Abstract
The aim of the authors’ study was to investigate, in patients with one leg amputated, the influence of electrostimulation on the arterial circulation of the other lower limb and on the ability of a leg with deteriorated blood flow to perform work. The study encompassed 50 patients who were admitted to the rehabilitation center to obtain a leg prosthesis and learn to walk after amputation of 1 lower limb because of severe circulatory disturbance. The patients were randomly divided into 2 groups. The first group contained 25 patients treated with a standard exercise program for patients with limb amputation (control group, C). In this control group, according to the Fontaine’s classification of peripheral arterial occlusive disease (PAOD), 15 patients were in stage I and 10 patients were in stage II. In the second group, the electro stimulated (ES) group, there were also 25 patients that had the same rehabilitation program, to which electrostimulation of the gastrocnemius muscle of the remaining leg was added. In this group, 14 patients were in stage I, 10 patients were in stage II, and 1 patient was in stage III of PAOD. For electrostimulation, biphasic charge-balanced asymmetrical current stimuli with a pulse duration of 0.25 ms were used. The electrostimulation program consisted of 2 hours of electrostimulation per day for 8 weeks. Each patient was examined at the start of the rehabilitation program (examination I), at the end of the 8-week program (examination II) and at the end of a 1-year follow-up period (examination III). The effects of the treatment were followed using clinical examination, determination of the ankle-brachial index (ABI), and by measuring the partial oxygen pressure (TcPO2) on the skin surface of the diseased leg at rest and during exercise. After 8 weeks of treatment, in 3 patients of the ES group, claudication disappeared, and they thus moved from clinical stage II to stage I. In the control group, there were no changes in the clinical stages of PAOD. At the end of the observation period, 6 patients in group C and 5 patients in the ES group registered a progression of PAOD. During the observation period, 3 patients in group C and 1 patient in the ES group had below-knee amputations of the remaining leg (p<0.01). Perfusion pressures and ABI of investigated legs were comparable between groups and did not change during treatment. After 1 year of observation, there was a trend to ABI decrease in both groups. The capability of the diseased leg for performing work increased significantly during treatment only in the ES group. During treatment, TcPO2 at rest on the dorsum of the foot increased nonsignificantly in the ES group but in group C a trend of decrease in its value was indicated. After 8 weeks of treatment, total and partial oxygen drop during exercise significantly decreased in the ES group; whereas, in group C, there was no significant change. During the 1-year observation period, these effects of electrostimulation disappeared; however, fewer amputations in the ES group favor the presumption that this could be a positive effect of electrostimulation. The results of the authors’ study showed that electrostimulation improved oxygen delivery to a leg with disturbed arterial circulation and increased its work load capacity. The changes are probably caused by improvement of microcirculation.
My comments:
This is an older study, but I think it’s good because they use electric stimulation parameters that I’d expect to be pretty effective at increasing blood flow:
- Duty cycle: 4 seconds on 4 seconds off
- Pulse Rate: 40 Hz,
- Pulse Duration: 250 uS
- Pulse Amplitude: 30-50 mA to the point where they got slight muscle contractions
- Frequency, Duration, Length of Treatment: 2 hours daily for 8 weeks.
For this population I would have used a larger pulse duration, but I expect 4 on 4 off would do a lot to increase circulation and improve function in patients with significant peripheral vascular disease. Their condition did decline after treatment was stopped, so it should probably be utilized permanently at home. As used in this study, the electric stimulation could be easily performed and tolerated while watching TV, while walking around, or even sleeping. It would be interesting to know if the parameters in this study affected capillary density and growth factors as as found with lower intensity TENS type stimulation.
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