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Lee M, Zulbaran-Rojas A, Bargas-Ochoa M, Martinez-Leal B, Bara R, Flores-Camargo A, Finco MG, Mishra RK, Beom J, Modi D, Shaib F, Najafi B. Gastrocnemius electrical stimulation increases ankle dorsiflexion strength in patients with post-acute sequelae of SARS-COV-2 (PASC): a double-blind randomized controlled trial. Sci Rep 2024; 14:17939. [PMID: 39095520 PMCID: PMC11297025 DOI: 10.1038/s41598-024-68100-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 07/18/2024] [Indexed: 08/04/2024] Open
Abstract
Post-Acute sequelae of SARS-CoV-2 (PASC) is a multisystem disorder causing persistent musculoskeletal deconditioning and reduced lower extremity strength. Electrical stimulation (E-Stim) to the gastrocnemius muscle can enhance strength outcomes by increasing the frequency of muscle fiber activation. We investigated its effect on individuals with PASC. Participants were randomized into intervention (IG) or control (CG) groups. The IG self-administered daily one-hour E-Stim to both their gastrocnemius muscles using a functional device over 4-week, while the CG used a sham device. Primary outcomes were ankle dorsiflexion strength assessed via dynamometry during maximum voluntary contractions, and gastrocnemius voluntary activation (GVA) via surface electromyography. The secondary outcome assessed activities of daily living (ADL), instrumental ADL, and mobility queries. Percentage improvement was calculated. Eighteen patients were analyzed (IG = 10; CG = 8). After 4 week, the IG showed a significantly higher improvement in ankle dorsiflexion strength (222.64%) compared to the CG (51.27%, p = 0.002). Additionally, the IG's ankle dorsiflexion strength improvement significantly correlated with GVA improvement (rho = 0.782) at 4 week. The secondary outcomes did not reveal significant changes in neither group. Self-administered gastrocnemius E-Stim improves ankle dorsiflexion strength in individuals with PASC. However, larger sample sizes and longer interventions are needed to validate these findings.
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Affiliation(s)
- Myeounggon Lee
- Digital Health Access Center (DiHAC), Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, 7200 Cambridge St, B01.529, Houston, TX, 77030, USA
| | - Alejandro Zulbaran-Rojas
- Digital Health Access Center (DiHAC), Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, 7200 Cambridge St, B01.529, Houston, TX, 77030, USA
| | - Miguel Bargas-Ochoa
- Digital Health Access Center (DiHAC), Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, 7200 Cambridge St, B01.529, Houston, TX, 77030, USA
| | - Bernardo Martinez-Leal
- Digital Health Access Center (DiHAC), Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, 7200 Cambridge St, B01.529, Houston, TX, 77030, USA
| | - Rasha Bara
- Digital Health Access Center (DiHAC), Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, 7200 Cambridge St, B01.529, Houston, TX, 77030, USA
| | - Areli Flores-Camargo
- Digital Health Access Center (DiHAC), Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, 7200 Cambridge St, B01.529, Houston, TX, 77030, USA
| | - M G Finco
- Department of Physical Therapy at the University of North Texas Health Science Center in Fort Worth, Fort Worth, TX, USA
| | - Ram Kinker Mishra
- Digital Health Access Center (DiHAC), Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, 7200 Cambridge St, B01.529, Houston, TX, 77030, USA
| | - Jaewon Beom
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Dipaben Modi
- Department of Pulmonary Critical Care, Baylor College of Medicine, Houston, TX, USA
| | - Fidaa Shaib
- Department of Pulmonary Critical Care, Baylor College of Medicine, Houston, TX, USA
| | - Bijan Najafi
- Digital Health Access Center (DiHAC), Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, 7200 Cambridge St, B01.529, Houston, TX, 77030, USA.
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Figueiredo T, Frazão M, Werlang LA, Kunz A, Peltz M, Furtado VC, Júnior EB, Júnior JM, Silva RM, Sobral Filho DC. Safety and feasibility of a functional electrical stimulation cycling-based muscular dysfunction diagnostic method in mechanically ventilated patients. Artif Organs 2024; 48:713-722. [PMID: 38400618 DOI: 10.1111/aor.14734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/18/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND A nonvolitional diagnostic method based on FES-Cycling technology has recently been demonstrated for mechanically ventilated patients. This method presents good sensitivity and specificity for detecting muscle dysfunction and survival prognosis, even in unconscious patients. As the clinical relevance of this method has already been reported, we aimed to evaluate its safety and feasibility. METHODS An observational prospective study was carried out with 20 critically ill, mechanically ventilated patients. The FES-cycling equipment was set in a specific diagnostic mode. For safety determination, hemodynamic parameters and peripheral oxygen saturation were measured before and immediately after the diagnostic protocol, as well as venous oxygen saturation and blood lactate. The creatine phosphokinase level (CPK) was measured before and 24, 48, and 72 h after the test. The time taken to carry out the entire diagnostic protocol and the number of patients with visible muscle contraction (capacity of perceptive muscular recruitment) were recorded to assess feasibility. RESULTS Heart rate [91 ± 23 vs. 94 ± 23 bpm (p = 0.0837)], systolic [122 ± 19 vs. 124 ± 19 mm Hg (p = 0.4261)] and diastolic blood pressure [68 ± 13 vs. 70 ± 15 mm Hg (p = 0.3462)], and peripheral [98 (96-99) vs. 98 (95-99) % (p = 0.6353)] and venous oxygen saturation [71 ± 14 vs. 69 ± 14% (p = 0.1317)] did not change after the diagnostic protocol. Moreover, blood lactate [1.48 ± 0.65 vs. 1.53 ± 0.71 mmol/L (p = 0.2320)] did not change. CPK did not change up to 72 h after the test [99 (59-422) vs. 125 (66-674) (p = 0.2799) vs. 161 (66-352) (p > 0.999) vs. 100 (33-409) (p = 0.5901)]. The time taken to perform the diagnostic assessment was 11.3 ± 1.1 min. In addition, 75% of the patients presented very visible muscle contractions, and 25% of them presented barely visible muscle contractions. CONCLUSIONS The FES cycling-based muscular dysfunction diagnostic method is safe and feasible. Hemodynamic parameters, peripheral oxygen saturation, venous oxygen saturation, and blood lactate did not change after the diagnostic protocol. The muscle damage marker (CPK) did not increase up to 72 h after the diagnostic protocol.
