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Background: Injuries to the common peroneal nerve often result in significant sensory and motor function loss, severely affecting patients' quality of life. Although existing treatments, including medication and surgery, provide some degree of efficacy, their effectiveness is limited by factors such as tolerance and adverse side effects. Methods: This study aims to evaluate the effects of a 4-week regimen of mirror therapy combined with neuromuscular electrical stimulation on lower limb function, muscle strength, and sensation in patients with common peroneal nerve injuries. The objective is to identify novel therapeutic strategies for lower limb peripheral nerve injuries.30 patients with Common peroneal nerve caused by pelvic fractures were selected from the Rehabilitation Medicine Department of Tianjin Hospital between July 2023 and July 2024. They were randomly divided into two groups: the neuromuscular electrical stimulation group (n = 15) and the mirror therapy with neuromuscular electrical stimulation group (n = 15). Results: After 4 weeks, it was found that mirror therapy with neuromuscular electrical stimulation has a significantly better therapeutic effect on Common peroneal nerve than simple electrical stimulation therapy, particularly in terms of superficial sensation, nerve conduction velocity and ROM. [ABSTRACT FROM AUTHOR]

Background: In hallux valgus, morphological changes and functional weakness of intrinsic foot muscles occur, especially in the abductor hallucis muscle. Objectives: This study aimed to investigate how a conservative treatment with the addition of neuromuscular electrical stimulation affects the volume and strength of the muscle, the correction of deformity, passive range of motion, pain, and disability. Methods: Twenty-eight female participants (48 feet) were randomly assigned to two groups. The interventions included orthoses and exercise (Ortho) in both groups. One group received additional neuromuscular electrical stimulation of abductor hallucis muscle to activate it. Each group received the treatments for one month and was assessed two times, at baseline before starting and after one month of treatment. Mixed within-between ANOVA, analysis of covariance, and nonparametric tests were used for data analysis. Results: The muscle volume, abduction strength, goniometric angle, and passive hallux dorsi/plantar flexion showed significant changes in both groups (p <.001). Subscales of the foot and ankle ability questionnaire, significantly changed (p ≤.05). Pain decreased significantly in the two groups (p <.001 and p =.02). Intermetatarsal angle did not significantly differ between the two groups (p =.86, partial eta effect size = 0.001). But, the hallux valgus angle mean (on MRI) in the Ortho group was less than that of the orthoNMES group (p =.007, partial eta effect size = 0.15). Conclusion: Both groups showed nearly identical treatment effects in the primary volume and hallux valgus correction outcome measures. In this study, adding neuromuscular electrical stimulation did not have an additional effect compared to conservative in the treatment of hallux valgus. Trial registration number: The RCT Code is IRCT20200915048725N1. [ABSTRACT FROM AUTHOR]

There have been few studies that have examined hemodynamic responses to low-frequency neuromuscular electrical stimulation (LF-NMES), and the effects of combining passive cycle ergometry are still unclear. The purpose of this study was to examine the effects of a combination of LF-NMES and passive cycle ergometry on hemodynamic responses with a primary focus on the Fick principle in healthy adults. A randomized, crossover trial was conducted to evaluate the responses to three types of supine exercises (LF-NMES alone, LF-NMES with passive cycle ergometry, and voluntary cycle ergometry) adjusted to the same exercise intensity as the oxygen consumption of 14 mL/kg/min in 13 healthy adult men. Blood pressure, heart rate, blood lactate concentration, stroke volume (SV), cardiac output (CO), and left ventricular end-diastolic volume (LVEDV) were measured during each exercise in all subjects. The arterial-venous oxygenation difference (A-V̇ o 2 difference) was calculated based on Fick's equation. LVEDV, SV, and CO were lower, and the A-V̇ o 2 difference and blood lactate concentration were higher in LF-NMES alone than those in voluntary cycle ergometry and LF-NMES with passive cycle ergometry (P < 0.05). The blood lactate concentration was lower in LF-NMES with passive cycle ergometry than that in LF-NMES alone, but slightly higher than that in voluntary cycle ergometry (P < 0.05). Hemodynamic and metabolic responses of exercise with LF-NMES alone seemed consistent with insufficient peripheral perfusion based on the elevation of A-V̇ o 2 difference and blood lactate concentration. The findings suggest that combining passive cycle ergometry with LF-NMES improves the insufficient peripheral perfusion induced by LF-NMES alone. NEW & NOTEWORTHY: This is the first study to evaluate cardiac output, oxygen consumption, and A-V̇ o 2 difference during LF-NMES of endurance exercise modality. LF-NMES alone may not demonstrate hemodynamic responses induced by voluntary endurance exercise, however, demonstrates those when combined with passive cycle ergometry. LF-NMES with passive cycle ergometry may be a more effective approach in cardiac rehabilitation for patients without the ability of voluntary exercise because it may increase cardiac output and venous return as represented by the LVEDV. [ABSTRACT FROM AUTHOR]

Neuromuscular Electrical Stimulation (NMES) uses electrical impulses to induce muscle contractions, providing benefits in rehabilitation, muscle activation, and as an adjunct to exercise, particularly for individuals experiencing immobilization or physical disability. NMES technology has significantly progressed, with advancements in device development and a deeper understanding of treatment parameters, such as frequency, intensity, and pulse duration. These improvements have expanded NMES applications beyond rehabilitation to include enhanced post-exercise recovery, improved blood glucose uptake, and increased lower limb venous return, potentially reducing thrombotic risks. Despite its benefits, NMES faces challenges in user compliance, often due to improper electrode placement and discomfort during treatment. Research highlights the importance of optimizing stimulation parameters, including electrode positioning, to improve both comfort and treatment efficacy. Recent innovations, such as automated processes for locating optimal stimulation points and adaptable electrode sizes, aim to address these issues. When combined with wearable technologies, these innovations could improve NMES treatment adherence and deliver more consistent, long-term therapeutic outcomes for patients with various physical limitations. Together, these developments indicate a promising future for NMES, presenting a valuable tool to enhance the benefits of physical activity across diverse populations, from rehabilitative care to broader health and wellness applications. [ABSTRACT FROM AUTHOR]

AbstractIntroductionMethodsResultsConclusions\nImplications for rehabilitationElectrical stimulation (E-stim) can reduce the impact of complications, like spasticity, bladder dysfunction in people with spinal cord injuries (SCIs), enhancing quality of life and health outcomes. With SCI prevalence high in regional Australia and a shift towards home-based community integrated care, the perspectives of people with SCI and healthcare professionals on current and future use of E-stim home-devices are needed.A mixed-methods concurrent triangulation approach was used. A cross-sectional survey collected demographics and perspectives on E-stim technology from 84 individuals with SCI and healthcare professionals. Focus groups with 36 participants explored the experiences, facilitators, and barriers of using E-stim home-devices.Healthcare professionals prioritised the use of E-stim for muscle strength and functional improvements, whereas people with SCI prioritised alleviating secondary complications. Healthcare professionals emphasised personal responsibility; however, people with SCI saw the clinical relationship as an important facilitator. Both groups agreed on the cost, accessibility, and funding as major barriers.Different expectations between healthcare professionals and people with SCI highlight the need for improved communication when establishing goals and expected outcomes. Successful E-stim home-device implementation relies on device availability and tailoring education to suit people with SCI and healthcare professionals.Having an easy access to an electrical stimulation (E-stim) home-device can be a useful tool to improve muscle strength and reduce secondary complications, such as spasticity, bladder, and bowel dysfunction in people with spinal cord injury (SCI).Communication between healthcare professionals and people with SCI with clear goals and expected outcomes should be improved for successful implementation of E-stim home-devices.Tailoring education for healthcare professionals, people with SCI and people involved in decision-making for implementation of E-stim home-devices is essential to meet the needs and priorities of people with SCI.Having an easy access to an electrical stimulation (E-stim) home-device can be a useful tool to improve muscle strength and reduce secondary complications, such as spasticity, bladder, and bowel dysfunction in people with spinal cord injury (SCI).Communication between healthcare professionals and people with SCI with clear goals and expected outcomes should be improved for successful implementation of E-stim home-devices.Tailoring education for healthcare professionals, people with SCI and people involved in decision-making for implementation of E-stim home-devices is essential to meet the needs and priorities of people with SCI. [ABSTRACT FROM AUTHOR]

