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The Effect of Electrical Stimulation of the Calf Muscle and Compression Stocking on Venous Blood Flow Velocity
... L'ESNM!se!réfère!à!l'application!d'impulsions!électriques,!à!travers!des!électrodes!posées!à! la! surface! de! la! peau! dans! le! but! de! générer! un! potentiel! d'action! aboutissant! à! la! contraction! involontaire! du! muscle! concerné! (Lyons! et! al.! 2002).! L'application! de! cette! modalité!au!niveau!du!mollet!a!pour!objectif!d'activer!la!pompe!veineuse!surale!dans!le!but! d'optimiser!le!retour!veineux! .!En!parallèle,!une!augmentation!du!débit! artériel!a!également!été!démontrée! (Abraham!et!al.!2013 • Sujets! en! position! assise!:! augmentation! significative! du! débit! veineux! (mu ...
... dans! le! cadre!de!la!maladie!veineuse!chronique! (Lyons!et!al.!2002;!Clarke!Moloney!et!al.!2006).!Dans! Etat!de!l'art! ...
... ESNM' surale' et' compression' (Lyons' et' al.' 2002). ' Nous' émettons' l'hypothèse' que' l'augmentation' du' débit' veineux' suite' à' l'activation' de' la' pompe' veineuse' surale' soit' à' l'origine'de'l'augmentation'du'débit'artériel.'En'effet,'l'amélioration'du'drainage'veineux'des' ...
Résumé : Le rôle du réseau veineux est central dans la fonction cardiovasculaire, pourtant, au regard de la littérature scientifique, il apparaît comme le« parent pauvre » comparé au cœur ou au réseau artériel. Ce constat vaut aussi bien pour la compréhension de l'hémodynamique veineuse que pour l'analyse physiopathologique de la maladie veineuse chronique en général et plus particulièrement lorsque le lien est fait avec la situation d'exercice. Nos différentes investigations avaient pour buts d'une part de mieux comprendre les adaptations du système veineux lors de l'activité physique et lors de la phase de récupération post-exercice et d'autre physiopathologiques de l'hyper pression veineuse sur la microcirculation chez le sujet atteint d'une pathologie veineuse. Ils ont également apporté une meilleure compréhension de la phase de récupération post-exercice et des effets bénéfiques des méthodes de récupération sur la performance et sur les adaptations vasculaires. L'interdépendance entre les différents secteurs (cœur, artères, microcirculation, veines) du système cardiovasculaire est un élément essentiel mis en évidence dans nos différents travaux. Ainsi, nous avons démontré que l'hémodynamique veineuse ne pouvait être analysée de manière isolée, mais au contraire part d'évaluer l'impact de la maladie veineuse chronique sur l'activité physique et réciproquement. Pour cela nous avons étudié les effets aigus de l'activité physique sur le fonctionnement de l'hémodynamique veineuse (évaluation de la pompe veineuse surale), et les effets de différentes méthodes de récupération (compression, immersion, électro stimulation neuro musculaire). Par ailleurs nous avons exploré les conséquences de la pathologie veineuse sur la réalisation d'une activité physique à travers l'analyse de la claudication veineuse. Les principaux résultats de nos travaux ont permis de mieux appréhender les adaptations de l'hémodynamique veineuse liées à l'exercice chez le sujet sain d'une part et de mieux comprendre les conséquences qu'elle devait être évaluée dans sa globalité, en mesurant les implications sur le remplissage cardiaque en aval et sur les échanges au niveau tissulaire en amont, et en recherchant la part du réseau splanchnique et celle du réseau des membres aux propriétés bien différentes sur le retour veineux systémique. En conclusion, nous avons comblé une partie des lacunes de la littérature en permettant une meilleure appréhension des relations veines, exercice physique, récupération et pathologie veineuse. Cependant, des interrogations persistent concernant la méthodologie à mettre en place pour l'évaluation du réseau veineux et les effets chroniques de la pratique intensive d'une activité physique sur la maladie veineuse chronique.
... These comprised 10 prospective randomised trials, 23-32 two prospective observational studies 33,34 and nine single-arm experimental studies. [35][36][37][38][39][40][41][42][43] Of the 10 randomised controlled trials, two trials randomised patients' legs instead of patients as unit of analysis. 31,32 Of the selected studies, nine 23,25,35,[37][38][39][40][41]43 included healthy volunteers as the population of interest, nine 24,26,28,[30][31][32][33][34]36 included patients undergoing surgical procedures, one study included trauma patients, 27 one study included patients with spinal cord injury 29 and one study included patients with chronic venous disorders 42 (Table 1). ...
... [35][36][37][38][39][40][41][42][43] Of the 10 randomised controlled trials, two trials randomised patients' legs instead of patients as unit of analysis. 31,32 Of the selected studies, nine 23,25,35,[37][38][39][40][41]43 included healthy volunteers as the population of interest, nine 24,26,28,[30][31][32][33][34]36 included patients undergoing surgical procedures, one study included trauma patients, 27 one study included patients with spinal cord injury 29 and one study included patients with chronic venous disorders 42 (Table 1). NMES was delivered by several devices and settings, as reported in Table 2. ...
... NMES was compared with leg elevation in one study. 31 Eight studies 32,35,37,38,[40][41][42][43] compared NMES with baseline measurements without NMES. ...
This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effectiveness of neuromuscular electrical stimulation in the prevention of venous thromboembolism.
... These comprised 10 prospective randomised trials, 23-32 two prospective observational studies 33,34 and nine single-arm experimental studies. [35][36][37][38][39][40][41][42][43] Of the 10 randomised controlled trials, two trials randomised patients' legs instead of patients as unit of analysis. 31,32 Of the selected studies, nine 23,25,35,[37][38][39][40][41]43 included healthy volunteers as the population of interest, nine 24,26,28,[30][31][32][33][34]36 included patients undergoing surgical procedures, one study included trauma patients, 27 one study included patients with spinal cord injury 29 and one study included patients with chronic venous disorders 42 (Table 1). ...
... [35][36][37][38][39][40][41][42][43] Of the 10 randomised controlled trials, two trials randomised patients' legs instead of patients as unit of analysis. 31,32 Of the selected studies, nine 23,25,35,[37][38][39][40][41]43 included healthy volunteers as the population of interest, nine 24,26,28,[30][31][32][33][34]36 included patients undergoing surgical procedures, one study included trauma patients, 27 one study included patients with spinal cord injury 29 and one study included patients with chronic venous disorders 42 (Table 1). NMES was delivered by several devices and settings, as reported in Table 2. ...
... NMES was compared with leg elevation in one study. 31 Eight studies 32,35,37,38,[40][41][42][43] compared NMES with baseline measurements without NMES. ...
To evaluate the effect of neuromuscular electrical stimulation on lower limb venous blood flow and its role in thromboprophylaxis.
Systematic review of randomised and non-randomised studies evaluating neuromuscular electrical stimulation, and reporting one or more of the following outcomes: incidence of venous thromboembolism, venous blood flow and discomfort profile.
Twenty-one articles were identified. Review of these articles showed that neuromuscular electrical stimulation increases venous blood flow and is generally associated with an acceptable tolerability, potentially leading to good patient compliance. Ten comparative studies reported DVT incidence, ranging from 2% to 50% with neuromuscular electrical stimulation and 6% to 47.1% in controls. There were significant differences, among included studies, in terms of patient population, neuromuscular electrical stimulation delivery, diagnosis of venous thromboembolism and blood flow measurements.
Neuromuscular electrical stimulation increases venous blood flow and is well tolerated, but current evidence does not support a role for neuromuscular electrical stimulation in thromboprophylaxis. Randomised controlled trials are required to investigate the clinical utility of neuromuscular electrical stimulation in this setting.
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... . Zusammengefasst zeigen andere Studien keine signifi kanten Unterschiede in Sprint-, Sprung-, oder Wurfperformances [5,6,[10][11][12]. Betrachten wir die Änderungen bezüglich der Fließgeschwindigkeit des Blutes aus einer technischen Sichtweise, so prüfte Lyons et al. (2002) Änderungen diesbezüglich [13]. Bei der Reizung der Wadenmuskulatur mittels elektrischer neuromuskulärer Stimulation (NMES) in Verbindung mit Kompressionstrümpfen erhöhte sich die Spitzengeschwindigkeit des Blutfl usses bei jeder Stimulation sehr stark (p < 0,01) [13]. ...