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Affiliation(s)
- Thainá Figueiredo
- Pernambuco University Heart Hospital/University of Pernambuco, Recife, Brazil
| | - Murillo Frazão
- Lauro Wanderley University Hospital, Federal University of Paraíba, João Pessoa, Brazil
- CLINAR Exercise Physiology, João Pessoa, Brazil
| | - Luís A Werlang
- INBRAMED-Brazilian Medical Equipment Industry, Porto Alegre, Brazil
| | - Adelar Kunz
- INBRAMED-Brazilian Medical Equipment Industry, Porto Alegre, Brazil
| | - Maikel Peltz
- INBRAMED-Brazilian Medical Equipment Industry, Porto Alegre, Brazil
| | - Veridiana C Furtado
- Pernambuco University Heart Hospital/University of Pernambuco, Recife, Brazil
| | - Edgar B Júnior
- Pernambuco University Heart Hospital/University of Pernambuco, Recife, Brazil
| | - Júlio M Júnior
- Pernambuco University Heart Hospital/University of Pernambuco, Recife, Brazil
| | - Rosane M Silva
- Pernambuco University Heart Hospital/University of Pernambuco, Recife, Brazil
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Cavalcante JGT, Ribeiro VHDS, Marqueti RDC, Paz IDA, Bastos JAI, Vaz MA, Babault N, Durigan JLQ. Effect of muscle length on maximum evoked torque, discomfort, contraction fatigue, and strength adaptations during electrical stimulation in adult populations: A systematic review. PLoS One 2024; 19:e0304205. [PMID: 38857245 PMCID: PMC11164398 DOI: 10.1371/journal.pone.0304205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 05/08/2024] [Indexed: 06/12/2024] Open
Abstract
Neuromuscular electrical stimulation (NMES) can improve physical function in different populations. NMES-related outcomes may be influenced by muscle length (i.e., joint angle), a modulator of the force generation capacity of muscle fibers. Nevertheless, to date, there is no comprehensive synthesis of the available scientific evidence regarding the optimal joint angle for maximizing the effectiveness of NMES. We performed a systematic review to investigate the effect of muscle length on NMES-induced torque, discomfort, contraction fatigue, and strength training adaptations in healthy and clinical adult populations (PROSPERO: CRD42022332965). We conducted searches across seven electronic databases: PUBMED, Web of Science, EMBASE, PEDro, BIREME, SCIELO, and Cochrane, over the period from June 2022 to October 2023, without restricting the publication year. We included cross-sectional and longitudinal studies that used NMES as an intervention or assessment tool for comparing muscle lengths in adult populations. We excluded studies on vocalization, respiratory, or pelvic floor muscles. Data extraction was performed via a standardized form to gather information on participants, interventions, and outcomes. Risk of bias was assessed using the Revised Cochrane risk-of-bias tool for cross-over trials and the Physiotherapy Evidence Database scale. Out of the 1185 articles retrieved through our search strategy, we included 36 studies in our analysis, that included 448 healthy young participants (age: 19-40 years) in order to investigate maximum evoked torque (n = 268), contraction fatigability (n = 87), discomfort (n = 82), and muscle strengthening (n = 22), as well as six participants with spinal cord injuries, and 15 healthy older participants. Meta-analyses were possible for comparing maximal evoked torque according to quadriceps muscle length through knee joint angle. At optimal muscle length 50° - 70° of knee flexion, where 0° is full extension), there was greater evoked torque during nerve stimulation compared to very short (0 - 30°) (p<0.001, CI 95%: -2.03, -1.15 for muscle belly stimulation, and -3.54, -1.16 for femoral nerve stimulation), short (31° - 49°) (p = 0.007, CI 95%: -1.58, -0.25), and long (71° - 90°) (p<0.001, CI 95%: 0.29, 1.02) muscle lengths. At long muscle lengths, NMES evoked greater torque than very short (p<0.001, CI 95%: -2.50, -0.67) and short (p = 0.04, CI 95%: -2.22, -0.06) lengths. The shortest quadriceps length generated the highest perceived discomfort for a given current amplitude. The amount of contraction fatigability was greater when muscle length allowed greater torque generation in the pre-fatigue condition. Strength gains were greater for a protocol at the optimal muscle length than for short muscle length. The quality of evidence was very high for most comparisons for evoked torque. However, further studies are necessary to achieve certainty for the other outcomes. Optimal muscle length should be considered the primary choice during NMES interventions, as it promotes higher levels of force production and may facilitate the preservation/gain in muscle force and mass, with reduced discomfort. However, a longer than optimal muscle length may also be used, due to possible muscle lengthening at high evoked tension. Thorough understanding of these physiological principles is imperative for the appropriate prescription of NMES for healthy and clinical populations.
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Affiliation(s)
- Jonathan Galvão Tenório Cavalcante
- Laboratory of Muscle and Tendon Plasticity, Graduate Program of Physical Education, University of Brasília, Brasília, Distrito Federal, Brazil
| | - Victor Hugo de Souza Ribeiro
- Laboratory of Muscle and Tendon Plasticity, Graduate Program of Rehabilitation Sciences, University of Brasília, Brasília, Distrito Federal, Brazil
| | - Rita de Cássia Marqueti
- Molecular Analysis Laboratory, Graduate Program of Rehabilitation Sciences, University of Brasília, Brasília, Distrito Federal, Brazil
| | - Isabel de Almeida Paz
- Exercise Research Laboratory, School of Physical Education, Physical Therapy and Dance, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Júlia Aguillar Ivo Bastos
- Laboratory of Muscle and Tendon Plasticity, Graduate Program of Rehabilitation Sciences, University of Brasília, Brasília, Distrito Federal, Brazil
| | - Marco Aurélio Vaz
- Exercise Research Laboratory, School of Physical Education, Physical Therapy and Dance, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Nicolas Babault
- Centre d’Expertise de la Performance, INSERM UMR1093-CAPS, UFR des Sciences du Sport, University of Burgundy Franche-Comté, Besançon, Dijon, France
| | - João Luiz Quagliotti Durigan
- Laboratory of Muscle and Tendon Plasticity, Graduate Program of Physical Education, University of Brasília, Brasília, Distrito Federal, Brazil
- Laboratory of Muscle and Tendon Plasticity, Graduate Program of Rehabilitation Sciences, University of Brasília, Brasília, Distrito Federal, Brazil
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Barbalho-Moulim MC, Paro FM, Pedrosa DF, Serafim LM, Kuster E, Carmo WAD, de Oliveira GP, de Lima MHBS, Pedreira AB, Duarte H, Wittmer VL. Effects of upper limbs' neuromuscular electrical stimulation (NMES) superimposed to voluntary contraction added to a protocol of intradialytic leg cycle ergometer exercise, in muscle strength, functional capacity and quality of life of adult patients with CKD: a randomized clinical trial protocol. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2024; 29:e2079. [PMID: 38477078 DOI: 10.1002/pri.2079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 02/02/2024] [Accepted: 02/18/2024] [Indexed: 03/14/2024]
Abstract
OBJECTIVE To investigate the effects of unilateral upper limbs' (ULM) neuromuscular electrical stimulation (NMES) superimposed on a voluntary contraction added to a protocol of intradialytic leg cycle ergometer exercise on muscle strength, functional capacity and quality of life of adult patients with chronic kidney disease (CKD). METHODS This randomized controlled clinical trial will be carried out at a Brazilian University Hospital. The patients will be evaluated and randomly allocated to an intervention group (i.e., unilateral NMES on the upper limb without hemodialysis fistula for 20 min and leg cycle ergometer for 30 min) or a control group (i.e., unilateral NMES-Sham on the upper limb without hemodialysis fistula for 20 min and leg cycle ergometer for 30 min). The patients will be treated for 8 weeks, with three weekly treatment sessions totaling 24 sessions. MEASUREMENTS ULM muscle strength, functional capacity, quality of life and also the feasibility, safety and patient adherence to the exercise protocol. All physical measurements will be collected by trained researchers before treatment (week 0) and at the end of treatment (week 9), always in the second hemodialysis session of the week. It will be used in an intention-to-treat analysis. RESULTS/CONCLUSIONS The outcomes of this clinical trial protocol may help to know the possible benefits of unilateral ULM' NMES superimposed on a voluntary contraction added to a protocol of leg cycle ergometer for patients with CKD and to aid clinical decisions about future implementation or not of this technique (NMES) in intradialytic physical training programs.
