Improvement in Peripheral Circulation - the Foot and Calf
- Electrical foot stimulation and implications for the prevention of venous thromboembolic disease
- Effect of neuromuscular electrical stimulation on foot/ankle volume during standing
- Electrical stimulation-induced contraction to reduce blood stasis during arthroplasty
- Venous hemodynamics of the lower extremities in response to electrical stimulation
- Chronic transcutaneous electrical stimulation of calf muscles improves functional capacity without inducing systemic inflammation in claudicants
- Haemodynamic Study Examining the Response of Venous Blood Flow to Electrical Stimulation of the Gastrocnemius Muscle in Patients with Chronic Venous Disease
1. Electrical foot stimulation and implications for the prevention of venous thromboembolic disease.
Kaplan RE, Czyrny JJ, Fung TS, Unsworth JD, Hirsh J.
Department of Pediatrics, State University of New York, Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York, USA. rkaplan@acsu.buffalo.edu
BACKGROUND: Venous stasis caused by immobility is an important risk factor for deep vein thrombosis following surgery and lower limb trauma, in bed-ridden medical patients, and in high-risk long distance air travelers. A safe and convenient method for reducing venous stasis would be useful in patients while in hospital and after discharge during their rehabilitation. SUBJECTS AND METHODS: 49 healthy subjects aged 51-76 were seated for 4 hours during which they received mild electrical stimulation of the calf, or sole of the foot (plantar muscles). Popliteal and femoral venous blood flow velocities were measured via doppler ultrasound. The non-stimulated lower extremity served as the simultaneous control. Subjects completed a questionnaire regarding their acceptance and tolerance of the electrical stimulation. RESULTS: There was a significant increase in venous femoral and popliteal blood flow for both calf (p < 0.035, p < 0.003), and plantar muscles (p < 0.0001, p < 0.009) on the stimulated side compared to the unstimulated side. The magnitude of the effect was similar for calf and plantar muscle stimulation. Subjects did not find the experience uncomfortable, and would use an electrical stimulator if told by their physician that they were at risk for developing blood clots. CONCLUSIONS: Mild electrical stimulation of the feet, as well as the calf, is a safe effective and convenient method for counteracting venous stasis and therefore has the potential to reduce the risk of deep vein thrombosis and pulmonary embolism for subjects who are immobilized.
Publication Types:
Clinical Trial
Controlled Clinical Trial
PMID: 12195689 [PubMed - indexed for MEDLINE]
2. Effect of neuromuscular electrical stimulation on foot/ankle volume during standing.
W Man IO, Lepar GS, Morrissey MC, Cywinski JK.
Centre for Applied Biomedical Research, School of Biomedical Sciences, Shepherd's House, King's College London, London, UK.
PURPOSE: The purpose of this study was to assess whether the increase in foot and ankle volume after 30 min of motionless standing in healthy subjects could be minimized by neuromuscular electrical stimulation (NMES). METHODS: A crossover, counterbalanced design was used where foot and ankle volume in 20 healthy subjects was measured using water volumetry before and after 30 min of motionless standing and standing with NMES applied to the lower leg muscles. The NMES produced repeated tetanic contractions of the gastrocnemius and tibialis anterior muscles causing slight ankle dorsi- and plantar-flexion. RESULTS: Posttest foot and ankle volume was significantly greater than pretest volume after 30 min of motionless standing (t = -7.093, P < 0.001), but no significant differences were found after 30 min of standing with NMES (t = -1.374, P = 0.185). The mean volume changes from pretest to posttest in the conditions without NMES and with NMES were significantly different (51 +/- 32 mL and 12 +/- 39 mL, respectively; t = 3.905, P = 0.001). CONCLUSION: This study demonstrates the potential uses of NMES as a means to reduce swelling in the lower limbs for individuals who do not fully activate the musculo-venous pump. The activation of the musculo-venous pump by NMES-induced muscle contraction may have minimized the increase in foot and ankle volume by increasing venous return, reducing venous stasis, increasing lymph flow, and increasing interstitial hydrostatic pressure, which would reduce capillary filtration and assist fluid reabsorption.
Publication Types:
Clinical Trial
Randomized Controlled Trial
PMID: 12673147 [PubMed - indexed for MEDLINE]
3. Electrical stimulation-induced contraction to reduce blood stasis during arthroplasty.
Faghri PD, Van Meerdervort HF, Glaser RM, Figoni SF.
School of Allied Health, University of Connecticut, Storrs 06269, USA.