... . Zusammengefasst zeigen andere Studien keine signifi kanten Unterschiede in Sprint-, Sprung-, oder Wurfperformances [5,6,[10][11][12]. Betrachten wir die Änderungen bezüglich der Fließgeschwindigkeit des Blutes aus einer technischen Sichtweise, so prüfte Lyons et al. (2002) Änderungen diesbezüglich [13]. Bei der Reizung der Wadenmuskulatur mittels elektrischer neuromuskulärer Stimulation (NMES) in Verbindung mit Kompressionstrümpfen erhöhte sich die Spitzengeschwindigkeit des Blutfl usses bei jeder Stimulation sehr stark (p < 0,01) [13]. ...
... Betrachten wir die Änderungen bezüglich der Fließgeschwindigkeit des Blutes aus einer technischen Sichtweise, so prüfte Lyons et al. (2002) Änderungen diesbezüglich [13]. Bei der Reizung der Wadenmuskulatur mittels elektrischer neuromuskulärer Stimulation (NMES) in Verbindung mit Kompressionstrümpfen erhöhte sich die Spitzengeschwindigkeit des Blutfl usses bei jeder Stimulation sehr stark (p < 0,01) [13]. Vergleichen wir die Steigerung mit der Ausgangssituation in Ruhe, erhöhte sich die Spitzenfl ießgeschwindigkeit mit Kompressionsstrümpfen um 502 % bei jeder NMES (266 % bei NMES ohne Kompression) [13]. ...
... Lyons et al. [26] observed a mean peak venous velocity of 43 cm/s in seated, healthy volunteers wearing compression stockings during 3 NMES induced contractions of the gastrocnemius muscle. This represented a 350% increase in peak venous velocities over resting levels. ...
... The measurement position used in this study was chosen to mimic the posture of subjects carrying out their stimulation sessions at home while facilitating a full range of plantar flexion. This necessitated a seated position with legs down and free of contact with the ground, in contrast to previously reported measurements while subjects were sitting with their legs raised [26,30] or lying in a prone position [29]. The effects of seated posture and leg elevation on popliteal venous peak velocities have been previously investigated by Morita et al. who measured peak velocities, volume flows and vein diameter changes in healthy volunteers in a prone position and in seated positions with their legs down and with legs elevated [27]. ...
... It is highly likely that these effects of posture were also responsible for the relatively low NMES elicited peak velocities at baseline. Peak velocities during NMES were approximately twice that of resting peak velocities which is less than previously reported values in healthy volunteers which were typically 3-6 times greater than resting values [26,29,31]. Griffin et al. [30] observed a 10-fold increase over resting peak velocities. ...
Neuromuscular electrical stimulation (NMES) of the calf muscles has been shown to cause instantaneous increases in venous outflow from the lower leg and could be used as an adjunct to current gold-standard compression therapies for the prevention of venous stasis and its related pathologies. However, little is known about the effects of NMES in combination with compression therapies on subject comfort, compliance and popliteal venous blood flow over the course of a week-long NMES protocol. This study aimed to assess the effects of a NMES and compression protocol for the prevention of venous stasis on the compliance, comfort and venous blood flow of healthy volunteers over the course of seven days.
Twenty-four healthy subjects were assigned to either a stimulation or control group. The stimulation group received 1.5 h of NMES daily while the control group received none. Daily measures of popliteal venous blood flow, subject compliance and comfort were recorded over 7 days.
Ejected blood flow volumes and peak velocities in the popliteal vein during NMES were sustained over a 30-min stimulation session and increased by approximately 100% over the course of seven days. Mean stimulation intensities increased progressively throughout the week, while perceived pain during NMES decreased significantly. Mean compliance to the 7-day protocol was 100%.
User habituation to a combined NMES and compression protocol resulted in significant increases in ejected venous volume and peak velocity over the course of 7 days. This resulted in the highest ejected venous volume reported from a single NMES induced contraction of the calf muscles to date which was twice the magnitude of values previously reported in the literature. These findings suggest that NMES based protocols applied over an extended period of days, weeks or months may provide greater hemodynamic effect for the prevention of venous stasis than previously observed during NMES sessions lasting less than a few hours.
... 2 In a previous study we showed that NMES applied to the gastrocnemius muscle significantly increased venous blood flow through the popliteal vein of healthy volunteers with and without leg compression. 3 However, no data exist as to the efficacy of this potential treatment in patients with venous leg ulceration. The present study, therefore, was undertaken to: 1. investigate the changes in popliteal venous blood flow velocities in patients with venous ulceration using NMES over the gastrocnemius muscle, 2. Compare the effect of NMES on venous blood flow with and without compression bandaging, 3. Assess the acceptability of NMES as a treatment option for patients with venous ulcers. ...
... Two round (5 cm diameter) neurostimulation hypoallergenic skin surface electrodes (PALS w Nidd Valley Medical) were applied to the back of each patient's calf and NMES was applied ( Fig. 1) as described previously by us. 3 The choice of positioning of the electrodes was based on a earlier study that established the pattern of electrode positions that would produce the maximum muscle contraction in response to electrical stimulation. 3 A BMR NeuroTech NT2000e (BMR Ltd, Galway, Ireland) muscle stimulator was used to stimulate the calf muscle. ...
... Two round (5 cm diameter) neurostimulation hypoallergenic skin surface electrodes (PALS w Nidd Valley Medical) were applied to the back of each patient's calf and NMES was applied ( Fig. 1) as described previously by us. 3 The choice of positioning of the electrodes was based on a earlier study that established the pattern of electrode positions that would produce the maximum muscle contraction in response to electrical stimulation. 3 A BMR NeuroTech NT2000e (BMR Ltd, Galway, Ireland) muscle stimulator was used to stimulate the calf muscle. The stimulator was set to deliver a pulse duration of 300 ms, a pulse frequency of 35 Hz, a contraction time of 2 s, a relaxation time of 6 s, a ramp-up time of 0.5 s and a ramp-down time of 0.2 s; we have previously shown that these parameters produce the most efficient muscle contraction with the minimum of discomfort. ...
The aim of this study was to explore the option of stimulating calf muscle contraction through externally applied neuromuscular electrical stimulation (NMES) and to measure venous blood flow response to this stimulation.
Ten patients with class 6 chronic venous disease (CEAP clinical classification) were recruited. Measurements of peak venous velocities in the popliteal vein were recorded by Duplex scanning in response to six test conditions; 1. Standing, 2. Voluntary calf muscle contraction, 3. Standing with NMES applied, 4. Standing with compression bandaging applied to the leg, 5. Voluntary calf muscle contraction with compression bandaging applied to the leg, 6. Stationary with compression bandaging applied to the leg and NMES applied. Comfort assessment was completed using visual analogue scales at each test stage and on study completion each patient completed a short structured interview to determine comfort and acceptability of NMES. Statistical analyses were carried out using SPSS, Version 9. Non-parametric testing was used in all analyses using the Wilcoxon Signed Ranks Test for paired samples.
There was a significant increase in venous velocities on voluntary contraction of the calf muscle (median resting vel 7.3 cm/s; voluntary contraction median 70 cm/s) and with the introduction of NMES, both with compression (median velocity 15 cm/s, p = 0.005 Wilcoxon) and without compression (median velocity 13 cm/s, p = 0.005 Wilcoxon). The greatest increase with NMES was when combined with compression bandaging. All patients reported the stimulus as an acceptable treatment option with 90% reporting NMES as comfortable.
Healing rates in venous ulceration with the application of compression bandaging remain between 50 and 70%. This study shows a positive haemodynamic response to NMES. Further research is needed to quantitatively measure the effect of NMES on ulcer healing.
... Transcutaneous neuromuscular ES involves the application of electrical stimuli to superficial skeletal muscles, with the main objective to trigger visible and valid muscle contractions due to the activation of motor neuron axons or intramuscular axonal branches (Gobbo et al. 2014). Because pre-gelled electrodes are placed on the skin surface over the motor point of the muscle of interest, surface ES is a completely non-invasive technique (Lyons et al. 2002). Depending on stimulation characteristics, ES is believed to increase local blood flow ( Vanderthommen et al. 2002). ...
... Similarly, an increment in the femoral arterial inflow through ES of the calf muscles (Abraham et al. 2013) has been observed. The interventions used, usually involve the application of ES bursts from 15 to 36 Hz with a pulse width of 300-350 µs, to activate the calf's muscle pump function (Clarke Moloney et al. 2006;Broderick et al. 2010;Lyons et al. 2002). Parallel to the vibration therapy, the effect of ES on the skin blood flow has also been studied. ...
... Transcutaneous neuromuscular ES involves the application of electrical stimuli to superficial skeletal muscles, with the main objective to trigger visible and valid muscle contractions due to the activation of motor neuron axons or intramuscular axonal branches (Gobbo et al. 2014). Because pre-gelled electrodes are placed on the skin surface over the motor point of the muscle of interest, surface ES is a completely non-invasive technique (Lyons et al. 2002). Depending on stimulation characteristics, ES is believed to increase local blood flow ( Vanderthommen et al. 2002). ...
