Research Areas of Focus
Neuromuscular stimulation of the lower limb
Stimulation of the muscle pumps of the calf and foot increases haemodynamic parameters in healthy subjects. Trials are being conducted to evaluate the effect of neuromuscular electrical stimulation (NMES) on haemodynamic and clinical parameters associated with vascular pathology.
Current Clinical Trials
EMMU - Evaluation of Musculoskeletal Microcirculation with Ultrasound
Many medical and surgical therapies in the treatment of peripheral vascular disease aim to increase the circulation in the legs. Measuring the changes in perfusion of skin and muscle are important parameters that are difficult to measure, especially in the management of diabetes and peripheral arterial disease. We are developing a new technique using ultrasound of the leg in combination with an infusion of microbubbles to the blood, which will provide important information into the aetiology and management of these diseases.
Further information: https://dl.dropboxusercontent.com/u/110640479/EMMU%20patient%20information.pdf
ULCERS - NMES in the management of diabetic foot ulcers
Diabetes affects approximately 347 million people worldwide, and by 2030 the WHO projects that diabetes will be the 7th leading cause of death. Diabetic foot ulcers are estimated to occur in 15% of all patients with diabetes, often co-existing with neuropathy and peripheral vascular disease which compromise the limb’s ability to heal. Foot infections in this cohort are common, and diabetic foot ulcers serve as a portal for infective organisms to enter the body. A diabetic foot infection is often the pivotal event leading to gangrene and lower extremity amputation. Diabetes accounts for over one million leg amputations every year, and represents 60% of all amputations in developed countries.
We are evaluating the metabolic profiles of diabetics with foot ulcers, and following them over 6 weeks to try to identify why some peoepl heal and others do not. We are also evaluating whether use of NMES can increase rates of healing.
Peripheral neuropathy is a dysfunction of the nerves most commonly affecting the arms and legs. Diabetes is the leading cause of neuropathy in the Western world, and diabetic neuropathy is estimated to affect between 20-50% of diabetic people. As regards complications of diabetes, peripheral neuropathy has the greatest detrimental effect on quality of life. Diabetic neuropathy is implicated in 50-75% of non-traumatic limb amputations.
Exercise has shown to have a positive effect on peripheral neuropathy, and we are investigating if NMES may work in a similar way.
Peripheral arterial disease (PAD) is a disease of the large and small arteries of the body, and has associations with cardio-respiratory disease, stroke, and diabetes. Its incidence is estimated at 7-14% in the general population, increasing with age to ~20% in the over-seventies. It is associated with progressive and profound effects on mobility, skin integrity and quality of life. Significant clinical manifestations include intermittent claudication (pain on walking that goes away when you stop), rest pain, gangrene, and limb loss. Management of PAD is based on exercise and lifestyle modification (smoking cessation, weight loss), as well as good control of existing blood pressure and diabetes.
Exercise can be difficult in intermittent claudication as it is associated with pain. We wish to evaluate if NMES may be helpful in dealing with this pain.
Closed to recruitment:
VeINS – Venous Insufficiency and Neuromuscular Stimulation
Problems with the veins in the legs can lead to fluid build-up, causing swelling, discomfort and ulceration. There are various options to treat this, including compression stockings, surgery and the use of mechanical devices. The VeINS trial will evaluate NMES in the management of chronic venous disease.
et al., 2017, Non-Invasive Management of Peripheral Arterial Disease., Adv Exp Med Biol, Vol:906, ISSN:0065-2598, Pages:387-406
et al., 2017, A Review of the Evidence to Support Neuromuscular Electrical Stimulation in the Prevention and Management of Venous Disease., Adv Exp Med Biol, Vol:906, ISSN:0065-2598, Pages:377-386
et al., 2017, Simulated Wound Assessment Using Digital Planimetry versus Three-Dimensional Cameras: Implications for Clinical Assessment, Annals of Vascular Surgery, Vol:41, ISSN:0890-5096, Pages:235-240
et al., 2017, A TEMPORAL AND SPATIAL ANALYSIS APPROACH TO AUTOMATED SEGMENTATION OF MICROBUBBLE SIGNALS IN CONTRAST-ENHANCED ULTRASOUND IMAGES: APPLICATION TO QUANTIFICATION OF ACTIVE VASCULAR DENSITY IN HUMAN LOWER LIMBS, Ultrasound in Medicine and Biology, Vol:43, ISSN:0301-5629, Pages:2221-2234
et al., 2017, Randomised Controlled Trial: Potential Benefit of a Footplate Neuromuscular Electrical Stimulation Device in Patients with Chronic Venous Disease, European Journal of Vascular and Endovascular Surgery, Vol:53, ISSN:1078-5884, Pages:114-121