Lucinda L. Baker ◽  
Salah Rubayi ◽  
Gerald E. Loeb
Keyword(s):  
Electrical Stimulation ◽  
Soft Tissue ◽  
Pressure Ulcers ◽  
Neuromuscular Electrical Stimulation ◽  
Gluteus Maximus ◽  
Clinical Results ◽  
Trophic Factors ◽  
Wound Complications ◽  
Maximum Pressure ◽  
Muscle Groups

Objective:BIONs™ (BIOnic Neurons) are injectable, wireless microstimulators that make chronic BION Active Seating (BAS) possible for pressure ulcer prevention (PUP). Neuromuscular electrical stimulation (NMES) produces skeletal motion and activates trophic factors, counteracting three major etiological mechanisms leading to pressure ulcers (PUs): immobility, soft-tissue atrophy, and ischemia. Companion papers I and II reviewed prior experience with NMES for PUP, and analyzed the biomechanical considerations, respectively. This paper presents a treatment strategy derived from this analysis, and the clinical results of the first three cases.Methods:Two BIONs implanted (one on inferior gluteal nerve to gluteus maximus (GM), and other on sciatic nerve to hamstrings (HS)), in 3 spinal cord injured (SCI) subjects already undergoing gluteal rotation flaps for PUs. BAS using HS when seated, and BION Conditioning (BC) via GM+HS when non-weightbearing. Follow-up: 1 yr, including 6 mo. treatment window (interface pressure mapping; muscle perfusion scans; MRI, X-ray volume assessments).Results:Successfully implanted and activated both desired muscle groups, selectively, in all. No PU recurrences or wound complications. Two subjects completed protocol. Mean results: Interface: contact pressure −10%; maximum pressure −20%; peak pressure area −15%. Vascularity: GM +20%, HS +110%. Perfusion: GM +70%, HS +440%. Muscle volume: GM +14%, HS +31%. Buttock soft-tissue padding: +49%. 1 BION failed; 1 BION rotated under GM.Conclusions:Promising proof-of-concept data supporting the feasibility of implanted microstimulators to achieve sufficiently strong and selective activation of target muscles for PUP. Ultimate goal is prophylactic deployment through bilateral, nonsurgical injection of BIONs in chronically immobile patients.

scholarly journals Preventing Ischial Pressure Ulcers: I. Review of Neuromuscular Electrical Stimulation

2011 ◽  
Vol 8 (3-4) ◽  
pp. 323-331
Author(s):  
Hilton M. Kaplan ◽  
Gerald E. Loeb
Keyword(s):  
Blood Flow ◽  
Electrical Stimulation ◽  
Soft Tissues ◽  
Pressure Ulcers ◽  
Neuromuscular Electrical Stimulation ◽  
Gluteus Maximus ◽  
Recurrence Rates ◽  
Normal Forces ◽  
The Past ◽  
Relative Value

Objective:Pressure ulcers (PUs) are common and debilitating wounds that arise when immobilized patients cannot shift their weight. Treatment is expensive and recurrence rates are high. Pathophysiological mechanisms include reduced bulk and perfusion of chronically atrophic muscles as well as prolonged occlusion of blood flow to soft tissues from lack of voluntary postural shifting of body weight. This has suggested that PUs might be prevented by reanimating the paralyzed muscles using neuromuscular electrical stimulation (NMES). A review of the published literature over the past 2 decades is detailed.Outcomes:Historically gluteus maximus (GM) has been an important target for NMES, but results have been difficult to interpret and suitable technology has been lacking.Conclusions:NMES of the buttock muscles appears to be valuable in terms of its trophic effects, improving vascularity and soft tissue bulk. It remains unclear, however, whether GM can actually achieve sufficient unloading of normal forces to permit blood flow in the capillary beds of the skin and muscle. Analysis of the skeletal biomechanics is required to assess the relative value of GM vs. hamstring (HS) hip extensors in this regard.

scholarly journals Effects of electrode size and placement on comfort and efficiency during low-intensity neuromuscular electrical stimulation of quadriceps, hamstrings and gluteal muscles

2022 ◽  
Vol 14 (1) ◽  
Author(s):  
J. Flodin ◽  
R. Juthberg ◽  
P. W. Ackermann
Keyword(s):  
Electrical Stimulation ◽  
Muscle Contraction ◽  
Current Density ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Neuromuscular Electrical Stimulation ◽  
Gluteus Maximus ◽  
Major Drawback ◽  
Electrode Size ◽  
Low Intensity