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Affiliation(s)
| | - Flavia Marini Paro
- Department of Integrated Education on Health, Federal University of Espírito Santo (UFES), Vitória, Espírito Santo, Brazil
| | - Diego França Pedrosa
- Department of Integrated Education on Health, Federal University of Espírito Santo (UFES), Vitória, Espírito Santo, Brazil
| | - Lais Mello Serafim
- Department of Integrated Education on Health, Federal University of Espírito Santo (UFES), Vitória, Espírito Santo, Brazil
| | - Elizângela Kuster
- Department of Integrated Education on Health, Federal University of Espírito Santo (UFES), Vitória, Espírito Santo, Brazil
| | - Willian Assis do Carmo
- Department of Integrated Education on Health, Federal University of Espírito Santo (UFES), Vitória, Espírito Santo, Brazil
| | - Gabriela P de Oliveira
- Department of Integrated Education on Health, Federal University of Espírito Santo (UFES), Vitória, Espírito Santo, Brazil
| | - Maria Helena B S de Lima
- Cassiano Antônio Moraes University Hospital (HUCAM), Universidade Federal do Espírito Santo (UFES), Vitória, Espírito Santo, Brazil
| | - Alexandre Bittencourt Pedreira
- Hemodialysis Sector-Nephrology Unit, Cassiano Antônio Moraes University Hospital (HUCAM), Brazilian Hospital Services Company (EBSERH), Vitória, Espírito Santo, Brazil
| | - Halina Duarte
- Department of Integrated Education on Health, Federal University of Espírito Santo (UFES), Vitória, Espírito Santo, Brazil
| | - Verônica Lourenço Wittmer
- Department of Integrated Education on Health, Federal University of Espírito Santo (UFES), Vitória, Espírito Santo, Brazil
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Nakashima Y, Iwaki D, Kataoka Y, Ariie T, Taito S, Nishikawa Y, Mio N, Mikami Y. Efficacy of neuromuscular electrical stimulation for thoracic and abdominal surgery: A systematic review and meta-analysis. PLoS One 2023; 18:e0294965. [PMID: 38032886 PMCID: PMC10688715 DOI: 10.1371/journal.pone.0294965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 11/10/2023] [Indexed: 12/02/2023] Open
Abstract
This systematic review and meta-analysis examined the efficacy of neuromuscular electrical stimulation (NMES) on lower limb muscle strength and health-related quality of life (HR-QOL) after thoracic and abdominal surgery. We searched the Cochrane Central Register of Controlled Trials, MEDLINE via PubMed, Excerpta Medica Database via Elsevier, Physiotherapy Evidence Database, Cumulative Index to Nursing and Allied Health Literature, World Health Organization International Clinical Trials Registry Platform via their dedicated search portal, and ClinicalTrials.gov on November 2021 and updated in April 2023 to identify randomized controlled trials that examined the effects of NMES after thoracic and abdominal surgery. The primary outcomes were lower limb muscle strength, HR-QOL, and adverse events. We used the Cochrane Risk of Bias Tool and the Grading of Recommendations, Assessment, Development, and Evaluation approach to assess the certainty of evidence. A total of 18 randomized control trials involving 915 participants, including 10 on cardiovascular surgery, two on pulmonary surgery, five on digestive system surgery, and one on other surgery, were included. NMES slightly increased lower limb muscle strength and adverse events in cardiovascular surgery. Adverse events (hypotension, pain, and muscle discomfort) occurred in seven patients. HR-QOL was measured in two studies on cardiovascular surgery, but these were not pooled due to concept heterogeneity. Overall, NMES slightly increases lower limb muscle strength after cardiovascular surgery without serious adverse events. However, higher-quality randomized control trials in thoracic and abdominal surgeries are needed.
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Affiliation(s)
- Yuki Nakashima
- Division of Rehabilitation, Department of Clinical Practice and Support, Hiroshima University Hospital, Hiroshima, Japan
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan
| | - Daisuke Iwaki
- Division of Rehabilitation, Department of Clinical Practice and Support, Hiroshima University Hospital, Hiroshima, Japan
- Department of Neuromechanics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yuki Kataoka
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan
- Department of Internal Medicine, Kyoto Min-iren Asukai Hospital, Kyoto, Japan
- Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine / Public Health, Kyoto, Japan
| | - Takashi Ariie
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan
- Department of Physical Therapy, School of Health Sciences at Fukuoka, International University of Health and Welfare, Fukuoka, Japan
| | - Shunsuke Taito
- Division of Rehabilitation, Department of Clinical Practice and Support, Hiroshima University Hospital, Hiroshima, Japan
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan
| | - Yuichi Nishikawa
- Faculty of Frontier Engineering, Institute of Science & Engineering, Kanazawa University, Kanazawa, Japan
| | - Naoki Mio
- Division of Rehabilitation, Department of Clinical Practice and Support, Hiroshima University Hospital, Hiroshima, Japan
| | - Yukio Mikami
- Department of Rehabilitation Medicine, Hiroshima University Hospital, Hiroshima, Japan
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Vieira L, Silva PE, de Melo PF, Maldaner V, Durigan JQ, Marqueti RDC, Nobrega O, Mathur S, Burtin C, Barin F, Machado-Silva W, Ramalho S, Chiappa GR, Gomes NO, Carvalho CRF, Cipriano GFB, Cipriano G. Early Neuromuscular Electrical Stimulation Preserves Muscle Size and Quality and Maintains Systemic Levels of Signaling Mediators of Muscle Growth and Inflammation in Patients with Traumatic Brain Injury: A Randomized Clinical Trial. Crit Care Res Pract 2023; 2023:9335379. [PMID: 37547450 PMCID: PMC10397495 DOI: 10.1155/2023/9335379] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/15/2022] [Accepted: 06/26/2023] [Indexed: 08/08/2023] Open
Abstract
Objective To investigate the effects of an early neuromuscular electrical stimulation (NMES) protocol on muscle quality and size as well as signaling mediators of muscle growth and systemic inflammation in patients with traumatic brain injury (TBI). Design Two-arm, single-blinded, parallel-group, randomized, controlled trial with a blinded assessment. Setting. Trauma intensive care unit at a university hospital. Participants. Forty consecutive patients on mechanical ventilation (MV) secondary to TBI were prospectively recruited within the first 24 hours following admission. Interventions. The intervention group (NMES; n = 20) received a daily session of NMES on the rectus femoris muscle for five consecutive days (55 min/each session). The control group (n = 20) received usual care. Main Outcome Measures. Muscle echogenicity and thickness were evaluated by ultrasonography. A daily blood sample was collected to assess circulating levels of insulin-like growth factor I (IGF-I), inflammatory cytokines, and matrix metalloproteinases (MMP). Results Both groups were similar at baseline. A smaller change in muscle echogenicity and thickness (difference between Day 1 and Day 7) was found in the control group compared to the NMES group (29.9 ± 2.1 vs. 3.0 ± 1.2, p < 0.001; -0.79 ± 0.12 vs. -0.01 ± 0.06, p < 0.001, respectively). Circulating levels of IGF-I, pro-inflammatory cytokines (IFN-y), and MMP were similar between groups. Conclusion An early NMES protocol can preserve muscle size and quality and maintain systemic levels of signaling mediators of muscle growth and inflammation in patients with TBI. This trial is registered with https://www.ensaiosclinicos.gov.br under number RBR-2db.
