Patients’ Perspectives of Pain, Time, and Hope When Living with Venous Leg Ulcers and Using the geko™ Device: A Qualitative Descriptive Inquiry.

Introduction: Venous leg ulcers have an impact on individuals’ perspectives of pain, time, and hope. Community nurses seek to provide person-centred care to patients living with venous leg ulcers. There is a paucity of research exploring individuals’ experiences while living with leg ulcers, specifically their insights into the role of a neuromuscular electrostimulation medical device (geko™). Methods: Using a qualitative descriptive approach and telephone interviews, seven participants shared their experiences living with venous leg ulcers and when using a geko™ device. Research ethics was approved, and informed client consent obtained. Thematic analysis method was utilized to analyze the data. Interviews were typed verbatim and analysis focused on a data-driven approach, leading themes emerged. Results: Participants described regular use of pain medications. They described the concept of ‘time’ from the onset of the venous leg ulcer, through wound reoccurrences, and treatments. Participants described feeling hopeful the geko™ device would support wound healing and assist the wound to become smaller and heal faster. Conclusions: This small qualitative study adds to a growing body of literature focused on the role of the geko™ adjunctive therapy in venous leg ulcer healing. More research is needed to understand the role of adjunctive therapies as they may offer patients' hope and create optimism toward wound healing as part of multi-modal treatment approach. Keywords: geko™, individual perspectives, qualitative descriptive, pain, time, hope

Microcirculatory changes in venous leg ulcers using intermittent electrostimulation of common peroneal nerve

Objective: Activation of the venous muscle pumps of the leg by intermittent transdermal neuromuscular stimulation of the common peroneal nerve has been previously shown to augment venous and arterial flow in patients with leg ulcers. This study aims to establish if microcirculation in the wound bed and periwound area are augmented by the activation of a neuromuscular electrostimulation device (NMES) (Geko, Firstkind Ltd., UK). Method: In this self-controlled, observational study, laser speckle contrast imaging was used to map and quantify microcirculatory flow in the wound bed and periwound area of patients with venous leg ulcers (VLU). Values of flow and pulsatility in these locations were compared with the NMES device, both active and inactive. Results: A total of 16 patients took part in the study. Microvascular flux increased by 27% (p=0.014) in the wound bed, and by 34% (p=0.004) in the periwound area, when the NMES device was activated. Pulsatility increased by 170% (p<0.001) in the wound bed and 173% (p<0.001) in the periwound area when the device was activated. Conclusion: Intermittent electrostimulation of the common peroneal nerve substantially increased both microcirculatory flux and pulsatility in the wound bed and in the periwound area of the VLUs of patients in this study. This provides a plausible mechanistic explanation for its reported efficacy in healing VLUs.

Effects of Blood Flow Restriction Combined With Resistance Training or Neuromuscular Electrostimulation on Muscle Cross-Sectional Area

Context: Low-load resistance training (LL) and neuromuscular electrostimulation (NES), both combined with blood flow restriction (BFR), emerge as effective strategies to maintain or increase muscle mass. It is well established that LL-BFR promotes similar increases in muscle cross-sectional area (CSA) and lower rating of perceived exertion (RPE) and pain compared with traditional resistance training protocols. On the other hand, only 2 studies with conflicting results have investigated the effects of NES-BFR on CSA, RPE, and pain. In addition, no study directly compared LL-BFR and NES-BFR. Objective: The aim of the study was to compare the effects of LL-BFR and NES-BFR on vastus lateralis CSA, RPE, and pain. Individual response for muscle hypertrophy was also compared between protocols. Design: Intrasubject longitudinal study. Setting: University research laboratory. Intervention: Fifteen healthy young males (age = 23 [5] y; weight = 77.6 [11.3] kg; height = 1.76 [0.08] m). Main Outcome Measures: Vastus lateralis CSA was measured through ultrasound at baseline (pre) and after 20 training sessions (post). The RPE and pain responses were obtained through modified 10-point scales, handled during all training sessions. Results: Both protocols demonstrated significant increases in muscle CSA (P < .0001). However, the LL-BFR demonstrated significantly greater CSA changes compared with NES-BFR (LL-BFR = 11.2%, NES-BFR = 4.6%; P < .0001). Comparing individual increases in CSA, 12 subjects (85.7% of the sample) presented greater muscle hypertrophy for LL-BFR than for the NES-BFR protocol. In addition, LL-BFR produced significantly lower RPE and pain responses (P < .0001). Conclusions: The LL-BFR produced significantly greater increases in CSA with significant less RPE and pain than NES-BFR. In addition, LL-BFR resulted in greater individual muscle hypertrophy responses for most subjects compared with NES-BFR.

Local and Contralateral Effects after the Application of Neuromuscular Electrostimulation in Lower Limbs

Neuromuscular electrostimulation (NMES) has been used mainly as a method to promote muscle strength, but its effects on improving blood flow are less well known. The aim of this study is to deepen the knowledge about the local and contralateral effects of the application of symmetric biphasic square currents on skin temperature (Tsk). An experimental pilot study was developed with a single study group consisting of 45 healthy subjects. Thermographic evaluations were recorded following the application of NMES to the anterior region of the thigh. The results showed an increase in the maximal Tsk of 0.67% in the anterior region of the thigh where the NMES was applied (p < 0.001) and an increase of 0.54% (p < 0.01) due to cross-education effects, which was higher when the NMES was applied on the dominant side (0.79%; p < 0.01). The duration of the effect was 20 min in the dominant leg and 10 min in the nondominant one. The application of a symmetrical biphasic current (8 Hz and 400 μs) creates an increase in the maximal Tsk at the local level. A temperature cross-education effect is produced, which is greater when the NMES is applied on the dominant side. This could be a useful noninvasive measurement tool in NMES treatments.

Possibilities of using neuromuscular electrostimulation for treating polyneuropathy in gluten intolerance (clinical observation)

The article presents a clinical observation of a 54-year-old patient with sensorimotor polyneuropathy and newly diagnosed celiac disease. It was shown that laboratory methods for examining patients with polyneuropathy are required to identify the etiology of the process in most cases. Attention is drawn to the possibility of developing polyneuropathy with gluten intolerance without obvious pathological manifestations of the gastrointestinal tract. The importance of not only observing a gluten-free diet for treatment, but also the use of pulsed currents in the form of an exponent to reduce pain, improve trophism of muscle tissue, increase muscle strength and restore deep sensitivity is reflected. Neuromuscular electrical stimulation is an effective therapy.

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

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

Evaluation of skin sensitivity in individuals presented with temporomandibular disorder

ABSTRACT Purpose: to identify the occurrence of a difference in skin sensitivity between analogous points on the face in individuals with temporomandibular disorder. Methods: a total of 60 individuals of both genders, aged 18 to 73 years, participated in the study. People classified with TMD signs and symptoms with the Fonseca Anamnestic Questionnaire were included. The skin sensitivity was evaluated with a Semmes-Weinstein esthesiometer. Sensitivity change was defined in this study as the occurrence of a difference between analogous points on both hemifaces. The localization of the points followed the regional block anatomical description and was confirmed with a neuromuscular electrostimulation device. The collected data were analyzed statistically with a 5% significance level. Results: the occurrence of a difference in sensitivity between the analogous points had a significant association with age group and severity of TMD. However, no association was perceived between sensitivity change and gender. Conclusion: in the population studied, the more severe the temporomandibular disorder, the greater the skin sensitivity change on the face. Also, the older the person, the higher the number of analogous points with a difference in sensitivity.