Neuromuscular Electrical Stimulation (NMES) uses electrical impulses to induce muscle contractions, providing benefits in rehabilitation, muscle activation, and as an adjunct to exercise, particularly for individuals experiencing immobilization or physical disability. NMES technology has significantly progressed, with advancements in device development and a deeper understanding of treatment parameters, such as frequency, intensity, and pulse duration. These improvements have expanded NMES applications beyond rehabilitation to include enhanced post-exercise recovery, improved blood glucose uptake, and increased lower limb venous return, potentially reducing thrombotic risks. Despite its benefits, NMES faces challenges in user compliance, often due to improper electrode placement and discomfort during treatment. Research highlights the importance of optimizing stimulation parameters, including electrode positioning, to improve both comfort and treatment efficacy. Recent innovations, such as automated processes for locating optimal stimulation points and adaptable electrode sizes, aim to address these issues. When combined with wearable technologies, these innovations could improve NMES treatment adherence and deliver more consistent, long-term therapeutic outcomes for patients with various physical limitations. Together, these developments indicate a promising future for NMES, presenting a valuable tool to enhance the benefits of physical activity across diverse populations, from rehabilitative care to broader health and wellness applications. [ABSTRACT FROM AUTHOR]

Background/Objectives: Innovative therapies are needed to reduce disability, facilitate activities of daily living, and improve the quality of life in patients with stroke. Non-invasive methods of stimulating the peripheral and central nervous system are increasingly being used to enhance the effects of existing therapies in stroke rehabilitation. One potentially relevant method for achieving greater improvement is repetitive peripheral magnetic stimulation (rPMS). This randomized controlled trial (RCT), the Peripheral MAgnetic stimulation in patients with spastic hemiparesis after Stroke Trial (REPMAST), will investigate whether rPMS improves upper extremity function, spasticity, and activities of daily living in patients with stroke compared with neuromuscular stimulation (NMS). Methods: REPMAST is an interventional, randomized controlled single-blinded study. Patients with subacute stroke are randomized to receive rPMS or NMS five days a week for three weeks in addition to standard rehabilitation therapy. The primary outcome is the change in the Fugl–Meyer Assessment for Upper Extremity between the beginning and end of the stimulation sessions. Secondary outcomes include changes in the Katz Index of Independence in Activities of Daily Living, the Timed Up and Go Test, the Modified Ashworth Scale, and the Tardieu Scale. A total sample size of 138 patients (69 in each group) is required to investigate the superiority of rPMS compared with NMS. Conclusions: The aim of this RCT is to provide evidence for an effective peripheral stimulation treatment for stroke recovery. [ABSTRACT FROM AUTHOR]

Background/Objectives: Previous studies have shown that neuromuscular electrical stimulation (NMES), while expensive, can provide some of the health benefits of exercise to people who cannot exercise their legs normally. The aim of this study was to quantify the increases in muscle metabolism in four muscles of the legs of able-bodied individuals with NMES. Methods: Healthy college-aged students were tested. NMES of four muscle groups was performed with inexpensive stimulators and reusable tin foil electrodes. The biceps femoris, vastus lateralis, medial gastrocnemius, and tibialis anterior muscles on one leg were stimulated for ten minutes with twitch stimulations at the highest comfortable stimulation current. Muscle metabolism was measured using the slope of oxygen consumption measured with near-infrared spectroscopy (NIRS) during 5 s of cuff ischemia. Results: Initial studies found fold increases in muscle metabolism above rest of 8.9 ± 8.6 for the vastus lateralis, 7.9 ± 11.9 for the biceps femoris, 6.6 ± 7.8 for the medial gastrocnemius, and 4.9 ± 3.9 for the tibialis anterior. Some participants were able to obtain large increases in muscle metabolism, while other participants had lower increases. Conclusions: The ability to produce large increases in metabolism has the potential to allow NMES to replace or augment exercise to improve health in people who cannot otherwise exercise. The devices used were inexpensive and could be adapted for easy use by a wide range of individuals. [ABSTRACT FROM AUTHOR]

Background and Objectives: Oropharyngeal dysphagia is a common swallowing disorder, characterized by difficulties in moving food and liquids from the mouth to the esophagus; it is particularly prevalent among older adults with neurological conditions. This study aimed to evaluate the effectiveness of a short-term complex treatment protocol combining dietary modifications, swallowing exercises, and transcutaneous neuromuscular electrostimulation in reducing the oropharyngeal dysphagia severity and aspiration risk among geriatric patients. Materials and Methods: A total of 64 participants aged 60 and older, with oropharyngeal dysphagia, at LSMU Kaunas Hospital between May 2021 and April 2023, were included in the study after excluding those with significant comorbidities. Diagnostic assessments included the water swallow test and Fiberoptic Endoscopic Evaluation of Swallowing, conducted before and after treatment. Results: The results indicated a statistically significant reduction in the severity of oropharyngeal dysphagia, with 18.8% of patients showing improvements from moderate to mild dysphagia and 33.3% from severe to moderate. Additionally, the median PAS score was four points (IQR 3–6) before treatment and significantly decreased to three points (IQR 2–4) after treatment (p < 0.001). Conclusions: These findings suggest that even a short-term multidisciplinary approach that lasts 10 days can effectively alleviate the symptoms of oropharyngeal dysphagia, enhance patient safety, and improve swallowing among geriatric patients suffering from this condition. [ABSTRACT FROM AUTHOR]

Context: Pulsed current and kilohertz frequency alternating current are 2 types of neuromuscular electrical stimulation (NMES) currents often used by clinicians during rehabilitation. However, the low methodological quality and the different NMES parameters and protocols used in several studies might explain their inconclusive results in terms of their effects in the evoked torque and the discomfort level. In addition, the neuromuscular efficiency (ie, the NMES current type that evokes the highest torque with the lowest current intensity) has not been established yet. Therefore, our objective was to compare the evoked torque, current intensity, neuromuscular efficiency (evoked torque/current intensity ratio), and discomfort between pulsed current and kilohertz frequency alternating current in healthy people. Design: A double-blind, randomized crossover trial. Methods: Thirty healthy men (23.2 [4.5] y) participated in the study. Each participant was randomized to 4 current settings: 2 kilohertz frequency alternating currents with 2.5 kHz of carrier frequency and similar pulse duration (0.4 ms) and burst frequency (100 Hz) but with different burst duty cycles (20% and 50%) and burst durations (2 and 5 ms); and 2 pulsed currents with similar pulse frequency (100 Hz) and different pulse duration (2 and 0.4 ms). The evoked torque, current intensity at the maximal tolerated intensity, neuromuscular efficiency, and discomfort level were evaluated. Results: Both pulsed currents generated higher evoked torque than the kilohertz frequency alternating currents, despite the similar between-currents discomfort levels. The 2 ms pulsed current showed lower current intensity and higher neuromuscular efficiency compared with both alternated currents and with the 0.4 ms pulsed current. Conclusions: The higher evoked torque, higher neuromuscular efficiency, and similar discomfort of the 2 ms pulsed current compared with 2.5-kHz frequency alternating current suggests this current as the best choice for clinicians to use in NMES-based protocols. [ABSTRACT FROM AUTHOR]