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Affiliation(s)
- Luciana Vieira
- University of Brasilia, Faculty of Ceilãndia, Sciences and Technologies in Health Program (PPGCTS), Brasília, DF, Brazil
- Physical Therapy Division, Hospital de Base do Distrito Federal, Brasília, DF, Brazil
| | - Paulo Eugênio Silva
- University of Brasilia, Faculty of Ceilãndia, Sciences and Technologies in Health Program (PPGCTS), Brasília, DF, Brazil
- Physical Therapy Division, Hospital de Base do Distrito Federal, Brasília, DF, Brazil
| | - Priscilla Flavia de Melo
- University of Brasilia, Faculty of Ceilãndia, Sciences and Technologies in Health Program (PPGCTS), Brasília, DF, Brazil
- Physical Therapy Division, Hospital de Base do Distrito Federal, Brasília, DF, Brazil
| | - Vinicius Maldaner
- University of Brasilia, Faculty of Ceilãndia, Sciences and Technologies in Health Program (PPGCTS), Brasília, DF, Brazil
- Human Movement and Rehabilitation Program, UniEVANGÉLICA, Anápolis, GO, Brazil
| | - Joao Q. Durigan
- University of Brasilia, Faculty of Ceilãndia, Sciences and Technologies in Health Program (PPGCTS), Brasília, DF, Brazil
- University of Brasilia, Faculty of Ceilãndia, Rehabilitation Sciences Program (PPGCR), Brasília, DF, Brazil
| | - Rita de Cassia Marqueti
- University of Brasilia, Faculty of Ceilãndia, Sciences and Technologies in Health Program (PPGCTS), Brasília, DF, Brazil
- University of Brasilia, Faculty of Ceilãndia, Rehabilitation Sciences Program (PPGCR), Brasília, DF, Brazil
| | - Otavio Nobrega
- University of Brasilia, Faculty of Ceilãndia, Sciences and Technologies in Health Program (PPGCTS), Brasília, DF, Brazil
- Medical Sciences Graduate Program (PPGCM), University of Brasilia (UnB), Brasília, DF, Brazil
| | - Sunita Mathur
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - Chris Burtin
- Rehabilitation Research Centre, Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Fabrício Barin
- University of Brasilia, Faculty of Ceilãndia, Sciences and Technologies in Health Program (PPGCTS), Brasília, DF, Brazil
| | - Wilcelly Machado-Silva
- University of Brasilia, Faculty of Ceilãndia, Sciences and Technologies in Health Program (PPGCTS), Brasília, DF, Brazil
| | - Sergio Ramalho
- University of Brasilia, Faculty of Ceilãndia, Sciences and Technologies in Health Program (PPGCTS), Brasília, DF, Brazil
| | - Gaspar R. Chiappa
- Human Movement and Rehabilitation Program, UniEVANGÉLICA, Anápolis, GO, Brazil
| | | | | | - Graziella F. B. Cipriano
- University of Brasilia, Faculty of Ceilãndia, Sciences and Technologies in Health Program (PPGCTS), Brasília, DF, Brazil
- University of Brasilia, Faculty of Ceilãndia, Rehabilitation Sciences Program (PPGCR), Brasília, DF, Brazil
| | - Gerson Cipriano
- University of Brasilia, Faculty of Ceilãndia, Sciences and Technologies in Health Program (PPGCTS), Brasília, DF, Brazil
- Human Movement and Rehabilitation Program, UniEVANGÉLICA, Anápolis, GO, Brazil
- University of Brasilia, Faculty of Ceilãndia, Rehabilitation Sciences Program (PPGCR), Brasília, DF, Brazil
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7
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Zulbaran‐Rojas A, Lee M, Bara RO, Flores‐Camargo A, Spitz G, Finco MG, Bagheri AB, Modi D, Shaib F, Najafi B. Electrical stimulation to regain lower extremity muscle perfusion and endurance in patients with post-acute sequelae of SARS CoV-2: A randomized controlled trial. Physiol Rep 2023; 11:e15636. [PMID: 36905161 PMCID: PMC10006649 DOI: 10.14814/phy2.15636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 03/12/2023] Open
Abstract
Muscle deconditioning and impaired vascular function in the lower extremities (LE) are among the long-term symptoms experienced by COVID-19 patients with a history of severe illness. These symptoms are part of the post-acute sequelae of Sars-CoV-2 (PASC) and currently lack evidence-based treatment. To investigate the efficacy of lower extremity electrical stimulation (E-Stim) in addressing PASC-related muscle deconditioning, we conducted a double-blinded randomized controlled trial. Eighteen (n = 18) patients with LE muscle deconditioning were randomly assigned to either the intervention (IG) or the control (CG) group, resulting in 36 LE being assessed. Both groups received daily 1 h E-Stim on both gastrocnemius muscles for 4 weeks, with the device functional in the IG and nonfunctional in the CG. Changes in plantar oxyhemoglobin (OxyHb) and gastrocnemius muscle endurance (GNMe) in response to 4 weeks of daily 1 h E-Stim were assessed. At each study visit, outcomes were measured at onset (t0 ), 60 min (t60 ), and 10 min after E-Stim therapy (t70 ) by recording ΔOxyHb with near-infrared spectroscopy. ΔGNMe was measured with surface electromyography at two time intervals: 0-5 min (Intv1 ) and: 55-60 min (Intv2 ). Baseline OxyHb decreased in both groups at t60 (IG: p = 0.046; CG: p = 0.026) and t70 (IG = p = 0.021; CG: p = 0.060) from t0 . At 4 weeks, the IG's OxyHb increased from t60 to t70 (p < 0.001), while the CG's decreased (p = 0.003). The IG had higher ΔOxyHb values than the CG at t70 (p = 0.004). Baseline GNMe did not increase in either group from Intv1 to Intv2 . At 4 weeks, the IG's GNMe increased (p = 0.031), whereas the CG did not change. There was a significant association between ΔOxyHb and ΔGNMe (r = 0.628, p = 0.003) at 4 weeks in the IG. In conclusion, E-Stim can improve muscle perfusion and muscle endurance in individuals with PASC experiencing LE muscle deconditioning.
