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Stacey MC, Sibbald RG, Evans R. Continuous muscle pump activation by neuromuscular electrical stimulation of the common peroneal nerve in the treatment of patients with venous leg ulcers: A position paper. Int Wound J 2024; 21:e70040. [PMID: 39223104 PMCID: PMC11368661 DOI: 10.1111/iwj.70040] [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: 07/15/2024] [Revised: 08/19/2024] [Accepted: 08/19/2024] [Indexed: 09/04/2024] Open
Abstract
The standard treatment for patients with confirmed Venous Leg Ulcers (VLUs) is compression therapy to improve the function of the calf muscle pump. There is a significant cohort of patients who are unable to tolerate optimal compression therapy or indeed any level of compression therapy. In addition, there is a cohort of patients who can tolerate compression whose ulcers show little or no evidence of healing. There is a need for ways to further improve calf muscle pump function and to improve venous ulcer healing in these patients. Published data were reviewed on the use of Muscle Pump Activation (MPA) using common peroneal nerve neuromuscular electrical stimulation (NMES) to improve calf muscle pump function. There is physiological evidence that MPA can improve calf muscle pump function and venous return in both control subjects and in patients with venous disease. The use of MPA has also been shown to improve venous flow volume and venous flow velocity on ultrasound scanning in patients with venous disease. MPA has been shown to improve microcirculation in the skin using Laser Doppler and laser Doppler Speckle Contrast Imaging, in both normal subjects as well as in patients with venous disease and VLU. A recent randomized controlled trial of MPA plus compression therapy compared with compression therapy alone, found significantly faster rates of healing with the use of MPA in addition to compression therapy. There are indications for the use of MPA as an adjunctive treatment to enhance calf muscle pump function in patients with VLU: who cannot tolerate compression therapy who can only tolerate suboptimal, low-level compression whose ulcer healing remains slow or stalled with optimal compression.
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Affiliation(s)
- Michael C. Stacey
- Department of SurgeryHamilton Health Sciences and McMaster UniversityHamiltonOntarioCanada
| | - R. Gary Sibbald
- Women's College Hospital, Toronto and Department of Medicine, Division of DermatologyUniversity of TorontoTorontoOntarioCanada
| | - Robyn Evans
- Women's College HospitalTorontoOntarioCanada
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Al-Zamil M, Minenko IA, Kulikova NG, Mansur N, Nuvakhova MB, Khripunova OV, Shurygina IP, Topolyanskaya SV, Trefilova VV, Petrova MM, Narodova EA, Soloveva IA, Nasyrova RF, Shnayder NA. Efficiency of Direct Transcutaneous Electroneurostimulation of the Median Nerve in the Regression of Residual Neurological Symptoms after Carpal Tunnel Decompression Surgery. Biomedicines 2023; 11:2396. [PMID: 37760837 PMCID: PMC10525175 DOI: 10.3390/biomedicines11092396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/28/2023] [Accepted: 08/25/2023] [Indexed: 09/29/2023] Open
Abstract
Carpal tunnel syndrome (CTS) is the most frequent entrapment neuropathy. CTS therapy includes wrist immobilization, kinesiotherapy, non-steroidal anti-inflammatory drugs, carpal tunnel steroid injection, acupuncture, and physical therapy. Carpal tunnel decompression surgery (CTDS) is recommended after failure of conservative therapy. In many cases, neurological disorders continue despite CTDS. The aim of this study was to investigate the efficiency of direct transcutaneous electroneurostimulation (TENS) of the median nerve in the regression of residual neurological symptoms after CTDS. Material and Methods: 60 patients aged 28-62 years with persisting sensory and motor disorders after CTDS were studied; 15 patients received sham stimulation with a duration 30 min.; 15 patients received high-frequency low-amplitude TENS (HF TENS) with a duration 30 min; 15 patients received low-frequency high-amplitude TENS (LF TENS) with a duration 30 min; and 15 patients received a co-administration of HF TENS (with a duration of15 min) and LF TENS (with a duration of 15 min). Results: Our research showed that TENS significantly decreased the pain syndrome, sensory disorders, and motor deficits in the patients after CTDS. Predominantly, negative and positive sensory symptoms and the pain syndrome improved after the HF TENS course. Motor deficits, reduction of fine motor skill performance, electromyography changes, and affective responses to chronic pain syndrome regressed significantly after the LF TENS course. Co-administration of HF TENS and LF TENS was significantly more effective than use of sham stimulation, HF TENS, or LF TENS in patients with residual neurological symptoms after CTDS.
