Overview
The aim of Re-Walk-Easy is to evaluate the effects of rehabilitation based on electrical stimulation on the motor performance of critically ill patients. The study will also investigate the pathophysiology of the two forms-the myopathic-predominant and the polyneuropathic-predominant variants-by examining the longitudinal progression of CIP and CIM and determining which form benefits more from electrical stimulation as a rehabilitative approach.
Description
Although rehabilitation is often recommended to patients with Intensive Care Unit Acquired Weakness (ICU-AW) to counteract the induced muscle weakness, systematic reviews failed to determine its efficacy. Neuro Muscular Electrical Stimulation (NMES) is part of clinical practice in ICU-AW however its effects are still under debate. The investigators hypothesize that this uncertainty stems from the lack of distinction between the two forms of the condition-Critical Illness Polyneuropathy (CIP) and Critical Illness Myopathy (CIM)-which have distinct pathological features and disease trajectories. In addition, the investigators hypothesize that motivating patients by requiring voluntary muscle activation during the Electrical Stimulation (i.e. Functional Electrical Stimulation - FES) will enhance rehabilitation.
The study will test the following hypothesis through a longitudinal clinical trial aimed at determining:
- which form will benefit the most from FES based-rehabilitation,
- the biomarkers of walking recovery in ICU-AW.
Eligibility
Critical Illness Patient Inclusion Criteria:
- clinical diagnosis of tetra/paraparesis of peripheral origin as disclosed by ENG/EMG examination;
- be independent before the episode of critical illness
Critical Illness Patient Exclusion Criteria:
- history of previous comorbidity for ICU-AW;
- previous known chronic polyneuropathy;
- severe coagulopathy;
- severe disorder of consciousness;
- contraindications to Electrical Stimulation application
Healthy Subjects Exclusion Criteria:
- Prosthetic implants
- musculoskeletal, neurological, cardiovascular and pulmonary disorders that may alter the gait