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Affiliation(s)
- Alejandro Zulbaran‐Rojas
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of SurgeryBaylor College of MedicineHoustonTexasUSA
| | - Myeounggon Lee
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of SurgeryBaylor College of MedicineHoustonTexasUSA
| | - Rasha O. Bara
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of SurgeryBaylor College of MedicineHoustonTexasUSA
| | - Areli Flores‐Camargo
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of SurgeryBaylor College of MedicineHoustonTexasUSA
| | - Gil Spitz
- Baylor St Luke's Medical Center, Exercise PhysiologyLiver Transplant ProgramHoustonTexasUSA
| | - M. G. Finco
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of SurgeryBaylor College of MedicineHoustonTexasUSA
| | - Amir Behzad Bagheri
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of SurgeryBaylor College of MedicineHoustonTexasUSA
| | - Dipaben Modi
- Department of Pulmonary Critical CareBaylor College of MedicineHoustonTexasUSA
| | - Fidaa Shaib
- Department of Pulmonary Critical CareBaylor College of MedicineHoustonTexasUSA
| | - Bijan Najafi
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of SurgeryBaylor College of MedicineHoustonTexasUSA
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Verceles AC, Serra M, Davis D, Alon G, Wells CL, Parker E, Sorkin J, Bhatti W, Terrin ML. Combining exercise, protein supplementation and electric stimulation to mitigate muscle wasting and improve outcomes for survivors of critical illness-The ExPrES study. Heart Lung 2023; 58:229-235. [PMID: 36473808 PMCID: PMC9992240 DOI: 10.1016/j.hrtlng.2022.11.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Neuromuscular electrical stimulation (NMES) with high protein supplementation (HPRO) to preserve muscle mass and function has not been assessed in ICU patients. We compared the effects of combining NMES and HPRO with mobility and strength rehabilitation (NMES+HPRO+PT) to standardized ICU care. OBJECTIVES To assess the effectiveness of combined NMES+HPRO+PT in mitigating sarcopenia as evidenced by CT volume and cross-sectional area when compared to usual ICU care. Additionally, we assessed the effects of the combined therapy on select clinical outcomes, including nutritional status, nitrogen balance, delirium and days on mechanical ventilation. METHODS Participants were randomized by computer generated assignments to receive either NMES+HPRO+PT or standard care. Over 14 days the standardized ICU care group (N = 23) received usual critical care and rehabilitation while the NMES+HPRO+PT group (N = 16) received 30 min neuromuscular electrical stimulation of quadriceps and dorsiflexors twice-daily for 10 days and mean 1.3 ± 0.4 g/kg body weight of high protein supplementation in addition to standard care. Nonresponsive participants received passive exercises and, once responsive, were encouraged to exercise actively. Primary outcome measures were muscle volume and cross-sectional area measured using CT-imaging. Secondary outcomes included nutritional status, nitrogen balance, delirium and days on mechanical ventilation. RESULTS The NMES+HPRO+PT group (N = 16) lost less lower extremity muscle volume compared to the standard care group (N = 23) and had larger mean combined thigh cross-sectional area. The nitrogen balance remained negative in the standard care group, while positive on days 5, 9, and 14 in the NMES+HPRO+PT group. Standard care group participants experienced more delirium than the NMES+HPRO+PT group. No differences between groups when comparing length of stay or mechanical ventilation days. CONCLUSIONS The combination of neuromuscular electrical stimulation, high protein supplementation and mobility and strength rehabilitation resulted in mitigation of lower extremity muscle loss and less delirium in mechanically ventilated ICU patients. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT02509520. Registered July 28, 2015.
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Affiliation(s)
- Avelino C Verceles
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Monica Serra
- Department of Medicine, Division of Geriatrics, Gerontology & Palliative Medicine, Sam and Ann Barshop Institute for Longevity and Aging Studies at University of Texas Health Science, San Antonio, TX, USA
| | - Derik Davis
- Division of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Gad Alon
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD
| | - Chris L Wells
- Department of Rehabilitation Services, University of Maryland Medical Center, Baltimore, MD, USA
| | - Elizabeth Parker
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD
| | - John Sorkin
- Department of Medicine, Division of Geriatrics and Palliative Medicine, University of Maryland School of Medicine, Baltimore MD, USA; Department of Veterans Affairs, Baltimore VA Maryland Health Care System, Geriatric Research, Education and Clinical Center, Baltimore, MD, USA
| | - Waqas Bhatti
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Michael L Terrin
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
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Zulbaran-Rojas A, Mishra R, Rodriguez N, Bara RO, Lee M, Bagheri AB, Herlihy JP, Siddique M, Najafi B. Safety and efficacy of electrical stimulation for lower-extremity muscle weakness in intensive care unit 2019 Novel Coronavirus patients: A phase I double-blinded randomized controlled trial. Front Med (Lausanne) 2022; 9:1017371. [PMID: 36561714 PMCID: PMC9763311 DOI: 10.3389/fmed.2022.1017371] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022] Open
Abstract
Background Intensive care unit (ICU) prolonged immobilization may lead to lower-extremity muscle deconditioning among critically ill patients, particularly more accentuated in those with 2019 Novel Coronavirus (COVID-19) infection. Electrical stimulation (E-Stim) is known to improve musculoskeletal outcomes. This phase I double-blinded randomized controlled trial examined the safety and efficacy of lower-extremity E-Stim to prevent muscle deconditioning. Methods Critically ill COVID-19 patients admitted to the ICU were randomly assigned to control (CG) or intervention (IG) groups. Both groups received daily E-Stim (1 h) for up to 14 days on both gastrocnemius muscles (GNMs). The device was functional in the IG and non-functional in the CG. Primary outcomes included ankle strength (Ankles) measured by an ankle-dynamometer, and GNM endurance (GNMe) in response to E-Stim assessed with surface electromyography (sEMG). Outcomes were measured at baseline, 3 and 9 days. Results Thirty-two (IG = 16, CG = 16) lower extremities in 16 patients were independently assessed. The mean time between ICU admission and E-Stim therapy delivery was 1.8 ± 1.9 days (p = 0.29). At 3 days, the IG showed an improvement compared to the CG with medium effect sizes for Ankles (p = 0.06, Cohen's d = 0.77) and GNMe (p = 0.06, d = 0.69). At 9 days, the IG GNMe was significantly higher than the CG (p = 0.04, d = 0.97) with a 6.3% improvement from baseline (p = 0.029). E-Stim did not alter vital signs (i.e., heart/respiratory rate, blood saturation of oxygen), showed no adverse events (i.e., pain, skin damage, discomfort), nor interfere with ICU standard of care procedures (i.e., mechanical ventilation, prone rotation). Conclusion This study supports the safety and efficacy of early E-Stim therapy to potentially prevent deterioration of lower-extremity muscle conditions in critically ill COVID-19 patients recently admitted to the ICU. If confirmed in a larger sample, E-Stim may be used as a practical adjunctive therapy. Clinical trial registration [https://clinicaltrials.gov/], identifier [NCT04685213].