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Affiliation(s)
- Mustafa Al-Zamil
- Department of Physiotherapy, Faculty of Continuing Medical Education, Peoples’ Friendship University of Russia, 117198 Moscow, Russia; (N.G.K.); (N.M.)
- Department of Restorative Medicine and Neurorehabilitation, Medical Dental Institute, 127253 Moscow, Russia;
| | - Inessa A. Minenko
- Department of Restorative Medicine and Neurorehabilitation, Medical Dental Institute, 127253 Moscow, Russia;
- Department of Sports Medicine and Medical Rehabilitation, I.M. Sechenov First Moscow State Medical University, 119991 Moscow, Russia;
| | - Natalia G. Kulikova
- Department of Physiotherapy, Faculty of Continuing Medical Education, Peoples’ Friendship University of Russia, 117198 Moscow, Russia; (N.G.K.); (N.M.)
- National Medical Research Center for Rehabilitation and Balneology, 121099 Moscow, Russia;
| | - Numman Mansur
- Department of Physiotherapy, Faculty of Continuing Medical Education, Peoples’ Friendship University of Russia, 117198 Moscow, Russia; (N.G.K.); (N.M.)
- Department of Restorative Medicine and Neurorehabilitation, Medical Dental Institute, 127253 Moscow, Russia;
- City Clinical Hospital Named after V. V. Vinogradov, 117292 Moscow, Russia
| | - Margarita B. Nuvakhova
- National Medical Research Center for Rehabilitation and Balneology, 121099 Moscow, Russia;
| | - Olga V. Khripunova
- Department of Sports Medicine and Medical Rehabilitation, I.M. Sechenov First Moscow State Medical University, 119991 Moscow, Russia;
| | - Irina P. Shurygina
- Department of Ophthalmology, Rostov State Medical University, 344022 Rostov, Russia;
| | - Svetlana V. Topolyanskaya
- Department of Hospital Therapy No. 2, I.M. Sechenov First Moscow State Medical University, 119991 Moscow, Russia;
| | - Vera V. Trefilova
- Institute of Personalized Psychiatry and Neurology, V.M. Bekhterev National Medical Research Centre for Psychiatry and Neurology, 192019 Saint Petersburg, Russia; (V.V.T.); (R.F.N.)
| | - Marina M. Petrova
- Shared Core Facilities “Molecular and Cell Technologies”, Professor V. F. Voino-Yasenetsky Krasnoyarsk State Medical University, 660022 Krasnoyarsk, Russia; (M.M.P.); (E.A.N.); (I.A.S.)
| | - Ekaterina A. Narodova
- Shared Core Facilities “Molecular and Cell Technologies”, Professor V. F. Voino-Yasenetsky Krasnoyarsk State Medical University, 660022 Krasnoyarsk, Russia; (M.M.P.); (E.A.N.); (I.A.S.)
| | - Irina A. Soloveva
- Shared Core Facilities “Molecular and Cell Technologies”, Professor V. F. Voino-Yasenetsky Krasnoyarsk State Medical University, 660022 Krasnoyarsk, Russia; (M.M.P.); (E.A.N.); (I.A.S.)
| | - Regina F. Nasyrova
- Institute of Personalized Psychiatry and Neurology, V.M. Bekhterev National Medical Research Centre for Psychiatry and Neurology, 192019 Saint Petersburg, Russia; (V.V.T.); (R.F.N.)
| | - Natalia A. Shnayder
- Institute of Personalized Psychiatry and Neurology, V.M. Bekhterev National Medical Research Centre for Psychiatry and Neurology, 192019 Saint Petersburg, Russia; (V.V.T.); (R.F.N.)
- Shared Core Facilities “Molecular and Cell Technologies”, Professor V. F. Voino-Yasenetsky Krasnoyarsk State Medical University, 660022 Krasnoyarsk, Russia; (M.M.P.); (E.A.N.); (I.A.S.)
