Neuromuscular electrostimulation via the common peroneal nerve promotes lower limb blood flow in a below-knee cast

Abstract

ObjectivesWe aimed to examine the characteristics of deep venous flow in the leg in a cast and the effects of a wearable neuromuscular stimulator (geko; FirstKind Ltd) and also to explore the participants’ tolerance of the stimulator.MethodsThis is an open-label physiological study on ten healthy volunteers. Duplex ultrasonography of the superficial femoral vein measured normal flow and cross-sectional area in the standing and supine positions (with the lower limb initially horizontal and then elevated). Flow measurements were repeated during activation of the geko stimulator placed over the peroneal nerve. The process was repeated after the application of a below-knee cast. Participants evaluated discomfort using a questionnaire (verbal rating score) and a scoring index (visual analogue scale).ResultsThe geko device was effective in significantly increasing venous blood flow in the lower limb both with a plaster cast (mean difference 11.5 cm/sec-1; p = 0.001 to 0.13) and without a plaster cast (mean difference 7.7 cm/sec-1; p = 0.001 to 0.75). Posture also had a significant effect on peak venous blood flow when the cast was on and the geko inactive (p = 0.003 to 0.69), although these differences were less pronounced than the effect of the geko (mean difference 3.1 cm/sec-1 (-6.5 to 10)). The geko device was well tolerated, with participants generally reporting only mild discomfort using the device.ConclusionThe geko device increases venous blood flow in the lower limb, offering a potential mechanical thromboprolylaxis for patients in a cast.Cite this article: Bone Joint Res 2013;2:179–85.

Neuromuscular electrical stimulation for thromboprophylaxis: A systematic review

“…In Warwick et al, 35 peak venous velocity was higher in all postural positions when the NMES device was active, both with a plaster cast (mean increase of 97%) and without a plaster cast (mean increase of 63%). In this study, venous blood velocity of the superficial femoral vein during electrical stimulation was measured by duplex ultrasound.…”

“…NMES was compared with leg elevation in one study. 31 Eight studies 32,35,37,38,[40][41][42][43] compared NMES with baseline measurements without NMES. …”

“…However, the incidence of DVT in patients with malignant disease was significantly lower Williams et al 23 Geko T-1 1 70-560 ms 2 7 N R Izumi et al 24 SEN-52901 10 NR NR 100 Jawad et al 25 Geko T-1 1 70-560 ms 2 7 N R Warwick et al 35 Geko T-1 1 0-400 ms 2 7 N R Broderick et al 36 Duo Williams et al 23 Izumi et al 24 Jawad et al 25 Goyal et al 26 Velmahos et al 27 Merli et al 29 Bostrom et al 30 Lindströ m et al 28 Doran et al 31 Doran and White 32…”

<b>The impact of high-frequency magnetic stimulation of peripheral nerves: muscle hardness, venous blood flow, and motor function of upper extremity in healthy </b><b>subjects </b>

“…It is plausible that a similar effect occurred also with magnetic stimulation. Recently, there has been an increasing number of reports on deep venous thrombosis prophylaxis by increasing venous return via electrical stimulation of the peripheral nerves (4,6,19,26). Since high-frequency peripheral nerve magnetic stimulation can be performed without direct contact, it is applicable for patients immobilized with a cast.…”

Augmentation of arterial blood velocity with electrostimulation in patients with critical limb ischemia unsuitable for revascularization

“…In healthy volunteers, the device was shown to cause augmentation of the venous, arterial, and microvascular blood supply in the leg. 6,7 Since maldistribution of the skin, microcirculation, and reduction of the total blood flow constitutes the major pathogenetic mechanisms in CLI, we hypothesized that augmentation of arterial microcirculation would be achievable by electrostimulation of the calf muscles. 8 Therefore, we conducted a prospectively randomized pilot study to reveal whether combination of electrostimulation and iloprost treatment achieve better results compared to iloprost alone in CLI patients who are not suitable candidates for surgical or endovascular revascularization.…”