Long-Term Prevention of Pressure Ulcers in High-Risk Patients: A Single Case Study of the Use of Gluteal Neuromuscular Electric Stimulation

Bogie KM, Wang X, Triolo RJ. Long-term prevention of pressure ulcers in high-risk patients: a single case study of the use of gluteal neuromuscular electric stimulation.ObjectiveTo evaluate the efficacy of gluteal neuromuscular electric stimulation (NMES) using implanted percutaneous electrodes to improve regional tissue health and decrease the risk of pressure ulcer development.DesignCase study of long-term use of gluteal NMES.SettingCommunity.ParticipantA patient with a C4-level American Spinal Injury Association grade A spinal cord injury, 22 years postinjury at study enrollment, and a clinical history of regular grade II and occasional IV ischial pressure ulcers.InterventionGluteal NMES using an electric stimulation system comprising a combination of implanted percutaneous electrodes and an external stimulator (controller).Main Outcome MeasuresObjective measurements of tissue health comprising evaluation of gluteal muscle thickness, interface pressures, and regional blood flow. Subjective self-reported sitting tolerance.ResultsIncreased gluteal muscle thickness and blood flow together with reduced regional interface pressures occurred. Weight-shifting because of alternating left and right gluteal NMES became more effective over time as the muscles strengthened. Sitting tolerance more than doubled.ConclusionsA gluteal NMES system has been developed that provides both improved regional tissue health and dynamic weight shifting while seated in the wheelchair. In the current case, regular daily use had a positive impact on multiple indirect indicators of tissue health. Continued use was indicated as the positive effects were lost when stimulation was discontinued.