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3
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Heeman W, Maassen H, Dijkstra K, Calon J, van Goor H, Leuvenink H, van Dam GM, Boerma EC. Real-time, multi-spectral motion artefact correction and compensation for laser speckle contrast imaging. Sci Rep 2022; 12:21718. [PMID: 36522524 PMCID: PMC9755276 DOI: 10.1038/s41598-022-26154-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
Laser speckle contrast imaging (LSCI) is so sensitive to motion that it can measure the movement of red blood cells. However, this extreme sensitivity to motion is also its pitfall as the clinical translation of LSCI is slowed down due to the inability to deal with motion artefacts. In this paper we study the effectiveness of a real-time, multi-spectral motion artefact correction and compensation by subduing an in vitro flow phantom and ex vivo porcine kidney to computer-controlled motion artefacts. On the in vitro flow phantom, the optical flow showed a good correlation with the total movement. This model results in a better signal-to-noise ratios for multiple imaging distances and the overestimation of perfusion was reduced. In the ex vivo kidney model, the perfusion overestimation was also reduced and we were still able to distinguish between ischemia and non-ischemia in the stabilized data whereas this was not possible in the non-stabilized data. This leads to a notably better perfusion estimation that could open the door to a multitude of new clinical applications for LSCI.
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Affiliation(s)
- Wido Heeman
- grid.4830.f0000 0004 0407 1981Faculty Campus Fryslân, University of Groningen, Wirdumerdijk 34, Leeuwarden, 8911 CE The Netherlands ,grid.4494.d0000 0000 9558 4598Department of Surgery, University Medical Centre Groningen, Hanzeplein 1, Groningen, 9713 GZ The Netherlands ,LIMIS Development BV, Henri Dunantweg 2, Leeuwarden, 8934 AD The Netherlands
| | - Hanno Maassen
- grid.4494.d0000 0000 9558 4598Department of Surgery, University Medical Centre Groningen, Hanzeplein 1, Groningen, 9713 GZ The Netherlands ,grid.4494.d0000 0000 9558 4598Department of Pathology and Medical Biology, University Medical Centre Groningen, Hanzeplein 1, Groningen, 9713 GZ The Netherlands
| | - Klaas Dijkstra
- grid.461051.7Centre of Expertise in Computer Vision and Data Science, NHL Stenden University of Applied Sciences, Rengerslaan 8-10, Leeuwarden, 8917 DD The Netherlands
| | - Joost Calon
- ZiuZ Visual Intelligence, Stationsweg 3, Gorredijk, 8401 DK The Netherlands
| | - Harry van Goor
- grid.4494.d0000 0000 9558 4598Department of Pathology and Medical Biology, University Medical Centre Groningen, Hanzeplein 1, Groningen, 9713 GZ The Netherlands
| | - Henri Leuvenink
- grid.4494.d0000 0000 9558 4598Department of Surgery, University Medical Centre Groningen, Hanzeplein 1, Groningen, 9713 GZ The Netherlands
| | - Gooitzen. M. van Dam
- grid.4494.d0000 0000 9558 4598Department of Surgery, University Medical Centre Groningen, Hanzeplein 1, Groningen, 9713 GZ The Netherlands
| | - E. Christiaan Boerma
- grid.4830.f0000 0004 0407 1981Faculty Campus Fryslân, University of Groningen, Wirdumerdijk 34, Leeuwarden, 8911 CE The Netherlands ,grid.414846.b0000 0004 0419 3743Department of Intensive Care, Medical Centre Leeuwarden, Henri Dunantweg 2, Leeuwarden, 8934 AD The Netherlands
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Calbiyik M, Yılmaz S. Role of Neuromuscular Electrical Stimulation in Increasing Femoral Venous Blood Flow After Total Hip Prosthesis. Cureus 2022; 14:e29255. [PMID: 36277586 PMCID: PMC9578661 DOI: 10.7759/cureus.29255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2022] [Indexed: 11/23/2022] Open
Abstract
Objective: This study aimed to investigate the role of neuromuscular electrical stimulation (NMES) in increasing femoral venous blood flow after total hip prosthesis and to evaluate its potential effects on preventing postoperative deep vein thrombosis (DVT). Materials and methods: A total of 64 patients who underwent total hip prosthesis were randomly separated into two groups. The NMES group (n=32) received low-molecular-weight heparin+NMES. And the non-NMES group (n=32) received a low-molecular-weight heparin+compression bandage. Results: There was no difference between the groups in terms of the presence of preoperative and postoperative leg edema. The calf diameter was significantly lower in the NMES group than in the non-NMES group in both the preoperative (p=0.003) and postoperative (p=0.008) period. Although the femoral vein peak velocity (VPV) was similar between the groups in the preoperative period, it was significantly higher in the NMES group than in the non-NMES group postoperatively (p=0.001). The femoral VPV after total hip prosthesis increased more in the NMES group (43.2%) compared with the non-NMES group (16.3%). In the non-NMES group, the D-dimer value in the preoperative period was lower than on postoperative days one and five (p<0.05). There was no significant difference between the D-dimer values on postoperative days one and five. In the NMES group, a statistically significant difference was determined between the preoperative and postoperative test results (F(2.93)=20.86, p=0.001). The preoperative D-dimer values were compared to the postoperative values on the first and fifth day, and according to the post hoc test results, the D-dimer values were significantly lower on the fifth postoperative day than on the first postoperative day, and the preoperative value was significantly lower than the fifth postoperative day value (p<0.05). Conclusion: Although the two groups were similar in terms of leg edema, there was a significant increase in femoral VPV in the NMES group. This could indicate a potential effect of NMES in preventing postoperative DVT and needs to be confirmed with further studies.
