Neuromuscular Electrical Stimulation for Intensive Care Unit–Acquired Weakness: Protocol and Methodological Implications for a Randomized, Sham-Controlled, Phase II Trial Neuromuscular electrical stimulation in mechanically ventilated patients: a randomized, sham-controlled pilot trial with blinded outcome assessment. Patient tolerance of neuromuscular electrical stimulation (NMES) in the presence of orthopaedic implants. Neuromuscular electrical stimulation as an adjunct to endurance and resistance training during pulmonary rehabilitation in stable chronic obstructive pulmonary disease Effectiveness of Neuromuscular Electrical Stimulation on Lower Limbs of Patients With Hemiplegia After Chronic Stroke: A Systematic Review. Home based neuromuscular electrical stimulation as a new rehabilitative strategy for severely disabled patients with chronic obstructive pulmonary disease (COPD) Effect of neuromuscular stimulation and individualized rehabilitation on muscle strength in Intensive Care Unit survivors: A randomized trial Repetitive facilitative exercise under continuous electrical stimulation for severe arm impairment after sub-acute stroke: A randomized controlled pilot study Comparison of the effectiveness of active and passive neuromuscular electrical stimulation of hemiplegic upper extremities: a randomized, controlled trial Muscle mass, strength and functional outcomes in critically ill patients after cardiothoracic surgery: does neuromuscular electrical stimulation help? The Catastim 2 randomized controlled trial Effectiveness of neuromuscular electrical stimulation therapy in patients with urinary incontinence after stroke Effects of combining robot-assisted therapy with neuromuscular electrical stimulation on motor impairment, motor and daily function, and quality of life in patients with chronic stroke: a double-blinded randomized controlled trial Comparison between two different neuromuscular electrical stimulation protocols for the treatment of female stress urinary incontinence: a randomized controlled trial. Efficiency of Neuromuscular Electrical Stimulation and Transcutaneous Nerve Stimulation on Hemiplegic Shoulder Pain: A Randomized Controlled Trial. Skeletal muscle structure and function in response to electrical stimulation in moderately impaired COPD patients. Haemodynamic performance of neuromuscular electrical stimulation (NMES) during recovery from total hip arthroplasty Upper-Limb Recovery After Stroke
Background As the population ages and critical care advances , a growing number of survivors of critical illness will be at risk for intensive care unit (ICU)–acquired weakness . Bed rest , which is common in the ICU , causes adverse effects , including muscle weakness . Consequently , patients need ICU-based interventions focused on the muscular system . Although emerging evidence supports the benefits of early rehabilitation during mechanical ventilation , additional therapies may be beneficial . Neuromuscular electrical stimulation ( NMES ) , which can provide some muscular activity even very early during critical illness , is a promising modality for patients in the ICU . Objective The objectives of this article are to discuss the implication s of bed rest for patients with critical illness , summarize recent studies of early rehabilitation and NMES in the ICU , and describe a protocol for a r and omized , phase II pilot study of NMES in patients receiving mechanical ventilation . Design The study was a r and omized , sham-controlled , concealed , phase II pilot study with caregivers and outcome assessors blinded to the treatment allocation . Setting The study setting will be a medical ICU . Participants The study participants will be patients who are receiving mechanical ventilation for 1 day or more , who are expected to stay in the ICU for an additional 2 days or more , and who meet no exclusion criteria . Intervention The intervention will be NMES ( versus a sham [ control ] intervention ) applied to the quadriceps , tibialis anterior , and gastrocnemius muscles for 60 minutes per day . Measurements Lower-extremity muscle strength at hospital discharge will be the primary outcome measure . Limitations Muscle strength is a surrogate measure , not a patient-centered outcome . The assessment s will not include laboratory , genetic , or histological measures aim ed at a mechanistic underst and ing of NMES . The optimal duration or dose of NMES is unclear . Conclusions If NMES is beneficial , the results of the study will help advance research aim ed at reducing the burden of muscular weakness and physical disability in survivors of critical illness PURPOSE The purpose of the study is to compare neuromuscular electrical stimulation ( NMES ) vs sham on leg strength at hospital discharge in mechanically ventilated patients . MATERIAL S AND METHODS We