Wednesday, 9 July 2008
Learning Objective 1: describe the usefulness of plantar stimulation in mobilizing lower extremity fluid in patients with heart failure.
Learning Objective 2: describe how total body composition testing with DEXA technology is used to assess improvements in total body fluid.
Heart failure (HF) constitutes the inability of the heart to supply adequate oxygen to the metabolizing tissues. Peripheral hemodymanics can be compromised reducing muscle blood flow due to an elevated back pressure limiting the driving pressure across the tissues and leading to considerable edema in the dependent portion of the body. Previous research has shown that the soleus muscle plays a critical role in promoting venous and lymphatic return to the central circulation, and that the use of plantar stimulation can reverse the pooling of fluid in the dependent lower extremities. In this study of 31 persons with diastolic heart failure, plantar stimulation was provided using a Juvent Corporation platform operating at 45 Hz with 50 micron peak-to-peak displacements. This displacement is sufficient to stimulate the mechanoreceptors on the plantar surface of the feet to stimulate the soleus muscle to contract thus propelling venous and lymphatic fluid from the lower extremities of the body. To assess the change in edematous fluid following 1 month of plantar stimulation, we utilized DEXA technology to ascertain the change in total body composition. We also assessed several parameters prior to and after the one month test including: functional status using the 6-minute walk test, quality of life using the Minnesota Quality of Life for Heart Failure tool, cardiopulmonary function using SPO2 and beat-to-beat blood pressure and heart rate monitoring, and assessment of venous function in the calf using air plethysmography. Results of this research will be presented.