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Greve KR, Joseph CF, Berry BE, Schadl K, Rose J. Neuromuscular electrical stimulation to augment lower limb exercise and mobility in individuals with spastic cerebral palsy: A scoping review. Front Physiol 2022; 13:951899. [PMID: 36111153 PMCID: PMC9468780 DOI: 10.3389/fphys.2022.951899] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Neuromuscular Electrical Stimulation (NMES) is an emerging assistive technology applied through surface or implanted electrodes to augment skeletal muscle contraction. NMES has the potential to improve function while reducing the neuromuscular impairments of spastic cerebral palsy (CP). This scoping review examines the application of NMES to augment lower extremity exercises for individuals with spastic CP and reports the effects of NMES on neuromuscular impairments and function in spastic CP, to provide a foundation of knowledge to guide research and development of more effective treatment. Methods: A literature review of Scopus, Medline, Embase, and CINAHL databases were searched from 2001 to 2 November 2021 with identified inclusion and exclusion criteria. Results: Out of 168 publications identified, 33 articles were included. Articles on three NMES applications were identified, including NMES-assisted strengthening, NMES-assisted gait, and NMES for spasticity reduction. NMES-assisted strengthening included the use of therapeutic exercises and cycling. NMES-assisted gait included the use of NMES to improve gait patterns. NMES-spasticity reduction included the use of transcutaneous electrical stimulation or NMES to decrease tone. Thirteen studies investigated NMES-assisted strengthening, eleven investigated therapeutic exercise and demonstrated significant improvements in muscle structure, strength, gross motor skills, walking speed, and functional mobility; three studies investigated NMES-assisted cycling and demonstrated improved gross motor skills and walking distance or speed. Eleven studies investigated NMES-assisted gait and demonstrated improved muscle structure, strength, selective motor control, gross motor skills, and gait mechanics. Seven studies investigated NMES for spasticity reduction, and five of the seven studies demonstrated reduced spasticity. Conclusion: A growing body of evidence supports the use of NMES-assisted strengthening, NMES-assisted gait, and NMES for spasticity reduction to improve functional mobility for individuals with spastic CP. Evidence for NMES to augment exercise in individuals with spastic CP remains limited. NMES protocols and parameters require further clarity to translate knowledge to clinicians. Future research should be completed to provide richer evidence to transition to more robust clinical practice.
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Affiliation(s)
- Kelly R. Greve
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Department of Rehabilitation, Exercise and Nutrition Sciences, University of Cincinnati, College of Allied Health Sciences, Cincinnati, OH, United States
| | - Christopher F. Joseph
- Department of Physical Therapy, Kennedy Krieger Institute, Baltimore, MD, United States
| | - Blake E. Berry
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Department of Rehabilitation, Exercise and Nutrition Sciences, University of Cincinnati, College of Allied Health Sciences, Cincinnati, OH, United States
| | - Kornel Schadl
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA, United States
- Motion and Gait Analysis Lab, Lucile Packard Children’s Hospital, Stanford Children’s Health, Stanford, CA, United States
| | - Jessica Rose
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA, United States
- Motion and Gait Analysis Lab, Lucile Packard Children’s Hospital, Stanford Children’s Health, Stanford, CA, United States
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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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Benito-Martínez E, Senovilla-Herguedas D, de la Torre-Montero JC, Martínez-Beltrán MJ, Reguera-García MM, Alonso-Cortés B. Local and Contralateral Effects after the Application of Neuromuscular Electrostimulation in Lower Limbs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17239028. [PMID: 33287409 PMCID: PMC7730668 DOI: 10.3390/ijerph17239028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/25/2020] [Accepted: 11/30/2020] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Elisa Benito-Martínez
- San Juan de Dios School of Nursing and Physical Therapy, Comillas Pontifical University, 28350 Madrid, Spain; (E.B.-M.); (D.S.-H.); (J.C.d.l.T.-M.); (M.J.M.-B.)
