electrical stimulation for critically ill post-covid-19 patients

Conditions: COVID-19; Muscle Atrophy; Muscle Weakness

Summary: unfortunately, hospital-acquired weakness is highly prevalent among covid-19 hospitalized patients, who often require prolonged bed-rest or paralytics for an extended period of time in order to maintain oxygenation. prolonged bed rest has been associated with pronounced loss of muscle mass that can exceed 10% over the 1st week, which leads to functional impairment and complications post-hospital discharge. physical therapy and in-hospital mobility program may reduce the incident of hospital-acquired weakness, but they are often impractical for covid-19 patients. in particular, conventional mobility programs are challenging for those who are being treated in an intensive care unit. the purpose of this study is to test feasibility and proof-of-concept effectiveness of daily use of lower extremity electrical stimulation (ee) therapy, as a practical solution to address lower extremity muscle deconditioning, to address chronic consequences of covid-19 including hospital-acquired weakness.

20 subjects that were hospitalized due to severe covid-19 infection and present neuromuscular complications (i.e., hospital acquired weakness due to neuromyopathy) will be recruited after the first phase of this study is completed. unlike phase i (study for prevention), this is a proof of concept randomized control trial (rct) study for recovery. the patients will be recruited from the covid-19 clinic at baylor college of medicine and will begin the study after being diagnosed with neuromyopathy due to prolonged hospitalization for covid-19. this will be performed by a critical care and pulmonary specialist at the bcm covid-19 clinic. the entire cohort will receive daily electrical stimulation in lower extremity (e.g. gastrocnemius, tibial anterior muscle) up to 1 hour to recover from neuromyopathy complications and prolonged hospital stay. participants will be randomized to intervention (ig) or control group (cg)). ee therapy will be provided using a bio-electric stimulation technology (best) platform (tennant biomodulator pro®, avazzia, inc.). the ee device will be functional for ig and non-functional for cg. in addition to taking the device home to deliver electrical stimulation themselves, the patients will attend a weekly assessment at the mcnair campus for up to 4 weeks. the primary outcomes include between group difference and change from the baseline in muscle endurance, muscle strength, lower extremity tissue oxygen saturation, neuropathy, and muscle atrophy.

Eligibility criteria:
inclusion criteria: * post-covid-19 patients who required hospitalization due to covid-19 severe infection. * post-covid-19 patients who required hospitalization and present neuromuscular sequelae due to covid-19 severe infection. exclusion criteria: * patient has a demand-type cardiac pacemaker, implanted defibrillator or other implanted electronic device. * active wound infection. * below the knee amputations. * based on the clinicians decision whether the patient is eligible for the study.

Keywords: electrical stimulation skin perfusion muscle dysfunction