conducted a r and omized pilot study of NMES vs sham applied to 3 bilateral lower extremity muscle groups for 60 minutes daily in the intensive care unit ( ICU ) . Between June 2008 and March 2013 , we enrolled adults who were receiving mechanical ventilation within the first week of ICU stay and who could transfer independently from bed to chair before hospital admission . The primary outcome was lower extremity muscle strength at hospital discharge using Medical Research Council score ( maximum , 30 ) . Secondary outcomes at hospital discharge included walking distance and change in lower extremity strength from ICU awakening . Clinical trials.gov : NCT00709124 . RESULTS We stopped enrollment early after 36 patients due to slow patient accrual and the end of research funding . For NMES vs sham , mean ( SD ) lower extremity strength was 28 ( 2 ) vs 27 ( 3 ) , P = .072 . Among secondary outcomes , NMES vs sham patients had a greater mean ( SD ) walking distance ( 514 [ 389 ] vs 251 [ 210 ] ft , P = .050 ) and increase in muscle strength ( 5.7 [ 5.1 ] vs 1.8 [ 2.7 ] , P = .019 ) . CONCLUSIONS In this pilot r and omized trial , NMES did not significantly improve leg strength at hospital discharge . Significant improvements in secondary outcomes require investigation in future research Neuromuscular electrical stimulation ( NMES ) may help reduce the incidence of deep vein thrombosis ( DVT ) in the postoperative total hip and knee arthroplasty patient . However , discomfort associated with stimulus may reduce patient acceptance of NMES as therapy . The aim of this study was to determine if patient comfort and tolerance of NMES  was affected by applying stimulation in proximity to an orthopaedic implant . There was a concern that this may cause a concentration of current around the metal which could result in hypersensitivity of NMES and reduce its effectiveness . Twenty patients took part in this study , 10 total hip and 10 total knee arthroplasty patients . Each patient was at least 3 weeks post surgery .  NMES was applied to the calf muscles of each leg using skin surface electrodes . Four excitatory levels were recorded , which were : sensory threshold , motor threshold , pain threshold and pain tolerance . Following this , patients underwent a 5 min stimulation session and indicated their overall comfort level on a visual analogue scale . Measurements of peak venous velocity , mean velocity and volume flow were recorded by duplex scanning from the popliteal vein at rest and in response to NMES elicited contractions during this session . Finally , patients completed a short verbal interview detailing their experience with the NMES treatment . The blood flow results showed increases in peak venous velocities , mean velocities and volume flow produced by NMES of 200 % , 60 % and 60 % respectively when compared to resting blood flow . Comfort assessment indicated that the presence of a metallic implant did not give rise to hypersensitivity due to NMES . Patients found the application of calf muscle NMES  comfortable and acceptable as a treatment . We conclude that the use of NMES on postoperative orthopaedic patients can be safely administered as a DVT prevention method Aim : The purpose of this study was to investigate whether adding neuromuscular electrical stimulation ( NMES ) to a comprehensive pulmonary rehabilitation ( cPR ) program would have additive effects on clinical -functional outcomes . Methods : Twenty-seven chronic obstructive pulmonary disease patients participating in a 10-week cPR program were r and omly allocated to NMES + cPR ( n = 13 ) or Sham + cPR ( n = 14 ) groups . Quadriceps strength , exercise capacity , symptoms , mood , activities of daily living and quality of life were evaluated pre- and post- interventions . Results : There were no significant differences in any of the physiological and subjective improvements induced by NMES + cPR versus Sham + cPR ( p > 0.05 ) . In fact , the NMES + cPR group showed lower increases in incremental shuttle walk test ( ISWT ) distance ( 38.4 vs 69.2 m , respectively ) and % ISWT distance ( 5.1 vs 9 % , respectively ) compared with the Sham + cPR group ( p < 0.05 ) . Conclusion : The increase in exercise capacity is less important when NMES is used as an adjunct to the cPR OBJECTIVE To investigate the effectiveness of neuromuscular electrical stimulation ( NMES ) with or without other interventions in improving lower limb activity  after chronic stroke . DATA SOURCES Electronic data bases , including PubMed , EMBase , Cochrane Library , PEDro ( Physiotherapy Evidence Data base ) , and PsycINFO , were search ed from the inception to January 2017 . STUDY SELECTION We selected the r and omized controlled trials ( RCTs ) involving chronic stroke survivors with lower limb dysfunction and comparing NMES or combined with other