| | - Diego Senovilla-Herguedas
- San Juan de Dios School of Nursing and Physical Therapy, Comillas Pontifical University, 28350 Madrid, Spain; (E.B.-M.); (D.S.-H.); (J.C.d.l.T.-M.); (M.J.M.-B.)
| | - Julio César de la Torre-Montero
- San Juan de Dios School of Nursing and Physical Therapy, Comillas Pontifical University, 28350 Madrid, Spain; (E.B.-M.); (D.S.-H.); (J.C.d.l.T.-M.); (M.J.M.-B.)
| | - María Jesús Martínez-Beltrán
- San Juan de Dios School of Nursing and Physical Therapy, Comillas Pontifical University, 28350 Madrid, Spain; (E.B.-M.); (D.S.-H.); (J.C.d.l.T.-M.); (M.J.M.-B.)
| | - María Mercedes Reguera-García
- SALBIS Research Group, Faculty of Health Sciences, Campus of Ponferrada, University of León, 24401 Ponferrada, Spain;
| | - Beatriz Alonso-Cortés
- SALBIS Research Group, Faculty of Health Sciences, Campus of Ponferrada, University of León, 24401 Ponferrada, Spain;
- Correspondence:
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Ravikumar R, Lane TR, Babber A, Onida S, Davies AH. A randomised controlled trial of neuromuscular stimulation in non-operative venous disease improves clinical and symptomatic status. Phlebology 2020; 36:290-302. [PMID: 33176593 PMCID: PMC8044600 DOI: 10.1177/0268355520968640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND This randomised controlled trial investigates the dosing effect of neuromuscular electrical stimulation (NMES) in patients with chronic venous disease (CVD). METHODS Seventy-six patients with CEAP C3-C5 were randomised to Group A (no NMES), B (30 minutes of NMES daily) or C (60 minutes of NMES daily). Primary outcome was percentage change in Femoral Vein Time Averaged Mean Velocity (TAMV) at 6 weeks. Clinical severity scores, disease-specific and generic quality of life (QoL) were assessed. RESULTS Seventy-six patients were recruited - mean age 60.8 (SD14.4) and 47:29 male. Six patients lost to follow-up. Percentage change in TAMV (p<0.001) was significantly increased in Groups B and C. Aberdeen Varicose Veins Questionnaire Score (-6.9, p=0.029) and Venous Clinical Severity Score (-4, p-0.003) improved in Group C, and worsened in Group A (+1, p=0.025). CONCLUSIONS Daily NMES usage increases flow parameters, with twice daily usage improving QoL and clinical severity at 6 weeks in CVD patients.
