25 Participants Needed

Neuromodulation for Muscle Weakness

BN
MN
Overseen ByMaria Noun, BS
Age: 18+
Sex: Any
Trial Phase: Academic
Sponsor: Bijan Najafi, PhD
No Placebo GroupAll trial participants will receive the active study treatment (no placebo)

Trial Summary

What is the purpose of this trial?

Post-intensive care syndrome (PICS) encompasses persistent physical, cognitive, and psychiatric symptoms following ICU discharge, commonly triggered by serious conditions such as respiratory failure, sepsis, and mechanical ventilation. PICS prevalence is reported to be as high as 84% up to 12 months in patients with at least 2 days spent in the ICU or with mechanical ventilatory support. As a consequence, many patients do not return to they former level of function for weeks, months and even years. Muscular affection manifested by muscle weakness is particularly seen and is provoked by a combination of damage to the nerves or directly the muscles fibers. This affection is referred to as CU-Acquired Weakness (ICUAW). One third of the time, lower extremities are affected, often due to prolonged immobilization or sedation. Evidence suggests that early mobilization reduces the incidence of ICUAW at discharge and improves the number of patients able of stand. However achieving this early intervention is not always feasible due to time or personnel constraints. The purpose of the study is to examine the effectiveness of lower extremity neuromodulation for prevention of muscle deconditioning in patients admitted to the ICU.

Do I have to stop taking my current medications for this trial?

The trial protocol does not specify whether you need to stop taking your current medications.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

What data supports the idea that Neuromodulation for Muscle Weakness is an effective treatment?

The available research shows that Neuromodulation for Muscle Weakness, also known as Neuromuscular Electrical Stimulation (NMES), is effective in strengthening weak muscles. One study highlights that NMES can improve muscle strength, as there is a positive relationship between the muscle forces generated during training and the gains in strength. However, patient discomfort can limit the effectiveness of NMES. Another study suggests that NMES can aid in recovery after lower extremity injuries or surgeries, especially when used at home with proper monitoring and communication with healthcare providers. This indicates that NMES can be a beneficial treatment for muscle weakness, particularly when adherence to the treatment is maintained.12345

What data supports the effectiveness of the treatment Neuromodulation for Muscle Weakness?

Research shows that neuromuscular electrical stimulation (NMES), a part of this treatment, is effective in strengthening weak muscles by improving their force-generating capacity. However, patient discomfort can limit its effectiveness, and adherence to at-home use is crucial for better outcomes.12345

What safety data is available for neuromodulation treatments for muscle weakness?

The safety data for neuromodulation treatments, such as Neuromuscular Electrical Stimulation (NMES), indicates that it is a widely-used and generally safe technique for muscle strengthening and rehabilitation. NMES is effective in enhancing muscle function and has been shown to be feasible even for ill or bedridden patients. However, there are specific contraindications, such as peripheral venous disorders or malignancy, where NMES should be avoided. Patient discomfort and non-response due to peripheral nerve damage are potential issues, but these can be managed with proper electrode placement and consideration of underlying conditions.23467

Is neuromuscular electrical stimulation (NMES) safe for humans?

Neuromuscular electrical stimulation (NMES) is generally considered safe for humans, even for those who are ill or bedridden, although it may cause discomfort and has specific contraindications (reasons not to use it) such as peripheral venous disorders or cancer. It is important to ensure proper electrode placement to minimize discomfort and maximize effectiveness.23467

Is Lower Extremity Neuromodulation a promising treatment for muscle weakness?

Yes, Lower Extremity Neuromodulation, which uses electrical stimulation to strengthen weak muscles, shows promise. It can help improve muscle strength, especially after injury or surgery, and may also aid in rehabilitation and prevent blood clots.23468

How is the Lower Extremity Neuromodulation treatment different from other treatments for muscle weakness?

Lower Extremity Neuromodulation, also known as Neuromuscular Electrical Stimulation (NMES), is unique because it uses electrical currents to directly stimulate muscles, helping to strengthen them even when voluntary movement is limited. This approach can be particularly beneficial for patients with muscle weakness due to nerve damage, as it bypasses the need for voluntary muscle activation.23468

Eligibility Criteria

This trial is for patients who have been in the ICU, especially those on ventilators or with serious conditions like respiratory failure or sepsis. It aims to help those at risk of developing muscle weakness and wasting after their ICU stay.