interventions with a control group of no electrical stimulation treatment . DATA EXTRACTION The primary outcome was defined as lower limb motor function , and the secondary outcomes included gait speed , Berg Balance Scale , timed Up and Go , 6-minute walk test , Modified Ashworth Scale , and range of motion . DATA SYNTHESIS Twenty-one RCTs involving 1481 participants were identified from 5759 retrieved articles . Pooled analysis showed that NMES had a moderate but statistically significant benefit on lower limb motor function ( st and ard mean difference 0.42 , 95 % confidence interval 0.26 - 0.58 ) , especially when NMES was combined with other interventions or treatment time within either 6 or 12 weeks . NMES also had significant benefits on gait speed , balance , spasticity , and range of motion but had no significant difference in walking endurance after NMES . CONCLUSIONS NMES combined with or without other interventions has beneficial effects in lower limb motor function in chronic stroke survivors . These data suggest that NMES should be a promising therapy to apply in chronic stroke rehabilitation to improve the capability of lower extremity in performing activities Background : Passive training of specific locomotor muscle groups by means of neuromuscular electrical stimulation ( NMES ) might be better tolerated than whole body exercise in patients with severe chronic obstructive pulmonary disease ( COPD ) . It was hypothesised that this novel strategy would be particularly effective in improving functional impairment and the consequent disability which characterises patients with end stage COPD . Methods : Fifteen patients with advanced COPD ( nine men ) were r and omly assigned to either a home based 6 week quadriceps femoris NMES training programme ( group 1 , n=9 , FEV1=38.0 (9.6)% of predicted ) or a 6 week control period before receiving NMES ( group 2 , n=6 , FEV1=39.5 (13.3)% of predicted ) . Knee extensor strength and endurance , whole body exercise capacity , and health related quality of life ( Chronic Respiratory Disease Question naire , CRDQ ) were assessed . Results : All patients were able to complete the NMES training programme successfully , even in the presence of exacerbations ( n=4 ) . Training was associated with significant improvements in muscle function , maximal and endurance exercise tolerance , and the dyspnoea domain of the CRDQ ( p<0.05 ) . Improvements in muscle performance and exercise capacity after NMES correlated well with a reduction in perception of leg effort corrected for exercise intensity ( p<0.01 ) . Conclusions : For severely disabled COPD patients with incapacitating dyspnoea , short term electrical stimulation of selected lower limb muscles involved in ambulation can improve muscle strength and endurance , whole body exercise tolerance , and breathlessness during activities of daily living Purpose Intensive Care Unit ( ICU ) survivors experience muscle weakness leading to restrictions in functional ability . Neuromuscular electrical stimulation ( NMES ) has been an alternative to exercise in critically ill patients . The aim of our study was to investigate its effects along with individualized rehabilitation on muscle strength of ICU survivors . Material and methods Following ICU discharge , 128 patients ( age : 53 ± 16 years ) were r and omly assigned to daily NMES sessions and individualized rehabilitation ( NMES group ) or to control group . Muscle strength was assessed by the Medical Research Council ( MRC ) score and h and grip at hospital discharge . Secondary outcomes were functional ability and hospital length of stay . Results MRC , h and grip , functional status and hospital length of stay did not differ at hospital discharge between groups ( p > 0.05 ) . & Dgr;MRC% one and two weeks after ICU discharge tended to be higher in NMES group , while it was significant higher in NMES group of patients with ICU‐acquired weakness at two weeks ( p = 0.05 ) . Conclusions NMES and personalized physiotherapy in ICU survivors did not result in greater improvement of muscle strength and functional status at hospital discharge . However , in patients with ICU‐aw NMES may be effective . The potential benefits of rehabilitation strategies should be explored in larger number of patients in future studies . Clinical trial registration : www . Clinical trials.gov : NCT01717833 HighlightsR and omized trial implementing Neuromuscular Electrical Stimulation ( NMES ) and rehabilitation program in ICU survivors . The program was performed from ICU discharge to hospital discharge . Outcome measures included assessment of muscle strength , functional ability and hospital length of stay . MRC , h and grip strength , functional status and length of stay did not differ at hospital . MRC improved significantly in patients with ICU‐acquired weakness