Objective To evaluates the impact of early application of neuromuscular electrical stimulation (NMES) on muscle strength, clinical outcomes, and long-term quality of life improvements in patients with severe acute pancreatitis (SAP) complicated with acute respiratory distress syndrome (ARDS). Methods A total of 75 patients diagnosed with SAP and ARDS admitted in Department of Critical Care Medicine of our hospital from September 2022 to August 2023 were recruited and then randomly divided into NMES group (n=37) and control group (n=38). After 16 patients were excluded, including 8 died during treatment, 3 discharged and 5 received palliative care, there were finally 29 patients in the NMES group and 30 in the control group. Within 48 h after ICU admission, the NMES group received NMES 1 h per day, for 7 d in addition to standard rehabilitation intervention. While, the control group were given conventional interventions for rehabilitation. Assessments at baseline and post-treatment included the incidence of ICU-acquired weakness (ICU-AW), Medical Research Council (MRC) score, duration of mechanical ventilation, lengths of ICU and total hospital stays, and activity, thickness and thickening fraction of the diaphragm. Mortality rates and Barthel index (BI) for self-care ability in 1, 3 and 6 months after discharge were recorded for follow-up assessments. Results The NMES group had significantly lower incidence of ICU-AW (P < 0.05), higher upper and lower limb MRC scores and overall MRC score at ICU discharge (P < 0.05), shorter durations of mechanical ventilation, ICU stay, and total hospital stay when compared with the control group(P < 0.05). There was no statistical difference in the BI at 1 month post-discharge between the 2 groups, but the indexes at 3 and 6 months were notably higher in the NMES group than the control group (P < 0.05). No obvious differences were observed between the 2 groups in terms of diaphragm activity, thickness, or thickening scores at enrollment, ICU discharge, or hospital discharge, nor in mortality rates at 1, 3, and 6 months after discharge. Conclusion Combined NMES and early rehabilitation therapy can improve muscle strength and reduce length of hospital stay in SAP patients complicated with ARDS, and may enhance long-term quality of life. However, it does not significantly affect diaphragm function or mortality rates.

Abstract Introductin Improper gait patterns, impaired balance and foot drop consistently plague stroke survivors, preventing them from walking independently and safely. Neuromuscular electrical stimulation (NMES) technology can help patients reactivate their muscles and regain motor coordination. This study aims to systematically review and summarize the evidence for the potential benefits of NMES on the improvement of gait patterns after stroke. Evidence acquisition PubMed, Cochrane Library, Embase, Science Direct and Web of Science were systematically searched until April 2024, to identify randomized controlled trials with the following criteria: stroke survivors as participants; NMES as intervention; conventional rehabilitation as a comparator; and gait assessment, through scales or quantitative parameters, as outcome measures. Evidence synthesis 29 publications involving 1711 patients met the inclusion criteria. Meta-analysis showed no significant differences in Ten-meter walk test, Fugl-Meyer assessment lower extremity, Modified Ashworth Assessment and asymmetry between the NMES group and the control group. Besides, NMES was associated with changes in outcome indicators such as quantitative gait analysis speed [SMD = 0.53, 95% CI (0.20, 0.85), P = 0.001], cadence [SMD = 0.76, 95% CI (0.32, 1.20), P = 0.0008], affected side step length [SMD = 0.73, 95% CI (0.16, 1.31), P = 0.01], angle of ankle dorsiflexion [WMD = 1.57, 95% CI (0.80, 2.33), P

Reduced propulsion of the paretic leg contributes to impaired walking in people poststroke. The goal of this study was to determine whether phasic electrical stimulation to the paretic gastrocnemius muscle combined with resistance applied to the nonparetic leg during swing phase while walking would enhance muscle activation of the paretic gastrocnemius and propulsive force of the paretic leg. Fifteen individuals who had a stroke visited the lab once to complete two experimental sessions (i.e., crossover design; session order randomized). Each session consisted of 1) treadmill walking with either "motor stimulation and swing resistance" or "swing resistance only" (10-min walking: 1-min baseline, 7-min adaptation to intervention, and 2-min postadaptation) and 2) instrumented treadmill walking before and after treadmill walking. Participants showed enhanced muscle activation of the paretic gastrocnemius (P = 0.03) and improved anteroposterior ground reaction force of the paretic leg (P = 0.01) immediately after the treadmill walking with "motor stimulation and swing resistance," whereas no improvements after the walking with "swing resistance only." Those enhanced gastrocnemius muscle activation (P = 0.02) and improved ground reaction force (P = 0.03) were retained until the late postadaptation period and 10 min after treadmill walking, respectively. Walking with "motor stimulation and swing resistance" may enhance forced use of the paretic leg and improve propulsive force of the paretic leg. Applying phasic electrical stimulation to the paretic gastrocnemius muscle and swing resistance to the nonparetic leg during walking can be used as a novel intervention strategy to improve motor control of the paretic leg and walking in people poststroke. NEW & NOTEWORTHY: Applying targeted motor stimulation to the paretic calf muscle and swing resistance to the nonparetic leg during walking induced significant enhancement in muscle activation of the paretic gastrocnemius and anterior-posterior ground reaction force of the paretic leg, whereas no enhancements were observed after walking with swing resistance only. Furthermore, the enhanced gastrocnemius muscle activation and ground reaction force of the paretic leg were partially retained at the late postadaptation period and 10 min after treadmill walking. [ABSTRACT FROM AUTHOR]

• We transplanted embryonic spinal motor neurons (SMNs) into peripheral nerve grafts. • SMNs formed a structure similar to the spinal cord. • The diaphragm was reinnervated. • Electrical stimulation of the nerve graft caused diaphragmatic contraction. • SMN transplantation had an inhibitory effect on the atrophy of denervated muscles. Respiratory muscle paralysis due to trauma or neurodegenerative diseases can have devastating consequences. Only a few studies have investigated the reconstruction of motor function in denervated diaphragms caused by such conditions. Here, we studied the efficacy of transplanting E14 embryonic spinal motor neurons (SMNs) into peripheral nerve grafts for functionally reconstructing a denervated diaphragm in a rat model. The diaphragms of 8-week-old male Fischer 344 rats were first denervated by transecting the phrenic nerves. Subsequently, peripheral nerve grafts taken from the lower limb were used for neurotization of the denervated diaphragms. One week later, fetal E14 SMNs were transplanted into the peripheral nerve grafts. After 3 months, we observed functional contraction of the diaphragm following neuromuscular electrical stimulation (NMES) of the peripheral nerve graft. Additionally, we confirmed that SMN transplantation into the peripheral nerve graft had an inhibitory effect on diaphragm muscle atrophy. The SMNs transplanted into the peripheral nerve grafts formed a structure similar to the spinal cord, and the neuromuscular junction of the denervated diaphragm was reinnervated. These findings suggest the establishment of an ectopic motor neuron pool in the peripheral nerve graft. Free peripheral intra-nerve SMN transplantation in combination with NMES, which can be applied for diaphragmatic pacing, offers novel insights into the development of neuroregenerative therapies for treating life-threatening and intractable respiratory muscle paralysis caused by severe nerve damage and degenerative diseases. [ABSTRACT FROM AUTHOR]

An increasing body of evidence confirms the effectiveness of physical exercise (PE) in promoting brain health by preventing age-related cognitive decline and reducing the risk of neurodegenerative diseases. The benefits of PE are attributed to neuroplasticity processes which have been reported to enhance cerebral health. However, moderate to high-intensity PE is necessary to induce these responses and these intensities cannot always be achieved especially by people with physical limitations. As a countermeasure, electrical stimulation (ES) offers several benefits, particularly for improving physical functions, for various neurological diseases. This review aims to provide an overview of key mechanisms that could contribute to the enhancement in brain health in response to ES-induced exercise, including increases in cerebral blood flow, neuronal activity, and humoral pathways. This narrative review also focuses on the effects of ES protocols, applied to both humans and animals, on cognition. Despite a certain paucity of research when compared to the more classical aerobic exercise, it seems that ES could be of interest for improving cerebral health, particularly in people who have difficulty engaging in voluntary exercise. [ABSTRACT FROM AUTHOR]

