Feasibility of Neuromuscular Electrical Stimulation in a Young Patient With Hematological Malignancy Unable to Perform Active Exercise: A Case Report.

Patients with hematological malignancies often have difficulty performing aerobic and resistance exercises because of the disease and the adverse effects from chemotherapy. Neuromuscular electrical stimulation (NMES) may provide an alternative rehabilitation option for patients with cancer who cannot perform conventional exercise therapy. However, the safety and feasibility of NMES in patients with severe thrombocytopenia remain unclear. This case report describes the feasibility of NMES during chemotherapy in a young patient with B-cell acute lymphoblastic leukemia (B-cell ALL), severe thrombocytopenia, and cachexia. The patient was a woman in her 20s with B-cell ALL and cachexia. Severe fatigue and thrombocytopenia prevented her from performing aerobic or resistance exercises. After consultation with a physiatrist and hematologist, belt-electrode NMES was introduced to maintain and improve muscle strength. The hematologist approved NMES use regardless of platelet (Plt) count, provided the purpose was to induce muscle contraction. Belt electrodes were applied to the trunk, thighs, and lower legs. NMES was administered at 20 Hz for 20 minutes with a duty cycle of 5 seconds of stimulation followed by 2 seconds of rest. The stimulation intensity was set at the maximum tolerable level that produced visible muscle contractions. Pain, discomfort, and petechial bleeding were monitored during and after NMES. No adverse events, such as bleeding or skin reactions, were observed, even when the Plt count dropped to 19,000/μL. In this case, NMES was feasible and was performed safely in a patient with B-cell ALL who was unable to perform conventional exercise therapy during chemotherapy. This case demonstrates that NMES was feasible and well tolerated under the reported stimulation parameters in one patient with B-cell ALL; confirmation through prospective studies with larger samples is required.