... Similarly, an increment in the femoral arterial inflow through ES of the calf muscles (Abraham et al. 2013) has been observed. The interventions used, usually involve the application of ES bursts from 15 to 36 Hz with a pulse width of 300-350 µs, to activate the calf's muscle pump function (Clarke Moloney et al. 2006;Broderick et al. 2010;Lyons et al. 2002). Parallel to the vibration therapy, the effect of ES on the skin blood flow has also been studied. ...
The aim of this study was to analyze the acute effects of isolated or simultaneously applied whole-body vibration (WBV) and electromyostimulation (ES) on the popliteal arterial blood velocity and skin temperature (ST) of the calf.
Thirteen healthy males were assessed in five different sessions. After a familiarization session, four interventions were applied in random order; WBV, ES, simultaneous WBV and ES (WBV+ES), and 30 s of WBV followed by 30 s of ES (WBV30/ES30). Each intervention consisted of 10 sets × 1 min ON + 1 min OFF. The subject was standing on the vibration platform (squat position, 30° knee flexion, 26 Hz, 5 mm peak-to-peak), and ES was applied on the gastrocnemius of both the legs (8 Hz, 400 µs).
The WBV+ES intervention was the only one that maintained the mean blood velocity (MBV) elevated above baseline during the 10 sets, from set-1 (134.6 % p < 0.01) to set-10 (112.6 % p < 0.05). The combined interventions were the only ones that maintained the peak blood velocity (PBV) elevated above baseline during all the sets, from set-1 (113.5 % p < 0.001) to set-10 (88.8 % p < 0.01) and from set-1 (58.4 % p < 0.01) to set-10 (49.1 % p < 0.05) for WBV+ES and WBV30/ES30, respectively.
The simultaneous application of WBV and ES produced a general greater increase in MBV and PBV than the application of each method alone or consecutive. This novel methodological proposal could be interesting in different fields such as sports or the rehabilitation process of different pathologies, to achieve an enhanced peripheral blood flow.
... Significant difference from voluntary contraction, . the GAS showed an increase of venous velocities of 266% [13]. This study showed a similar increase of 248%. ...
... In this paper, we have systematically investigated all possible stimulation sites to find the optimal single-and two-channel stimulation setups. Previous work found that GAS stimulation could achieve a 266% improvement over static venous blood flow velocities [13]. This study has confirmed the previous report but highlighted that this mechanism represents only 27% of venous blood volume expelled during voluntary contraction. ...
Neuromuscular electrical stimulation (NMES) has previously been used to activate the musculature of the lower leg and increase venous return to the heart. However, there is little evidence to suggest the superiority of one particular stimulation site over another. In this paper, we aim to reveal the optimal stimulation site on the lower leg in a group of healthy adults. Doppler ultrasound measurements of venous blood volume expelled and peak venous velocity in response to various single and two-channel applications of NMES were taken for each subject. We found that soleus NMES is the most effective single-channel stimulation method, capable of expelling 58.3% of the blood achieved during a voluntary contraction, alternatively soleus plus tibialis posterior stimulation is capable of expelling 76.5%. Based on these and other factors we suggest that the soleus and soleus plus tibialis posterior are the most effective NMES sites for improving venous return.
... Several studies investigating NMES-based calf pump stimulation in healthy and patients populations have reported significant increases in venous return [7], arterial flow [8] and venous volume changes in the lower limbs [6,9]. More recently NMES has been applied to the calf muscles in conjunction with compression hosiery to evaluate its possible role as a therapeutic modality for venous insufficiency [10]. ...
... Multiple-regression was used to model the effect of selected prediction variables on measures on peak venous velocity. NMES force, NMES current and BMI were selected as possible prediction variables for modeling peak venous velocity based on prior work in the area of NMES [1] and the influence of the calf muscle pump on popliteal venous flow [10,14]. ...
In spite of significant gains in venous flow using Neuromuscular Electrical Stimulation (NMES) of the calf muscles, little is known about the relationship between the applied electrical stimulus and the resulting venous blood flow in the deep veins of the leg. This retrospective study of repeated measures of blood flow, muscle force and NMES signals of 14 healthy subjects undergoing a week long NMES protocol aimed to determine the relationship between the applied NMES signals and the resulting muscle force and blood flow measures. Statistical analyses revealed strong correlations between NMES blood flow, NMES plantar flexion force and the applied NMES intensity.
... These stimulator parameters were selected based on previous extensive experience with using ES in venous return assist applications [52][53][54][55][56][57] . ...
Due to possible sensory impairments in people with Parkinson's disease, several methodological aspects of electrical stimulation as a potential cueing method remain to be explored. This study aimed to investigate the applicability and tolerability of sensory and motor electrical stimulation in 10 people with Parkinson's disease. The study focused on assessing the electrical stimulation voltages and visual analogue scale discomfort scores at the electrical sensory, motor, discomfort, and pain thresholds. Results show that sensory electrical stimulation at the tibialis anterior, soleus, hamstrings, and quadriceps stimulation sites was applicable and tolerable for 6/10, 10/10, 9/10, and 10/10 participants, respectively. Furthermore, motor electrical stimulation at the tibialis anterior, soleus, hamstrings, and quadriceps stimulation sites were applicable and tolerable for 7/10, 7/10, 7/10, and 8/10 participants, respectively. Interestingly, the thresholds for the lower leg were higher than those of the upper leg. The data presented in this paper indicate that sensory and motor electrical stimulation is applicable and tolerable for cueing applications in people with Parkinson's disease. Sensory electrical stimulation was applicable and tolerable at the soleus and quadriceps sites. Motor electrical stimulation was not tolerable for two participants at any of the proposed stimulation sites. Therefore, future studies investigating motor electrical stimulation cueing, should apply it with caution in people with Parkinson's disease.
... Sekk et al determined the efficiency of venous exercise in relation to the VBFV. Forty-two healthy persons (13 males, 31 females, mean age: 23.4 [20][21][22][23][24][25][26][27][28][29][30] years) participated in the study. They concluded that the venous exercise performed by the lower limb significantly increased (10.1 [8.0-13.2] to 12.9 cm/s, P < .001) the VBFV on the opposite side compared to the resting VBFV (Table 3). ...
Our aim was to measure the venous blood flow velocity (VBFV) in case of hemiparetic patients, after passive and active thromboembolic methods, as well as the consensual effect in the hemiparetic limb following the active venous exercises in the healthy limb. We examined 215 patients, with the median age of 58.0 (55.0-63.0) years. The VBFV was measured with a HADECO BIDOP ES-100 V II type Doppler ultrasound device, using an 8 MHz head, on the femoral vein at the level of the hip joint. For statistical analysis, SPSS version 22 was used. After passive movement, on the hemiparetic side, compared to the value in resting state, the VBFV significantly (12.6; 11.6-13.5 cm/s; P < .001) increased. Following active venous exercises performed on the healthy side, the VBFV significantly (18.0; 15.6-19.6 cm/s; P < .001) increased compared to the value in resting state. Following the active venous exercises performed on the healthy side, the VBFV measured on the hemiparetic side (consensual effect) was significantly (15.1 [14.1-16.5] cm/s; P < .001) higher than the value on the hemiparetic side in resting state. Active and passive mechanical thromboprophylaxis methods can be effective. Movements of the healthy limb significantly increase the VBFV in the inactive limb, and patients can perform it themselves several times a day.
... Several studies have demonstrated that ES is able to increase venous velocity and flow in healthy participants. [8][9][10][11][12][13][14][15] Two recent systematic reviews demonstrated that there is moderate quality evidence to support ES over no prophylaxis in a clinical setting for preventing VTE. 16,17 However, how patient selection influences efficacy and the most effective device and protocol is unknown. ...
Introduction:
Electrical stimulation could provide an alternative method for preventing venous thromboembolism in stroke patients. The purpose of this preliminary study was to explore the effects of electrical stimulation and intermittent pneumatic compression on enhancing lower limb venous return in healthy and chronic stroke patients and also to evaluate patient and nurse satisfaction.
Methods:
We investigated the effectiveness of two electrical stimulation devices: Geko (Firstkind Ltd, High Wycombe, UK) and Orthopaedic Microstim 2V2 (Odstock Medical Ltd, Salisbury, UK); and one intermittent pneumatic compression device: Huntleigh Flowstron Universal (Huntleigh Healthcare Ltd, Cardiff, UK). We recruited 12 healthy and 5 chronic stroke participants. The devices were fitted sequentially, and Doppler ultrasound measurements were taken. Eight patients and nurses were also recruited for a separate usability evaluation.
