Research Evidence

The geko™ device has been the subject of scientific rigor to demonstrate its ability to increase blood circulation.
The body of evidence continues to grow, targeting clinical issues such as CVI, in the management of lower leg wounds.

Clinical Issue Device Effect

Abnormal Calf Muscle Pump
• Non-healing VLU correlate with impairment of the calf muscle pumps • The geko™ device creates concentric contraction of the extensor muscles
• 55% of patients with CVI have Calf Muscle Pump Dysfunction related to that cause dorsiflexion of the ankle and passive stretch of the calf flexor
altered gait, causing venous hypertension1 muscles. This acts as a calf muscle pump, which may enhance venous return
by increasing intramuscular pressure.2
• This may be effective in reducing venous stasis and edema, influencing
muscle oxygenation.2
• The results may indicate that the geko™ device effectively counteracts
increases in muscle blood volume and deoxygenated hemoglobin during
venous stasis.2
Edema
• Dependent edema begins in the perimalleolar region and ascends the leg in • Case studies have shown that some patients with chronic and complex edema
early stages of CVI, changes over time to become fibrotic and indurated with have had edema reductions with the geko™ device.4
Lipodermatosclerosis (LDS) due to changes in the fibrinolytic system.3 • In a trial of the geko™ device in individuals with CVI, leg swelling reduced by
• It may develop into lymphedema. 16% (p<0.05) in patients with venous disease.5,6
• Many patients with chronic VLU who were unable to tolerate ANY compression
therapy, or who only tolerated minimal 10-15 mm Hg compression were
able to start or increase their level of compression, leading to further edema
reduction.7
• There is also a fibrinolytic effect8 with the geko™ device which may reduce
the fibrotic changes of LDS.
Incompetent Venous Valves
• 84% of people with VLUs have superficial vein valve failure9, • The geko™ device reduces venous refilling and venous volume seen in venous
• Failure of the deep vein valves speeds venous disease9 and increases stasis due to the activation of the muscle pumps.10
the risk of venous ulcers • It decreases the amount of “sludge” blood (erythrocytes seen as light gray
• Both cause venous reflux and venous hypertension.9 in an ultrasound image) that is not effectively ejected forward through the
valves.11
• When off, the Venous Sludge Index (VSI) was 53.5, when activated, the geko™
device stimulation reduced the VSI to 7.6 ( p=0.0005).11
Decreased Range of Motion, Decreased Muscle Strength and Activation, Decreased Mobility
• Decreased ROM can be related to nociceptive and neuropathic pain, woody • In case series studies, patients have reported an increased ability to flex
fibrosis/lipodermatosclerosis, edema, and fixed ankle joint related to CVI, and dorsiflex their foot and ankle,3 with increased strength in their legs with
over time develop decreased muscle strength and activation, and decreased increased exercise tolerance.4
mobility.17, 12
Pain
• People living with VLUs often report pain as 10/10 and are unable to tolerate • Up to 90% of individuals with chronic VLUs using the geko™ device indicated
compression therapy, a key intervention in treating CVI.7 a marked reduction in pain13, 21
• Patients unable to tolerate compression pre-geko™ were able to start and/or
increase to therapeutic levels with the effect of the geko™ device7
Neuropathy
• Neuropathy in individuals with CVI without Diabetes is related to perineural • A pre-geko™ study of a low frequency stimulation device to either the
degeneration, edema, collagen replacement and contributes to trophic skin common peroneal or saphenous nerve,15 depending on proximity to the
changes and impaired healing.14 ulcer, in conjunction with a four-layer compression bandaging system over
• Worse in proximal medial and lateral malleolus, proximal medial and lateral 12 weeks, showed nearly 4x greater improvement in the nerve sensation and
calf and thigh.14 2x the response to capsaicin applied topically, (both parameters reflecting
• Maybe an unrecognized source of pain.14 improvement in C-fibre function).15
• The improvement of C-fibre activation is also an indicator of the reversal of
the neuropathy.18
Decreased Arterial Flow
• 15 to 30% of people with CVI will also have peripheral arterial disease (PAD)16 • The geko™ device augments arterial, venous and microcirculatory volume
flow in peripheral arterial disease patients and may prove a useful treatment
adjunct.19, 8
Ambulatory Venous Hypertension
• Unabated venous hypertension may result in dermal changes • The geko™ device was tested in 19 healthy volunteers, using settings of 100
with hyperpigmentation, subcutaneous tissue fibrosis, termed μs, 200 μs and 400 μs while volunteers were standing, sitting and lying. Mean