Abstract Background Neuromuscular electrical stimulation (NMES) may prevent muscle atrophy, accelerate rehabilitation and enhance blood circulation. Yet, one major drawback is that patient compliance is impeded by the discomfort experienced. It is well-known that the size and placement of electrodes affect the comfort and effect during high-intensity NMES. However, during low-intensity NMES the effects of electrode size/placement are mostly unknown. Therefore, the purpose of this study was to investigate how electrode size and pragmatic placement affect comfort and effect of low-intensity NMES in the thigh and gluteal muscles. Methods On 15 healthy participants, NMES-intensity (mA) was increased until visible muscle contraction, applied with three electrode sizes (2 × 2 cm, 5 × 5 cm, 5 × 9 cm), in three different configurations on quadriceps and hamstrings (short-transverse (ST), long-transverse (LT), longitudinal (L)) and two configurations on gluteus maximus (short-longitudinal (SL) and long-longitudinal (LL)). Current–density (mA/cm2) required for contraction was calculated for each electrode size. Comfort was assessed with a numerical rating scale (NRS, 0–10). Significance was set to p < 0.05 and values were expressed as median (inter-quartile range). Results On quadriceps the LT-placement exhibited significantly better comfort and lower current intensity than the ST- and L-placements. On hamstrings the L-placement resulted in the best comfort together with the lowest intensity. On gluteus maximus the LL-placement demonstrated better comfort and required less intensity than SL-placement. On all muscles, the 5 × 5 cm and 5 × 9 cm electrodes were significantly more comfortable and required less current–density for contraction than the 2 × 2 cm electrode. Conclusion During low-intensity NMES-treatment, an optimized electrode size and practical placement on each individual muscle of quadriceps, hamstrings and gluteals is crucial for comfort and intensity needed for muscle contraction.

Method to Reduce Muscle Fatigue During Transcutaneous Neuromuscular Electrical Stimulation in Major Knee and Ankle Muscle Groups

2014 ◽  
Vol 29 (8) ◽  
pp. 722-733 ◽  
Author(s):  
Dimitry G. Sayenko ◽  
Robert Nguyen ◽  
Tomoyo Hirabayashi ◽  
Milos R. Popovic ◽  
Kei Masani
Keyword(s):  
Electrical Stimulation ◽  
Muscle Fatigue ◽  
Neuromuscular Electrical Stimulation ◽  
Ankle Muscle ◽  
Muscle Groups

scholarly journals Preventing Ischial Pressure Ulcers: II. Biomechanics

2011 ◽  
Vol 8 (3-4) ◽  
pp. 333-343
Author(s):  
Hilton M. Kaplan ◽  
Lucinda L. Baker ◽  
Rahman Davoodi ◽  
Nga Ting Wong ◽  
Gerald E. Loeb
Keyword(s):  
Rigid Body ◽  
Pressure Ulcers ◽  
Neuromuscular Electrical Stimulation ◽  
Treatment Strategies ◽  
Gluteus Maximus ◽  
Companion Paper ◽  
Disuse Atrophy ◽  
Pressure Area ◽  
Stimulation Experiments ◽  
Extensor Torque

Background:Pressure ulcers (PUs) are common and debilitating wounds that arise when immobilized patients cannot shift their weight. Neuromuscular Electrical Stimulation (NMES) has been investigated for Pressure Ulcer Prevention (PUP) for over 20 years. Historically gluteus maximus (GM) has been considered an important actuator in attempting to redistribute seated pressures through NMES.Methods:Analysis of skeletal biomechanics to quantify the value of GM relative to hamstring hip extensors (HS), using muscle moment models based on torques and rigid body mass estimates from the literature. Surface stimulation experiments (n= 10 + 1,non-paralyzed) to validate model and identify promising stimulation sites and treatment strategies that would approximate healthy biomechanics.Results:Literature values and Rigid Body Analysis estimate: ~63 Nm extensor torque requirement calculated for complete ipsilateral unloading of the buttocks. Muscle Moment Analysis: GM can provide 70% of total hip extensor torque when walking vs. 18% when seated. HS can provide 100 Nm hip extension torque when seated, exceeding 63 Nm requirement. Surface Stimulation: ipsilateral seated interface pressure mean −26% during HS stimulation vs. +16% with GM; peak pressure area −94% HS vs. +213% GM.Conclusions:GM activation reduces disuse atrophy and improves circulation, but appears neither required, nor desired, for unloading when seated. HS stimulation alone should be capable of sufficient unloading. This new proposed approach is explored clinically in companion paper III.

scholarly journals Flexor Carpi Ulnaris Muscle Flap for Soft Tissue Reconstruction after Total Elbow Arthroplasty

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Syunro Okamoto ◽  
Kaoru Tada ◽  
Hachinota Ai ◽  
Hiroyuki Tsuchiya
Keyword(s):  
Soft Tissue ◽  
Muscle Flap ◽  
Clinical Results ◽  
Soft Tissue Defect ◽  
Total Elbow Arthroplasty ◽  
Wound Complications ◽  
Soft Tissue Reconstruction ◽  
Elbow Arthroplasty ◽  
Flexor Carpi Ulnaris ◽  
Tissue Reconstruction

