Safety and effectiveness of neuromuscular electrical stimulation in cardiac surgery:A systematic review

BACKGROUND Lack of mobilization and prolonged stay in the intensive care unit(ICU)are major factors resulting in the development of ICU-acquired muscle weakness(ICUAW).ICUAW is a type of skeletal muscle dysfunction and a common complication of patients after cardiac surgery,and may be a risk factor for prolonged duration of mechanical ventilation,associated with a higher risk of readmission and higher mortality.Early mobilization in the ICU after cardiac surgery has been found to be low with a significant trend to increase over ICU stay and is also associated with a reduced duration of mechanical ventilation and ICU length of stay.Neuromuscular electrical stimulation(NMES)is an alternative modality of exercise in patients with muscle weakness.A major advantage of NMES is that it can be applied even in sedated patients in the ICU,a fact that might enhance early mobilization in these patients.AIM To evaluate safety,feasibility and effectiveness of NMES on functional capacity and muscle strength in patients before and after cardiac surgery.METHODS We performed a search on Pubmed,Physiotherapy Evidence Database(PEDro),Embase and CINAHL databases,selecting papers published between December 2012 and April 2023 and identified published randomized controlled trials(RCTs)that included implementation of NMES in patients before after cardiac surgery.RCTs were assessed for methodological rigor and risk of bias via the PEDro.The primary outcomes were safety and functional capacity and the secondary outcomes were muscle strength and function.RESULTS Ten studies were included in our systematic review,resulting in 703 participants.Almost half of them performed NMES and the other half were included in the control group,treated with usual care.Nine studies investigated patients after cardiac surgery and 1 study before cardiac surgery.Functional capacity was assessed in 8 studies via 6MWT or other indices,and improved only in 1 study before and in 1 after cardiac surgery.Nine studies explored the effects of NMES on muscle strength and function and,most of them,found increase of muscle strength and improvement in muscle function after NMES.NMES was safe in all studies without any significant complication.CONCLUSION NMES is safe,feasible and has beneficial effects on muscle strength and function in patients after cardiac surgery,but has no significant effect on functional capacity.

Evaluating neuromuscular electrical stimulation for preventing and managing intensive care unit-acquired weakness:Current evidence and future directions

Intensive care unit-acquired weakness(ICU-AW)is a prevalent issue in critical care,leading to significant muscle atrophy and functional impairment.Aiming to address this,Neuromuscular Electrical Stimulation(NMES)has been explored as a therapy.This systematic review assesses NMES's safety and effectiveness in enhancing functional capacity and mobility in pre-and post-cardiac surgery patients.NMES was generally safe and feasible,with intervention sessions varying in frequency and duration.Improvements in muscle strength and 6-minute walking test distances were observed,particularly in preoperative settings,but postoperative benefits were inconsistent.NMES showed promise in preventing muscle loss and improving strength,although its impact on overall functional capacity remained uncertain.Challenges such as short ICU stays and body composition affecting NMES efficacy were noted.NMES also holds potential for other conditions like cerebral palsy and stroke.Further research is needed to optimize NMES protocols and better understand its full benefits in preventing ICU-AW and improving patient outcomes.

Analysis on the Effect of Yiqi Huoxue Decoction Combined with Neuromuscular Electrical Stimulation in Improving ICU-Acquired Debility in Mechanically Ventilated Patients

Objective:To investigate the effect of Yiqi Huoxue decoction combined with neuromuscular electrical stimulation on improving intensive care unit(ICU)acquired debility in mechanically ventilated patients.Methods:50 patients who were admitted to the ICU and received mechanical ventilation treatment in our hospital from June 2022 to June 2023 and were complicated with ICU-acquired neurasthenia were selected,and randomly grouped using the randomized envelope method into two groups:control group with 25 patients who received neuromuscular electrical stimulation alone;observation group with 25 patients who received the traditional Chinese medicine Yiqi Huoxue decoction.Comparison indexes:treatment efficiency,degree of emotional recovery(APACHEⅡscore),muscle strength status(MRC score),motor status(FAC rating),and self-care ability(BI index score).Results:The treatment efficiency of patients in the observation group patients was higher as compared to those in the control group(P<0.05).There was no significant difference in the comparison of the results of the scores(ratings)of each index between the two groups before treatment(P>0.05).After the treatment,the APACHEⅡscores of patients in the observation group were significantly lower as compared to those in the control group,while the MRC scores,FAC ratings,and BI index scores were higher in the observation group than those of the control group patients(P<0.05).Conclusion:The combined application of Yiqi Huoxue decoction and neuromuscular electrical stimulation in the treatment of patients with ICU-acquired neurasthenia complicated by mechanical ventilation significantly enhanced the clinical efficacy,the patient’s muscle strength,motor status,and ability of self-care.Hence,it has high application value and is worthy to be popularized.