Deep venous thrombosis and subsequent pulmonary embolism due to venous pooling/stasis commonly occur in patients during hip and/or knee arthroplasty (i.e., replacement). This problem may be alleviated by using techniques to promote lower limb blood flow. Electrical stimulation-induced contractions have been shown to activate the skeletal muscle pump, promote limb blood flow, and may be effective for reducing venous pooling/stasis and edema. Therefore, electrical stimulation may reduce the incidence of deep venous thrombosis (DVT) and pulmonary embolism (PE) during and following surgery. The overall goal of this project was to evaluate the clinical efficacy of sequential electrical stimulation-induced leg muscle contractions on the venous blood flow during surgery. The degree of venous pooling/stasis was monitored via electrical impedance changes in the thorax. The changes in the patient's central hemodynamics were then calculated. Thirty patients were recruited and randomly assigned to either a control group (n = 15, mean age = 66.4 +/- 7.3) or experimental group (n = 15, age = 60.7 +/- 9.7). Both groups received the standard medical treatment for prevention of DVT (i.e., coumadin, heparin, etc.) and compression stockings (TED, Kendall). The control group used the sequential compression device (SCD + TED) and the experimental group used electrical stimulation (ES + TED). Electrical stimulation was applied via surface electrodes to the lower-limb muscles (tibialis anterior and gastrocnemius) and upper limb muscles (quadriceps femoris and hamstrings). These muscles contracted sequentially, using an eight-channel electrical stimulator. Four seconds of calf (contraction/compression) were followed by 7-s of calf and thigh (contraction/compression) interspersed by 60-s rest period during both electrical stimulation or sequential compression device. This cycle continued throughout the surgery (60-75 min) for both groups. At 15 min intervals, venous return was monitored by impedance cardiograph. Physiologic responses including ventricular stroke volume (SV), cardiac output (CO), heart rate (HR), total peripheral resistance (TPR), as well as mean arterial pressure (MAP) were monitored. These responses were statistically analyzed and compared throughout the surgery within each group and between the two groups. The results show stroke volume and cardiac output to be higher throughout surgery in the electrical stimulation group as compared with the sequential compression device group. The heart rate was consistently lower during electrical stimulation for both groups. Total peripheral resistance did not change in the electrical stimulation group; but increased in the sequential compression device group. The data suggest that continuous electrical stimulation-induced contractions could improve lower leg circulation by eliciting the physiologic muscle pump. This will lead to improved venous circulation and reduction of blood stasis during total hip and/or knee surgery. This technique may offer greater protection against DVT and PE during surgery than the commonly used sequential compression device.
Publication Types:
Clinical Trial
Randomized Controlled Trial
PMID: 9086386 [PubMed - indexed for MEDLINE]
4. Venous hemodynamics of the lower extremities in response to electrical stimulation.
Faghri PD, Votto JJ, Hovorka CF.
School of Allied Health, University of Connecticut, Storrs 06269-2101, USA.
OBJECTIVE: To evaluate the calf muscle pump function using an air plethysmograph (APG) applied to the lower leg of subjects during three different tiptoe exercises. DESIGN: A controlled trial design was selected to compare the hemodynamic effects of three exercise conditions on a group of able-bodied, healthy patients. SETTING: Testing was performed in an outpatient clinic at a rehabilitation hospital. SUBJECTS: Patient groups were selected from a convenience sample of 10 healthy volunteers with normal venous capacitance and no reflux, determined through impedance pleythysmography before the study. INTERVENTIONS: Three exercise conditions undertaken by each subject consisted of loaded and unloaded lower leg muscle contractions produced by (1) voluntary contraction (VOL), (2) electrical stimulation of the gastocnemius-soleus and tibialis anterior muscles (ES), and (3) combined ES and VOL (ES/VOL). MAIN OUTCOME MEASURE: Hemodynamic measurements of venous filling index upon standing from the supine (VFI), ejection fraction (EF), ejection volume (EV), residual volume (RV), and residual volume fraction (RVF) were recorded after each protocol. These results were used to compare the lower leg hemodynamic effects of the treatments. RESULTS: Combined ES/VOL single tiptoe exercise produced the highest EV (97.8mL), followed by VOL (80.6mL) and ES (51.7mL) (p < .0008). The EF was also highest for combined ES/VOL (73.1%), followed by VOL (64.5%) and ES (37.8%) (p < .0001). Ten tiptoe ES exercises produced the highest RV (96.2mL), followed by ES/VOL (44.7mL) and VOL (28.2mL) (p < .0001). RVF was also highest in the ES group (71%), followed by ES/VOL (33.4%) and VOL (22.8%) (p < .0001). CONCLUSION: Periodic single ES-induced calf muscle contractions produced significant muscle pump function and could be used to improve venous blood flow and reduce stasis in the lower leg. Continuous ES-induced contractions, on the other hand, could improve lower leg peripheral perfusion while eliciting the physiologic venous muscle pump. Higher RV and RVF after 10 ES-induced contractions in this sample of healthy subjects with normal VFI may be caused by an increase in arterial blood perfusion after repeated ES-induced contractions.