(1) Background: Obstetric brachial plexus palsy (OBPP) is an unpredictable and unpreventable neurological injury, caused by shoulder dystocia during birth, that affects the brachial plexus and leads to motor and sensory deficits in the child's upper extremity. The limited literature on early therapeutic assessment of newborns with OBPP highlights a gap in specialized care that, if filled, could enhance decision-making and support timely treatment. The objective of this paper is to analyze the therapeutic intervention techniques used at an early stage and their functional impact, from the occupational therapy discipline in the treatment of the upper extremity in babies and children with OBPP. (2) Method: Systematic review design and meta-analysis. A systematic review is a comprehensive analysis of existing research on a specific topic, using rigorous methods to identify, evaluate, and synthesize studies. Meta-analysis, often part of a systematic review, combines results from multiple studies to identify overall trends and enhance reliability, providing a clearer summary of evidence. Articles that included pediatric patients (from birth to 12 years of age) with a diagnosis of OBPP were reviewed. The results of the techniques used were analyzed according to each study, with the scale or method of assessment considered by the study for the presentation of data. The articles were assessed for methodological quality using the "PEDro Validity Scale". (3) Results: A total of 2190 articles were found, with 108 analyzed and 22 fully meeting this study's standards. Fourteen had a quantitative design, while the others included clinical guidelines. The most statistically reliable intervention techniques were CIMT (constraint-induced movement therapy) and splinting (dynamic and static), with second-tier techniques like joint manipulation, NMES, early infant management education, and serial casting used when needed. This study focused on children from birth to eight years old, with assessment tools primarily measuring upper limb range of motion, external rotation, supination, and impairment levels, though bimanual activity assessment was less common. (4) Conclusions: The early implementation of the techniques that provide us with the most data are CIMT, splinting, NMES, and joint manipulation linked to health education for families. In second place, we have the use of TB infiltrations and serial casts, when the treatment of the previous techniques fails in some cases. [ABSTRACT FROM AUTHOR]

In individuals with a spinal cord injury (SCI), rapid skeletal muscle atrophy and metabolic dysfunction pose profound rehabilitation challenges, often resulting in substantial loss of muscle mass and function. This study evaluates the effect of combined neuromuscular electrical stimulation (Comb-NMES) on skeletal muscle cross-sectional area (CSA) and inflammatory signaling within the acute phase of SCI. We applied a novel Comb-NMES regimen, integrating both high-frequency resistance and low-frequency aerobic protocols on the vastus lateralis muscle, to participants early post-SCI. Muscle biopsies were analyzed for CSA and inflammatory markers pre- and post-intervention. The results suggest a potential preservation of muscle CSA in the Comb-NMES group compared to a control group. Inflammatory signaling proteins such as TLR4 and Atrogin-1 were downregulated, whereas markers associated with muscle repair and growth were modulated beneficially in the Comb-NMES group. The study's findings suggest that early application of Comb-NMES post-SCI may attenuate inflammatory pathways linked to muscle atrophy and promote muscle repair. However, the small sample size and variability in injury characteristics emphasize the need for further research to corroborate these results across a more diverse and extensive SCI population. [ABSTRACT FROM AUTHOR]

Objective: This study aims to fill the knowledge gap regarding the effects of high frequency facial neuromuscular electrical stimulation (fNMES) on facial aging, using a device equipped with CERTEC (Cell Energy Regeneration Technology) operating between 40 and 190 kHz. Methods: This prospective split‐face study was conducted at Tokyo University Hospital between March and May 2023 with 24 healthy adult women aged 30–59. The intervention group used the fNMES device along with basic skin care on one side of the face, and basic skin care alone on the other side for 8 weeks. Evaluations included changes in skin wrinkles, sagging, and blood flow. Results: This study found significant improvements in skin elasticity and degree of wrinkles in the areas intervened with fNMES (p < 0.05, respectively). In addition, the intervention resulted in significant improvements in jawline angle (p < 0.01), submental volume (p < 0.05), cheek volume (p < 0.05), maximum nasolabial fold depth (p = 0.03), and total volume of the nasolabial folds (p = 0.03). The fNMES intervention also showed improvement in blood flow (p < 0.05). These improvements were also subjectively assessed by the participants in subject questionnaires at 8 weeks after the intervention (p < 0.05). Conclusion: This study suggests that high frequency fNMES effectively improves facial skin elasticity, reduces wrinkles and sagging, promotes blood flow, and contributes to overall facial appearance rejuvenation. Although further studies are needed, high frequency fNMES appeared promising as a noninvasive anti‐aging therapy. [ABSTRACT FROM AUTHOR]

Objective To explore the application effect of neuromuscular electrical stimulation combined with early swallowing function training in patients with swallowing disorders after craniocerebral injury. Methods A total of 184 patients with swallowing disorders caused by craniocerebral injury admitted to the hospital from April 2021 to April 2023 were selected and randomly divided into the control group and the observation group by the random number table method, with 92 cases in each group. Patients in the control group were given routine rehabilitation intervention, while the patients in the observation group were given neuromuscular electrical stimulation combined with early swallowing function training on the basis of routine rehabilitation intervention. The intervention time of both groups was two months. The rehabilitation effects of the two groups were compared. Results The scores of standard swallowing function scale, the national institutes of health stroke scale and swallowing quality of life scale in the observation group were higher than those in the control group, and the differences were statistically significant（P＜0. 05). The incidence of complications such as aspiration pneumonia, aspiration and malnutrition in the observation group was lower than that in the control group, and the differences were statistically significant（P＜0. 05). Conclusion The combination of neuromuscular electrical stimulation and early swallowing function training intervention in patients with swallowing disorders after craniocerebral injury can improve swallowing and neurological function in the patients, reduce the risk of complications, and further enhance their quality of life. [ABSTRACT FROM AUTHOR]

Purpose: Despite its susceptibility to muscle fatigue, combined neuromuscular electrical stimulation (NMES) and blood flow restriction (BFR) are effective regimens for managing muscle atrophy when traditional resistance exercises are not feasible. This study investigated the potential of low-level laser therapy (LLLT) in reducing muscle fatigue after the application of combined NMES and BFR. Methods: Thirty-six healthy adults were divided into control and LLLT groups. The LLLT group received 60 J of 850-nm wavelength LLLT before a training program of combined NMES and BFR of the nondominant extensor carpi radialis longus (ECRL). The control group followed the same protocol but received sham laser therapy. Assessments included maximal voluntary contraction, ECRL mechanical properties, and isometric force tracking for wrist extension. Results: The LLLT group exhibited a smaller normalized difference in maximal voluntary contraction decrement (-4.01 ± 4.88%) than the control group (-23.85 ± 7.12%) (P < 0.001). The LLLT group demonstrated a smaller decrease in muscle stiffness of the ECRL compared with the control group, characterized by the smaller normalized changes in frequency (P = 0.002), stiffness (P = 0.002), and relaxation measures (P = 0.011) of mechanical oscillation waves. Unlike the control group, the LLLT group exhibited a smaller posttest increase in force fluctuations during force tracking (P = 0.014), linked to the predominant recruitment of low-threshold MU (P < 0.001) without fatigue-related increases in the discharge variability of high-threshold MU (P >0.05). Conclusions: LLLT preexposure reduces fatigue after combined NMES and BFR, preserving force generation, muscle stiffness, and force scaling. The functional benefits are achieved through fatigue-resistant activation strategies of motor unit recruitment and rate coding. [ABSTRACT FROM AUTHOR]

Objective: COVID-19 presents with varying severities, with about 5% of patients requiring intensive care unit (ICU) admission due to acute respiratory distress syndrome (ARDS). This severe condition often leads to ICU-acquired weakness (ICUAW) and muscle atrophy, affecting long-term functional recovery. Early physical therapy may mitigate these outcomes, though evidence remains inconclusive. This observational study aimed to evaluate functional outcomes at hospital discharge in COVID-19 patients who underwent early rehabilitation post-ICU discharge. Material and Method: Patients aged ≥ 18 with COV1D- 19-induced ARDS transitioned from ICU to quarantine wards were enrolled from March 2021 to March 2022. Clinical assessments included oxygen saturation, heart rate, blood pressure, muscle strength (MRC Scale). Individualized exercise programs and neuromuscular electrical stimulation (NMES) sessions were administered daily in quarantine wards. Results: Twenty-one patients (14 males, 7 females; median age 71±15.77 years) were included, undergoing 186 rehabilitation sessions. Muscle strength assessments showed 4 patients with MRC scores <48, indicating significant muscle weakness. By discharge, 12 patients could walk independently, 4 patients could sit without assistance, and others had. varying degrees of mobility limitations. Oxygen requirements decreased for most, with 15 patients not needing respiratory support at discharge. Rehabilitation interventions were well- tolerated without significant complications. Conclusion: Early, tailored rehabilitation, including physical therapy and NMES, significantly improves functional outcomes in COVID-19 ARDS survivors. Findings highlight the importance of individualized rehabilitation programs in enhancing recovery and quality of life. Future research should focus on establishing comprehensive rehabilitation guidelines for critically ill COVID-19 patients. [ABSTRACT FROM AUTHOR]