Effects of Neuromuscular Electrical Stimulation in Combination with Glutamine Administration on Skeletal Muscle Atrophy in Colon-26 Tumor-Bearing Mice

The depressed protein synthetic response,a phenomenon termed anabolic resistance,has been shown to be involved in muscle wasting induced by cancer cachexia.Moreover,a positive relationship between the protein synthetic rate and intracellular glutamine(GLN)concentration has been found in skeletal muscles.This study investigated the effects of neuromuscular electrical stimulation(ES)and GLN administration on muscle wasting and GLN metabolism in colon-26(C-26)tumor-bearing mice.CD2F1 mice were divided into 8 groups:control(CNT),CNT+ES,CNT+GLN,CNT+ES+GLN,C-26,C-26+ES,C-26+GLN,C-26+ES+GLN.Cancer cachexia was induced by subcutaneous injection of C-26 cells and developed for four weeks.ES was performed on the left plantar flexor muscles every other day,and GLN(1 g/kg)was administered daily intraperitoneally starting one day after the C-26 injection.Tumor-free body mass and fast-twitch gastrocnemius(Gas)muscle weight were lower in the C-26 group than in the CNT group(-19%and-17%,respectively).Neither ES training nor GLN administration,alone or in combination,ameliorated the loss of Gas muscle weight in the C-26 mice.However,ES training in combination with GLN administration inhibited the increased expression of GLN synthetase(GS)in the C-26 muscles.Thus,it is likely that GLN plays a critical role in muscle protein metabolism and,therefore,can be targeted as a tentative treatment of cancer cachexia.

Neuromuscular electrical stimulation for a dysphagic stroke patient with cardiac pacemaker using magnet mode change: A case report

BACKGROUND Electromagnetic interference(EMI),means disturbance to the operation of implanted electrical devices caused by external sources.If cardiac pacemaker is implanted into the body,the risk of EMI should be considered when performing neuromuscular electrical stimulation(NMES).So far,no case has been reported that clinical magnets are used to safely manage the EMI risk of patients with cardiac pacemaker in NMES.CASE SUMMARY A 72-year-old male with swallowing disorder due to pure motor lacunar syndrome was transferred to rehabilitation department six days after the symptom onset.EMI risk needed be considered when implementing NMES on pharyngeal muscles,since cardiac pacemaker was implanted on his left chest due to the sick sinus syndrome.In the first NMES,the function of the pacemaker was directly monitored using telemetric instruments.From the second day,by a simple method of placing a magnet on the pacemaker,we chose to move the pacemaker into a mode that the device was not influenced by external stimulus.This magnet method has been used repeatedly for a year for the safe NMES treatment.We could remove Levin tube four months after the initial symptom and dysphagia related symptoms had not been noted during two-year follow-up period.CONCLUSION This report is the first case of dysphagia rehabilitation that EMI risk was handled using mode change of pacemaker with magnet.This method is unfamiliar to doctors,but safe and easy approach.This paper could be guidance for clinicians who need to treat patients with EMI risk.

Quantifying Neuromuscular Electrical Stimulation Dosage after Knee Arthroplasty

Recovering functional ability after total knee arthroplasty （TKA） requires recovery of strength and voluntary activation. Short-term recovery of strength and activation are enhanced following a protocol combining strength training with neuromuscular electrical stimulation （NMES）. The purpose of the study was to determine if a dose response curve could be constructed for patients who received NMES as part of their treatment after TKA. NMES dosage was quantified as the electrically evoked knee extensor torque, expressed as a percentage of the subject＇s maximal voluntary contraction. Dose-response curves were generated, with the associations between NMES training intensity and quadriceps strength, voluntary activation, and lean muscle cross-sectional area examined using Pearson Product-Moment Correlation Coefficients. Significantly, linear correlations were observed between NMES training intensity and both quadriceps strength and voluntary activation, but not lean muscle cross-sectional area. These results suggest that maximizing the elicited training force during rehabilitation will enhance short-term recovery following TKA.