Results:
The electrical stimulation devices emulated the blood flow characteristics of intermittent pneumatic compression in both healthy and stroke participants provided that the intensity of electrical stimulation was sufficient. Patients and nurses also felt that the electrical stimulation devices were acceptable.
Conclusions:
Electrical stimulation may offer benefit as an alternative method for venous thromboembolism prevention in stroke patients. The apparent benefit is sufficient to warrant further investigation in a full powered randomised controlled trial.
... [1,2] These options can still have certain limitations such as patient discomfort, tissue injury, improper fitting, [2,3] or arterial insufficiency in patients with peripheral arterial disease, [4] so alternative physical strategies like electrical stimulation (ES) are being investigated. ES has been shown to have an additive effect to compression stockings [5] and to be at least as effective as IPC in terms of the venous hemodynamic response, [6,7] and besides, to show some other advantages such as arterial and microcirculatory flux enhancement. [8,9] In addition, ES can also play a specific role by stimulating or replacing the neural supply to the veins, which has been proposed recently as the fourth factor in thrombus pathogenesis. ...
Background:
Transcutaneous electrical nerve stimulation (TENS) is used to prevent venous stasis and thromboembolism. However, best electrostimulation parameters have yet to be established. The aim of the study was to compare the hemodynamic effects and the participants' relative discomfort of 3 TENS sequences at the maximum tolerated intensity stimulus.
Methods:
Twenty-four healthy university students (50% male) participated in a cross-over, randomized study. Each participant received 2 TENS sequences on peroneal nerve at 1 and 5 Hz, and the third one on soleus muscle at 5 Hz. Popliteal flow volume (FV) and peak velocity (PV) were measured using Doppler ultrasound and the relative change from basal values was recorded. Discomfort questionnaires -visual analogue scale (VAS) and verbal rating scale (VRS)- were also administered to compare sensations among the three applications.
Results:
All interventions produced significant hemodynamic responses compared to baseline. Both 5 Hz applications obtained higher FV increments than 1 Hz TENS (P < .001). The muscle application resulted in the lowest PV increment (P < .001). TENS at 5 Hz on nerve location was the worst tolerated, with higher values in VRS (P = .056) and VAS (P = .11), although not significant.
Conclusion:
TENS at 5 Hz on soleus site may be the most appropriate protocol for enhancing venous return.
... A previous report showed that IPC produces similar influences on velocity and volume of venous flow in the lower limbs [15]. It has been thought that EMS activates muscle pumping by contracting the lower extremity skeletal muscles and thus produces more physiological hemodynamic forces than IPC or compression stocking [16,17]. From this point of view, one report compared EMS with IPC in terms of the influences of lower limb hemodynamics and showed that EMS led to more effective ejection of blood in conditions of venous stasis of the lower limbs [18]. ...
Background
Deep vein thrombosis (DVT) is a major complication in critical care. There are various methods of prophylaxis, but none of them fully prevent DVT, and each method has adverse effects. Electrical muscle stimulation (EMS) could be a new effective approach to prevent DVT in intensive care unit (ICU) patients. We hypothesized that EMS increases the venous flow of the lower limbs and has a prophylactic effect against the formation of DVT.
Methods
This study included 26 patients admitted to a single ICU. We enrolled patients who could not move themselves due to spinal cord injury, head injury, central nervous system abnormalities, and sedation for mechanical ventilation. The patients were randomly allocated to either the EMS group or the control group. Patients in the EMS group received 30-min sessions of EMS applied to the bilateral lower extremities on arbitrary days within 14 days after admission. The control patients received no EMS. The peak flow velocity and diameter of the popliteal vein (Pop.V) and common femoral vein (CFV) were measured by ultrasound and then the volumes of venous flow were calculated using a formula.
Results
There were no statistically significant differences in patient characteristics between the two groups except for the mortality rate. In the EMS group, the median and interquartile range (IQR, 25th–75th percentile) of velocities of the Pop.V and CFV were higher during EMS compared with at rest: 10.6 (8.0–14.8) vs 24.5 (15.1–37.8) cm/s and 17.0 (12.3–23.8) vs 24.3 (17.0–33.0) cm/s, respectively (p < 0.05). The median (IQR) of volumes of venous flow of the Pop.V and CFV at rest and during EMS were 4.2 (2.7–7.2) vs 8.6 (5.4–16.1) cm³/s and 12.9 (9.7–21.4) vs 20.8 (12.3–34.1) cm³/s, respectively (p < 0.05). There were no major complications related to EMS.
Conclusions
EMS increased the venous flow of the lower limbs. EMS could be one potential method for venous thromboprophylaxis.
Trial registration
UMIN000013642
... Previous studies combining NMES (DUO Stim or BMR Neurotech) with GCS have shown an additive enhancement of hemodynamic flow measurements. 19,20 This may translate into added clinical benefit with combined use of NMES devices with GCS in future interventional trials. ...
Background Occupational edema is reported to occur in healthy individuals after working in a sitting or standing position for extensive periods of time. It can be associated with feelings of tiredness, heaviness of the legs, and pain. Three licensed medical devices were compared in their management of occupational edema.
Subjects and Methods A total of 10 subjects were recruited from a clinical workspace. Right leg volume and great saphenous vein diameter was measured in the morning, and 6 hours later. On subsequent separate days, grade 2 graduated compression stockings (Active Compression Socks, Mediven, United Kingdom), geko (Firstkind Ltd, United Kingdom), and Revitive (Actegy Ltd, United Kingdom) were used bilaterally according to manufacturer's instructions.
Results Leg volumes increased by median 41 mL (p < 0.05) with no intervention. Percentage increase in leg volume was found to be significantly reduced by stockings compared with control (−1.7%, p < 0.01), and were more effective than electrical devices. Changes in vein diameter poorly correlate with leg volume changes.
Conclusion Occupational edema can occur over as little as 6 hours. All devices were well tolerated and reduced leg swelling. Stockings were the only device to significantly reduce leg swelling in this small trial.
... Often this is caused by valve destruction in the deep veins of the lower leg and reduced efficiency of the calf muscle pump. In previous studies we have investigated the use of Neuromuscular Electrical Stimulation (NMES) to improve venous return with the aim of alleviating the effects of chronic venous insufficiency [1]- [6]. ...
Neuromuscular Electrical Stimulation (NMES) has previously been used to enhance venous return from the lower leg. By artificially activating lower leg muscles, venous blood may be effectively ejected from the muscle and adjacent veins. It could easily be assumed that combined NMES of the gastrocnemius and soleus would be the most effective single-channel application in this regard, as these muscles represent the largest muscular bulk in the lower leg. However, we have previously reported that soleus stimulation in isolation is substantially more effective. To understand why this is the case, we recorded fine-wire EMG during NMES of the gastrocnemius and soleus muscles. We found that gastrocnemius and soleus stimulation are effective in eliciting selective stimulation of these muscles. However, combined stimulation of these muscles using a single set of electrodes was only capable in generating ~50% of the response in each muscle, insufficient to generate their theoretical maximum venous return.
... NMES is used to generate a physiological contraction of muscles by delivering a series of controlled electrical pulses via skin surface electrodes placed over the motor points of the targeted muscle. For example, NMES applied to the calf muscle artificially activates the calf muscle pump and results in ejection of blood from the venous compartment (Lyons et al 2002). This calf muscle activation produces venous flow similar to that of a voluntary muscle contraction, with relaxation of the muscle allowing the vessels to refill. ...
Deep Vein Thrombosis (DVT) is a life threatening condition and a serious concern among hospitalised patients, with death occurring in approximately 6% of cases. Intermittent pneumatic compression (IPC) is commonly used for DVT prevention, however suffers from low compliance and issues of usability and portability. Neuromuscular electrical stimulation (NMES) has been shown to improve lower limb hemodynamics but direct comparison with IPC in terms of hemodynamics is rare but very important to determine the potential effectiveness of NMES in DVT prevention.
Lower limb IPC was compared to calf NMES, in 30 healthy volunteers (18–23 years). Each intervention was carried out on each leg, on the popliteal vein measured using Doppler ultrasound. All interventions produced significantly greater haemodynamic responses compared to baseline. Calf-IPC and NMES produced significant increases in venous blood velocity (cm/s) and volume of blood ejected per cycle (1 cycle of NMES expels 23.22 ml compared to the baseline ejected volume of 2.52 ml, measured over 1 s (p < 0.001 versues baseline).
Improving lower limb hemodynamics is vital in preventing DVT. NMES resulted in larger ejected volumes compared to IPC (x3 greater than foot-IPC and x1.7 greater than calf-IPC) more effectively emptying the veins and soleal sinuses. This is an important finding as DVT occurs predominantly in the soleal sinuses. NMES is silent and portable and thus does not suffer many of the issues associated with IPC. This work supports the potential widespread application of NMES in hospital and home settings where the risk of DVT formation is high.
