Impact of NMES and HPRO on Recovery After SAH- Pilot Study

Inclusion criteria

• . Being diagnosed with aneurysmal SAH
• . Aneurysmal repair within 48 hours of ictus.
• . Age between 25 and 80 years old. (>=25 years old and <=80 years old)
• . Expected stay in the NCCU > 72 hours.
• . Admission Hunt Hess Grade >=2.
• modified Fisher score >1.

Exclusion criteria

• . Subjects diagnosed with SAH from trauma, rupture of an arteriovenous malformation, neoplasm, vasculitis, or other secondary causes;
• . Unlikely to survive one week post hemorrhage either due to impending brain death or likely request for withdrawal of care;
• . Unlikely to remain in the ICU for more than 7 days;
• . Body mass index < 15 or >40 kg/m2;
• . Allergy to whey protein;
• . Evidence of lower extremity paresis or spasticity within 48 hours of injury
• . Pre-morbid modified Rankin Score >1.
• . Known pregnancy
• . Presence of active malignancy
• . Diagnosis of an inflammatory disorder
• . Presence of a neuromuscular disorder
• . Diagnosis of chronic renal insufficiency or acute kidney injury (GFR < 30 mL/min/1.73m2)
• . Hepatic insufficiency defined as AST/ALT levels >2.5 above normal upper limits.
• . On-going seizure activity as assessed clinically or by electrographic detection on continuous electroencephalogram (cEEG) at time of enrollment
• . Prisoner.