PMID: 9685103 [PubMed - indexed for MEDLINE]
5. Chronic transcutaneous electrical stimulation of calf muscles improves functional capacity without inducing systemic inflammation in claudicants.
Anderson SI, Whatling P, Hudlicka O, Gosling P, Simms M, Brown MD.
Department of Physiology, University of Birmingham, UK.
OBJECTIVES: To assess whether electrical stimulation of ischaemic calf muscles in claudicants causes a systemic inflammatory response and to evaluate effects of its chronic application on muscle function and walking ability. DESIGN: Prospective randomised controlled trial of calf muscle stimulation. MATERIALS AND METHODS: Stable claudicants were randomised to receive either active chronic low frequency (6 Hz) motor stimulation (n=15) or, as a control treatment, submotor transcutaneous electrical nerve (TENS) stimulation (n=15) of calf muscles in one leg, 3 x 20 min per day for four weeks. Leucocyte activation was quantified by changes in cell morphology, vascular permeability by urinary albumin:creatinine ratio (ACR), calf muscle function by isometric twitch contractions and walking ability by treadmill performance pre- and post-intervention. RESULTS: Acute active muscle stimulation activated leucocytes less (28% increase) than a standard treadmill test (81% increase) and did not increase ACR. Chronic calf muscle stimulation significantly increased pain-free walking distance by 35 m (95% CI 17, 52, P<0.001) and maximum walking distance by 39 m (95% CI 7, 70, P<0.05) while control treatment had no effect. Active stimulation prevented fatigue of calf muscles during isometric electrically evoked contractions by abolishing the slowing of relaxation that was responsible for loss of force. CONCLUSIONS: Chronic electrical muscle stimulation is an effective treatment for alleviating intermittent claudication which, by targeted activation of a small muscle mass, does not engender a significant systemic inflammatory response.
Publication Types:
Clinical Trial
Randomized Controlled Trial
6. Haemodynamic Study Examining the Response of Venous Blood Flow to Electrical Stimulation of the Gastrocnemius Muscle in Patients with Chronic Venous Disease.
Clarke Moloney M, Lyons GM, Breen P, Burke PE, Grace PA.
Department of Vascular Surgery, The Regional Hospital and St John's Hospital, Limerick, Ireland.
OBJECTIVES: The aim of this study was to explore the option of stimulating calf muscle contraction through externally applied neuromuscular electrical stimulation (NMES) and to measure venous blood flow response to this stimulation. METHODS: Ten patients with class 6 chronic venous disease (CEAP clinical classification) were recruited. Measurements of peak venous velocities in the popliteal vein were recorded by Duplex scanning in response to six test conditions; 1. Standing, 2. Voluntary calf muscle contraction, 3. Standing with NMES applied, 4. Standing with compression bandaging applied to the leg, 5. Voluntary calf muscle contraction with compression bandaging applied to the leg, 6. Stationary with compression bandaging applied to the leg and NMES applied. Comfort assessment was completed using visual analogue scales at each test stage and on study completion each patient completed a short structured interview to determine comfort and acceptability of NMES. Statistical analyses were carried out using SPSS, Version 9. Non-parametric testing was used in all analyses using the Wilcoxon Signed Ranks Test for paired samples. RESULTS: There was a significant increase in venous velocities on voluntary contraction of the calf muscle (median resting vel 7.3cm/s; voluntary contraction median 70cm/s) and with the introduction of NMES, both with compression (median velocity 15cm/s, p=0.005 Wilcoxon) and without compression (median velocity 13cm/s, p=0.005 Wilcoxon). The greatest increase with NMES was when combined with compression bandaging. All patients reported the stimulus as an acceptable treatment option with 90% reporting NMES as comfortable. CONCLUSIONS: Healing rates in venous ulceration with the application of compression bandaging remain between 50 and 70%. This study shows a positive haemodynamic response to NMES. Further research is needed to quantitatively measure the effect of NMES on ulcer healing.
PMID: 16242978 [PubMed - as supplied by publisher]