... re-emerging in the clinical arena as a new safe and well tolerated method. Portable electric calf stimulators that can significantly increase venous blood velocity [20][21][22][23] are now available. ...
Aim:
The aim of this pilot study was to evaluate the potential effect of electrical calf muscle stimulation (EMS) in the prevention of postoperative deep vein thrombosis (DVT) in high risk patients and to assess efficacy and safety of EMS in patients with calf DVT.
Methods:
This was a prospective non-randomized controlled study involving 80 patients over the age of 40 having major surgery (44 abdominal and 36 cranial or spinal surgery; duration more than 60 min under general anesthesia). Patients were divided into 2 comparable groups: main (N.=40) and control (N.=40). In both groups graduated middle stretch compression bandage with compression level 20-40 mmHg was applied and low dose unfractioned heparin (LDUH) injections (5000 U s.c. 3 t.i.d) were started on 1st or 2-5th day after surgery and continued until discharge. The time of starting LDUH was comparable in both groups. In addition, electrical calf muscle stimulation (EMS) with Veinoplus device was performed for not less than 5 periods of 20 minutes per day (total >100 minutes) in the main group. Control of venous patency was performed with duplex ultrasound obligatory at baseline (first 24 h after surgery) and then every 3 days until discharge.
Results:
The incidence of DVT was 2.5% in the main group and 25% in the control group (P=0.007). In patients without DVT at baseline it was 3% versus 21% (P=0.025). Patients with baseline thrombosis who underwent EMS did not have any new cases of DVT and PE, while in patients without EMS thrombosis progression was observed in 43% cases also without pulmonary embolism (not significant).
Conclusion:
EMS with Veinoplus device at >100 min per day (>5 sessions) can decrease the rate of postoperative DVT in high risk patients. Using of EMS in patients with calf DVT does not increase the rate of PE. These findings need to be confirmed in a randomized controlled trial.
... Our group has a longstanding interest in using NMES to artificially activate the calf muscle pump to aid venous return (Lyons et al 2002a, Clarke-Moloney et al 2006, Breen et al 2012. We intend to use this mechanism to aid venous leg ulcer healing in conjunction with the standard treatment (Corley et al 2008). ...
Particular neuromuscular electrical stimulation (NMES) applications require the use of the same electrodes over a long duration (>1 day) without having access to them. Under such circumstance the quality of the electrode-skin contact cannot be assessed. We used the NMES signal itself to assess the quality of the electrode-skin contact and the electrical properties of the underlying tissues over a week. A 14% decrease in the skin's stratum corneum resistance (from 20 to 17 kΩ) and a 15% decrease in the resistance of the electrodes and underlying tissues (from 550 to 460 Ω) were observed in the 14 healthy subjects investigated. A follow-on investigation of the effect of exercise-induced sweating on the electrical properties of the electrode-skin-underlying tissue composite during NMES indicated a correlation between the decrease in the resistance values observed over the course of the week and the accumulation of sweat at the electrode-skin interface. The value of the capacitance representing the dielectric properties of the skin's stratum corneum increased after exercise-induced sweating but did not change significantly over the course of the week. We conclude that valuable information about the electrode-skin-underlying tissue composite can be gathered using the NMES signal itself, and suggest that this is a practical, safe and relatively simple method for monitoring these electrical properties during long-term stimulation.
... На сегодняшний день появление на рынке современных устройств для электроимпульсного воздействия на мышцы голени требует оценки их гемодинамической и клинической эффективности в вопросе профилактики ВТЭО, в особенности у пациентов из категории высокого риска. И, если гемодинамический эффект применения миостимуляции находит отражение в литературе [10,[24][25][26][27][28], то результаты клинического использования современных устройств на сегодняшний день отсутствуют. ...
The present clinical and experimental study was carried out in order to evaluate efficacy of electrical stimulation of the crural muscles with the purpose of preventing postoperative venous thromboembolic complications. At the first stage by means of ultrasonographic angioscanning in apparently healthy volunteers (n=21) we evaluated the linear velocity of blood flow on the popliteal vein on the background of using myostimulation and compression bandage with various levels of pressure applied either separately or in a combination with each other. It was revealed that electrical stimulation of the crural muscles led to a 2.8-4.5-fold increase in the peck velocity of blood flow, while the compression decreased the parameters of the venous outflow both at rest and during muscular contraction. By means of theoretical calculations it was determined that an optimal compression profile for a combination with electrical stimulation is a pressure under the bandage equalling 20-40 mm Hg, providing substantial acceleration of the venous outflow with the laminary blood flow preserved. At the second stage we assessed efficacy of comprehensive prevention of venous thromboembolism with the use of electromyostimulation, the respective compression bandage and direct anticoagulants in surgical-profile patients from a high-risk group (n=90) by means of ultrasound screening of the venous system during the whole postoperative period. When myostimulation was used in the regimen of 3-5 procedures a day, the frequency of venous thrombosis amounted to 40% (n=10) and did not significantly differ from that in patients not subjected to myostimulation (25%, n=40). When myostimulation was used in the regimen of 5-10 procedures per day, the frequency of venous thrombosis turned out to be considerably lower (2.5%, n=40). A conclusion was made on efficacy of using this method in the examined group of patients.
... In as early as 1964, Doran et al. [24] demonstrated an improvement in venous return when electrical muscle stimulation was applied to the calf muscles of patients compared to when no stimulation was used. Since Doran's study, dramatic improvements in lower limb venous blood flow have been demonstrated in healthy patients with calf NMES resulting in peak velocities of 43-120 cm/s in the popliteal vein [17,[25][26][27][28]. More recent contributions to the area of NMES for blood flow assist included the investigation of the ideal pulse repetition rate on ejected blood volume from the lower limb [25] and the benefits of targeting the peroneal nerve with surface stimulation rather than targeting the motor points of the muscle directly [26]. ...
Patients post total hip arthroplasty (THA) remain at high risk of developing Deep Vein Thrombosis (DVT) during the recovery period following surgery despite the availability of effective pharmacological and mechanical prophylactic methods. The use of calf muscle neuromuscular electrical stimulation (NMES) during the hospitalised recovery period on this patient group may be effective at preventing DVT. However, the haemodynamic effectiveness and comfort characteristics of NMES in post-THA patients immediately following surgery have yet to be established.
The popliteal veins of 11 patients, who had undergone unilateral total hip replacement surgery on the day previous to the study, were measured using Doppler ultrasound during a 4 hour neuromuscular electrical stimulation (NMES) session of the calf muscles. The effect of calf muscle NMES on peak venous velocity, mean venous velocity and volume flow were compared to resting values. Comfort was assessed using a 100mm non-hatched visual analogue scale taken before application of NMES, once NMES was initiated and before NMES was withdrawn.
In the operated limb NMES produced increases in peak venous velocity of 99% compared to resting. Mean velocity increased by 178% compared to resting and volume flow increased by 159% compared to resting. In the un-operated limb, peak venous velocity increased by 288%, mean velocity increased by 354% and volume flow increased by 614% compared to basal flow (p<0.05 in all cases). There were no significant differences observed between the VAS scores taken before the application of NMES, once NMES was initiated and before NMES was withdrawn (p=.211).
NMES produces a beneficial hemodynamic response in patients in the early post-operative period following orthopaedic surgery. This patient group found extended periods of calf-muscle NMES tolerable.
Trial registration
ClinicalTrials.gov NCT01785251
... The fast dynamic response of the sensor also shows the effect of muscle flexing, i.e. the muscle pump action. Previous studies have shown that muscle contraction in the presence of a compression bandage or stocking results in a significant increase in venous blood flow (Lyons et al, 2002). Standing and elevation produce pressure fluctuations above and below the value for a seated subject respectively, as expected. ...
... In as early as 1964, Doran et al. [10] demonstrated an improvement in venous return when electrical muscle stimulation was applied to the calf muscles of patients compared to when no stimulation was used. Since Doran's study, dramatic improvements in lower limb venous blood flow have been demonstrated in healthy patients with calf NMES resulting in peak velocities of 43-120 cm/s in the popliteal vein [7,[11][12][13][14]. More recent contributions to the area of NMES for blood flow assist included the investigation of the ideal pulse repetition rate on ejected blood volume from the lower limb [11] and the benefits of targeting the peroneal nerve with surface stimulation rather than targeting the motor points of the muscle directly [12]. ...