after 2 weeks of NMES.Intervention may be beneficial in ICU survivors with ICU‐acquired weakness Abstract Objective : To investigate the effectiveness of repetitive facilitative exercise ( RFE ) under surface neuromuscular electrical stimulation ( NMES ) in patients with post-stroke hemiplegia . Methods : This r and omized , controlled , observer-blinded , pilot trial r and omized 27 adults with severe arm impairment [ Fugl-Meyer Arm scale ( FMA ) ≤ 20 ] due to stroke of 3–13 weeks duration into three groups and provided treatment on a 4-week , 40 minutes/day , 5 days/week schedule . The RFE-under-NMES group were given 100–150 repetitions of st and ardized movements of shoulder , elbow and wrist joints of their affected arm with concurrent low-amplitude NMES for each corresponding musculature . The RFE group was given the same exercise regimen but without NMES . The control group was treated with a conventional arm rehabilitation programme without NMES . FMA was assessed at baseline and 4 weeks . Results : All 27 participants ( nine in each group ) completed the trial . At 4 weeks , the RFE-under-NMES group evidence d significantly greater improvement compared with the control group on the FMA ( p = 0.003 ) , but not with the RFE group ( p = 0.092 ) . The RFE group showed improvement compared with the control group , but it was not significant ( p = 0.199 ) . Conclusions : RFE under NMES is feasible in clinical setting s and may be more effective than conventional rehabilitation in lessening arm impairment after sub-acute stroke To compare the efficacy of electromyography (EMG)-triggered ( active ) neuromuscular electrical stimulation ( NMES ) and passive NMES in enhancing the upper extremity ( UE ) motor and functional recovery of subacute and chronic stage stroke patients . Thirty-one hemiplegic patients were r and omly assigned to active NMES ( n=11 ) , passive NMES ( n=10 ) , and control ( sham stimulation ) ( n=10 ) groups . Each treatment regimen was applied five times per week for 45 min for 3 weeks . All of the patients performed the same neurophysiologic exercise program for 45 min five times per week for 3 weeks . Patients were assessed by the UE component of the Fugl-Meyer Motor Assessment ( UE-FMA ) , the self-care component of the Functional Independence Measure ( self-care FIM ) , the Motor Activity Log ( MAL ) , goniometric measurements of active wrist and metacarpophalangeal joint extension , surface EMG potentials , grip strength , and the modified Ashworth scale in a blinded manner . Data were obtained before and at the end of the treatment . Participants were similar in all clinical and demographic features ( P>0.05 ) . All groups were comparable with respect to UE-FMA , MAL , self-care FIM , wrist and finger flexor spasticity , active range of motion ( ROM ) , grip strength , and surface EMG potentials before treatment ( P>0.05 ) . The active ROM , grip strength , FMA , FIM , surface EMG potentials , and MAL : amount of use were significantly improved in the EMG-triggered NMES group compared with the controls ( P<0.05 ) . The active wrist extension ROM and FMA scores were significantly improved in the passive NMES group compared with the controls ( P<0.05 ) . There were no statistically significant differences between active and passive NMES groups in any of the parameters evaluated at the end of the treatment ( P>0.05 ) . Both active and passive NMES as adjuvant therapy in the neurophysiologic exercise program effectively enhanced the UE motor and functional recovery of stroke survivors . Vergleich der Wirksamkeit der elektromyographisch (EMG)-getriggerten ( aktiven ) neuromuskulären Elektrostimulation ( NMES ) und passiven NMES zur Verbesserung der motorischen und funktionellen Erholung der oberen Extremitäten bei Schlaganfallpatienten in der subakuten und chronischen Phase . Insgesamt 31 einseitig gelähmte Patienten wurden r and omisiert den aktiven NMES- ( n=11 ) , passiven NMES- ( n=10 ) und Kontrollgruppen ( Sham-Stimulation ) ( n=10 ) zugeordnet . Jede Therapie wurde fünfmal pro Woche jeweils 45 Minuten lang über drei Wochen hinweg angew and t. Alle Patienten unterzogen sich fünfmal pro Woche jeweils 45 Minuten lang über drei Wochen hinweg dem gleichen neurophysiologischen Übungsprogramm . Die Beurteilung der Patienten erfolgte anh and der Komponente “ obere Extremitäten ” des motorischen Funktionstests nach Fugl-Meyer ( UE-FMA ) , der Selbstversorgungskomponente des funktionalen Selbständigkeitsindexes ( Selbstversorgung FIM ) , des Motor Activity Log ( MAL ) , der goniometrischen  Messung der aktiven H and gelenk- und Fingergrundgelenkextension , der Oberflächen-EMG-Potenziale , der Griffstärke und der modifizierten Ashworth-Skala in verblindeter Form . Date n wurden vor und nach Abschluss der Beh and lung erfasst . Die Teilnehmer schnitten bei allen