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Affiliation(s)
- Alejandro Zulbaran-Rojas
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, United States
| | - Ramkinker Mishra
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, United States
| | - Naima Rodriguez
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, United States
| | - Rasha O. Bara
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, United States
| | - Myeounggon Lee
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, United States
| | - Amir Behzad Bagheri
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, United States
| | - James P. Herlihy
- Department of Pulmonary Critical Care, Baylor College of Medicine, Houston, TX, United States
| | - Muhammad Siddique
- Department of Pulmonary Critical Care, Baylor College of Medicine, Houston, TX, United States
| | - Bijan Najafi
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, United States,*Correspondence: Bijan Najafi,
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Fernandes JA, Silva MLD, Trancho AC, Macedo JRDD, Martins HR, Silva PE. Assessment of neuromuscular electrical stimulation in critically ill patients: physical therapists’ knowledge and barriers to its use. FISIOTERAPIA E PESQUISA 2022. [DOI: 10.1590/1809-2950/21003529032022en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
ABSTRACT Transcutaneous neuromuscular electrical stimulation (NMES) is considered an important tool to prevent muscle mass and strength loss in patients admitted to intensive care units (ICU). This study aimed to evaluate physical therapists’ profile and knowledge of NMES and identify the main barriers to its use in ICUs. This observational cross-sectional study was conducted via a structured questionnaire created by the authors. It consisted of 12 objective questions to analyze physical therapists’ knowledge of NMES use in critically ill patients. Physical therapists were invited to participate in this study during an international symposium on NMES. In total, 56 physical therapists, with a mean age of 33.5±7.2 years and working an average of 9.7±7 years after graduation, completed the survey. Overall, 34 respondents worked in ICUs, of which only four (12%) reported regular NMES use in their ICUs. We found a low average of correct answers to our questionnaire (25%; 3/12). The main barriers reported to using NMES in ICUs were lack of knowledge (28; 50%) and equipment (24; 43%). The number of correct answers expert and non-expert physical therapists was not statistically significant (p=0.68). Thus, we observed participants’ poor knowledge of NMES use in critically ill patients. Respondents showed that NMES has been underused in their ICUs. Lack of knowledge and equipment seems to be the main barriers for the use of NMES in ICUs.
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Baron MV, Silva PE, Koepp J, Urbanetto JDS, Santamaria AFM, Dos Santos MP, de Mello Pinto MV, Brandenburg C, Reinheimer IC, Carvalho S, Wagner MB, Miliou T, Poli-de-Figueiredo CE, Pinheiro da Costa BE. Efficacy and safety of neuromuscular electrical stimulation in the prevention of pressure injuries in critically ill patients: a randomized controlled trial. Ann Intensive Care 2022; 12:53. [PMID: 35695996 PMCID: PMC9188909 DOI: 10.1186/s13613-022-01029-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 06/05/2022] [Indexed: 11/30/2022] Open
Abstract
Background Pressure injuries (PIs), especially in the sacral region are frequent, costly, and increase morbidity and mortality of patients in an intensive care unit (ICU). These injuries can occur as a result of prolonged pressure and/or shear forces. Neuromuscular electrical stimulation (NMES) can increase muscle mass and improve local circulation, potentially reducing the incidence of PI. Methods We performed a randomized controlled trial to assess the efficacy and safety of NMES in preventing PI in critically ill patients. We included patients with a period of less than 48 h in the ICU, aged ≥ 18 years. Participants were randomly selected (1:1 ratio) to receive NMES and usual care (NMES group) or only usual care (control group—CG) until discharge, death, or onset of a PI. To assess the effectiveness of NMES, we calculated the relative risk (RR) and number needed to treat (NNT). We assessed the muscle thickness of the gluteus maximus by ultrasonography. To assess safety, we analyzed the effects of NMES on vital signs and checked for the presence of skin burns in the stimulated areas. Clinical outcomes were assessed by time on mechanical ventilation, ICU mortality rate, and length of stay in the ICU. Results We enrolled 149 participants, 76 in the NMES group. PIs were present in 26 (35.6%) patients in the CG and 4 (5.3%) in the NMES group (p ˂ 0.001). The NMES group had an RR = 0.15 (95% CI 0.05–0.40) to develop a PI, NNT = 3.3 (95% CI 2.3–5.9). Moreover, the NMES group presented a shorter length of stay in the ICU: Δ = − 1.8 ± 1.2 days, p = 0.04. There was no significant difference in gluteus maximus thickness between groups (CG: Δ = − 0.37 ± 1.2 cm vs. NMES group: Δ = 0 ± 0.98 cm, p = 0.33). NMES did not promote deleterious changes in vital signs and we did not detect skin burns. Conclusions NMES is an effective and safe therapy for the prevention of PI in critically ill patients and may reduce length of stay in the ICU. Trial registration RBR-8nt9m4. Registered prospectively on July 20th, 2018, https://ensaiosclinicos.gov.br/rg/RBR-8nt9m4
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Affiliation(s)
- Miriam Viviane Baron
- Pontifical Catholic University of Rio Grande do Sul, Rio Grande do Sul, Porto Alegre, Brazil. .,Instituto Interdisciplinar de Educação, Ciência e Saúde, Fortaleza, Ceará, Brazil.
| | - Paulo Eugênio Silva
- Secretaria de Estado de Saúde do Distrito Federal, Hospital de Base do Distrito Federal, Distrito Federal, Brasília, Brazil
| | - Janine Koepp
- University of Santa Cruz do Sul, Santa Cruz do Sul, Rio Grande do Sul, Brazil
| | | | | | | | | | - Cristine Brandenburg
- Faculdade de Educação, Ciências e Letras do Sertão Central, Quixadá, Ceará, Brazil.,Instituto Interdisciplinar de Educação, Ciência e Saúde, Fortaleza, Ceará, Brazil
| | | | - Sonia Carvalho
- Rigshospital, Inge Lehmannsvej, Copenhagen East, Denmark
| | - Mário Bernardes Wagner
- Pontifical Catholic University of Rio Grande do Sul, Rio Grande do Sul, Porto Alegre, Brazil
| | - Thomas Miliou
- State University of Campinas, Campinas, São Paulo, Brazil
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Silva PE, Durigan JLQ, Babault N. Bedside voluntary and evoked forces evaluation in intensive care unit patients, not only force evaluation: a letter to the Editor. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2021; 25:233. [PMID: 34210359 PMCID: PMC8252314 DOI: 10.1186/s13054-021-03636-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 06/08/2021] [Indexed: 11/12/2022]
Affiliation(s)
- Paulo Eugênio Silva
- Research Group Fisiologia Clínica e Inovação Tecnológica (CNPq); Physical Therapy Division, Hospital de Base do Distrito Federal (IGESDF), Brasília, DF, 70330-150, Brazil.
