Neuromuscular electrostimulation viathe common peroneal nerve promotes lower limb blood flow in a below-kneecast: A potential for thromboprophylaxis

D J Warwick, A Shaikh, S Gadola, M Stokes, P Worsley, D Bain, A T Tucker, S D Gadola, D J Warwick, A Shaikh, S Gadola, M Stokes, P Worsley, D Bain, A T Tucker, S D Gadola

Abstract

Objectives: We aimed to examine the characteristics of deep venous flow in the leg in a cast and the effects of a wearable neuromuscular stimulator (geko; FirstKind Ltd) and also to explore the participants' tolerance of the stimulator.

Methods: This is an open-label physiological study on ten healthy volunteers. Duplex ultrasonography of the superficial femoral vein measured normal flow and cross-sectional area in the standing and supine positions (with the lower limb initially horizontal and then elevated). Flow measurements were repeated during activation of the geko stimulator placed over the peroneal nerve. The process was repeated after the application of a below-knee cast. Participants evaluated discomfort using a questionnaire (verbal rating score) and a scoring index (visual analogue scale).

Results: The geko device was effective in significantly increasing venous blood flow in the lower limb both with a plaster cast (mean difference 11.5 cm/sec(-1); p = 0.001 to 0.13) and without a plaster cast (mean difference 7.7 cm/sec(-1); p = 0.001 to 0.75). Posture also had a significant effect on peak venous blood flow when the cast was on and the geko inactive (p = 0.003 to 0.69), although these differences were less pronounced than the effect of the geko (mean difference 3.1 cm/sec(-1) (-6.5 to 10)). The geko device was well tolerated, with participants generally reporting only mild discomfort using the device.

Conclusion: The geko device increases venous blood flow in the lower limb, offering a potential mechanical thromboprolylaxis for patients in a cast. Cite this article: Bone Joint Res 2013;2:179-85.

Keywords: Deep-vein thrombosis; Doppler ultrasonography; Electrical stimulation; Mechanical prophylaxis; Plaster cast; Thromboprophylaxis.

Conflict of interest statement

ICMJE Conflict of Interest:Dr Tucker ad Dr Bain have paid consultancy agreements with FirstKind. Fees were received by SG for performance of ultrasonography. Nominal reimbursement at established R&D rates were provided for PI time to the Institution. The PI and all other authors received no personal reimbursement or reward in kind.

Figures

Fig. 1
Fig. 1
Photograph of the geko electrostimulation device (FirstKind Ltd, High Wycombe, United Kingdom).
Fig. 2
Fig. 2
Bar chart showing the mean peak velocity of the femoral vein according to activation of the geko device and posture. The error bars denote the standard error of the mean.
Fig. 3
Fig. 3
Bar chart showing the mean cross-sectional area of the femoral vein according to activation of the geko device and posture. The error bars denote the standard error of the mean.
Fig. 4
Fig. 4
Box and whisker plot of the verbal rating score (VRS) for discomfort using the geko device in all postural positions with and without plaster cast. The VRS ranges from 1 (no sensation) to 5 (severe discomfort). The error bars denote the interquartile range (WB, weight-bearing; NWB, non-weight-bearing).
Fig. 5
Fig. 5
Box and whisker plot of the visual analogue scale (VAS) feedback for discomfort using the geko device in all postural positions with and without plaster cast. The VAS ranges from 0 (no sensation) to 10 (severe discomfort) (WB, weight-bearing; NWB, non-weight-bearing).

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