Abstract
Purpose
Disuse atrophy of the lower limbs of patients with consciousness disturbance has often been recognized as “an unavoidable consequence,” such that the mechanism was not investigated diligently. In this study, we examined the preventive effects of electrical muscle stimulation (EMS) against disuse atrophy of the lower limbs in patients in coma after stroke or traumatic brain injury in the intensive care unit.
Materials and Methods
We evaluated changes in cross-sectional area of lower limb muscles weekly with computed tomography in 6 control group patients and 9 EMS group patients. Electrical muscle stimulation was performed daily from day 7 after admission. We evaluated the anterior thigh muscle compartment, posterior thigh muscle compartment, anterior leg muscle compartment, and posterior leg muscle compartment.
Results
In the control group, the decrease in cross-sectional area progressed in all compartments every week (P < .0001). Cross-sectional areas of all compartments at day 14 were significantly decreased in the control group compared with those in the EMS group at day 7 (P < .001). We were able to limit the rate of muscle atrophy as measured in the cross-sectional areas to within 4% during the period of EMS (days 7-42) in 5 patients. The difference between the control and the EMS groups was statistically significant (P < .001).
Conclusion
Electrical muscle stimulation is effective in the prevention of disuse muscle atrophy in patients with consciousness disorder.
Introduction
The patients presenting with long-term consciousness disturbance for more than several months often experience remarkable lower limb motor dysfunction from muscle disuse, forcing them to use a wheelchair or impairing their activities of daily living. Dramatic reduction in muscle mass occurs within 4 to 6 weeks of bed rest and is accompanied by a decrease ranging from 6% to 40% in muscle strength [1]. Disuse atrophy in the lower limbs of patients with consciousness disorder is often recognized as “an unavoidable consequence.” Thus, the mechanism of disuse atrophy in the lower limbs of such patients has not been studied sufficiently.
Electrical muscle stimulation (EMS) has been used in patients with severe chronic obstructive pulmonary disease and chronic heart disease [2], [3], [4] who could not exercise actively because of these conditions. Electrical muscle stimulation was useful in improving exercise capacity, skeletal muscle performance, and quality of life in these patients.
In recent years, the concept of sarcopenia has attracted wide clinical attention [5], [6]. Sarcopenia is a syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength with a risk of adverse outcomes such as physical disability, poor quality of life, and death [6]. To prevent and treat sarcopenia, various methods of nutrition, exercise, and medication have been applied [7], [8], [9]. The findings reported herein may be of great use in elucidating the mechanism of, and devising new therapy for, sarcopenia.
On the basis of these findings, we examined the preventive effect of EMS on disuse atrophy in the lower limbs of patients with consciousness disturbance as an alternative form of exercise. The aims of this study were to evaluate lower limb muscle atrophy over a long period of bed rest and to elucidate whether disuse atrophy of the lower limb muscles in patients in coma can be prevented with EMS during the acute phase after stroke or traumatic brain injury (TBI) in the intensive care unit.
Section snippets
Participants
Participants comprised in this study were admitted to the Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan, from January 2004 to December 2010 and were treated in the intensive care unit. Eligible patients were included if they met the following criteria: coma within the first 24 hours of hospitalization, first-time stroke or TBI without other associated thoracic or abdominal injury, age between 16 and 75 years, paralysis of one
Participants' characteristics
Participants' characteristics are shown in Table 1. The control group was composed of 3 men and 3 women with a mean ± SD age of 59.8 ± 17.2 years. All participants in the control group were measured for 6 weeks. The causes of coma were TBI in 3 patients and stroke in 3 patients (Table 1). The EMS group was composed of 9 patients. Evaluation of the effect of EMS was performed weekly for 6 weeks, but the measurement for the full 6 weeks was made only in 5 patients because of improvement of the
Discussion
In this study, we showed that use of EMS as an alternative form of exercise has a preventive effect on lower limb atrophy from disuse in patients in coma resulting from stroke or TBI. With EMS, it was possible to maintain the same cross-sectional measure on CT. To our knowledge, this is the first report to show the usefulness of EMS, as verified by CT measurement, in preventing muscle atrophy from disuse in patients with a consciousness disorder.
Patients with consciousness disturbances
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