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Affiliation(s)
- Raveena Ravikumar
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Tristan Ra Lane
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK.,Cambridge Vascular Unit, Cambridge University Hospitals NHS Trust, Addenbrookes Hospital, Cambridge, UK
| | - Adarsh Babber
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Sarah Onida
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK.,Department of Vascular Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - Alun H Davies
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK.,Department of Vascular Surgery, Imperial College Healthcare NHS Trust, London, UK
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9
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Barcala-Furelos R, González-Represas A, Rey E, Martínez-Rodríguez A, Kalén A, Marques O, Rama L. Is Low-Frequency Electrical Stimulation a Tool for Recovery after a Water Rescue? A Cross-Over Study with Lifeguards. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165854. [PMID: 32806727 PMCID: PMC7460120 DOI: 10.3390/ijerph17165854] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/26/2020] [Accepted: 08/10/2020] [Indexed: 11/16/2022]
Abstract
This study aimed to evaluate the degree to which transcutaneous electrical stimulation (ES) enhanced recovery following a simulated water rescue. Twenty-six lifeguards participated in this study. The rescue consisted of swimming 100 m with fins and rescue-tube: 50 m swim approach and 50 m tow-in a simulated victim. Blood lactate clearance, rated perceived effort (RPE), and muscle contractile properties were evaluated at baseline, after the water rescue, and after ES or passive-recovery control condition (PR) protocol. Tensiomiography, RPE, and blood lactate basal levels indicated equivalence between both groups. There was no change in tensiomiography from pre to post-recovery and no difference between recovery protocols. Overall-RPE, legs-RPE and arms-RPE after ES (mean ± SD; 2.7 ± 1.53, 2.65 ± 1.66, and 2.30 ± 1.84, respectively) were moderately lower than after PR (3.57 ± 2.4, 3.71 ± 2.43, and 3.29 ± 1.79, respectively) (p = 0.016, p = 0.010, p = 0.028, respectively). There was a significantly lower blood lactate level after recovery in ES than in PR (mean ± SD; 4.77 ± 1.86 mmol·L-1 vs. 6.27 ± 3.69 mmol·L-1; p = 0.045). Low-frequency ES immediately after a water rescue is an effective recovery strategy to clear out blood lactate concentration.
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Affiliation(s)
- Roberto Barcala-Furelos
- REMOSS Research Group, Faculty of Education and Sport Sciences, University of Vigo, 36005 Pontevedra, Spain; (R.B.-F.); (A.K.)
- CLINURSID Network Research, Department of Psychiatry, Radiology and Public Health, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain
| | - Alicia González-Represas
- Department of Functional Biology and Health Sciences, Faculty of Physiotherapy, University of Vigo, 36005 Vigo, Spain;
| | - Ezequiel Rey
- REMOSS Research Group, Faculty of Education and Sport Sciences, University of Vigo, 36005 Pontevedra, Spain; (R.B.-F.); (A.K.)
- Correspondence:
| | - Alicia Martínez-Rodríguez
- Department of Physiotherapy, Medicine and Biomedical Sciences, Universidade da Coruña, 15006 La Coruña, Spain;
| | - Anton Kalén
- REMOSS Research Group, Faculty of Education and Sport Sciences, University of Vigo, 36005 Pontevedra, Spain; (R.B.-F.); (A.K.)
| | - Olga Marques
- Faculty of Sports Sciences and Physical Education, University of Coimbra, 3040-156 Coimbra, Portugal; (O.M.); (L.R.)
- Research Unit for Sport and Physical Activity (CIDAF), 3040-156 Coimbra, Portugal
| | - Luís Rama
- Faculty of Sports Sciences and Physical Education, University of Coimbra, 3040-156 Coimbra, Portugal; (O.M.); (L.R.)
- Research Unit for Sport and Physical Activity (CIDAF), 3040-156 Coimbra, Portugal
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10
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Xie W, Levine MA, Aquil S, Pacoli K, Al-Ogaili R, Luke PP, Sener A. Daily use of a muscle pump activator device reduces duration of hospitalization and improves early graft outcomes post-kidney transplantation: A randomized controlled trial. Can Urol Assoc J 2020; 15:26-32. [PMID: 32745003 DOI: 10.5489/cuaj.6487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Kidney and simultaneous pancreas-kidney (SPK) transplant recipients can have prolonged postoperative hospitalization due to edema. Thrombo-embolic-deterrent (TED) stockings with intermittent pneumatic compression devices (TED+IPC) have been used to improve venous return during the perioperative period. The objective of this trial was to evaluate the effects of TED+IPC vs. muscle pump activator (MPA) devices on factors that could reduce postoperative complications and duration of hospitalization. METHODS In this single-center, prospective, randomized, controlled trial, 221 kidney and SPK transplant recipients were randomized to either wearing TED+IPC or MPA for six days postoperatively. Groups were compared with respect to postoperative urine output, lower limb edema, weight, days in hospital, mobility, serum creatinine, delayed graft function, need for dialysis, and lower extremity blood flow. RESULTS Patients in the MPA group had significantly higher urine output and less increase in mid-calf leg circumference and weight gain compared to the TED+IPC group (p=0.003, p=0.001, and p=0.003, respectively). The MPA group also experienced shorter hospitalization (p=0.038), higher femoral vein velocity (p=0.001), and took more steps (p=0.009). Incidence of delayed graft function (p=0.72) and number of dialysis runs (p=0.39) was not different between study groups. Subgroup analysis of primary endpoints in donation after cardiac death recipients and SPK recipients did not yield any significance between the study arms. CONCLUSIONS Postoperative use of the MPA device increases urine output, decreases leg edema, minimizes weight gain, and decreases duration of hospitalization after kidney transplantation. A larger and longer-term trial is needed to evaluate the impact on graft function.