Patients post total hip arthroplasty (THA) remain at high risk of developing Deep Vein Thrombosis (DVT) during the recovery period following surgery. The use of calf muscle neuromuscular electrical stimulation (NMES) during the hospitalized recovery period on this patient group may be effective at preventing DVT. However, the haemodynamic effectiveness and comfort characteristics of NMES in post-THA patients immediately following surgery has yet to be demonstrated. The popliteal veins of 5 patients, who had undergone unilateral total hip replacement surgery on the day previous to the study, were measured using Doppler ultrasound during a 4 hour calf-muscle NMES session. The effect of calf muscle NMES on peak venous velocity and volume flow were compared to resting values. Comfort was assessed using a 100 mm non-hatched visual analogue scale taken before application of NMES, once NMES was initiated and before NMES was withdrawn. Results of the study showed that NMES produces a beneficial hemodynamic response in patients in the early postoperative period following orthopaedic surgery. This patient group found extended periods of calf-muscle NMES tolerable.
... This phenomenon could be explained by possible differences in the extent of the lower leg musculature between both legs for a given patient. Differences in calf muscle bulk could also explain variances in the popliteal haemodynamic characteristics of patients with similar age and life styles, during both voluntary and artificial calf muscle pump action [31,32]. As such, we plan to use this calf muscle bulk calculator in a study to further examine these unusual characteristics. ...
An unsupervised technique to estimate the relative size of a patient's lower leg musculature in vivo using magnetic resonance imaging (MRI) in the context of venous insufficiency is presented. This post-acquisition technique was designed to segment calf muscle bulk, which could be used to make inter- or intra-patient comparisons of calf muscle size in the context of unilateral leg ulcers and venous return. Pre-processing stages included partial volume reduction, intensity inhomogeneity correction and contrast equalization. The algorithm created a binary mask of voxels that fell within a computed threshold designated as representing muscle based on a 3-class fuzzy clustering approach. The segmentation was improved using a set of morphological operations to remove adipose tissue, spongy bone and cortical bone. The technique was evaluated for accuracy against a manual segmented ground truth. Results showed that the automatic technique performed sufficiently well in terms of accuracy and efficacy. The automatic method did not suffer from intra-observer variability.
... NMES applied to the calf muscles facilitates venous return by activating the skeletal muscle pump. NMES administered for blood flow assist applications has demonstrated positive hemodynamic responses in healthy subjects and patients suffering from chronic venous disease [24,25]. ...
Bed rest poses an increased risk factor for a potentially fatal venous thromboembolism (VTE). Lack of activation of the calf muscle pump during this resting period gives rise to venous stasis which may lead to deep vein thrombosis (DVT) development. Our aim was to investigate the effects that 4h of bed rest have on the lower limb hemodynamics of healthy subjects and to what extent electrically elicited contractions of the calf muscles can alleviate these effects. Outcome variables included popliteal vein blood flow and heart rate. Primary results indicated that the resting group experienced a significant decline in popliteal venous blood flow of approximately 47% with approximately 13% decrease in heart rate. The stimulated groups maintained a significantly higher venous blood flow and heart rate. Volume flow in the contralateral limb remained constant throughout the study and was comparable to that of the stimulated limb's recovery flow. The results suggest that even short periods of bed rest can significantly reduce lower limb blood flow which could have implications for DVT development. Electrically elicited calf muscle contractions significantly improve lower limb blood flow and can alleviate some debilitating effects of bed rest.
... The aim of this study was to evaluate the effect of bed rest on lower limb venous hemodynamics and to determine to what extent prophylaxis, in the form of neuromuscular electrical stimulation (NMES) induced calf muscle contractions, alleviates these effects. NMES has demonstrated positive hemodynamic responses in healthy subjects and patients suffering from chronic venous disease [9,12]. NMES has reported benefits over pneumatic compression devices [13]. ...
Venous stasis, due to lack of activation of the calf muscle pump of postoperative patients, can result in the development of a thrombus which, in turn, can lead to a potentially fatal pulmonary embolism. The presented study investigates the effects that four hours of bed rest has on the lower limb hemodynamics of healthy subjects and, to what extent electrically elicited contractions of the calf muscles can alleviate these effects. Results indicated that the non-stimulated group experienced a decline in popliteal venous blood flow of approximately 45 % and a 10 % decrease in heart rate. The stimulated group maintained a higher venous blood flow and heart rate. The results suggest that even short periods of bed rest can significantly reduce lower limb blood flow which could have implications for DVT development in post-operative patients. Electrically elicited calf muscle contractions significantly improves lower limb blood flow and can alleviate the debilitating effects of bed rest.
... A number of treatment mechanisms to generate artificial calf muscle pump activity have been developed for those predisposed to prolonged inactivity. The authors have previously shown that application of neuromuscular stimulation to the calf increases blood flow in healthy subjects and in patients with chronic venous insufficiency [6], [7]. The performance of this technique was evaluated through measured changes in peak venous blood flow velocities. ...
Various venous flow increasing methods are used to reduce venous thromboembolism, but the data about superiority among these methods is lacking. We evaluated the percent increase in peak venous velocity and venous volume after each methods compared with baseline value in using pulse wave doppler ultrasonography. Twenty limbs in 10 healthy volunteers were studied. We evaluated five methods including raising lower limbs, elastic stocking, foot pump, calf pump, neuromuscular electrical stimulation (NMES) at popliteal vein and seven methods adding dorsiflexion and plantar flexion at common femoral vein.
Excepting spontaneous movements, calf pump was most effective for increasing venous flow velocity and volume. Although not spread to common femoral vein, foot pump had a significant effect and NMES had a modest effect in venous velocity at popliteal vein. Further prospective controlled trial is necessary to clarify the relationship between peak venous velocity, volume and clinical outcomes.
Ankle exercises are useful for preventing deep vein thrombosis, as they increase venous blood flow velocity. The cause for the increased venous blood flow velocity during ankle exercises may be the skeletal-muscle pump, but the mechanism is not clearly understood. The purpose of this study was to investigate the effects of the dorsiflexion angle and gastrocnemius muscle contraction on venous blood flow velocity during ankle exercises and to investigate the mechanism of the increase in venous blood flow velocity. The blood flow velocity in the popliteal vein, ankle joint angle, and surface electromyographic activity of the gastrocnemius muscle were measured at rest and during ankle exercises in the prone position in young healthy volunteers. The significant increase in venous blood flow velocity was observed during dorsiflexion phase, max dorsiflexion and during planter flexion phase. The peak venous blood flow velocity was different in each subject and classified into four types. The correlations of venous blood velocity to ankle joint angle and with the surface electromyographic activity of the gastrocnemius muscle were not statistically significant. These findings suggest that venous blood flow velocity increases not only during plantar flexion and dorsiflexion.
Background:
Neuromuscular electrical stimulation (NMES) has emerged as a viable alternative for venous thromboembolism prophylaxis. Electrical stimulation of the peroneal nerve using NMES may potentially interfere with somatosensory evoked potential (SSEP) acquisition. This feasibility study evaluates a NMES device and its effect on SSEP acquisition as an initial step in a randomized clinical trial to assess NMES for intraoperative venous thromboembolism prophylaxis.
Methods:
Healthy volunteers underwent SSEP testing during NMES in an outpatient setting. Concurrently, SSEP recordings of the posterior tibial nerve with stimulation at each ankle were obtained in 3 conditions: sham, NMES in place but inactive; ipsi, NMES active on leg ipsilateral to SSEP acquisition; and contra, NMES active on the leg contralateral to SSEP acquisition. Nonparametric statistical methods, including repeated measures, were used for data analysis.
Results:
Stimulation intensities on the left, right, and bilaterally did not differ (p≥0.20). Strong positive correlations were noted between the ipsilateral geko stimulus pulse width and ipsilateral SSEP stimulation intensities (left: rs=0.866, p=0.001; right: rs=0.877, p=0.001). Women required significantly higher pulse width settings than men (p=0.01). Finally, visual inspection of waveforms, as used during dynamic IONM, did not show any significant variations of P37 cortical waveforms during NMES.
Conclusions:
As a preliminary step to testing NMES intraoperatively for venous thromboembolism prophylaxis, interference with SSEP acquisition was investigated in the outpatient laboratory setting. Within a small sample of healthy volunteers, no significant changes were seen in P37 cortical latencies to suggest interference between the NMES device and SSEP waveforms.
Currently, 1% of the population of the Western world suffers from venous leg ulcers as a result of chronic venous insufficiency. Current treatment involves the use of moist wound healing, compression bandages, and intermittent pneumatic compression. Neuromuscular electrical stimulation is a novel potential new therapeutic method for the promotion of increased lower limb hemodynamics. The aim of this study was to measure the hemodynamic changes in the lower limb with the use of two neuromuscular electrical stimulation devices. Twelve healthy volunteers received two neuromuscular stimulation device interventions. The GekoTM and National University of Ireland (NUI) Galway neuromuscular electrical stimulation devices were randomized between dominant and non-dominant legs. Hemodynamic measurements of peak venous velocity (cm/s), the time average mean velocity (TAMEAN) (cm/s), and ejected volume (mL) of blood were recorded. Peak venous velocity was significantly increased by the GekoTM and the NUI Galway device compared to baseline blood flow (p < 0.0001), while only the voluntary contraction produced significant increases in TAMEAN and ejected volume (both p < 0.05). Neuromuscular muscular electrical stimulation can produce adequate increases in lower limb hemodynamics sufficient to prevent venous stasis. Greater use of neuromuscular stimulation devices could be considered in the treatment of conditions related to chronic venous insufficiency but requires further research.