Therapeutic efficacy of swallowing neuromuscular electrical stimulation combined with acupuncture for post-stroke dysphagia

Objective To seek a better therapy for treating post-stroke dysphagia. Methods Patients with stroke and swallowing disorders were randomly divided into ordinary acupuncture group （group A, 58 cases） and swallowing neuromuscular electrical stimulation combined with acupuncture group （group B, 62 cases）. Two-group patients were given the same basic internal medical treatment. In addition, group A was given normal acupuncture treatment with the choice of local points： Junjin （金津 EX-HN 12）, Yuye（玉液 EX-HN 23）, Fengchi （风池 GB 20）, Yifeng （翳风 TE 17）, Lianquan （廉泉 CV 23）, Wangu （完骨 GB 12）. Group B was given swallowing neuromuscular electrical stimulation combined with acupuncture： GB 20, Fengfu （风夜 GV 16）, TE 17, Yiming （翳明 EX-HN 14）, Yamen （哑门 GV 15）, Tianrong（天容 SI 17）, Tianchuang （天窗 SI 16）, CV 23, the uniform reinforcing-reducing manipulation was used; EX- HN 12, EX-HN 13, the piercing and blood-letting method （1-2 mL blood） was used; at the same time, the swallowing neuromuscular electrical stimulation therapy device was used to electrically stimulate the nerves and muscles in the throat and neck at specific output pulse current （50-100 Hz）. Treatment was made twice a day, 30 minutes each time. Two weeks after the treatment, the patients were assessed in symptoms improvement and clinical efficacy. Results The total effective rate in group B was 91.4% and 75.8% in group A; in the total efficiency comparison in both groups, χ^2=5.232, P〈0.05. The difference in improvement of symptoms with post-stroke dysphagia treated with above mentioned combination treatment was statistically significant between both groups （P〈0.05）. Conclusion The above mentioned swallowing neuromuscular electrical stimulation combined with acupuncture treatment has a better clinical effect when compared with ordinary acupuncture.

A Hemodynamic Study of the Effect of Neuromuscular Electrical Stimulation on Enhancing Popliteal Venous Flow

Neuromuscular electrical stimulation has been studied to be a method of prophylaxis for deep venous thrombosis by activating the calf muscle pump. However, there is little evidence of the effects of different stimulating parameters on hemodynamics and comfort levels. The objective of this paper is to compare the effects of different stimulating parameters(current amplitude, pulse-width) on hemodynamic alterations of the popliteal vein and the comfort levels in a group of fourteen healthy subjects. Doppler ultrasound detection of peak venous velocity and blood volume were taken from baseline, twelve sequential electrical stimulations and foot dorsiflexion for each subject. A visual analogue scale was used to assess the subjects' pain perception of neuromuscular electrical stimulation. The results showed that peak venous velocity and blood volume augmented as current amplitude and pulse-width increased while pain level also increased. A compromise was reached that parameters consisting of an amplitude of 10 m A and a pulse-width of 500 μs would obtain a high-peak venous velocity and blood flow volume with a relatively comfortable perception. In addition, parameters consisting of an amplitude of 20 m A and a pulse-width of 300 μs were also shown to be a promising choice. However, further studies need to be done to validate and enrich these findings.

Clinical observation of acupoint injection combined with nerve electrical stimulation in the treatment of post-stroke dysphagia

