Electrical Stimulation in Addition to Passive Exercise Has a Small Effect on Spasticity and Range of Motion in Bedridden Elderly Patients: A Pilot Randomized Crossover Study

Abstract

Purpose: Belt electrode skeletal muscle electrical stimulation (B-SES) can stimulate large portions of muscles including deep sites without localisation of the stimulation area. The purpose of this study is to investigate both immediate treatment effects of B-SES and long-term treatment effects of B-SES with passive exercise on range of motion (ROM) and muscle tone of lower extremities in bedridden elderly patients. Methods: Outcome measures before and after B-SES treatment alone (4 Hz, 20 min, both lower extremities) were examined for the immediate effect. Outcome measures were: ROM and Modified Ashworth scale (MAS) of hip flexion and adduction; knee flexion and extension; and knee joint distance at position of flexion abduction in hip (distance of knee). A randomized crossover trial was conducted to examine the long-term effect of adding B-SES to passive exercise on ROM and MAS. Results and Discussion: The immediate effect study had 18 patients. ROM and MAS of 4 joint angles in 2 joints and distance of knee significantly improved after B-SES treatment. The long-term effect study had 11 patients. Friedman test revealed ROM and MAS of 4 joint angles in 2 joints and distance of knee significantly improved during B-SES intervention but not control intervention. B-SES in addition to passive stretch has a more statistically significant effect on contracture and spasticity in large portions of the lower How to cite this paper:

Physical Rehabilitation Programs for Bedridden Patients with Prolonged Immobility: A Scoping Review

“…Most studies were performed in research institutes ( n = 10) and hospital contexts ( n = 10), followed on rehabilitation units ( n = 3), welfare or nursing homes ( n = 2), one long-term care facility (LTC) and one hospice. Studies performed in hospital context involved multiple conditions such as multi-trauma [ 54 ], hip fracture [ 45 ], sarcopenia [ 53 ], older patients with unspecified conditions [ 30 , 41 , 49 ], patients with COPD mechanical ventilated [ 42 ], or other mechanical ventilated patients [ 43 ], namely in the ICU [ 42 , 51 ]. Rehabilitation units involved patients with stroke [ 31 ], patients with multiple sclerosis [ 44 ], and one patient with head trauma caused by a car accident [ 38 ].…”

“…The other seven were directed to the cardiorespiratory domain and six to mixed/other domains. Most of the programs included in this scoping were applied only to lower limbs [ 28 , 30 , 32 , 36 , 37 , 40 , 41 ], also including [ 34 ], which only focused on toe joints. On the other hand, two studies [ 33 , 39 ] worked on both upper and lower limbs, and three studies [ 29 , 31 , 38 ] worked on the upper and lower body.…”

“…Four studies [ 28 , 32 , 36 , 37 ] used devices for lower limb mobilization with different typologies (flywheel ergometer, leg press, and ankle or leg mobilizer), whereas one [ 40 ] used elastic bands, and [ 34 ] used a device for passive mobilization of toe joints. Devices for electrical stimulation were also widely used in the musculoskeletal [ 31 , 38 , 41 ], cardiorespiratory [ 42 , 46 , 48 ], and other/mixed domains [ 51 ]. Tilt tables for verticalization were also used in both musculoskeletal [ 31 ], cardiorespiratory [ 46 ], and mixed domains [ 49 ].…”

“…muscle strength [ 31 , 33 , 51 ] (mainly using the MRC scale), handgrip strength (using a dynamometer) [ 30 ], and force power (using a load cell) [ 28 ]. Still, in this domain, range of motion (ROM) [ 35 , 41 ], joint angular velocity [ 28 ], and angle measures [ 39 ] were also evaluated. Other techniques, such as dual-energy X-ray absorptiometry to measure bone mineral density [ 32 ] and EMG [ 28 ], were used.…”

“…In this context, we observed that programs were applied to people with very different diseases (from hip fracture to stroke). On the other hand, other studies in the hospital context [ 30 , 41 ] and welfare/nursing homes [ 35 , 50 ] included patients (mostly older) with disuse syndrome, irrespective of the underlying cause [ 12 , 16 ]. Two studies [ 42 , 51 ] were specifically applied in the ICU context, demonstrating the importance of rehabilitation in intensive care to be performed as soon as possible [ 57 , 58 ].…”