Objectives:
The purpose of this pilot study was to examine and compare the effects of graduated compression stockings, local vibration, and combined graduated compression stockings and local vibration on popliteal venous blood velocity.
Method:
Twenty-four healthy subjects received four 15 min interventions (control, graduated compression stockings alone, local vibration alone, and combined graduated compression stockings and local vibration), while resting inactive in the prone position. Popliteal vein blood velocity was investigated before (PRE) and at the end (POST) of each intervention using Doppler ultrasound.
Results:
At POST, peak velocity was reported to be 26.3 ± 53.5% (p < 0.05) greater for local vibration than control (CONT). Peak velocity was 46.2 ± 54.6% (p < 0.001) and 21.1 ± 37.6% (p < 0.01) higher for graduated compression stockings than CONT and local vibration, respectively. Graduated compression stockings + local vibration presented 64.1 ± 58.0% (p < 0.001), 38.4 ± 52.4% (p < 0.001) and 15.0 ± 31.6% (p < 0.05) greater values than CONT, local vibration and graduated compression stockings, respectively.
Conclusions:
This study demonstrated an increase in popliteal venous blood velocity after graduated compression stockings and local vibration application. Their combination provided the greatest effects.
Background:
Venous thromboembolism (VTE) is a serious but preventable cause of morbidity and mortality. Neuromuscular electrical stimulation systems (NMES) for the prevention of VTE may be beneficial for patients in whom pharmacological or standard mechanical prophylaxis methods are contraindicated or are regarded as unsafe or impractical. Although findings of experimental studies suggest that NMES reduce venous stasis, the clinical utility and effectiveness of NMES in VTE prevention remain controversial.
Objectives:
To assess the effectiveness of neuromuscular electrical stimulation in the prevention of venous thromboembolism.
Search methods:
The Cochrane Vascular Group Information Specialist (CIS) searched the Specialised Register (22 March 2017) and the Cochrane Central Register of Controlled Studies (CENTRAL (2017, Issue 2)). The CIS also searched trial registries for details of ongoing and unpublished studies. The review authors searched the bibliographic lists of relevant articles and reviews to look further for potentially eligible trials.
Selection criteria:
We planned to include randomised controlled trials (RCTs) and quasi-randomised trials that compared any form of neuromuscular electrical stimulation as an intervention for VTE prophylaxis (alone or combined with pharmacological or other mechanical methods) versus no prophylaxis and other mechanical or pharmacological methods of VTE prophylaxis.
Data collection and analysis:
At least two independent review authors were involved in study selection, data extraction, methodological quality assessment of included studies, and data analysis. We resolved disagreements by discussion between the two review authors. If no agreement could be reached, a third review author acted as an adjudicator. The main outcomes of the review were total deep vein thrombosis (DVT), symptomatic and asymptomatic DVT, pulmonary embolism (PE), total VTE and bleeding (major and minor). The quality of evidence was assessed using the GRADE approach and is indicated in italics.
Main results:
We included in the review five randomised controlled trials and three quasi-randomised trials, enrolling a total of 904 participants. Among these, four studies included patients undergoing major surgical procedures; one study included patients undergoing surgery for hip fracture under spinal anaesthesia; one study included trauma patients with a contraindication for prophylactic heparin; one study included neurosurgical patients who were operated on under general anaesthesia; and one study included patients with non-functional spinal cord injuries. Overall, eight studies investigated 22 treatment arms. Four studies compared the NMES arm with a no prophylaxis arm, and five studies compared the NMES arm with alternative methods of prophylaxis arms. Alternative methods of prophylaxis included low-dose heparin (5000 IU subcutaneously) - two studies, Dextran 40 - one study, graduated compression stockings (GCS) and intermittent pneumatic compression devices (IPCD) - one study. One study compared combined NMES and low-dose heparin versus no prophylaxis or low-dose heparin alone.We found no clear difference in risks of total DVT (odds ratio (OR) 1.01, 95% confidence interval (CI) 0.60 to 1.70, P = 0.98; 6 studies, 415 participants; low-quality evidence), asymptomatic DVT (OR 1.61, 95% CI 0.40 to 6.43, P = 0.50; 1 study, 89 participants; low-quality evidence), symptomatic DVT (OR 0.40, 95% CI 0.02 to 10.07, P = 0.58; 1 study, 89 participants; low-quality evidence), PE (OR 1.31, 95% CI 0.38 to 4.48, P = 0.67; 2 studies, 126 participants;low-quality evidence), and total VTE (OR 0.92, 95% CI 0.34 to 2.52, P = 0.88; 1 study, 72 participants; low-quality evidence) between prophylaxis with NMES and alternative methods of prophylaxis. None of the studies in this comparison reported bleeding.Compared with no prophylaxis, NMES showed lower risks of total DVT (OR 0.40, 95% CI 0.23 to 0.70, P = 0.02; 4 studies, 576 participants; moderate-quality evidence) and total VTE (OR 0.23, 95% CI 0.09 to 0.59, P = 0.002; 1 study, 77 participants; low-quality evidence). Data show no clear differences in risk of asymptomatic DVT (OR 0.32, 95% CI 0.06 to 1.62, P = 0.17; 1 study, 200 participants; low-quality evidence), symptomatic DVT (OR 0.06, 95% CI 0.00 to 1.36, P = 0.08; 1 study, 160 participants;low-quality evidence), or PE (OR 0.36, 95% CI 0.12 to 1.07, P = 0.07; 1 study, 77 participants; low-quality evidence) between prophylaxis with NMES and no prophylaxis. None of the studies in this comparison reported bleeding.In comparison with low-dose heparin, NMES was associated with higher risk of total DVT (OR 2.78, 95% CI 1.19 to 6.48, P = 0.02; 2 studies, 194 participants; low-quality evidence), but data were inadequate for other comparisons (NMES vs Dextran 40, NMES vs GCS, or NMES vs IPCD) and for other clinical outcomes such as symptomatic or asymptomatic DVT, PE, total VTE, and bleeding in individual comparisons.Overall, we judged the quality of available evidence to be low owing to high or unclear risk of bias and imprecise effect estimates due to small numbers of studies and events.
Authors' conclusions:
Low-quality evidence shows no clear difference in the risk of DVT between NMES and alternative methods of prophylaxis but suggest that NMES may be associated with lower risk of DVT compared with no prophylaxis (moderate-quality evidence) and higher risk of DVT compared with low-dose heparin (low-quality evidence). The best available evidence about the effectiveness of NMES in the prevention of VTE is not adequately robust to allow definitive conclusions. Adequately powered high-quality randomised controlled trials are required to provide adequately robust evidence.
Introduction:
The prevention and management of venous disease is a therapeutic challenge. Movement of blood through the venous system is augmented by the action of muscles on the deep veins, and can be achieved through the application of electrical current. The efficacy of currently available clinical devices for this purpose is unknown, and is investigated here.
Methods:
A literature search of the EMBASE and Medline databases was performed, and studies were included if they were full text articles, written in english, pertaining to venous disease and neuromuscular electrical stimulation (NMES).
Results:
NMES devices increase venous haemodynamic parameters such as peak velocity and volume flow. Studies report them to be non-inferior to intermittent pneumatic compression. They are effective in the prevention of venous thromboembolism, though inferior to low molecular weight heparin. NMES can reduce symptoms of chronic venous disease.
Discussion:
NMES is an important tool in the prevention and management of venous disease, and avoids the significant risks associated with heparin administration. Data explored here is heterogenous in device, protocol, and reported end-points, therefore should be interpreted with care. Long term effects of treatment with NMES have not been explored.
Introduction
The prevention and management of venous disease is a therapeutic challenge. Movement of blood through the venous system is augmented by the action of muscles on the deep veins, and can be achieved through the application of electrical current. The efficacy of currently available clinical devices for this purpose is unknown, and is investigated here.
Methods
A literature search of the EMBASE and Medline databases was performed, and studies were included if they were full text articles, written in english, pertaining to venous disease and neuromuscular electrical stimulation (NMES).
Results
NMES devices increase venous haemodynamic parameters such as peak velocity and volume flow. Studies report them to be non-inferior to intermittent pneumatic compression. They are effective in the prevention of venous thromboembolism, though inferior to low molecular weight heparin. NMES can reduce symptoms of chronic venous disease.