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Introduction Neuromuscular electrical stimulation (NMES) has been validated as an efficient tool to train and evaluate the neuromuscular system. Recently, it has been used to estimate persistent inward currents (PICs) in motoneurons (Donnelly et al., 2021). Notably, PICs play an important role in motor unit behavior (Heckman & Enoka, 2012) and are thought to be involved in the centrally mediated responses to NMES. This study aimed to examine the reproducibility of indirect PIC indicators, such as extra force production during wide-pulse high-frequency (WPHF) NMES, sustained electromyographic (EMG) activity following WPHF NMES and force production in response to Achille’s tendon vibration combined with NMES. Methods Twenty-one healthy participants (8 women, 26±4 years) underwent two 10s-trains of WPHF NMES and two 33s-Achille’s tendon vibration combined with NMES bouts on the plantar flexors in two different sessions. Extra force was calculated as the relative percent increase in force between the last and the 2nd second of the stimulation. EMG activity was recorded from the gastrocnemius medialis (GM) and soleus (SOL) muscles with high density grids to evaluate sustained activity spatial distribution. The force increase observed during vibration + NMES, calculated as the difference between the reflexive force during vibration and the initial torque after the first NMES burst was measured and referred as the warm-up effect (Mesquita et al., 2021). Intrasession and intersession reproducibility were assessed with intraclass correlation coefficients (ICC). Results Intrasession ICCs for extra force production were excellent, reaching 0.79 and 0.77 for sessions 1 and 2, respectively. Sustained EMG activity showed high reliability, with ICCs of 0.84 and 0.81 for GM, and 0.79 and 0.77 for SOL in sessions 1 and 2. The warm-up effect demonstrated excellent reliability in session 1 (ICC = 0.87) but moderate reliability in session 2 (ICC = 0.51). Intersession reliability was high for extra force (ICC = 0.79) and the warm-up effect (ICC = 0.75). However, sustained EMG activity showed moderate reliability between sessions, with ICCs of 0.51 for GM and 0.40 for SOL. Discussion/Conclusion This study demonstrates excellent intrasession reliability for extra force production and sustained EMG activity as indirect PIC indicators but more variable reliability for the warm-up effect within sessions. Intersession reliability was high for extra force and the warm-up effect but moderate for sustained EMG activity. These findings have important implications for using these indicators in research to better understand motor unit behavior and in clinical settings to optimize NMES training. References Donnelly, C., Stegmüller, J., Blazevich, A. J., Crettaz von Roten, F., Kayser, B., Neyroud, D., & Place, N. (2021). Modulation of torque evoked by wide-pulse, high-frequency neuromuscular electrical stimulation and the potential implications for rehabilitation and training. Scientific Reports, 11(1), 6399. https://doi.org/10.1038/s41598-021-85645-0 Heckman, C. J., & Enoka, R. M. (2012). Motor unit. Comprehensive Physiology, 2(4), 2629–2682. https://doi.org/10.1002/cphy.c100087 Mesquita, R. N. O., Taylor, J. L., Kirk, B., & Blazevich, A. J. (2021). Involuntary sustained firing of plantar flexor motor neurones: Effect of electrical stimulation parameters during tendon vibration. European Journal of Applied Physiology, 121(3), 881–891. https://doi.org/10.1007/s00421-020-04563-7

BackgroundInjuries to the common peroneal nerve often result in significant sensory and motor function loss, severely affecting patients’ quality of life. Although existing treatments, including medication and surgery, provide some degree of efficacy, their effectiveness is limited by factors such as tolerance and adverse side effects.MethodsThis study aims to evaluate the effects of a 4-week regimen of mirror therapy combined with neuromuscular electrical stimulation on lower limb function, muscle strength, and sensation in patients with common peroneal nerve injuries. The objective is to identify novel therapeutic strategies for lower limb peripheral nerve injuries.30 patients with Common peroneal nerve caused by pelvic fractures were selected from the Rehabilitation Medicine Department of Tianjin Hospital between July 2023 and July 2024. They were randomly divided into two groups: the neuromuscular electrical stimulation group (n = 15) and the mirror therapy with neuromuscular electrical stimulation group (n = 15).ResultsAfter 4 weeks, it was found that mirror therapy with neuromuscular electrical stimulation has a significantly better therapeutic effect on Common peroneal nerve than simple electrical stimulation therapy, particularly in terms of superficial sensation, nerve conduction velocity and ROM.

Xiamin Pu,1 Houqiang Huang,2 Xiaolei Zhao,3 Feng Liu,1 Yebo Leng,4 Ya Deng,5 Lingyi Huang,5 Xingchen Zhou,5 Fen Xu,1 Yongli Huang,6 Shengmin Guo2 1Department of Cardiovascular Medicine, The Affiliated Hospital, Southwest Medical University, Luzhou, 646000, People’s Republic of China; 2Department of Nursing, The Affiliated Hospital, Southwest Medical University, Luzhou, 646000, People’s Republic of China; 3Department of Hematology, The Affiliated Hospital, Southwest Medical University, Luzhou, 646000, People’s Republic of China; 4Department of Orthopedics, The Affiliated Hospital, Southwest Medical University, Luzhou, 646000, People’s Republic of China; 5School of Nursing, Southwest Medical University, Luzhou, 646000, People’s Republic of China; 6Department of Outpatient, The Affiliated Hospital, Southwest Medical University, Luzhou, People’s Republic of ChinaCorrespondence: Shengmin Guo, Department of Nursing, The Affiliated Hospital, Southwest Medical University, Luzhou, 646000, People’s Republic of China, Tel +86-13980255653, Email 2930773281@qq.comBackground: A global public health problem, frailty is closely associated with poor prognosis after percutaneous coronary intervention (PCI) in older patients with acute myocardial infarction (AMI). Although exercise intervention is the most commonly used method to reverse and alleviate frailty, its application is restricted in patients with acute myocardial infarction following PCI due to cardiovascular instability and autonomic imbalance. Consequently, there is a need for a new practical intervention to address frailty syndrome in these patients.Purpose: This study aimed to investigate the effect of neuromuscular electrical stimulation in frail older AMI patients post-PCI.Patients and Methods: A single-blind, randomized controlled trial was carried out in the Department of Cardiovascular Medicine from March to October 2023. A total of 100 eligible participants were randomly divided into two groups: experimental (n = 50) and control (n = 50) groups, respectively. Both groups received usual care. The experimental group underwent neuromuscular electrical stimulation (NMES) on bilateral quadriceps and gastrocnemius muscles for 30 minutes daily from day 1 to day 7 after surgery. The primary outcomes measured included the frailty score, lower limb muscle strength, and lower limb muscle quality. Secondary outcomes included the activities of daily living score, inflammatory markers, and length of hospital stay. All participants were included in an intention-to-treat analysis after the study ended.Results: The frailty scores of the two groups exhibited a gradual decrease over time, and the scores of the experimental group were lower than those of the control group at 4 and 7 days after surgery (P< 0.001). Concurrently, the lower limb muscle strength showed an increasing trend over the time in the experimental group and a decreasing trend in the control group, and the scores of the experimental group surpassed those of the control group (p< 0.001). Moreover, a statistical difference was observed in the lower limb muscle mass across the groups after 7 days postoperatively compared with baseline on both sides (p< 0.05).Conclusion: Neuromuscular electrical stimulation has the potential to enhance lower limb function and alleviate frailty in elderly patients with acute myocardial infarction after PCI. These findings introduce a novel intervention approach for frailty management in the elderly population.Keywords: acute myocardial infarction, older, frailty, neuromuscular electrical stimulation, PCI

