title: Effects of electrical muscle stimulation early in the quadriceps and tibialis anterior muscle of critically ill patients.
abstract: BACKGROUND
  Electrical muscle stimulation (EMS) is applied to critically ill patients in order to improve their muscle strength, thereby preventing hypotrophy and promoting functional recovery.
  
  
  OBJECTIVE
  To assess the effects of early EMS on the range of movement of the ankle joint, and on thigh and leg circumference in critically ill patients.
  
  
  METHODS
  This is a prospective randomized clinical trial comprising 11 patients undergoing mechanical ventilation. Before and after EMS the thigh and leg circumference in both lower limbs and the goniometry of the tibiotarsal joint were measured. The angle of 90° on the goniometer was taken as the standard neutral position (NP), with the arm fixed on the lateral malleolus of the ankle joint. Other measurements, namely dorsiflexion and plantar flexion, referred to as mobile arm, were taken from the NP. These recordings were obtained following an active contraction of the patients' muscles.
  
  
  RESULTS
  Compared with the electrostimulated limb, a difference in dorsiflexion of the control limb was observed (96.2 ± 24.9 versus 119.9 ± 14.1°; p = 0.01). A girth of 10 cm of the leg was found in limb reduction when compared to the electrostimulated one (24.7 ± 3.1 versus 26.4 ± 4.0 cm; p = 0.03).
  
  
  CONCLUSIONS
  EMS used at low current intensity and for a short duration failed to prevent muscle atrophy in critically ill patients. However, we did find a significant improvement in active dorsiflexion of the ankle joint suggesting that it could help to prevent against stance plantar flexion in these patients.
authors.affiliation: Department of Physiotherapy, Institute of Biology and Health, Universidade Catœlica de Pernambuco -- UNICAP , Recife, PE , Brazil .
authors.forename: Letícia Ferreira
authors.initials: LF
authors.lastname: Falavigna
authors.forename: Michele Gonçalves
authors.initials: MG
authors.lastname: Silva
authors.forename: Amanda Lopes de Almeida
authors.initials: AL
authors.lastname: Freitas
authors.forename: Priscila Figueiredo dos Santos
authors.initials: PF
authors.lastname: Silva
authors.forename: Marçal Durval Siqueira
authors.initials: MD
authors.lastname: Paiva Júnior
authors.forename: Célia Maria Machado Barbosa
authors.initials: CM
authors.lastname: de Castro
authors.forename: Maria do Amparo
authors.initials: Mdo A
authors.lastname: Andrade
authors.forename: Marcos Antonio Cavalcanti
authors.initials: MA
authors.lastname: Gallindo
authors.forename: Luana Carneiro
authors.initials: LC
authors.lastname: Ribeiro
authors.forename: Francimar Ferrari
authors.initials: FF
authors.lastname: Ramos
authors.forename: Flávio Maciel Dias
authors.initials: FM
authors.lastname: de Andrade
authors.forename: Eduardo Eriko Tenório
authors.initials: EE
authors.lastname: de França
mesh_terms: D000293:Adolescent; D000328:Adult; D000843:Ankle Joint / Q000502:physiology*; D016638:Critical Illness / Q000534:rehabilitation*; D004599:Electric Stimulation Therapy; D005260:Female; D006801:Humans; D007866:Leg / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009133:Muscular Atrophy / Q000517:prevention & control; D011446:Prospective Studies; D052097:Quadriceps Muscle / Q000502:physiology*; D016059:Range of Motion, Articular; D055815:Young Adult