Discussion
NMES is an important tool in the prevention and management of venous disease, and avoids the significant risks associated with heparin administration. Data explored here is heterogenous in device, protocol, and reported end-points, therefore should be interpreted with care. Long term effects of treatment with NMES have not been explored.
Neuromuscular electrical stimulation has been studied to be a method of prophylaxis for deep venous thrombosis by activating the calf muscle pump. However, there is little evidence of the effects of different stimulating parameters on hemodynamics and comfort levels. The objective of this paper is to compare the effects of different stimulating parameters (current amplitude, pulse-width) on hemodynamic alterations of the popliteal vein and the comfort levels in a group of fourteen healthy subjects. Doppler ultrasound detection of peak venous velocity and blood volume were taken from baseline, twelve sequential electrical stimulations and foot dorsiflexion for each subject. A visual analogue scale was used to assess the subjects’ pain perception of neuromuscular electrical stimulation. The results showed that peak venous velocity and blood volume augmented as current amplitude and pulse-width increased while pain level also increased. A compromise was reached that parameters consisting of an amplitude of 10mA and a pulse-width of 500 μs would obtain a high-peak venous velocity and blood flow volume with a relatively comfortable perception. In addition, parameters consisting of an amplitude of 20mA and a pulse-width of 300 μs were also shown to be a promising choice. However, further studies need to be done to validate and enrich these findings.
This study investigated the hemodynamic properties of the plantar venous plexus (PVP), a peripheral venous pump in the human foot, with Doppler ultrasound. We investigated how different ways of introducing mechanical changes vary in effectiveness of displacing blood volume from the PVP. The contribution of the PVP was analyzed during both natural and device-elicited compressions. Natural compressions consisted of weight bearing on the foot and toe curl exercises. Device-elicited compressions consisted of intermittent pneumatic compression (IPC) of the foot and electrically elicited foot muscle contractions. Ten healthy participants had their posterior tibial, peroneal, anterior tibial, and popliteal vein blood flow monitored while performing these natural and device-elicited compressions of the PVP supine and in an upright position. Results indicated that 1) natural compression of the PVP, weight bearing and toe curls, expelled a significantly larger volume of blood than device-elicited PVP compression, IPC and electrical stimulation; 2) there was no difference between the venous volume elicited by weight bearing and by toe curls; 3) expelled venous volume recorded at the popliteal vein under all test conditions was significantly greater than that recorded from the posterior tibial and peroneal veins; 4) there was no significant difference between the volume in the posterior tibial and peroneal veins; 5) ejected venous volume recorded in the upright position was significantly higher than that recorded in the supine position. Our study shows that weight bearing and toe curls make similar contributions to venous emptying of the foot.
This study aims to investigate the effects of thromboprophylactic transcutaneous electrical nerve stimulation (TpTENS) of the peroneal nerve on venous blood flow in the limbs of volunteers. TpTENS might be considered for use in preventing venous stasis during surgical treatment.
In 10 volunteers, peak venous velocity (PV) and flow volume (FV) in the popliteal vein were measured using duplex ultrasonography during calf-muscle stimulation. The effects of TpTENS of the peroneal nerve were compared with those of other mechanical methods, including electrical muscle stimulation, intermittent pneumatic compression, active ankle motion and calf squeeze, used to prevent venous stasis and achieve thromboprophylaxis.
TpTENS had similar effects on popliteal vein blood flow in comparison with other established methods of thromboprophylaxis. The PV increased its basal flow by 3.9 times (p < 0.01) and FV by 2.7 times (p < 0.01), respectively, compared with baseline values.
TpTENS is as effective as other electrical and mechanical methods of calf-muscle pump activation in achieving acceleration of venous flow in the lower limb.
The aim of this study was to examine the effects of the sitting posture on the lower limb venous flow and to explore the beneficial effects of neuromuscular electrical stimulation (NMES) and an ottoman-type seat on the venous flow. Healthy adult volunteers without a history of lower limb surgery or thromboembolism were recruited, and the flow velocity, cross-sectional area, and flow volume of the popliteal vein were measured using Doppler ultrasound. A posture change from the prone position to the sitting position on the ottoman-type seat decreased the flow velocity and increased the cross-sectional area of the popliteal vein, and the flow volume was not altered over 120 min. The flow velocity was further decreased, and the cross-sectional area was further increased by subjects sitting on a regular driving seat when compared with the values obtained with an ottoman-type seat. The popliteal flow velocity in the NMES leg was significantly higher than in the non-NMES leg throughout the 120-min testing in the sitting position, but no difference in the cross-sectional area was found between the NMES and the non-NMES legs. Thus lower limb venous stasis elicited by the sitting posture was improved by the ottoman-type seat and NMES.
Intradialytic exercise has been described to improve blood pressure stability and dialysis efficacy. However, comorbid conditions in the dialysis population often preclude the widespread use of active intradialytic exercise. Therefore, we investigated the effect of intradialytic transcutaneous muscle stimulation (TEMS) and passive cycling movements (PCMs) on blood pressure and dialysis efficacy in patients.
Prospective, controlled, randomized, crossover investigation.
Ten patients were randomly allocated to TEMS, PCMs, or no intervention (NI) for 9 consecutive dialysis sessions.
Participants were studied with NI, PCMs using a motor-driven ergometer, and bilateral TEMS of the leg musculature. Individual dialysis prescriptions were unchanged during the investigation.
The effect of TEMS and PCMs on blood pressure and dialysis efficacy in patients was assessed.
Mean blood pressure increased from 121/64 +/- 21/15 mm Hg with NI to 132/69 +/- 21/15 mm Hg (P < 0.001) during sessions with PCMs and 125/66 +/- 22/16 mm Hg (P < 0.05) during sessions with TEMS. Urea and phosphate removal during dialysis were significantly (P < 0.001) greater with TEMS (19.4 +/- 3.7 g/dialysis and 1,197 +/- 265 mg/dialysis) or PCMs (20.1 +/- 3.4 g/dialysis and 1,172 +/- 315 mg/dialysis) than with NI (15.1 +/- 3.9 g/dialysis and 895 +/- 202 mg/dialysis). Body weight, ultrafiltration, Kt/V, and increases in hemoglobin and albumin levels during dialysis did not differ among the NI, PCMs, and TEMS groups.
The study design does not allow extension of the findings to prolonged treatment.
Future studies during longer observation periods will have to prove the persistence of these acute findings. Both TEMS and PCMs deserve future investigations in dialysis patients because they increase intradialytic blood pressure and facilitate urea and phosphate removal when applied short term.
It is conventionally believed that venous return to the heart increases during inspiration through the combined effect of the fall in intrathoracic pressure and the squeezing of the splanchnic veins by diaphragm descent. In the present study we have tested the hypothesis that in humans venous return from the legs decreases, rather than increases, during inspiration as a result of the rise in abdominal pressure. Ten normal subjects were examined in recumbent posture during various respiratory maneuvers. Venous return from the legs was monitored using an ultrasonic flow recorder (Doppler effect) placed over the femoral veins. Quiet inspiration was associated with a fall in femoral venous blood flow which, for the 10 subjects, averaged (mean +/- SE) 65 +/- 11% of the end-expiratory value. There was, however, a substantial variability between subjects, which could be largely explained by differences in abdominal pressure swings (delta Pab). In fact when the subjects voluntarily changed their patterns of inspiratory muscle use, the amount of fall in femoral blood flow during inspiration varied in proportion to the diaphragmatic contribution to tidal volume and delta Pab; i.e., flow decreased more as the diaphragm contributed more to inspiration and the rise in Pab was greater. During "pure" diaphragmatic breathing flow always ceased completely, whereas during predominantly rib cage inspiration flow increased rather than decreased. Isovolume belly-in maneuvers and gentle external compression of the abdomen also caused cessation of femoral blood flow, indicating that diaphragmatic contraction is not mandatory for venous return from the legs to be impeded during inspiration.(ABSTRACT TRUNCATED AT 250 WORDS)
Principles of Anatomy and Physiology 6th ed
- Gj Tortora
- Np Anagnostakos
Tortora GJ, Anagnostakos NP (Eds). Principles of Anatomy
and Physiology 6th ed. Harper Collins Publishers, 1990.
Neuromuscular Electrical Stimulation ± A Practical Guide
- Ll Baker
- Dr Mcneal
- La Benton
- Br Bowman
- Rl Waters
Baker LL, McNeal DR, Benton LA, Bowman BR, Waters RL.
Neuromuscular Electrical Stimulation ± A Practical Guide 3rd ed.
Los Amigos Research & Education Institute, 1993.