Abstract The INSPIRE randomized clinical trial demonstrated that a high protein diet (HPRO) combined with neuromuscular electrical stimulation (NMES) attenuates muscle atrophy and may improve outcomes after aneurysmal subarachnoid hemorrhage We sought to identify specific metabolites mediating these effects. Blood samples were collected from subjects on admission prior to randomization to either standard of care (SOC; N = 12) or HPRO + NMES (N = 12) and at 7 days. Untargeted metabolomics were performed for each plasma sample. Sparse partial least squared discriminant analysis identified metabolites differentiating each group. Correlation coefficients were calculated between each metabolite and total protein per day and muscle volume. Multivariable models determined associations between metabolites and muscle volume. Unique metabolites (18) were identified differentiating SOC from HPRO + NMES. Of these, 9 had significant positive correlations with protein intake. In multivariable models, N-acetylleucine was significantly associated with preserved temporalis [OR 1.08 (95% CI 1.01, 1.16)] and quadricep [OR 1.08 (95% CI 1.02, 1.15)] muscle volume. Quinolinate was also significantly associated with preserved temporalis [OR 1.05 (95% CI 1.01, 1.09)] and quadricep [OR 1.04 (95% CI 1.00, 1.07)] muscle volume. N-acetylserine and β-hydroxyisovaleroylcarnitine were associated with preserved temporalis or quadricep volume. Metabolites defining HPRO + NMES had strong correlations with protein intake and were associated with preserved muscle volume.

Abstract Introduction Individuals with spinal cord injury (SCI) can experience accelerated cognitive aging. Myokines (factors released from muscle cells during contractions), such as brain-derived neurotrophic factor (BDNF), are thought to have beneficial effects on cognition. Neuromuscular electrical stimulation (NMES) was shown to elicit a large release of myokines. However, the effects of NMES on cognitive function have not been studied. Objective To present the study protocol for a clinical trial evaluating the effects of NMES aimed at improving cognition and BDNF. Methods A replicated randomized three-phases single-case experimental design (SCED) with sequential multiple baseline time series and a single-armed prospective trial will be conducted with 15 adults with chronic SCI (> 12 months after injury) above L1 neurological level undergoing 30-min quadriceps NMES, 3 days per week for 12 weeks. Main study endpoints Primary endpoint is cognitive performance (assessed by a smartphone test) conducted three times per week during the baseline phase with random duration of 3 to 8 weeks, the intervention phase of 12 weeks, and the follow-up phase of 3 weeks after a no measurement rest period of 12 weeks. Secondary endpoints are changes in BDNF levels and cognitive performance measured before the baseline period, before and after intervention and after a 12 weeks follow-up. Conclusion This will be the first study investigating the effects of 12 weeks NMES on both cognition and BDNF levels in individuals with SCI. The SCED results provide information on individual treatment effect courses which may direct future research. Trial registration ClinicalTrials.gov (NCT05822297, 12/01/2023).

الملخص: أهداف البحث: يهدف هذا البحث إلى مقارنة تأثيرات التحفيز الكهربائي العصبي العضلي مع القولبة التسلسلية المتقطعة إلى القولبة التسلسلية وحدها على جوانب مختلفة من وظيفة الطرف السفلي لدى الأطفال الذين يعانون من الشلل الدماغي المزدوج. تمثل القولبة التسلسلية تقنية سريرية تستخدم لزيادة المدى السلبي للحركة، وخفض فرط التوتر، وتحسين المشي لدى الأطفال المصابين بالشلل الدماغي. طريقة البحث: شملت هذه التجربة المقارنة العشوائية ثلاثة وثلاثين طفلا مصابا بالشلل الدماغي المزدوج. عند دخولهم في البحث، تم تعيينهم بشكل عشوائي إما إلى المجموعة (أ) أو المجموعة (ب). تلقت المجموعة (أ) قولبة تسلسلية جنبا إلى جنب مع برنامج علاج طبيعي مخصص، بينما تلقت المجموعة (ب) تدخلات مماثلة مثل المجموعة أ جنبا إلى جنب مع التحفيز الكهربائي العصبي العضلي المطبق من خلال النوافذ أثناء القولبة. شملت التقييمات نطاق الحركة، ومقياس التارديو المعدل، ومقياس الدينامومتر المحمول، ومقياس المشية الرصدي. وأجريت التقييمات قبل وبعد ثمانية أسابيع من التدخل. النتائج: أظهرت كلا المجموعتين تحسينات كبيرة في نطاق عطف ظهري للحركة، والزاوية المأبضية، والتشنج الديناميكي في عضلات الساق، والتشنج الديناميكي في أوتار الركبة بعد التدخل. ومع ذلك، لوحظت فروق ذات دلالة إحصائية بين المجموعتين بعد التدخل في قوة المثنية الظهرية، وقوة الباسطة في الركبة، ودرجة مقياس المشية الرصدية، لصالح المجموعة (ب). الاستنتاجات: قد يساعد استخدام التحفيز الكهربائي العصبي العضلي أثناء الشلل الدماغي في التغلب على الانخفاض الكبير في القوة الذي يحدث نتيجة للقولبة التسلسلية. يتيح ذلك تحقيق نتائج أفضل في تقليل النغمة وتحسين نطاق الحركة دون انخفاض كبير في القوة، بالإضافة إلى تحسن أكبر في وظيفة المشي. Abstract: Objectives: This research was aimed at comparing the effects of neuromuscular electrical stimulation (NMES) combined with interrupted serial casting (SC) versus SC alone on various aspects of lower limb function in children with diplegic cerebral palsy. SC is a clinical technique used to increase passive range of motion (ROM), decrease hypertonicity, and improve walking in children with cerebral palsy (CP). Methods: This randomized comparative trial involved 33 children with diplegic CP, who were randomly assigned to group A or group B at recruitment. Group A received SC along with a customized physical therapy program, whereas group B received the same interventions as group A along with NMES applied through cast windows during casting. Evaluations were based on ROM, the Modified Tardieu Scale, handheld dynamometer measurements, and the Observational Gait Scale. Assessments were conducted before and after 8 weeks of intervention. Results: Both groups exhibited significant improvements in dorsiflexion ROM, popliteal angle, gastrocnemius dynamic spasticity, and hamstring dynamic spasticity after the intervention (P = 0.0001 for all). However, significant differences (P

Background: Neuromuscular electrical stimulation (NMES) can generate muscle contractions and elicit excitability of neural circuits. However, the optimal stimulation frequency for effective neuromodulation remains unclear. Methods: Eleven able‐bodied individuals participated in our study to examine the effects of: (1) low‐frequency NMES at 25 Hz, (2) high‐frequency NMES at 100 Hz; and (3) mixed‐frequency NMES at 25 and 100 Hz switched every second. NMES was delivered to the right tibialis anterior (TA) muscle for 1 min in each condition. The order of interventions was pseudorandomized between participants with a washout of at least 15 min between conditions. Spinal reflexes were elicited using single‐pulse transcutaneous spinal cord stimulation applied over the lumbar enlargement to evoke responses in multiple lower‐limb muscles bilaterally and maximum motor responses (Mmax) were elicited in the TA muscle by stimulating the common peroneal nerve to assess fatigue at the baseline and immediately, 5, 10, and 15 min after each intervention. Results: Our results showed that spinal reflexes were significantly inhibited immediately after the mixed‐frequency NMES, and for at least 15 min in follow‐up. Low‐frequency NMES inhibited spinal reflexes 5 min after the intervention, and also persisted for at least 10 min. These effects were present only in the stimulated TA muscle, while other contralateral and ipsilateral muscles were unaffected. Mmax responses were not affected by any intervention. Conclusions: Our results indicate that even a short‐duration (1 min) NMES intervention using low‐ and mixed‐frequency NMES could inhibit spinal reflex excitability of the TA muscle without inducing fatigue. [ABSTRACT FROM AUTHOR]