klinischen und demographischen Merkmalen ähnlich ab ( P<0.05 ) . Alle Gruppen waren vergleichbar hinsichtlich UE-FMA , MAL , Selbstversorgungs-FIM , Spastizität der H and gelenks- und Fingerbeuger , aktiver Bewegungsamplitude ( ROM ) , Griffstärke und Oberflächen-EMG-Potenziale vor der Beh and lung ( P>0.05 ) . Aktive ROM , Griffstärke , FMA , FIM , Oberflächen-EMG-Potenziale und MAL : Das Ausmaß der Anwendung war in der EMG-getriggerten NMES-Gruppe verglichen mit den Teilnehmern der Kontrollgruppe signifikant verbessert ( P<0.05 ) . Die ROM- und FMA-Scores der aktiven H and gelenkextension waren in der passiven NMES-Gruppe verglichen mit der Kontrollgruppe signifikant verbessert ( P<0.05 ) . Es lagen keine statistisch signifikanten Unterschiede zwischen den aktiven und passiven NMES-Gruppen bei den zu Ende der Beh and lung beurteilten Parametern vor ( P>0.05 ) . Die aktive und passive NMES als Begleittherapie des neurophysiologischen Übungsprogramms verbesserte die motorische und funktionelle Genesung der oberen Extremitäten von Überlebenden eines Schlaganfalls effektiv . El objetivo de este estudio fue comparar la eficacia de la estimulación eléctrica neuromuscular ( EENM ) ( activa ) mediante electromiografía ( EMG ) y EENM pasiva con respecto a la mejora de la recuperación motora y funcional de las extremidades superiores ( ES ) en pacientes con accidente cerebrovascular subagudo y crónico . Treinta y un pacientes hemiplégicos fueron asignados de forma aleatoria al grupo de EENM activa ( n=11 ) , al grupo de EENM pasiva ( n=10 ) y al grupo control ( estímulo falso ) ( n=10 ) . Cada uno de los tratamientos se aplicó cinco veces a la semana durante 45 minutos , durante 3 semanas . Todos los pacientes fueron sometidos al mismo programa de ejercicios neurofisiológicos , con una duración de 45 minutos , cinco veces a la semana durante 3 semanas . Los pacientes fueron analizados mediante el componente de extremidades superiores de la puntuación de Fugl-Meyer ( FM-ES ) , el componente de cuidado personal de la Medida de Independencia Funcional ( MIF-CP ) , el Registro de Actividad Motora ( MAL , por sus siglas en inglés ) , las medidas goniométricas de la extensión articular activa metacarpofalángica y de la muñeca , los potenciales de EMG de superficie , la fuerza de prensión y la escala modificada de Ashworth con enmascaramiento . Se recopilaron datos previamente y posteriormente al tratamiento . Los participantes poseían características clínicas y demográficas similares ( P<0.05 ) . Todos los grupos eran comparables con respecto a FM-ES , MAL , MIF-CP , la espasticidad flexora de la muñeca y el dedo , el rango activo de movimiento ( RM ) , la fuerza de prensión y los potenciales de EMG de superficie antes de comenzar el tratamiento ( P>0.05 ) . El RM activo , la fuerza de prensión , la puntuación de FM , MIF , los potenciales de EMG de superficie y MAL mejoraron significativamente en el grupo de EENM mediante EMG en comparación con el grupo control ( P<0.05 ) . Las puntuaciones de FM y RM activo de la extensión de la muñeca mejoraron significativamente en el grupo de EENM pasiva en comparación con el grupo control ( P<0.05 ) . No se observaron diferencias estadísticamente significativas entre los grupos de EENM activa y pasiva en ninguno de los parámetros evaluados al finalizar el tratamiento ( P>0.05 ) . Tanto la EENM activa como la EENM pasiva , como tratamientos adyuvantes dentro del programa de ejercicios neurofisiológicos , mejoraron efectivamente la recuperación motora y funcional de los supervivientes de accidente cerebrovascular . Comparer l’efficacité de la stimulation électrique neuromusculaire ( NMES ) déclenchée par électromyographie ( EMG ) ( active ) et de la NMES passive dans l’amélioration de la récupération motrice et fonctionnelle des extrémités supérieures ( UE ) chez les patients victimes d’AVC en phase subaiguë et chronique . Trente et un patients hémiplégiques ont été assignés de manière aléatoire à des groupes de NMES active ( n=11 ) , passive ( n=10 ) et de contrôle ( stimulation leurre ) ( n=10 ) . Chaque traitement a été appliqué cinq fois par semaine pendant 45 min pendant 3 semaines . Tous les patients ont suivi le même programme d’exercice neurophysiologique pendant 45 min , cinq fois par semaine , pendant 3 semaines . Les patients ont été évalués en aveugle par la composante UE de l'évaluation motrice de Fugl-Meyer ( UE-FMA ) , la composante de soins auto-administrés de la mesure d’indépendance fonctionnelle ( FIM soins auto-administrés ) , le  Motor Activity Log ( MAL ) , les mesures goniométriques du poignet actif et de l’extension de l’articulation métacarpophalangienne , les potentiels EMG de surface , la force de préhension et l'échelle Ashworth modifiée . Les données ont été recueillies avant et à la fin du traitement . Les participants