Background:Post-stroke dysphagia is one of the common clinical symptoms in the rehabilitation department of primary hospitals,which seriously affects the quality of life of patients and their families.Majority of medical workers have comprehensively studied post-stroke dysphagia as it easily induces inhalation pneumonia,asphyxia,and many other complications.At present,many methods for post-stroke dysphagia have been proved to be effective.With regard to comprehensive treatment effect,patient compliance,technology promotion difficulty,grassroots hospital operability,and other factors,we found that acupoint injection combined with nerve electrical stimulation is a good method worthy of promotion.Methods:A total of 130 patients with dysphagia after stroke were randomly divided into nerve electrical stimulation group(n=41),acupoint injection group(n=40),and comprehensive treatment group(nerve electrical stimulation plus acupoint injection,n=49).The therapeutic effect in each group was evaluated before treatment and 20 days after treatment using the improved water swallow test,video fluoroscopic swallowing study,and standardized swallowing assessment.Results:After 20 days of treatment,significant differences were noted in each group.The scores of improved water swallow test decreased from 4.10±0.74 to 2.12±0.95 in the nerve electrical stimulation group,4.00±0.78 to 2.28±1.04 in the acupoint injection group,and 4.16±0.77 to 1.73±0.79 in the comprehensive treatment group;video fluoroscopic swallowing study scores increased from 3.71±2.16 to 5.05±2.111 in the nerve electrical stimulation group,3.80±1.94 to 5.20±1.942 in the acupoint injection group,and 3.73±2.22 to 6.24±2.21 in the comprehensive treatment group;and standardized swallowing assessment scores of the three groups also decreased from 35.13±3.38 to 28.17±3.42,34.66±3.46,and 34.48±3.26 to 26.39±3.86,respectively.The overall scores of each group after treatment were significantly different from those before treatment(P<0.05),indicating that both nerve electrical stimulation and acupoint injection were effective for post-stroke dysphagia;the scores of nerve electrical stimulation group and acupoint injection group were similar,but those of the comprehensive treatment group were significantly better than the single treatments(P<0.05).It shows that the two treatment methods have synergistic effect,and combined treatments have more benefits.Conclusion:Nerve electrical stimulation and acupoint injection have a synergistic therapeutic effect on post-stroke dysphagia.The combined treatment is more beneficial to patients with post-stroke dysphagia than the single treatments.

Early application of percutaneous neuromuscular electric stimulation in interfering motor function of limbs and difference in temperature of axilla of patients with ischemic stroke

BACKGROUND： Temperature of axilla could be affected due to motor dysfunction of limbs and neural changes of vessel after ischemic stroke. OBJECTIVE： To observe the effect of percutaneous neuromuscular electric stimulation （PNES） on difference in temperature of axilla and analyze the relationship between function of limbs and difference in temperature of axilla. DESIGN： Randomized grouping and controlled observation SETTING： Department of Neurology, General Hospital of Shenyang Military Area Command of Chinese PLA PARTICIPANTS： Sixty patients with ischemic stroke were selected from Neurological Department of General Hospital of Shenyang Military Area Command of Chinese PLA from January to June 2003. All cases were diagnosed with clinical diagnosis criteria of ischemic stroke established by the Fourth Chinese Classification of Cerebrovasular Disease and CT examination and received neuromuscular electric stimulation （NES）. Patients were randomly divided into control group and treatment group with 30 in each group. METHODS： Control group： Patients received routinely neurological therapy. Treatment group： Except routine therapy, patients suffered from NES at 48 hours after hospitalization. NMT-91 NES equipment was used to stimulated injured limbs with low frequency once 30 minutes a day in total of 10 times a course, especially extensor muscle of upper limb and flexor muscle of lower limb. Prescription of hemiplegia was internally decided by equipment with the output frequency of 200 Hz. Intensity of electric output could cause muscle contraction. The therapy needed two or three courses. Temperature of bilateral axilla was measured every day to calculate the difference with the formula of （temperature of axilla on the injured side - temperature of axilla on the healthy side）. Motor function of limbs was measured with FugI-Meyer Motor Assessment （FMA） during hospitalization and at 2 and 4 hours after hospitalization. Among 90 points, upper and lower limb function was 54, equilibrium function 10, sensory function 10, and motion of joint 16. The higher the scores were, the better the function was. Correlation of data was dealt with linear correlation analysis. MAIN OUTCOME MEASURES ： Assessment and correlation between difference in temperature of axilla and motor function of injured limbs during hospitalization and at 2 and 4 weeks after hospitalization. RESULTS： All 60 patients with ischemic stroke were involved in the final analysis. ① Difference in temperature： Difference of 2 and 4 weeks after hospitalization was lower than that in control group and at just hospitalization [treatment group： （0.056±0.000）, （0.024±0.003） ℃; control group： （0.250±0.001）, （0.131 ±0.001）℃; hospitalization; （0.513±0.001） ℃, P 〈 0.05-0,01]. ② FMA scores： Scores of 2 and 4 weeks after hospitalization were higher than those in control group and at just hospitalization [treatment group; （43.50±15.09）, （67.97 ±18.21） points; control group： （33.33 ±13.54）, （40.87±19.34） points; hospitalization： （26.43 ±11.87） points, P 〈 0.05-0.01]. ③ Correlation： Difference in temperature of axilla was negative correlation with FMA scores （c=- -0.255 1, P 〈 0.05）. CONCLUSION： ① PNES can accelerate recovery of limb function and decrease temperature of axilla of patients with ischemic stroke. ② The lower the difference in temperature is, the better the functional recovery is.