Researchers at the Baylor College of Medicine’s Interdisciplinary Consortium on Advanced Motion Performance (iCAMP) earned top honors at the recent American Podiatric Medical Association (APMA) Annual Scientific Meeting for poster abstracts that offer potentially promising treatment options to address lower extremity issues in high-risk patients.
One of the common challenges in podiatry is finding an offloading alternative that combines the efficacy and adherence of a total contact cast with the practical acceptability of a removable cast walker for the treatment of patients with diabetic foot ulcers (DFUs). With this in mind, Park and colleagues penned a proof-of-concept poster abstract that looks at combining a smart offloading system with remote patient monitoring to bolster patient adherence and dose safer weightbearing activity in this patient population. The poster earned first place in the single case or small case study/series poster abstract category at the APMA conference.
Catherine Park, PhD, the lead author of the poster abstract, explains that the smart offloading boot system, developed by Sensoria Health, Inc., features an offloading boot equipped with microelectronics, a smartwatch with a Sensoria Walk app and a cloud-based clinical dashboard. The system enables patients to receive alerts and feedback about adherence with wearing the boot, and the clinical dashboard allows patients and clinicians to monitor wearing of the boot and physical activity, according to Dr. Park.
“Through the clinical dashboard, a patient can consult with a clinician about his or her adherence to wearing the boot, and a clinician can reinforce the patient’s adherence,” notes Dr. Park, who was recently a Postdoctoral Associate with iCAMP at the Baylor College of Medicine. “We believe that these functionalities can contribute to improvements of DFU treatments and a reduction in health-care costs for people with DFUs.”
Dr. Park says a subsequent study will compare this smart offloading boot system versus the use of an irremovable offloading device and use of a removable offloading boot in patients with DFUs. Other goals of this study will be assessing the impact of these modalities on physical activity and quality of life, according to Dr. Park, a Big Data Scientist Training Enhancement Program (BD-STEP) Fellow with the Center for Innovations in Quality, Effectiveness and Safety (IQuESt) at the United States Department of Veterans Affairs.
“We think that giving people information about how much they are wearing their boot, using readily available technology, will help them follow the doctor’s directions better and help their wounds heal faster,” suggests Dr. Park. “More specifically, we hypothesize that adherence reinforcement features offered by a smart boot could speed up wound healing while improving patient-centered outcomes such as better sleep quality, optimized mobility and enhanced acceptability.”
A Closer Look at Electrical Stimulation of Lower Extremity Muscles in ICU Patients with COVID-19
Could electrical stimulation have an impact in preventing lower extremity muscle weakness in ICU patients with COVID-19?
Zulbaran and colleagues recently sought to answer this question with a double-blinded, randomized controlled trial involving 19 patients (38 lower extremities) admitted to an intensive care unit (ICU) with acute respiratory failure. Researchers employed bioelectric stimulation through the Tennant Biomodulator (Avazzia, Inc.) for 60 minutes a day over a nine-day period. The researchers found significantly higher gastrocnemius muscle endurance at three and nine days in the treatment group compared to the control group, which had a significant 7 percent decline after three days in comparison to the baseline. The use of electrical stimulation also preserved gastrocnemius muscle strength, and facilitated a 15 percent increase in ankle strength at nine days compared to the baseline, according to a poster abstract of the study, which garnered third place in the single case or small case study/series poster abstract category at the APMA conference.
“The benefit of receiving electrical stimulation since the day of admission was reflected in our results as patients persisted with muscle stability during the initial three-day period of the study without physical therapy involvement,” notes Alejandro Zulbaran, MD, the lead author of the study. “On the other hand, after involving mild exercise, muscle conditions improved almost to baseline values. This means that together, physical therapy and electrical stimulation may not only preserve muscle but might enhance recovery. A longer follow-up study would be needed to explore this.”
Dr. Zulbaran says maintaining limb functionality should be emphasized more for immobile ICU patients to reduce the risk of possible short-term as well as long-term complications.
“Preserving limb functionality while being in an immobile status due to ICU admission should be a priority, especially in critically ill patients who require ventilatory assistance. Immobilization can provoke neuromyogenic disturbances, such as atrophy, within hours from admission, and these disturbances are known to delay extubation and extend hospital length of stay,” points out Dr. Zulbaran, a Research Assistant in the Department of Surgery at the Baylor College of Medicine.1,2 “Previous coronavirus outbreaks (other than SARS-CoV-2) have resulted in impaired pulmonary and physical function, leading to significantly lower exercise capacity two years after infection.3 Moreover, during the COVID-19 pandemic, patients have reported muscle illnesses up to eight months after recovery from severe infection.4-6 This means that if lower-limb conditions receive less attention, long-term complications may persist.”
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2. Latronico N, Fagoni N, Gobbo M. Neuromuscular electrical stimulation in critically ill patients. In: H. Prabhakar (ed): Essentials of Neuroanesthesia, Ch. 46. Academic Press, Cambridge, Ma., 2017, pp. 771-781.
3. Ngai JC, Ko FW, Ng SS, To KW, Tomng M, Hui DS. The long-term impact of severe acute respiratory syndrome on pulmonary function, exercise capacity and health status. Respirology. 2010;15(3):543-50.
4. Arnold DT, Milne A, Samms E, Stadon L, Maskell NA, Hamilton FW. Symptoms after COVID-19 vaccination in patients with persistent symptoms after acute infection: a case series. Ann Intern Med. 2021 May 25;M21-1976. doi: 10.7326/M21-1976. Online ahead of print.
5. Al-Aly Z, Xie Y, Bowe B. High-dimensional characterization of post-acute sequelae of COVID-19. Nature. 2021;594:259-264.
6. Huang C, Huang L, Wang Y, et al. 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. Lancet. 2021;397(10270):220-232.