“lipodermatosclerosis”, and eventual ulceration.9 Venous Transit Times (VTT) from the dorsal foot to the popliteal vein were
measured along with ambulatory venous pressure and leg volume.
• The geko™ device had a statistically significant impact, reducing VTT by up to
64%, Mean ambulatory pressure by up to 67% and leg volume by 17% (P<
0.001).10
References:
1. Williams KJ, Ayekoloye O, Moore HM, Davies AH. The calf muscle pump revisited. J Vasc Surg Venous Lymphat
Disord. 2014;2(3):329-34. doi: 10.1016/j.jvsv.2013.10.053. Epub 2014 Jan 28
2. Zhang Q, Styf J, Ekström L, Holm AK. Effects of electrical nerve stimulation on force generation, oxygenation and
blood volume in muscles of the immobilized human leg. Scand J Clin Lab Invest. 2014 Aug;74(5):369-77
3. Vivas A, Lev-Tov H, Kirsner RS. In the Clinic: Venous Leg Ulcers. Ann Intern Med. 2016;165(3):ITC17-ITC32
4. Ingves MV, Power AH. Two Cases of Transcutaneous Electrical Nerve Stimulation of the Common Peroneal
Nerve Successfully Treating Refractory, Multifactorial Leg Edema. Journal of Investigative Medicine High
Impact Case Reports. October- December 2014: 1–4. Available at: http://journals. sagepub.com/doi/
abs/10.1177/2324709614559839
5. Williams KJ, Babber A., Ravikumar R, Ellis M, Davies AH. Pilot Trial of neuromuscular stimulation in the management
of chronic venous disease. 2 Posters from VEINS Conference, UK. 2014
6. Williams KJ, Davies AH. Pilot trial of neuromuscular stimulation in the management of chronic venous disease.
British Journal of Surgery. 2015;102:20
7. Harris C, Duong R, Vanderheyden G, Byrnes B, Cattryse R, Orr A, Keast D. Evaluation of a muscle pumpactivating
device for non-healing venous leg ulcers. Int Wound J2017; 14:1189–1198
8. Barnes R, Madden LA, Chetter IC. Fibrinolytic effects of peroneal nerve stimulation in patients with lower limb
vascular disease. Blood Coagulation and Fibrinolysis. 2016; 27:275-280
9. Eberhardt RT, Raffetto JD. Chronic venous insufficiency. Contemporary reviews in cardiovascular medicine
circulation. 2014;130:333-346. http://circ.ahajournals.org/content/130/4/333
10. Khanbhai M, Hansrani V, Sultan J, Burke J, McCollum CN. The effect of neuromuscular electrostimulation on lower
limb venous physiology. Academic Surgery Unit, Institute of Cardiovascular Sciences, Manchester Academic Health
Science Centre. Society of Academic & Research Surgery, VASCULAR 1 Wednesday 7 January 2015 09.45-11.20
http:/ www.surgicalresearch. org.uk/sars-2015/
11. Lattimer C, Azzam M, Kalodiki E. Common peroneal nerve stimulation reduces blood sludging in the popliteal vein
standing and lying. 2016. http://www.gekodevices.com/ media/128135/acp_2016_geko.pdf
12. Back TL, Padberg FT, Jr., Araki CT, Thompson PN & Hobson RW, 2nd. Limited range of motion is a significant factor in
venous ulceration. J Vasc Surg 1995; 22(5):519–23
13. Brooke J. Loney A. The geko™ a neuromuscular electrostimulation (NEMS) device and its healing effect on diabetic
foot and venous leg ulcers. CAET/WOCN Conference, May 2015
14 Padberg FT, Maniker AH, Carmel G, Pappas PJ, Silva MB, and Hobson RW. Sensory impairment: A feature of chronic
venous insufficiency. J Vasc Surg 1999;30:836-43
15. Ogrin R, Darzins P, Khalil Z. The use of sensory nerve stimulation and compression bandaging to improve sensory
nerve function and healing of chronic venous leg ulcers. Current Aging Science. 2009;2(1):72–80
16. Marston W. Mixed Arterial and Venous Ulcers. Wounds. 2011;23(12):351–356
17. O’Brien JA, Edwards HE, Finlayson KJ& Kerr G. Understanding the relationships between the calf muscle pump, ankle
range of motion and healing for adults with venous leg ulcers: A review of the literature [online]. Wound Practice &
Research: Journal of the Australian Wound Management Association, Vol. 20, No. 2, Jun 2012: 80-85
18. Orsted HL, O’Sullivan-Drombolis D, Haley J, LeBlanc K, Parsons L. The effects of low frequency nerve stimulation to
support the healing of venous leg ulcers. Canadian Association of Wound Care Consensus Paper – Nov 2016
19. Barnes R, Shahin Y, Tucker AT, Chetter IC. Haemodynamic efficacy of the geko™ electrical neuromuscular stimulation
device in claudicants. Oral presentation at Society of Academic & Research Surgery, 2014 Annual Meeting (January
8/9, 2014), Cambridge University, England. http://www.surgicalresearch.org.uk/wp-content/uploads/2013/10/1A_
Vascular_Surgery_1.pdf
20. Harding KG. A New Innovation in Wound Treatment. Presenting at CAWD Conference 2016.
21 Harris C, Rabley-Koch C, Carol, Ramage D, Cattryse, R Case Study, Debilitating chronic veno-lymphoedema: using a
muscle pump activator medical device to heal wounds and improve skin integrity

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