| | | | - Nicolas Babault
- INSERM UMR1093 - CAPS, Faculty of Sport Sciences, University of Bourgogne Franche-Comté, 21000, Dijon, France
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Segers J, Vanhorebeek I, Langer D, Charususin N, Wei W, Frickx B, Demeyere I, Clerckx B, Casaer M, Derese I, Derde S, Pauwels L, Van den Berghe G, Hermans G, Gosselink R. Early neuromuscular electrical stimulation reduces the loss of muscle mass in critically ill patients - A within subject randomized controlled trial. J Crit Care 2020; 62:65-71. [PMID: 33285371 DOI: 10.1016/j.jcrc.2020.11.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 11/17/2020] [Accepted: 11/20/2020] [Indexed: 01/21/2023]
Abstract
PURPOSE To investigate the effect of Neuromuscular Electrical Stimulation (NMES) on muscle thickness, strength and morphological and molecular markers of the quadriceps. MATERIALS AND METHODS Adult critically ill patients with an expected prolonged stay received unilateral quadriceps NMES sessions for 7 consecutive days. Before and after the intervention period, quadriceps thickness was measured with ultrasound. After the intervention period, strength was assessed in cooperative patients and muscle biopsies were taken. Multivariable regression was performed to identify factors affecting muscle thickness loss. RESULTS Muscle thickness decreased less in the stimulated leg (-6 ± 16% versus -12 ± 15%, p = 0.014, n = 47). Strength was comparable. Opioid administration, minimal muscle contraction and more muscle thickness loss in the non-stimulated muscle were independently associated with better muscle thickness preservation. Stimulated muscles showed a shift towards larger myofibers and higher MyHC-I gene expression. NMES did not affect gene expression of other myofibrillary proteins, MuRF-1 or atrogin-1. Signs of myofiber necrosis and inflammation were comparable for both muscles. CONCLUSIONS NMES attenuated the loss of muscle mass, but not of strength, in critically ill patients. Preservation of muscle mass was more likely in patients receiving opioids, patients with a minimal muscle contraction during NMES and patients more prone to lose muscle mass. TRIAL REGISTRATION clinicaltrials.govNCT02133300.
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Affiliation(s)
- Johan Segers
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Herestraat 49, B-3000 Leuven, Belgium; Department of Intensive Care, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium
| | - Ilse Vanhorebeek
- Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, B-3000 Leuven, Belgium
| | - Daniel Langer
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Herestraat 49, B-3000 Leuven, Belgium
| | - Noppawan Charususin
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Herestraat 49, B-3000 Leuven, Belgium; Department of Physical therapy, Faculty of Allied Health Sciences, Thammasat University, Pathumthani, Thailand
| | - Weili Wei
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Herestraat 49, B-3000 Leuven, Belgium; Department of Respiratory and Critical Care, Tongji Hospital, Shangai, China
| | - Bregje Frickx
- Medical Intensive Care Unit, Department of General Internal Medicine, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium
| | - Inge Demeyere
- Department of Intensive Care, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium
| | - Beatrix Clerckx
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Herestraat 49, B-3000 Leuven, Belgium; Department of Intensive Care, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium
| | - Michael Casaer
- Department of Intensive Care, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium; Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, B-3000 Leuven, Belgium
| | - Inge Derese
- Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, B-3000 Leuven, Belgium
| | - Sarah Derde
- Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, B-3000 Leuven, Belgium
| | - Lies Pauwels
- Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, B-3000 Leuven, Belgium
| | - Greet Van den Berghe
- Department of Intensive Care, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium; Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, B-3000 Leuven, Belgium
| | - Greet Hermans
- Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, B-3000 Leuven, Belgium; Medical Intensive Care Unit, Department of General Internal Medicine, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium
| | - Rik Gosselink
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Herestraat 49, B-3000 Leuven, Belgium; Department of Intensive Care, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium.
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Neuromuscular electrical stimulation in critically ill traumatic brain injury patients attenuates muscle atrophy, neurophysiological disorders, and weakness: a randomized controlled trial. J Intensive Care 2019; 7:59. [PMID: 31890221 PMCID: PMC6909464 DOI: 10.1186/s40560-019-0417-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 12/03/2019] [Indexed: 12/15/2022] Open
Abstract
Background Critically ill traumatic brain injury (TBI) patients experience extensive muscle damage during their stay in the intensive care unit. Neuromuscular electrical stimulation (NMES) has been considered a promising treatment to reduce the functional and clinical impacts of this. However, the time needed for NMES to produce effects over the muscles is still unclear. This study primarily aimed to assess the time needed and effects of an NMES protocol on muscle architecture, neuromuscular electrophysiological disorder (NED), and muscle strength, and secondarily, to evaluate the effects on plasma systemic inflammation, catabolic responses, and clinical outcomes. Methods We performed a randomized clinical trial in critically ill TBI patients. The control group received only conventional physiotherapy, while the NMES group additionally underwent daily NMES for 14 days in the lower limb muscles. Participants were assessed at baseline and on days 3, 7, and 14 of their stay in the intensive care unit. The primary outcomes were assessed with muscle ultrasound, neuromuscular electrophysiology, and evoked peak force, and the secondary outcomes with plasma cytokines, matrix metalloproteinases, and clinical outcomes. Results Sixty participants were randomized, and twenty completed the trial from each group. After 14 days, the control group presented a significant reduction in muscle thickness of tibialis anterior and rectus femoris, mean of - 0.33 mm (- 14%) and - 0.49 mm (- 21%), p < 0.0001, respectively, while muscle thickness was preserved in the NMES group. The control group presented a higher incidence of NED: 47% vs. 0% in the NMES group, p < 0.0001, risk ratio of 16, and the NMES group demonstrated an increase in the evoked peak force (2.34 kg/f, p < 0.0001), in contrast to the control group (- 1.55 kg/f, p < 0.0001). The time needed for the NMES protocol to prevent muscle architecture disorders and treat weakness was at least 7 days, and 14 days to treat NED. The secondary outcomes exhibited less precise results, with confidence intervals that spanned worthwhile or trivial effects. Conclusions NMES applied daily for fourteen consecutive days reduced muscle atrophy, the incidence of NED, and muscle weakness in critically ill TBI patients. At least 7 days of NMES were required to elicit the first significant results. Trial registration The trial was registered at ensaiosclinicos.gov.br under protocol RBR-8kdrbz on 17 January 2016.