Background & objective: Intensive Care Unit-Acquired Weakness (ICU-AW) is a weakness found in critically ill patients, and this weakness can persist even after discharge from the Intensive Care Unit (ICU). Various rehabilitation medicine procedures have been shown to be effective in prevention as well as managing the established weakness in this cohort of the patients. We analyzed the effect of Neuromuscular Electrical Stimulation (NMES) therapy on the global muscle strength, quadriceps femoris muscle, and creatine kinase examination in patients known to have ICU-AW. Methodology: The type of study used a pre-experimental one-group pre-posttest, and the study population consisted of 23 patients who experienced ICU-AW. Patients were given NMES therapy at the beginning of treatment in the ICU and then evaluated using the Medical Research Council Scale for Muscle Strength (MRC-SS), Manual Muscle Test (MMT), and creatine kinase levels. Results: NMES therapy provides significant results on increasing muscle strength on the fifth day with MRC-SS 42.78 (24-60) and MMT 3.57 (2-5) (P < 0.001), as well as a significant decrease in creatine kinase levels given therapy at the beginning of ICU admission. Conclusion: NMES therapy increases global muscle strength and quadriceps femoris muscle and decreases creatine kinase levels. [ABSTRACT FROM AUTHOR]

The early (≤50 ms) rate of torque development (RTD) is dependent upon the speed of neuromuscular activation; however, few studies have evaluated the determinants of rate of velocity development (RVD), which may be load-dependent. The purpose here was to explore the relationship between stimulation frequency with the early and late (≥100 ms) phase isometric RTD and isotonic RVD. The knee extensors of 16 (five female) young recreationally active participants were stimulated using 14 frequencies from 1 to 100 Hz during isometric and isotonic ("unloaded" and 7.5% of the isometric maximal voluntary contraction [MVC]) contractions. Isometric RTD and isotonic RVD were evaluated for the early (0–50 ms) and late (0–100 ms) phases from torque and velocity onset, respectively. Sigmoid functions were fit and bilinear regressions were used to examine the slopes of the steep portion of the curve and the plateau frequency. RTD- and RVD-frequency relationships were well described by a sigmoid function (all r2 > 0.96). Compared with the late phase, early isometric RTD, and unloaded RVD displayed lower slopes (all P ≤ 0.001) and higher plateau frequencies (all P < 0.001). In contrast, early and late RVD of a moderately loaded isotonic contraction did not display different slopes (P = 0.055) or plateau frequencies (P = 0.690). Early isometric RTD and unloaded isotonic RVD are more dependent on changes in stimulation frequency compared with late phases. However, RVD for a moderately loaded isotonic contraction displayed similar responses for the early and late phases. Therefore, a high frequency of activation is critical for early torque and velocity generation but dependent upon the load for isotonic contractions. NEW & NOTEWORTHY: We show that during an "unloaded" isotonic contraction, the early phase rate of velocity development is more dependent upon a high electrical activation frequency compared with the late phase, similar to isometric torque. However, early and late phase rates of velocity development of moderately loaded isotonic contractions display similar responses. These results indicate that the determinants of isotonic shortening function are dependent on the externally applied load, highlighting the importance of task-specificity of contraction. [ABSTRACT FROM AUTHOR]

Introduction: Children suffering from primary dysphagia require enteral nutrition due to a lack of sufficient skills in oral feeding and swallowing. There are no data on neuromuscular electrical stimulation (NMES) in primary dysphagia treatment. Our aim was to identify possible changes in the swallowing function in children with limited cooperation and compare functional oral intake before and after NMES therapy. Material and methods: A prospective study was performed to assess the effects of therapy among children with primary dysphagia and lack of progress in the development of swallowing function. The therapy was introduced for 30 minutes twice a day for 5 consecutive days. Such an intense cycle of therapy was repeated every one/two months. Each participant was scheduled for 10 therapeutic cycles. Evaluation was based on parents' and therapists' clinical observations, analysis of changes in several aspects of swallowing function, videofluoroscopic examination and the functional oral intake scale (FOIS). Results: The studied group consisted of 34 children (mean age 33 months). Only 10 patients completed the full 10 cycles of therapy. The average number of cycles was 3.5 ±2.3. 23/34 patients improved their feeding abilities. There was a significant improvement on the FOIS scale [1 (1; 2) vs. 2.5 (2; 6); baseline vs. final; median (lower; upper quartile); p < 0.0001]. Additionally, we observed a positive change in the following aspects of swallowing function: effectiveness of defensive laryngeal reactions (15/34); control of saliva (9/34); reduction of gurgling breath (9/34); enhancement of facial and tongue muscle tonus (12/34); coordination between swallowing and breathing (6/34); initiation or increasing frequency of oral feeding (14/34). Conclusions: Electrical stimulation improves functional oral intake. It may increase the frequency of oral feeding and reduce enteral nutrition regardless of the children's age at the beginning of the therapy. [ABSTRACT FROM AUTHOR]

The INSPIRE randomized clinical trial demonstrated that a high protein diet (HPRO) combined with neuromuscular electrical stimulation (NMES) attenuates muscle atrophy and may improve outcomes after aneurysmal subarachnoid hemorrhage We sought to identify specific metabolites mediating these effects. Blood samples were collected from subjects on admission prior to randomization to either standard of care (SOC; N = 12) or HPRO + NMES (N = 12) and at 7 days. Untargeted metabolomics were performed for each plasma sample. Sparse partial least squared discriminant analysis identified metabolites differentiating each group. Correlation coefficients were calculated between each metabolite and total protein per day and muscle volume. Multivariable models determined associations between metabolites and muscle volume. Unique metabolites (18) were identified differentiating SOC from HPRO + NMES. Of these, 9 had significant positive correlations with protein intake. In multivariable models, N-acetylleucine was significantly associated with preserved temporalis [OR 1.08 (95% CI 1.01, 1.16)] and quadricep [OR 1.08 (95% CI 1.02, 1.15)] muscle volume. Quinolinate was also significantly associated with preserved temporalis [OR 1.05 (95% CI 1.01, 1.09)] and quadricep [OR 1.04 (95% CI 1.00, 1.07)] muscle volume. N-acetylserine and β-hydroxyisovaleroylcarnitine were associated with preserved temporalis or quadricep volume. Metabolites defining HPRO + NMES had strong correlations with protein intake and were associated with preserved muscle volume. [ABSTRACT FROM AUTHOR]

Background and Objectives: Muscle atrophy caused by chronic ankle instability (CAI) can incur muscle weakness, altered movement patterns, and increased risk of injury. Previous studies have investigated the effects of rehabilitative exercises and neuromuscular electrical stimulation (NMES) on characteristics in CAI individuals, but few studies have examined their effects on foot and ankle muscle morphology. This study aimed to determine the effects of rehabilitative exercises and NMES on muscle morphology and dynamic balance in individuals with CAI. Materials and Methods: Participants with CAI (n = 47) were randomly divided into control (CG), rehabilitative exercise (REG), NMES (NG), and rehabilitative exercise and NMES combined (RNG) groups. The six-week intervention program consisting of rehabilitative exercises and NMES was applied to groups excluding CG. Muscle morphology and dynamic balance were evaluated using a portable wireless diagnostic ultrasound device and dynamic balance tests. For statistical analysis, an effect size with 95% confidence interval was calculated to assess mean differences according to intervention. Results: After six weeks, significant increases in morphology and dynamic balance were observed for all muscles except flexor hallucis longus (p > 0.05) in the intervention groups except for CG. However, no significant changes were observed in the CG (p > 0.05). Conclusions: These findings suggest that intervention programs may help prevent muscle atrophy and improve balance in CAI individuals. [ABSTRACT FROM AUTHOR]