The soft tissue at the tip of the olecranon is very thin, leading to the frequent occurrence of wound complications after total elbow arthroplasty. To cover a soft tissue defect of the elbow, the flexor carpi ulnaris muscle flap is thought to be appropriate for reconstruction of the elbow with regard to its size, location, and blood supply. We got positive clinical results, so we report our experiences of using a flexor carpi ulnaris muscle flap for soft tissue reconstruction after total elbow arthroplasty.

scholarly journals Differential contractile response of critically ill patients to neuromuscular electrical stimulation

Critical Care ◽  
2019 ◽  
Vol 23 (1) ◽  
Author(s):  
Julius J. Grunow ◽  
Moritz Goll ◽  
Niklas M. Carbon ◽  
Max E. Liebl ◽  
Steffen Weber-Carstens ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Muscle Strength ◽  
Critically Ill ◽  
Sofa Score ◽  
Critically Ill Patients ◽  
Contractile Response ◽  
Neuromuscular Electrical Stimulation ◽  
Electrical Current ◽  
Icu Discharge ◽  
Muscle Groups

Abstract Background Neuromuscular electrical stimulation (NMES) has been investigated as a preventative measure for intensive care unit-acquired weakness. Trial results remain contradictory and therefore inconclusive. As it has been shown that NMES does not necessarily lead to a contractile response, our aim was to characterise the response of critically ill patients to NMES and investigate potential outcome benefits of an adequate contractile response. Methods This is a sub-analysis of a randomised controlled trial investigating early muscle activating measures together with protocol-based physiotherapy in patients with a SOFA score ≥ 9 within the first 72 h after admission. Included patients received protocol-based physiotherapy twice daily for 20 min and NMES once daily for 20 min, bilaterally on eight muscle groups. Electrical current was increased up to 70 mA or until a contraction was detected visually or on palpation. Muscle strength was measured by a blinded assessor at the first adequate awakening and ICU discharge. Results One thousand eight hundred twenty-four neuromuscular electrical stimulations in 21 patients starting on day 3.0 (2.0/6.0) after ICU admission were included in this sub-analysis. Contractile response decreased from 64.4% on day 1 to 25.0% on day 7 with a significantly lower response rate in the lower extremities and proximal muscle groups. The electrical current required to elicit a contraction did not change over time (day 1, 50.2 [31.3/58.8] mA; day 7, 45.3 [38.0/57.5] mA). The electrical current necessary for a contractile response was higher in the lower extremities. At the first awakening, patients presented with significant weakness (3.2 [2.5/3.8] MRC score). When dividing the cohort into responders and non-responders (> 50% vs. ≤ 50% contractile response), we observed a significantly higher SOFA score in non-responders. The electrical current necessary for a muscle contraction in responders was significantly lower (38.0 [32.8/42.9] vs. 54.7 [51.3/56.0] mA, p < 0.001). Muscle strength showed higher values in the upper extremities of responders at ICU discharge (4.4 [4.1/4.6] vs. 3.3 [2.8/3.8] MRC score, p = 0.036). Conclusion Patients show a differential contractile response to NMES, which appears to be dependent on the severity of illness and also relevant for potential outcome benefits. Trial registration ISRCTN ISRCTN19392591, registered 17 February 2011

Neuromuscular electrical stimulation as an alternative to physical exercise in patients with COPD

2018 ◽  
pp. 59-64
Author(s):  
T. V. Kunafina ◽  
◽  
A. G. Chuchalin ◽  
A. S. Belevsky ◽  
N. N. Mescheryakova ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Physical Exercise ◽  
Neuromuscular Electrical Stimulation

Preliminary outcomes in transcutaneous neuromuscular electrical stimulation use in patients with dysphagia

2018 ◽  
Vol 8 (31) ◽  
pp. 167-174
Author(s):  
Codrut Sarafoleanu ◽  
Raluca Enache
Keyword(s):  
Traumatic Brain Injury ◽  
Head And Neck Cancer ◽  
Electrical Stimulation ◽  
Neurodegenerative Disorders ◽  
Structural Changes ◽  
Congenital Abnormalities ◽  
Neuromuscular Electrical Stimulation ◽  
Therapy Options ◽  
Dysphagia Treatment ◽  
Risk Of Aspiration

Abstract Dysphagia is a common disorder associated with a large number of etiologies like aging, stroke, traumatic brain injury, head and neck cancer, neurodegenerative disorders, structural changes or congenital abnormalities. The type of the treatment and its results depend on the type, severity and the cause of dysphagia. The primary goal of dysphagia treatment is to improve the swallowing process and decrease the risk of aspiration. Along with the existing rehabilitation swallowing treatments, new adjunctive therapy options developed, one of them being the neuromuscular electrical stimulation (NMES). The authors present the principles of NMES, a small literature review about the results of this therapy and their experience in using transcutaneous NMES in dysphagia patients.

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