1. Neuromuscular Electrical Stimulation Therapy for Muscular Atrophy Nick Cruickshank Mary Collins

2. Experiment Objectives Study of muscular atrophy in individuals following surgical intervention or chronically disabling disease The population of interest includes individuals diagnosed with knee osteoarthritis (KOA) who have undergone total knee replacement surgery (TKA) Neuromuscular Electrical Stimulation (NMES) – experimental therapy used as a preventative measure against muscular atrophy

3. Treatments – Fixed Effects 1.NMES – subjects treated with neuromuscular electrical stimulation 2.PT – subjects treated with the standard care of physical therapy 3.DT – subjects given drug therapy to increase acetylcholine signaling and stimulate motor function

4. Experimental Procedure Muscular atrophy will be quantified based on quadriceps cross-sectional measurements from each treatment group Muscle tissue sectioned and frozen in Optimal Cutting Media in cooled isopentane Immunohisotchemistry and computed tomography used to measure quadriceps sections cut from muscle tissue Measurements taken after five weeks of treatment therapy

5. Statistical Model Y ij = μ + α i + ε ij i = treatments = 1, 2, 3 j = subjects = 1, 2, …, r α i = Fixed Effects of Muscle Atrophy Prevention Technique (NMES, PT, DT) ε ij = Experimental Error with Mean = 0 and Variance = σ e 2

6. Statistical Analyses Tukey method for all pairwise comparisons Widest margin of error Analysis of effectiveness of each treatment Specific contrasts: ( * = Main contrasts of interest) NMES vs. PT * NMES vs. DT * NMES vs. PT + DT * PT vs. DT PT vs. NMES + DT DT vs. NMES + PT

7. Power Analysis Significance Level, α = 0.05 Power = 0.9 V1 = 2, V2 = 21 τ1 = -1σ, τ2 = +1σ, τ3 = 0 σ 2 = 1344.72 * ϕ = √[(rΣτ i 2 )/tσ 2 ]  ϕ = 2.309401077 r = 8, n = 24 * From prior experimental data collected in the lab.

8. Results NMES is the treatment of interest, with PT and DT used as comparison variables NMES is an experimental therapy that would be the most cost-effective treatment Ideally the experiment proves that NMES is equally effective if not more effective at treating muscular atrophy