NMES treatment

Patients were placed in a supine position. The patient’s calfskin was exposed, and then two self-adhesive electrodes (6 cm × 9 cm) were placed on the motor point of the target muscle (the skin area with the lowest stimulation threshold when stimulating the muscle)(Fig. ​muscle)(Fig.2).2). The adhesive area was marked with a marking pen to allow stimulation in the same position every day. The electrode plate was connected with a neuromuscular electrical stimulator (QT-22 T, ITO, Japan). Based on the recommendations of the physiotherapy techniques textbook, for mild to moderate disuse myatrophy, the parameters are set as follows: pulsed current and a biphasic, asymmetrical, balanced rectangular waveform [21, 22], frequency of 30 Hz(the frequency that feels comfortable to the human body [23]), wave width of 300 μs(consistent with the time value for stimulating the motor nerve [24]), on/off ratio of 1:4, adjusting the current intensity according to the patient’s feelings, 20 min/time, twice a day for at least 7 days until the patient was released from the ICU. Effective muscle stimulation is defined as palpable and visible muscle contraction. The same therapist performed the treatment.

Neuromuscular electrical stimulation treatment. a NMES on the gastrocnemius and tibialis anterior muscles in experimental group I . b NMES on gastrocnemius alone in experimental group II