The Effect of Electrical Muscle Stimulation and In-bed Cycling on Muscle Strength and Mass of Mechanically Ventilated Patients: A Pilot Study

Background Critically ill patients experience muscle weakness, which leads to functional disability. Both functional electrical stimulation (FES) and in-bed cycling can be an alternative measure for intensive care unit (ICU) patients who are not feasible for active exercise. The aim of this study was to examine whether FES and in-bed cycling have a positive effect on muscle mass in ICU patients. Methods Critically ill patients who received mechanical ventilation for at least 24 hours were included. After passive range of motion exercise, in-bed cycling was applied for 20 minutes, and FES was applied for 20 minutes on the left leg. The right leg received in-bed cycling and the left leg received both FES and in-bed cycling. Thigh circumferences and rectus femoris cross-sectional area (CSA) were assessed with ultrasonography before and after the intervention. Muscle strength was assessed by Medical Research Council scale. Results A total of 10 patients were enrolled in this study as a pilot study. Before and after the intervention, the CSA of right rectus femoris increased from 5.08 ± 1.51 cm2 to 6.01 ± 2.21 cm2 , which was statistically significant (P = 0.003). The thigh circumference was also increased and statistically significant (P = 0.006). There was no difference between left and right in regard to FES application. There is no significant change in muscle strength before and after the intervention (right and left, P = 0.317 and P = 0.368, respectively). Conclusions In-bed cycling increased thigh circumferences rectus femoris CSA. Adding FES did not show differences

The Adaptation and Development of the Proclean Notion of Κατάβασις: From Proclus to Maximus the Confessor

This paper examines the impact of Proclus’ notion of divine descent, i.e., κατάβασις, on the formation of core theological doctrines in Pseudo-Dionysius and Maximus the Confessor. The notion of κατάβασις was originally employed by pagan Proclus to explain the downward providence of gods toward humans, emphasizing the dominant role of gods for human perfection. In his exegesis on Alcibiades I, Proclus identified Socrates as the incarnation of divine providence, a divinely inspired lover in charge of Alcibiades’ conversion to philosophical life. Pseudo-Dionysius adapted the Proclean notion of κατάβασις by supplementing it with the Christian notion of God’s ecstatic love, understood as God’s providential act toward His creation. In the Celestial Hierarchy and Ecclesiastical Hierarchy, Dionysius endeavored to reveal the reciprocal-ecstatic union between God and humans made possible by His ecstatic κατάβασις during the liturgy. Maximus adapted and further developed the Dionysian notion of κατάβασις. While stressing the crucial role of the κατάβασις for human salvation, he gave it a new meaning by synthesizing it in the context of his anthropology, which stressed the holistic transformation of the human body and soul as a result of the divine descent