Exclusion Criteria

I have spent less than 48 hours in the ICU.
I have major foot problems like wounds, deformities, or past amputations.
Demand-type cardiac pacemaker, implanted defibrillator, or other implanted electronic devices
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Timeline

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

Treatment

Participants receive daily neuromodulation in the lower extremity for up to 1 hour, using a functional or non-functional device, for up to four weeks or until hospital discharge

Up to 4 weeks
Daily sessions

Follow-up

Participants are monitored for safety and effectiveness after treatment, including assessments of muscle endurance, thickness, and other health metrics

4 weeks

Post-study Follow-up

Anxiety levels, independence in daily living activities, and mobility are assessed 4 weeks after hospital discharge

1 month after study termination

Treatment Details

Interventions

  • Lower Extremity Neuromodulation
Trial Overview The study tests if neuromodulation (stimulating nerves/muscles) can prevent muscle weakening in ICU patients. Participants are divided into two groups: one receives standard care while the other gets additional lower extremity neuromodulation.
Participant Groups
2Treatment groups
Active Control
Placebo Group
Group I: Intervention GroupActive Control1 Intervention
Subjects will receive a functional neuromodulation device to wear for 1 hour daily up to four weeks or until hospital discharge, whichever came first.
Group II: Control groupPlacebo Group1 Intervention
Subjects will receive a non-functional neuromodulation device to wear for 1 hour daily up to four weeks or until hospital discharge, whichever came first.

Find a Clinic Near You

Who Is Running the Clinical Trial?

Bijan Najafi, PhD

Lead Sponsor

Trials
5
Recruited
280+

Avazzia, Inc

Industry Sponsor

Trials
7
Recruited
290+

Findings from Research

The RehabTracker system, designed to monitor adherence to at-home neuromuscular electrical stimulation (NMES) therapy, successfully recorded 83% of rehabilitation sessions in a small cohort of 7 patients recovering from anterior cruciate ligament injuries, indicating its potential effectiveness in improving adherence.
The system's mobile health app facilitated real-time communication between patients and providers, with 100% of push notifications received by patients, suggesting that enhanced monitoring and communication could lead to better rehabilitation outcomes.
A Cyber-Physical System for Near Real-Time Monitoring of At-Home Orthopedic Rehabilitation and Mobile-Based Provider-Patient Communications to Improve Adherence: Development and Formative Evaluation.Stevens, T., McGinnis, RS., Hewgill, B., et al.[2020]
In a study involving 10 adults, neuromuscular electrical stimulation (NMES) with a 200-microsecond pulse duration allowed participants to tolerate significantly greater muscle torques compared to a 50-microsecond pulse duration, indicating enhanced efficacy for muscle strengthening.
The findings suggest that medium pulse durations may be more effective for maximizing muscle torque responses, despite the common belief that shorter pulses are preferable due to lower pain thresholds.
Comparison of maximum tolerated muscle torques produced by 2 pulse durations.Scott, WB., Causey, JB., Marshall, TL.[2014]
The newly developed NMES-dynamometer system demonstrated high reliability for assessing knee extensor muscle function, with intra-rater correlation coefficients of 0.91 for maximal voluntary force and 0.94 for supramaximal twitch force, indicating consistent results across different testing sessions.
Inter-rater reliability was also strong, with coefficients of 0.89 and 0.86 for the same measures, suggesting that different raters can use this system effectively to evaluate muscle function with minimal variability.
Development and reliability of a new system for bedside evaluation of non-volitional knee extension force.Vaz, MA., Fröhlich, M., Júnior, DPDS., et al.[2022]

References

A Cyber-Physical System for Near Real-Time Monitoring of At-Home Orthopedic Rehabilitation and Mobile-Based Provider-Patient Communications to Improve Adherence: Development and Formative Evaluation. [2020]
Comparison of maximum tolerated muscle torques produced by 2 pulse durations. [2014]
Development and reliability of a new system for bedside evaluation of non-volitional knee extension force. [2022]
Utilizing the reaction of degeneration test for individuals with focal paralysis. [2021]
Neuromuscular electrical stimulation for motor recovery in pediatric neurological conditions: a scoping review. [2021]
Motor point heatmap of the calf. [2023]
A murine model of muscle training by neuromuscular electrical stimulation. [2021]
Can the Use of Neuromuscular Electrical Stimulation Be Improved to Optimize Quadriceps Strengthening? [2019]
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