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de Araujo AET, Silva PE, Carvalho KLD, Fachin-Martins E, Babault N, Durigan JLQ. Intra and inter-raters reliability and agreement of stimulus electrodiagnostic tests with two different electrodes in sedated critically-ill patients. Physiother Theory Pract 2019; 36:1447-1456. [PMID: 30739542 DOI: 10.1080/09593985.2019.1567890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: The aim of the present study was to verify the intra- and inter-rater reliability and agreement of the stimulus electrodiagnostic test (SET) measurements obtained by pen and square electrodes in the vastus lateralis and tibialis anterior muscles. Design: An intra- and inter-rater reliability and agreement study was performed for the SET by two independent raters. Two different sizes of cathode electrodes (1 cm2 and 25 cm2) and two muscles were assessed (tibialis anterior and vastus lateralis). Results: Chronaxie did not change according to the different electrodes. A high intra-rater reliability (0.72 ≤ r ≤ 0.88) was detected independently of the electrode and muscle assessed. Moreover, moderate and almost perfect agreements (0.51 ≤ Kappa ≤ 1.00) were detected on intra-rater assessment. Similar correlations (0.74 ≤ r ≤ 0.79) were found for intra-rater reliability. However, dissimilar inter-rater agreement was detected: Kappa ≤ 0.40 for tibialis anterior and Kappa = 1.00 for vastus lateralis. Conclusion: The SET presented high reliability and moderate agreement in intra-rater evaluations. A fair agreement was found in the inter-rater assessment of the tibialis anterior. Evaluations performed with different electrode sizes did not influence the results. Therefore, the SET should be performed by a unique rater in test retest situations.
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Affiliation(s)
- Amaro Eduardo Tavares de Araujo
- Physical Therapy Division, Hospital de Base do Distrito Federal. St. Médico Hospitalar Sul - Asa Sul , Brasília, Federal District, Brazil
| | - Paulo Eugênio Silva
- Physical Therapy Division, Hospital de Base do Distrito Federal. St. Médico Hospitalar Sul - Asa Sul , Brasília, Federal District, Brazil
| | - Karina Livinode de Carvalho
- Physical Therapy Division, Hospital de Base do Distrito Federal. St. Médico Hospitalar Sul - Asa Sul , Brasília, Federal District, Brazil
| | - Emerson Fachin-Martins
- College of Ceilândia, Centro Metropolitano, University of Brasília , Brasília, Federal District, Brazil
| | - Nicolas Babault
- Centre d'Expertise de la Performance G. Cometti, U1093-INSERM, CAPS, Faculté des Siences du Sport, Université de Bourgogne-Franche-Comté , Dijon, France
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Parry SM, Chapple LAS, Mourtzakis M. Exploring the Potential Effectiveness of Combining Optimal Nutrition With Electrical Stimulation to Maintain Muscle Health in Critical Illness: A Narrative Review. Nutr Clin Pract 2018; 33:772-789. [PMID: 30358183 DOI: 10.1002/ncp.10213] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Muscle wasting occurs rapidly within days of an admission to the intensive care unit (ICU). Concomitant muscle weakness and impaired physical functioning can ensue, with lasting effects well after hospital discharge. Early physical rehabilitation is a promising intervention to minimize muscle weakness and physical dysfunction. However, there is an often a delay in commencing active functional exercises (such as sitting on the edge of bed, standing and mobilizing) due to sedation, patient alertness, and impaired ability to cooperate in the initial days of ICU admission. Therefore, there is high interest in being able to intervene early through nonvolitional exercise strategies such as electrical muscle stimulation (EMS). Muscle health characterized as the composite of muscle quantity, as well as functional and metabolic integrity, may be potentially maintained when optimal nutrition therapy is provided in complement with early physical rehabilitation in critically ill patients; however, the type, dosage, and timing of these interventions are unclear. This article explores the potential role of nutrition and EMS in maintaining muscle health in critical illness. Within this article, we will evaluate fundamental concepts of muscle wasting and evaluate the effects of EMS, as well as the effects of nutrition therapy on muscle health and the clinical and functional outcomes in critically ill patients. We will also highlight current research gaps in order to advance the field forward in this important area.
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Affiliation(s)
- Selina M Parry
- Department of Physiotherapy, The University of Melbourne, Victoria, Australia
| | - Lee-Anne S Chapple
- Intensive Care Research, Royal Adelaide Hospital, South Australia, Australia
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Silva PE, Maldaner V, Vieira L, de Carvalho KL, Gomes H, Melo P, Babault N, Cipriano G, Durigan JLQ. Neuromuscular electrophysiological disorders and muscle atrophy in mechanically-ventilated traumatic brain injury patients: New insights from a prospective observational study. J Crit Care 2017; 44:87-94. [PMID: 29078131 DOI: 10.1016/j.jcrc.2017.10.026] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 10/15/2017] [Accepted: 10/18/2017] [Indexed: 12/14/2022]
Abstract
PURPOSE It is unclear whether the muscular changes in mechanically-ventilated traumatic brain injury patients (TBI) are only associated with disuse or additionally to neuromuscular electrophysiological disorders (NED). The correlation between muscle atrophy and NED may affect functional outcomes and rehabilitation programs significantly. MATERIAL AND METHODS An observational study was performed to investigate the presence of NED and muscle atrophy in TBI patients undergoing mechanical ventilation. NED was diagnosed by the stimulus electrodiagnosis test when chronaxie was ≥1000μs. The muscle structure (thickness and echogenicity) was assessed by B-mode ultrasound. Tibialis anterior (TA), rectus femoris (RF), and biceps brachialis (BB) muscles were analyzed. Patients were followed from the first day of admission in the intensive care unit (ICU) to the fourteenth day. RESULTS Twenty-two patients were analyzed. An increase of 48% in NED from day 1 to day 14 was detected in TA (p=0.004). All muscles presented a significant decrease in thickness (~18%, p<0.05), but echogenicity increased only in TA (19%), p<0.01 and RF (23%), p<0.01. CONCLUSIONS Mechanically-ventilated patients with TBI developed NED in addition to changes in muscle structure during their stay in the ICU.
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Affiliation(s)
- Paulo Eugênio Silva
- Physical Therapy Division, University Hospital of Brasília, University of Brasilia, Brasília, DF, Brazil; Health Sciences and Technologies PhD Program, University of Brasilia, DF, Brazil; Physical Therapy Division, Hospital de Base do Distrito Federal, Brasilia, DF, Brazil.
| | - Vinicius Maldaner
- Physical Therapy Division, Hospital de Base do Distrito Federal, Brasilia, DF, Brazil; Health Science School, Health Science Master Program, Brasilia, DF, Brazil
| | - Luciana Vieira
- Health Sciences and Technologies PhD Program, University of Brasilia, DF, Brazil; Clinical Research Center, Hospital de Base do Distrito Federal, Brasilia, DF, Brazil
| | | | - Hedian Gomes
- Physical Therapy Division, Fisioterapia Integrada de Brasília, Brasília, DF, Brazil
| | - Priscilla Melo
- Health Sciences and Technologies PhD Program, University of Brasilia, DF, Brazil; Physical Therapy Division, Hospital de Base do Distrito Federal, Brasilia, DF, Brazil
| | - Nicolas Babault
- INSERM-U1093 Cognition Action et Plasticité Senorimotrice; UFR STAPS, Université de Bourgogne-Franche-Comté, Dijon, France
| | - Gerson Cipriano
- Assistant Professor, Physical Therapy Division, University of Brasilia, Brasília, DF, Brazil
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