Neuromuscular electrical stimulation keeps a tetraplegic subject in his chair: A case study

Abstract

Pressure ulcers are an important complication of spinal cord injury which place an enormous burden on society due to their ®nancial, psychosocial, and vocational implications. Although they are now rarely fatal, they can still have devastating consequences, often needing prolonged hospitalisation to be properly managed. This study reviews the use of electrical stimulation to overcome increasing debility due to sacral pressure ulcers and saddle soreness in a man with tetraplegia. After 24 months of regular cyclic stimulation he had increased circumferential dimensions across his buttocks by up to 21%, and increased his sitting tolerance.Keywords: NMES; FES; pressure ulcer; tetraplegia; care study General backgroundPressure ulcers have long been recognised as one of the more serious and costly complications of spinal cord injury, occurring in up to 80% of those with a spinal cord injury. 1 Their prevention and management is a constant demand on the individual concerned, other family members, carers, and hospital sta . 2 Signi®cant, negative psychological e ects of these complications have been recognised by a number of authors. 1,3 ± 5 The ®nancial burden of hospitalisation for pressure ulcers amounts to many thousands of dollars per year, and has been estimated to range from $US15 000 to $70 000 for each ulcer. 3 Another complication is a loss of physical condition associated with the imposed bed rest, 6 making return to the previous level of function a di cult, lengthy and arduous procedure.Despite these factors, there is little really known about the epidemiology of pressure ulcers ± those most at risk, the in¯uence of time since injury, and the in¯uence and inter-relationship of the multitude of risk and preventive factors. 3 Byrne and Salzberg (1996) identi®ed more than 50 risk factors, which they separated into categories. Their 15 major risk factors were divided into three categories 1. Severity of spinal cord injury; 2. Pre-existing conditions; and 3. Malnutrition and anaemia.Other potential risk factors identi®ed included medical factors, past history, gender and ethnicity, medications, and issues related to movement, socioeconomic, psychological and nutritional status. 1 This case study describes the use of neuromuscular electrical stimulation in the management of recurrent sacral pressure ulcers in a man with tetraplegia.

Effects of Intermittent Electrical Stimulation on Superficial Pressure, Tissue Oxygenation, and Discomfort Levels for the Prevention of Deep Tissue Injury

“…50,52 Treating advanced stage ulcers can require surgery and lengthy hospital stays. 17,47 In countries of the developed world, the annual costs of treating pressure ulcers are estimated to be in the billions of dollars. 2,51,63 Pressure ulcers can originate at the level of the skin and progress inwards.…”

Gluteal blood flow and oxygenation during electrical stimulation-induced muscle activation versus pressure relief movements in wheelchair users with a spinal cord injury

“…13,14 This may exert a decisive influence on the capacity to transport oxygen in the areas most affected by disuse resulting from the SCI itself. This is especially important when prolonged treatment is required, for example, in an attempt to prevent PUs.…”

“…The positive effect of ES on interface pressure as well as the positive effect of shifting posture on oxygenation has been demonstrated 13,14 However, there is no extensive literature describing the effect of ES on ischial oxygenation, nor has the effect of ES been compared with the effect of PRMs or the relationship between IT pressure and oxygenation and BF been described.…”

Prolonged electrical stimulation-induced gluteal and hamstring muscle activation and sitting pressure in spinal cord injury: Effect of duty cycle

“…This has a tremendous effect on the individual's physical and psychological condition [3][4]. The consequences also result in high costs for the community [4][5].…”

“…Another potentially useful method for prevention of PUs is muscle activation by electrical stimulation (ES), which has been found to improve both interface pressure distribution and intrinsic risk factors, indicated by Levine et al [6][7], Levine and Kett [8], and others [3][4][5][9][10].…”