présentaient des caractéristiques cliniques et démographiques semblables ( P<0.05 ) . Tous les groupes étaient comparables en ce qui concerne les paramètres UE-FMA , MAL , FIM soins auto-administrés , spasticité des fléchisseurs du poignet et des doigts , amplitude active des mouvements ( ROM ) , force de préhension et potentiels EMG de surface avant le traitement ( P>0.05 ) . ROM active , force de préhension , FMA , FIM , potentiels EMG de surface et MAL : volume d’utilisation significativement amélioré chez le groupe NMES déclenchée par EMG par rapport au groupe témoin ( P<0.05 ) . Les scores ROM et FMA d’extension du poignet actif ont été considérablement améliorés chez le groupe NMES passive par rapport au groupe témoin ( P<0,05 ) . Il n’a été constaté aucune différence statistiquement significative entre les groupes NMES active et passive dans les paramètres évalués à la fin du traitement ( P>0.05 ) . La NMES active ou passive comme thérapie adjuvante dans le programme d’exercice neurophysiologique a efficacement amélioré la récupération motrice et fonctionnelle UE des patients ayant survécu à un AVC Background The effects of neuromuscular electrical stimulation ( NMES ) in critically ill patients after cardiothoracic surgery are unknown . The objectives were to investigate whether NMES prevents loss of muscle layer thickness ( MLT ) and strength and to observe the time variation of MLT and strength from preoperative day to hospital discharge . Methods In this r and omized controlled trial , 54 critically ill patients were r and omized into four strata based on the SAPS II score . Patients were blinded to the intervention . In the intervention group , quadriceps muscles were electrically stimulated bilaterally from the first postoperative day until ICU discharge for a maximum of 14 days . In the control group , the electrodes were applied , but no electricity was delivered . The primary outcomes were MLT measured by ultrasonography and muscle strength evaluated with the Medical Research Council ( MRC ) scale . The secondary functional outcomes were average mobility level , FIM score , Timed Up and Go Test and SF-12 health survey . Additional variables of interest were grip strength and the relation between fluid balance and MLT . Linear mixed models were used to assess the effect of NMES on MLT , MRC score and grip strength . Results NMES had no significant effect on MLT . Patients in the NMES group regained muscle strength 4.5 times faster than patients in the control group . During the first three postoperative days , there was a positive correlation between change in MLT and cumulative fluid balance ( r = 0.43 , P = 0.01 ) . At hospital discharge , all patients regained preoperative levels of muscle strength , but not of MLT . Patients did not regain their preoperative levels of average mobility ( P = 0.04 ) and FIM score ( P = 0.02 ) at hospital discharge , independent of group allocation . Conclusions NMES had no effect on MLT , but was associated with a higher rate in regaining muscle strength during the ICU stay . Regression of intramuscular edema during the ICU stay interfered with measurement of changes in MLT . At hospital discharge patients had regained preoperative levels of muscle strength , but still showed residual functional disability and decreased MLT compared to pre-ICU levels in both groups . Trial registration Clinical trials.gov identifier NCT02391103 . Registered on 7 March 2015 Background : This study aim ed to evaluate the effectiveness of neuromuscular electrical stimulation ( NMES ) therapy in patients with urinary incontinence after stroke ( UIAS ) . Methods : A total of 82 patients with UIAS were r and omly assigned to 2 groups that received NMES therapy ( NMES group ) or sham NMES ( sham group ) for 10 weeks . The primary efficacy endpoints were measured by urodynamic values , and Overactive Bladder Symptom Score ( OABSS ) . The secondary efficacy endpoints were assessed by International Consultation on Incontinence Question naire-Short Form ( ICIQ-SF ) score , Barthel Index ( BI ) scale , and adverse events . All outcomes were evaluated at baseline and at the end of 10 weeks treatment . Results : After 10-week treatment , the patients received NMES therapy showed better efficacy in primary endpoints of urodynamic values ( P < .01 ) and OABSS ( P < .01 ) , and secondary endpoints of ICIQ-SF ( P < .01 ) and BI ( P < .01 ) , compared with patients who underwent sham NMES . No adverse events were recorded in both groups . Conclusions : In summary , we demonstrated that 10 weeks of NMES therapy was efficacious in patients with UIAS Background Robot-assisted therapy ( RT ) is a widely used intervention approach to enhance motor recovery in patients after stroke , but its effects on functional improvement remained uncertain . Neuromuscular electrical