Clinical safety of early rehabilitation using electrical muscle stimulation for patients with intracranial hypertension.

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Tomoyuki Kino, MD,PhD Kuniyasu Saigusa, MD, PhD


The benefits of early rehabilitation in critically ill patients in the intensive care unit (ICU) have been reported in recent literature. However, there are few reports concerning the safety and the risk of early rehabilitation in ICU patients with intracranial hypertension due to stroke or traumatic brain injury. Immobilized patients with intracranial hypertension cannot attempt to voluntarily move their extremities and body, therefore passive range of motion exercise tends to play a major role in early rehabilitation in the ICU, and it leads to disuse muscle atrophy in a short period of time. Our institution introduced belt electrode-skeletal muscle electrical stimulation (B-SES), which can cause more effective muscle contraction than conventional electrical muscle stimulation (EMS) to prevent disuse muscle atrophy in patients with intracranial hypertension. Although there is currently not enough data available to determine whether B-SES is safe for patients with intracranial hypertension, we applied B-SES to patients who underwent neurosurgical procedures for managing increased intracranial pressure (ICP) in the ICU. This trial revealed that ICP as well as the other vital signs in all patients did not worsen during the B-SES procedure. The purpose of this article is to discuss the safety, the efficacy, the current problems, and the future of B-SES for patients with intracranial hypertension.

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KINO, Tomoyuki; SAIGUSA, Kuniyasu. Clinical safety of early rehabilitation using electrical muscle stimulation for patients with intracranial hypertension.. Medical Research Archives, [S.l.], v. 8, n. 7, july 2020. ISSN 2375-1924. Available at: <>. Date accessed: 08 aug. 2020. doi:
Review Articles


1. Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009;373(9678):1874-82.
2. Kayambu G, Boots R, Paratz J. Physical therapy for the critically ill in the ICU: a systematic review and meta-analysis. Crit Care Med. 2013;41(6):1543-54.
3. Hodgson CL, Stiller K, Needham DM, Tipping CJ, Harrold M, Baldwin CE, et al. Expert consensus and recommendations on safety criteria for active mobilization of mechanically ventilated critically ill adults. Crit Care. 2014;18(6):658.
4. Kress JP, Hall JB. ICU-acquired weakness and recovery from critical illness. N Engl J Med. 2014;371(3):287-8.
5. Nakamura K, Kihata A, Naraba H, Kanda N, Takahashi Y, Sonoo T, et al. Efficacy of belt electrode skeletal muscle electrical stimulation on reducing the rate of muscle volume loss in critically ill patients: A randomized controlled trial. J Rehabil Med. 2019;51(9):705-11.
6. Gruther W, Kainberger F, Fialka-Moser V, Paternostro-Sluga T, Quittan M, Spiss C, et al. Effects of neuromuscular electrical stimulation on muscle layer thickness of knee extensor muscles in intensive care unit patients: a pilot study. J Rehabil Med. 2010;42(6):593-7.
7. Karatzanos E, Gerovasili V, Zervakis D, Tripodaki ES, Apostolou K, Vasileiadis I, et al. Electrical muscle stimulation: an effective form of exercise and early mobilization to preserve muscle strength in critically ill patients. Crit Care Res Pract. 2012;2012:432752.
8. Hirose T, Shiozaki T, Shimizu K, Mouri T, Noguchi K, Ohnishi M, et al. The effect of electrical muscle stimulation on the prevention of disuse muscle atrophy in patients with consciousness disturbance in the intensive care unit. J Crit Care. 2013;28(4):536.e1-7.
9. Takeda K, Tanino G, Miyasaka H. Review of devices used in neuromuscular electrical stimulation for stroke rehabilitation. Med Devices (Auckl). 2017;10:207-13.
10. Tanaka S, Kamiya K, Matsue Y, Yonezawa R, Saito H, Hamazaki N, et al. Effects of acute phase intensive electrical muscle stimulation in frail elderly patients with acute heart failure (ACTIVE-EMS): Rationale and protocol for a multicenter randomized controlled trial. Clin Cardiol. 2017;40(12):1189-96.
11. Hasegawa S, Kobayashi M, Arai R, Tamaki A, Nakamura T, Moritani T. Effect of early implementation of electrical muscle stimulation to prevent muscle atrophy and weakness in patients after anterior cruciate ligament reconstruction. J Electromyogr Kinesiol. 2011;21(4):622-30.
12. Suzuki Y, Kamiya K, Tanaka S, Hoshi K, Watanabe T, Harada M, et al. Effects of electrical muscle stimulation in frail elderly patients during haemodialysis (DIAL): rationale and protocol for a crossover randomised controlled trial. BMJ Open. 2019;9(5):e025389.
13. Guideline Committee of the Japan Stroke Society for the management of stroke Japanese guidelines for the management of stroke 2015, supplement in 2017 . . Tokyo: Kyowa Kikaku; 2017.
14. Miyamoto T, Fukuda K, Kimura T, Matsubara Y, Tsuda K, Moritani T. Effect of percutaneous electrical muscle stimulation on postprandial hyperglycemia in type 2 diabetes. Diabetes Res Clin Pract. 2012;96(3):306-12.
15. Stefanou C. Electrical muscle stimulation in thomboprophylaxis: review and a derived hypothesis about thrombogenesis-the 4th factor. Springerplus. 2016;5(1):884.
16. Ogoh S, Ainslie PN. Cerebral blood flow during exercise: mechanisms of regulation. J Appl Physiol (1985). 2009;107(5):1370-80.

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