Design considerations for the development of neuromuscular electrical stimulation (NMES) exercise in cancer rehabilitation

Mapping the development process of transcutaneous neuromuscular electrical stimulation devices for neurorehabilitation, the associated barriers and facilitators, and its applicability to acquired dysarthria: a qualitative study of manufacturers' perspectives

PURPOSE

The fragmented nature of the medical device market limits our understanding of how particular sub-markets navigate the device development process. Despite the widespread use of transcutaneous neuromuscular electrical stimulation (NMES), its use for acquired dysarthria treatment has not been sufficiently explored. This study aims to provide a preliminary understanding of the stages involved in the development of NMES devices designed for neurorehabilitation. It also aims to investigate manufacturers' perceptions concerning factors that facilitate or impede its development and determine its applicability for acquired dysarthria.

MATERIALS AND METHODS

In-depth semi-structured online interviews were conducted with eight NMES device manufacturers located across Europe, North America and Oceania. The interviews were video-recorded, automatically transcribed, manually reviewed, and analysed using a qualitative content analysis.

RESULTS

NMES device development for neurorehabilitation involves six complex phases with sequential and overlapping activities. Some emerging concepts were comparable to established medical device models, while others were specific to NMES. Its adaptability to different neurological disorders, the positive academia-industry collaborations, the industry's growth prospects and the promising global efforts for standardised regulations are all key facilitators for its development. However, financial, political, regulatory, and natural constraints emerged as barriers. Indications and challenges for the applicability of NMES for acquired dysarthria treatment were also discussed.

CONCLUSION

The findings provide a foundation for further investigations on the NMES market sub-sector, particularly in the context of neurorehabilitation. The study also provides insights into the potential adoption of NMES for acquired dysarthria, which can serve as a reference for future research.

Electric Muscle Stimulation (EMS) Does Not Improve Anaerobic Performance Measures During a Repeated Wingate Test

Introduction: The aim of this study was to examine differences between a control warm-up and an Electric Muscle Stimulation (EMS)-induced warm-up in off-road cyclists when examining anaerobic performance measures from a repeated Wingate test (WAnT). Methods: Twelve trained off-road cyclists completed a randomized crossover study (age: 31 ± 10 years, height: 176.79 ± 6.09 cm, body mass: 74.57 ± 4.77 kg). Participants completed two randomized, separate testing sessions involving a control warm-up and an EMS warm-up before undergoing the repeated WAnT, which was used to collect anaerobic performance and physiolo- gical measures during both sessions. High-frequency EMS was applied to the knee extensor muscles for 4 min after a standardized warm-up during the EMS session. Results: Analysis revealed that there were no significant differences between mean power output, peak power output, and percentage decrement between the two sessions. The EMS session resulted in significantly lower average HR values and significantly lower differences in pre-to-post-test blood lactate values when compared to the control session. Discussion: According to the results of this study, an acute application of EMS is not a useful tool for off-road cyclists to improve power output or maintain anaerobic capacity. Hence, its use before competition is questionable.

The Potential of Electrical Stimulation and Smart Textiles for Patients with Diabetes Mellitus

Diabetes mellitus is one of the most frequent diseases in the general population. Electrical stimulation is a treatment modality based on the transmission of electrical pulses into the body that has been widely used for improving wound healing and for managing acute and chronic pain. Here, we discuss recent advancements in electroceuticals and haptic/smart devices for quality of life and present in which patients and how electrical stimulation may prove to be useful for the treatment of diabetes-related complications.

Effects of neuromuscular electrical stimulation combined with resistance exercises on muscle strength in adult hematological cancer patients: A randomized controlled study

OBJECTIVE

We compared the effects of resistance exercise (REx) and resistance exercise combined with neuromuscular electrical stimulation (NMES+REx) on muscle strength, functional lower extremity strength, and mobility in hematological cancer patients during chemotherapy.

METHODS

Forty-three adult patients were recruited and randomized into the REx group versus personalized and progressive NMES+REx. The lower extremity muscle strength (digital hand dynamometer) test and functional and mobility tests [30-s sit-to-stand test, Timed Up and Go test (TUG)] were performed pre-and postintervention.

RESULTS

The Eastern Cooperative Oncology Group-Performance Score (ECOG-PS) of 90% of all patients was ≥2. Increases in steroid dose after transplantation were associated with decreases in hip flexion and knee extension muscle strength values (respectively; r_s:-0.468, p:0.008; r_s:-0.527, p: 0.002). There was a significant improvement in strength measurement, functional and mobility tests, and ECOG-PS in both groups (p<0.05). The NMES+REx group had significantly higher hip flexion and knee extension values than the REx group (respectively; p=0.001; p=0.048).

CONCLUSION

REx training given to hematological cancer patients receiving intensive chemotherapy after hematopoietic stem cell transplantation improved muscle weakness. The combination of NMES training with resistance exercises resulted in significant results comparable to REx training alone in adult hematological patients with moderate-low ECOG-PS.

Therapeutic Potential of Electromyostimulation (EMS) in Critically Ill Patients—A Systematic Review

Ample evidence exists that intensive care unit (ICU) treatment and invasive ventilation induce a transient or permanent decline in muscle mass and function. The functional deficit is often called ICU-acquired weakness with critical illness polyneuropathy (CIP) and/or myopathy (CIM) being the major underlying causes. Histopathological studies in ICU patients indicate loss of myosin filaments, muscle fiber necrosis, atrophy of both muscle fiber types as well as axonal degeneration. Besides medical prevention of risk factors such as sepsis, hyperglycemia and pneumonia, treatment is limited to early passive and active mobilization and one third of CIP/CIM patients discharged from ICU never regain their pre-hospitalization constitution. Electromyostimulation [EMS, also termed neuromuscular electrical stimulation (NMES)] is known to improve strength and function of healthy and already atrophied muscle, and may increase muscle blood flow and induce angiogenesis as well as beneficial systemic vascular adaptations. This systematic review aimed to investigate evidence from randomized controlled trails (RCTs) on the efficacy of EMS to improve the condition of critically ill patients treated on ICU. A systematic search of the literature was conducted using PubMed (Medline), CENTRAL (including Embase and CINAHL), and Google Scholar. Out of 1,917 identified records, 26 articles (1,312 patients) fulfilled the eligibility criteria of investigating at least one functional measure including muscle function, functional independence, or weaning outcomes using a RCT design in critically ill ICU patients. A qualitative approach was used, and results were structured by 1) stimulated muscles/muscle area (quadriceps muscle only; two to four leg muscle groups; legs and arms; chest and abdomen) and 2) treatment duration (≤10 days, >10 days). Stimulation parameters (impulse frequency, pulse width, intensity, duty cycle) were also collected and the net EMS treatment time was calculated. A high grade of heterogeneity between studies was detected with major cofactors being the analyzed patient group and selected outcome variable. The overall efficacy of EMS was inconclusive and neither treatment duration, stimulation site or net EMS treatment time had clear effects on study outcomes. Based on our findings, we provide practical recommendations and suggestions for future studies investigating the therapeutic efficacy of EMS in critically ill patients.

Systematic Review Registration: [https://www.crd.york.ac.uk/prospero/], identifier [CRD42021262287].