Hi Andrew,I have used electrical stimulation in research studies and clinically
and have never excluded someone with a history of VTE. The IRB has never seen
that as a concern in my research either. I did a quick search and came across
one study that might be helpful but it doesn't address your specific question
about the difference between the contractions. The link is
https://www.minervamedica.it/en/journals/international-angiology/article.php?cod=R34Y2018N05A0400.
The primary difference with estim muscle contractions is that you recruit both
fast and slow twitch fibers simultaneously rather than the physiologic way that
we recruit from slow to fast. I am assuming you are mainly using FES so those
contractions will not be maximal, so this conservative approach surprises me.
If I come across any more info, I will let you know.Therese Johnston
-----Original Message-----
From: Andrew Moul <amoul@xxxxxxxxx>
To: neuropt@xxxxxxxxxxxxx <neuropt@xxxxxxxxxxxxx>
Sent: Wed, Nov 2, 2022 3:22 pm
Subject: [neuropt] VTE and Estim in neuro population
#yiv7454929234 P {margin-top:0;margin-bottom:0;}Hey neuro peeps.
I have a neuro adjacent concern and hoping that someone can point me in the
right direction in the literature.
I work at an inpatient rehab facility, and we have a few physicians that are
incredibly conservative when it comes to physical therapy with patients with
either active VTE or history of VTE, even after anticoagulation. Specifically
with electrical stimulation. We treat patients with SCI and CVA and electrical
stimulation is a very common intervention. They do not want us to do electrical
stimulation in ANY patient with a VTE or history of VTE.
When we push them, they keep saying that "the risks vs benefits aren't there"
We want to show them that there is no difference in risk of a clot dislodging
with stim vs ambulation or any other means of increasing venous blood flow.
They allow us to ambulate patients, complete exercise, etc. But they have a
very specific aversion to estim, not even allowing stim on the lower
extremities with a patient that has a VTE in the upper extremity.
I have found a TON of articles about stim being used for VTE prophylaxis, but I
am hoping to find something that shows risk of muscle contraction and venous
blood flow from stim is no different than muscle contraction and venous blood
flow with all other activities.
Any help that you can provide would be appreciated, or if you have other
suggestions of people to reach out to, I would be grateful.
Thanks everyone.
Andrew Moul, PT, DPT, NCSBoard Certified Clinical Specialist in Neurologic
Physical TherapyAssistant Professor - ClinicalEugene Applebaum College of
Pharmacy and Health Sciences259 Mack Ave. Detroit, MI 48201 Office
#2337amoul@wayne.eduPronouns: he, him, his313-577-5531
In addition to my position at Wayne State University I am a practicing
clinician at the Rehabilitation Institute of Michigan. If my email response is
delayed please forgive me as I am likely engaged in patient care. I promise to
give your email thoughtful consideration as soon as possible.