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Affiliation(s)
- Wen Xie
- Department of Surgery, Schulich School of Medicine & Dentistry, St. Joseph's Hospital, London, ON, Canada
| | - Max A Levine
- Department of Surgery, Schulich School of Medicine & Dentistry, St. Joseph's Hospital, London, ON, Canada.,Multi-Organ Transplant Program, London Health Sciences Centre, London, ON, Canada
| | - Shahid Aquil
- Department of Surgery, Schulich School of Medicine & Dentistry, St. Joseph's Hospital, London, ON, Canada
| | - Katharine Pacoli
- Matthew Mailing Centre for Translational Transplant Studies, London Health Sciences Centre, London, ON, Canada
| | - Rafid Al-Ogaili
- Department of Surgery, Schulich School of Medicine & Dentistry, St. Joseph's Hospital, London, ON, Canada
| | - Patrick P Luke
- Department of Surgery, Schulich School of Medicine & Dentistry, St. Joseph's Hospital, London, ON, Canada.,Multi-Organ Transplant Program, London Health Sciences Centre, London, ON, Canada.,Matthew Mailing Centre for Translational Transplant Studies, London Health Sciences Centre, London, ON, Canada
| | - Alp Sener
- Department of Surgery, Schulich School of Medicine & Dentistry, St. Joseph's Hospital, London, ON, Canada.,Multi-Organ Transplant Program, London Health Sciences Centre, London, ON, Canada.,Matthew Mailing Centre for Translational Transplant Studies, London Health Sciences Centre, London, ON, Canada.,Department of Microbiology & Immunology, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
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11
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Heeman W, Steenbergen W, van Dam GM, Boerma EC. Clinical applications of laser speckle contrast imaging: a review. JOURNAL OF BIOMEDICAL OPTICS 2019; 24:1-11. [PMID: 31385481 PMCID: PMC6983474 DOI: 10.1117/1.jbo.24.8.080901] [Citation(s) in RCA: 130] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 07/02/2019] [Indexed: 05/02/2023]
Abstract
When a biological tissue is illuminated with coherent light, an interference pattern will be formed at the detector, the so-called speckle pattern. Laser speckle contrast imaging (LSCI) is a technique based on the dynamic change in this backscattered light as a result of interaction with red blood cells. It can be used to visualize perfusion in various tissues and, even though this technique has been extensively described in the literature, the actual clinical implementation lags behind. We provide an overview of LSCI as a tool to image tissue perfusion. We present a brief introduction to the theory, review clinical studies from various medical fields, and discuss current limitations impeding clinical acceptance.
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Affiliation(s)
- Wido Heeman
- University of Groningen, Faculty Campus Fryslân, Leeuwarden, The Netherlands
- University Medical Centre Groningen, Department of Surgery, Optical Molecular Imaging Groningen, Groningen, The Netherlands
- LIMIS Development BV, Leeuwarden, The Netherlands
| | - Wiendelt Steenbergen
- University of Twente, Techmed Center, Faculty of Science and Technology, Biomedical Photonic Imaging Group, Enschede, The Netherlands
| | - Gooitzen M. van Dam
- University Medical Centre Groningen, Department of Surgery, Optical Molecular Imaging Groningen, Groningen, The Netherlands
| | - E. Christiaan Boerma
- Medical Centre Leeuwarden, Department of Intensive Care, Leeuwarden, The Netherlands
- Address all correspondence to E. Christiaan Boerma, E-mail:
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12
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Aquil S, Alharbi B, Navaratnam R, Sharma H, Luke PP, Sener A. Use of a Muscle Pump Activator Leads to Improved Lower Limb Edema, Lower Limb Blood Flow, and Urine Output Compared With Standard TED Stockings and Compression Devices Following Kidney Transplant: A Randomized Controlled Trial. Transplant Proc 2019; 51:1838-1844. [PMID: 31256870 DOI: 10.1016/j.transproceed.2019.04.