stimulation ( NMES ) is one potential adjuvant intervention approach to RT that could directly activate the stimulated muscles and improve functional use of the paretic h and . Methods This was a r and omized , double-blind , sham-controlled study . Thirty-nine individuals with chronic stroke were r and omly assigned to the RT combined with NMES ( RT + ES ) or to RT with sham stimulation ( RT + Sham ) groups . The participants completed the intervention 90 to 100 minutes/day , 5 days/week for 4 weeks . The outcome measures included the upper extremity Fugl-Meyer Assessment ( UE-FMA ) , modified Ashworth scale ( MAS ) , Wolf Motor Function Test ( WMFT ) , Motor Activity Log ( MAL ) , and Stroke Impact Scale 3.0 ( SIS ) . All outcome measures were assessed before and after intervention , and the UE-FMA , MAL , and SIS were reassessed at 3 months of follow-up . Results Compared with the RT + Sham group , the RT + ES group demonstrated greater improvements in wrist flexor MAS score , WMFT quality of movement , and the h and function domain of the SIS . For other outcome measures , both groups improved significantly after the interventions , but no group differences were found . Conclusion RT + ES induced significant benefits in reducing wrist flexor spasticity and in h and movement quality in patients with chronic stroke . Trial registration Clinical Trials.gov . BACKGROUND Neuromuscular electrical stimulation ( NMES ) is widely treatment for stress urinary incontinence ( SUI ) but there is no consensus in literature regarding the most effective treatment parameters . OBJECTIVE To compare two NMESintra-vaginal protocol s for the treatment of SUI in women . METHODS The study included 20 volunteers with an average age of 55.55±6.51 years and with the clinical diagnosis of SUI . Volunteers were r and omly divided into two groups : group 1 ( G1 ) received NMES with medium-frequency current and group 2 ( G2 ) received NMES with low-frequency current .  Functional assessment s of pelvic floor muscles ( PFM ) were performed by perineometry . The severity of signs and symptoms were objective ly evaluated using the 1 hour pad test and subjectively evaluated using a visual analog scale that measured the discomfort caused by the SUI . Shapiro-Wilk test was used to analyze data normality , and the Friedman test was used to analyze nonparametric data . For analysis of symptoms related to SUI the Fisher exact test and the Mann-Whitney test were used . Significance level of 5 % was set for all data analysis . RESULTS No significant differences ( p>0.05 ) were found between groups for any of the variable assessed . The within group analysis of initial and final evaluations ( after NMES ) demonstrated significant differences ( p<0.05 ) in amount of urine lost , the discomfort caused by urinary incontinence and perineal pressure for both treatment groups . CONCLUSION The two NMES protocol s applied were equally effective in the treatment of SUI OBJECTIVE To compare the efficacy of neuromuscular electrical stimulation ( NMES ) and transcutaneous nerve stimulation ( TENS ) on  hemiplegic shoulder pain ( HSP ) . DESIGN This is a prospect i ve r and omized controlled trial . SETTING A rehabilitation hospital . PARTICIPANTS Participants ( N=90 ) were r and omized into  NMES  ( n=36 ) , TENS ( n=36 ) , or control groups ( n=18 ) . INTERVENTIONS NMES ( 15Hz , pulse width 200μs ) was applied to supraspinatus and deltoids ( medial and posterior parts ) , whereas TENS ( 100Hz , pulse width 100μs ) was used on the same areas . The surface electrodes were placed near the motor points of the supraspinatus and medial or posterior bundle of deltoids . The 4-week treatment consisted of 20 sessions , each session composed of 1 hour of stimulation per day . Routine rehabilitation program without any stimulation was administered to the control and the NMES/TENS groups . Numerical rating scale ( NRS ) , active/passive range of motion ( AROM/PROM ) of shoulder , upper extremity Fugl-Meyer Assessment ( FMA ) , modified Ashworth scale ( MAS ) , Barthel Index ( BI ) , and stroke-specific quality of life scale ( SSQOLS ) were assessed in a blinded manner at baseline , 2 , 4 , and 8 weeks after treatment , respectively . MAIN OUTCOME MEASURES The primary endpoint was the improvement from baseline in NRS for HSP at 4 weeks . RESULTS NRS scores in NMES , TENS , and control groups had decreased by 2.03 , 1.44 , and 0.61 points , respectively after 4 weeks of treatment , with statistically significant differences among the 3 groups ( P<.001 ) . The efficacy of the NMES group was significantly better than that of the TENS group ( P=.043 ) . Moreover , the efficacy of NMES and TENS groups was superior to that of the control group ( P<.001 , P=.044 , respectively ) . The differences in the therapeutic efficacy on shoulder AROM/PROM , FMA , MAS , BI , and SSQOLS scores were not significant among the 3 groups . CONCLUSIONS TENS and NMES  can effectively improve HSP , the efficacy of NMES being distinctly superior to that of TENS in maintaining long-term analgesia . However , NMES was not more efficacious than the TENS or control group in improving the shoulder joint mobility , upper limb function , spasticity , the ability of daily life activity , and stroke-specific quality of life in HSP patients STUDY OBJECTIVE To determine the structural and functional consequences of high-frequency neuromuscular electrical stimulation ( hf-NMES ) in a group of moderately impaired out patients with chronic obstructive pulmonary disease ( COPD ) . DESIGN A prospect i ve , cross-over r and omized trial . SETTING An university-based , tertiary center . PATIENTS AND MATERIAL S Seventeen patients ( FEV(1)=49.6+/-13.4 % predicted , Medical Research Council dyspnoea grade s II-III ) underwent 6-weeks hf-NMES ( 50Hz ) and sham stimulation of the quadriceps femoris in a r and omized , cross-over design . Knee strength was measured by isokinetic dynamometry ( peak torque ) and leg muscle mass ( LMM ) by DEXA ; in addition , median cross-sectional area ( CSA ) of type I and II fibres and capillary-fibre ratio were evaluated in the vastus lateralis . The 6-min walking distance ( 6MWD ) was also determined . RESULTS At baseline , patients presented with well-preserved functional capacity , muscle strength and mass : there was a significant relationship between strength and type II CSA ( P<0.05 ) . NMES was not associated with significant changes in peak torque , LMM or 6MWD as compared to sham ( P>0.05 ) . At micro-structural level , however , electrical stimulation increased type II , but decreased type I , CSA ; no change , however , was found in the relative fibre distribution or capillary : fibre ratio ( P<0.05 ) . There was no significant association between individual changes in structure and function with training ( P>0.05 ) . Post-NMES increase in type II CSA was inversely related to baseline mass and strength ( P<0.05 ) . CONCLUSION NMES may promote a modest degree of type II muscle fibre hypertrophy in COPD patients with well-preserved functional status . These micro-structural changes , however , were not translated into increased volitional strength in this sub- population Background 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 . Methods 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 100 mm non-hatched visual analogue scale taken before application of NMES , once NMES was initiated and before NMES was withdrawn . Results 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 ) . Conclusions 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 Clinical Trials.gov Background and purpose . This study compared the effect of cyclic neuromuscular electrical stimulation ( NMES ) , electromyographically (EMG)-triggered NMES , and sensory stimulation on motor impairment and activity limitations in patients with upper-limb hemiplegia . Methods . This was a multicenter , single-blind , multiarm parallel-group study of nonhospitalized hemiplegic stroke survivors within 6 months of stroke . A total of 122 individuals were r and omized to receive either cyclic NMES , EMG-triggered NMES , or sensory stimulation twice every weekday in 40-minute sessions , over an 8 week-period . Patients were followed for 6 months after treatment concluded . Results . There were significant increases in the Fugl-Meyer Assessment [ F(1 , 111 ) = 92.6 , P < .001 ] , FMA Wrist and H and [ F(1 , 111 ) = 66.7 , P < .001 ] , and modified Arm Motor Ability Test [ mAMAT ; time effect : F(1 , 111 ) = 91.0 , P < .001 ] for all 3 groups . There was no significant difference in the improvement among groups in the FMA [ F(2 , 384 ) = 0.2 , P = .83 ] , FMA Wrist and H and [ F(2 , 384 ) = 0.4 , P = .70 ] , or the mAMAT [ F(2 , 379 ) = 1.2 , P = .31 ] . Conclusions . All groups exhibited significant improvement of impairment and functional limitation with electrical stimulation therapy applied within 6 months of stroke . Improvements were likely a result of spontaneous recovery . There was no difference based on the type of electrical stimulation that was administered
No outcomes evaluated the effect on participation restrictions .
NMES , as an adjunct to current rehabilitation practice s in critically ill patients , may maintain muscle strength .
OBJECTIVE To review , in conformance with the Preferred Reporting Items for Systematic Review s and Meta-Analyses guidelines , the totality of evidence for the use of neuromuscular electrical stimulation ( NMES ) in the critical care setting , when compared with usual care , under all domains of the World Health Organisation , International Classification of Functioning , Disability and Health ( ICF ) framework .