A neurogenic dysphagia is dysphagia caused by problems with the central and peripheral nervous systems, is particularly prevalent in conditions such as Parkinson's disease and stroke. It significantly impacts the quality of life for affected individuals and causes additional burdens, such as malnutrition, aspiration pneumonia, asphyxia, or even death from choking due to improper eating. Physical therapy offers a non-invasive treatment with high efficacy and low cost. Evidence supporting the use of physical therapy in dysphagia treatment is increasing, including techniques such as neuromuscular electrical stimulation, sensory stimulation, transcranial direct current stimulation, and repetitive transcranial magnetic stimulation. While initial studies have shown promising results, the effectiveness of specific treatment regimens still requires further validation. At present, there is a lack of scientific evidence to guide patient selection, develop appropriate treatment regimens, and accurately evaluate treatment outcomes. Therefore, the primary objectives of this review are to review the results of existing research, summarize the application of physical therapy in dysphagia management, we also discussed the mechanisms and treatments of physical therapy for neurogenic dysphagia. [ABSTRACT FROM AUTHOR]

Introduction: Individuals with spinal cord injury (SCI) can experience accelerated cognitive aging. Myokines (factors released from muscle cells during contractions), such as brain-derived neurotrophic factor (BDNF), are thought to have beneficial effects on cognition. Neuromuscular electrical stimulation (NMES) was shown to elicit a large release of myokines. However, the effects of NMES on cognitive function have not been studied. Objective: To present the study protocol for a clinical trial evaluating the effects of NMES aimed at improving cognition and BDNF. Methods: A replicated randomized three-phases single-case experimental design (SCED) with sequential multiple baseline time series and a single-armed prospective trial will be conducted with 15 adults with chronic SCI (> 12 months after injury) above L1 neurological level undergoing 30-min quadriceps NMES, 3 days per week for 12 weeks. Main study endpoints: Primary endpoint is cognitive performance (assessed by a smartphone test) conducted three times per week during the baseline phase with random duration of 3 to 8 weeks, the intervention phase of 12 weeks, and the follow-up phase of 3 weeks after a no measurement rest period of 12 weeks. Secondary endpoints are changes in BDNF levels and cognitive performance measured before the baseline period, before and after intervention and after a 12 weeks follow-up. Conclusion: This will be the first study investigating the effects of 12 weeks NMES on both cognition and BDNF levels in individuals with SCI. The SCED results provide information on individual treatment effect courses which may direct future research. Trial registration: ClinicalTrials.gov (NCT05822297, 12/01/2023). [ABSTRACT FROM AUTHOR]

OBJECTIVES: We published a meta-analysis in March 2020 to assess the impact of rehabilitation in the ICU on clinical outcomes. Since then, 15 new randomized controlled trials (RCTs) have been published; we updated the meta-analysis to show how the recent studies have tipped the scale. DESIGN: Systematic review and meta-analysis. SETTING: An update of secondary data analysis of RCTs published between January 1998 and July 2023 performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PATIENTS: Critically ill adults. INTERVENTIONS: Cycling exercises or neuromuscular electrical stimulation (NMES) or protocolized physical rehabilitation (PPR) or functional electrical stimulation-assisted cycle ergometry (FESCE) compared with standard of care. MEASUREMENTS AND MAIN RESULTS: Days on a mechanical ventilator, length of stay in ICU and at the hospital, and mortality. We found 15 RCTs (one on cycling, eight on NMES alone, four on PPR, and two on FESCE) into which 2116 patients were randomized. The updated meta-analysis encompasses a total of 5664 patients. The exercise interventions did not influence mortality (odds ratio, 1.00 [0.87-1.14]; n = 53 RCTs) but reduced the duration of mechanical ventilation (mean difference, -1.76 d [-2.8 to -0.8 d]; n = 46) and length of stay in ICU (-1.16 d [-2.3 to 0.0 d]; n = 45). The effects on the length of mechanical ventilation and ICU stay were only significant for the PPR subgroup by a median of -1.7 days (95% CI, -3.2 to -0.2 d) and -1.9 days (95% CI, -3.5 to -0.2 d), respectively. Notably, newly published trials provided consistent results and reduced the overall heterogeneity of these results. CONCLUSIONS: None of the rehabilitation intervention strategies being studied influence mortality. Both mechanical ventilation and ICU stay were shortened by PPR, this strengthens the earlier findings as all new RCTs yielded very consistent results. However, no early rehabilitation interventions in passive patients seem to have clinical benefits. Regarding long-term functional outcomes, the results remain inconclusive. [ABSTRACT FROM AUTHOR]

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Neuromuscular electrical stimulation (NMES) is a novel treatment method that stimulates patients' swallowing functions. This systemic review was designed to evaluate the impact of NMES on dysphagia in stroke patients. Databases including PubMed, Embase, Web of Science, and Cochrane Library were searched from the date of establishment to January 28th, 2022. Two investigators identified all included studies and compared the swallowing function after NMES treatment with traditional therapy (TT). The Cochrane risk bias assessment tool was utilized to analyze the quality of included studies. Research outcomes included Swallowing Quality of Life (SWAL-QoL), Penetration–Aspiration Scale (PAS), Functional Oral Intake Scale (FOIS), Dysphagia Outcomes and Severity Scale (DOSS), the Repeat Salivary Swallowing Test (RSST), and Water Swallowing Test (WST). We extracted the mean and standard deviation of specific outcomes at the baseline level and after the treatment in both NMES and TT groups for subsequent meta-analysis. 9 randomized controlled trials (RCTs) and quasi-RCTs were included, and remarkable differences were found between patients treated with or without NMES in respect of FOIS scores (SMD = 0.48; 95% CI 0.26–0.70, P < 0.0001), PAS scores (SMD = − 0.56; 95% CI 1.01–0.10, P = 0.02), and SWAL-QoL scores (SMD = 0.57; 95% CI 0.00–1.14, P = 0.05). No significant difference was manifested in WST, RSST, and DOSS (SMD: − 0.02; 95% CI 0.38–0.35, P = 0.93). Evidence suggests that NMES is more effective for post-stroke dysphagia patients than treatment without NMES. [ABSTRACT FROM AUTHOR]

Neuromuscular Electrical Stimulation (NMES) uses electrical impulses to induce muscle contractions, providing benefits in rehabilitation, muscle activation, and as an adjunct to exercise, particularly for individuals experiencing immobilization or physical disability. NMES technology has significantly progressed, with advancements in device development and a deeper understanding of treatment parameters, such as frequency, intensity, and pulse duration. These improvements have expanded NMES applications beyond rehabilitation to include enhanced post-exercise recovery, improved blood glucose uptake, and increased lower limb venous return, potentially reducing thrombotic risks. Despite its benefits, NMES faces challenges in user compliance, often due to improper electrode placement and discomfort during treatment. Research highlights the importance of optimizing stimulation parameters, including electrode positioning, to improve both comfort and treatment efficacy. Recent innovations, such as automated processes for locating optimal stimulation points and adaptable electrode sizes, aim to address these issues. When combined with wearable technologies, these innovations could improve NMES treatment adherence and deliver more consistent, long-term therapeutic outcomes for patients with various physical limitations. Together, these developments indicate a promising future for NMES, presenting a valuable tool to enhance the benefits of physical activity across diverse populations, from rehabilitative care to broader health and wellness applications.

This study examined the effect of reciprocal electrical stimulation (RES) across elbow flexors and extensors on the reaction of degeneration percentage and motor function in Erb's palsy infants. Forty infants with Erb’s palsy aged between 2-5 months were randomly allocated to one of two equal groups: the control group (A) received standard physical therapy, the study group (B) received traditional physical therapy plus a 15-minute RES through elbow flexors and extensors. For three months, interventions were carried out three times each week. The percentage of reaction of degeneration and motor function were assessed pre- and post-treatment using electromyography and Toronto active motion scale respectively. There was a significantly greater reduction in the percentage of reaction of degeneration and increase in the Toronto active motion scale score in the study group (B) as compared to the control group (A) (p < 0.001, p =0.007 consequently), indicating more improvements following the RES application. Incorporating the RES in the traditional rehabilitation programs for Erb's palsied infants is likely effective in improving motor functions. It is advisable for the pediatric physical therapist to consider such a therapeutic approach in caring for those infants.