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 04/22/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the effects of using thromboembolic deterrent (TED) stockings and intermittent pneumatic compression (IPC) vs a muscle pump activator (MPA) device on limb edema and patient satisfaction after transplant. METHODS In this single-center randomized controlled trial, 118 patients were randomly assigned to wear TED + IPC (n = 64) or the MPA device (n = 54) from postoperative days 1 to 6. We measured patients' weight and lower leg and thigh circumferences daily. Ultrasonography of the allograft and lower limbs was carried out on postoperative days 1 and 5 to assess resistive index in the transplanted kidney and flow in the femoral vein. We monitored urine output and serum creatinine level. RESULTS We observed a significant increase in calf and thigh circumference from baseline in the TED + IPC group but not in the MPA group (2.3 [SD, 1] cm vs 0.25 [SD, 0.8] cm, respectively, P < .002). Ultrasonography showed higher femoral vein velocities in the MPA group than the TED + IPC group (0.5 [SD, 0.2] cm, P < .001). The mean total urine output in 6 days was higher in the MPA group than the TED + IPC group (P = .05), which corresponded to large change in TED + IPC weight of 6.2 kg vs 2.1 kg in the MPA group (P = .04). Patients were more satisfied with the use of the MPA device than TED + IPC. No major complications were encountered in either group. CONCLUSIONS This is the first study to show that the use of an MPA device in the immediate postoperative period following kidney transplant leads to decreased lower limb edema and increased total urine output. Patients were more satisfied with the use of the MPA device than TED + IPC.
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Affiliation(s)
- Shahid Aquil
- Department of Surgery, Division of Urology, Western University, London, Ontario, Canada; Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Multi-Organ Transplant Program, London Health Sciences Center, London, Ontario, Canada
| | - Bijad Alharbi
- Department of Surgery, Division of Urology, Western University, London, Ontario, Canada; Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Multi-Organ Transplant Program, London Health Sciences Center, London, Ontario, Canada
| | - Roshan Navaratnam
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Hemant Sharma
- Department of Surgery, Division of Urology, Western University, London, Ontario, Canada; Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Multi-Organ Transplant Program, London Health Sciences Center, London, Ontario, Canada
| | - Patrick P Luke
- Department of Surgery, Division of Urology, Western University, London, Ontario, Canada; Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Multi-Organ Transplant Program, London Health Sciences Center, London, Ontario, Canada; Matthew Mailing Center for Translational Transplant Studies, London Health Sciences Center, London, Ontario, Canada
| | - Alp Sener
- Department of Surgery, Division of Urology, Western University, London, Ontario, Canada; Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Multi-Organ Transplant Program, London Health Sciences Center, London, Ontario, Canada; Matthew Mailing Center for Translational Transplant Studies, London Health Sciences Center, London, Ontario, Canada; Department of Microbiology and Immunology, Western University, London, Ontario, Canada; Center for Human Immunology, Western University, London, Ontario, Canada.
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13
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Bahadori S, Immins T, Wainwright TW. A Novel Approach to Overcome Movement Artifact When Using a Laser Speckle Contrast Imaging System for Alternating Speeds of Blood Microcirculation. J Vis Exp 2017. [PMID: 28892025 PMCID: PMC5614397 DOI: 10.3791/56415] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The laser speckle contrast imager (LSCI) provides a powerful yet simple technique for measuring microcirculatory blood flow. Ideal for blood dynamic responses, the LSCI is used in the same way as a conventional Laser Doppler Imager (LDI). However, with a maximum skin depth of approximately 1 mm, the LSCI is designed to focus on mainly superficial blood flow. It is used to measure skin surface areas of up to 15 cm x 20 cm. The new technique introduced in this paper accounts for alternating speeds of microcirculations; i.e. both slow and fast flow flux measurement using the LSCI. The novel technique also overcomes LSCI's biggest shortcoming, which is high sensitivity to artifact movement. An adhesive opaque patch (AOP) is introduced for satisfactory recording of microcirculatory blood flow, by subtracting the LSCI signal from the AOP from the laser speckle skin signal. The optimal setting is also defined because the LSCI is most powerful when flux changes are measured relative to a reference baseline, with blood microcirculatory flux expressed as a percentage change from the baseline. These changes may be used for analyzing the status of the blood flow system.
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Affiliation(s)
| | - Tikki Immins
- Orthopaedic Research Institute, Bournemouth University
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