Neuromodulation : journal of the International Neuromodulation Society
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Objective. This article presents an overview of the use of intrathecal bupivacaine (with and without opioid), focusing on laboratory data and clinical use for chronic pain. Some background on epidural use is included to support the intrathecal literature. ⋯ In addition, outcome studies are needed specifically to differentiate use of intrathecal bupivacaine based on the source and mechanism of pain. Conclusions. While there are few long-term randomized prospective studies at this point, we conclude that intrathecal bupivacaine appears to be a safe and efficacious treatment in both cancer and noncancer pain.
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Objectives. Our objective was to describe and analyze through a third party disinterested observer the results obtained by using motor cortex stimulation (MCS) for the treatment of central dysesthetic diffuse-distal type of paraplegic pain and intentional tremor secondary to the total removal of a cervical ependymoma. Design. ⋯ In this single case report MCS was extremely useful in eliminating almost all of the patient's pain-evoked phenomena. Both steady burning pain and tremor were also improved. This is only one case report and MCS warrants further investigation as to its utility in controlling central dysesthetic pain in paraplegia and postchordotomy dysesthesias.
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The objective of this study was to test myoelectrically controlled functional electrical stimulation of the same muscle (AutoMCS) on patients with either stroke or spinal cord injury. The paretic anterior tibialis (TA) muscle was stimulated with an amplitude controlled continuously by the volitional myoelectric signal from the same muscle. Surface electrodes were used and volitional myoelectric signals were extracted by analog/digital signal processing techniques. ⋯ An immediate carryover effect was seen in one stroke subject. The analysis of the tracking control showed only little loss of controllability with the system. We conclude that for selected subjects this method can instantly increase the muscle force of the anterior tibialis without significantly compromising tracking control or tracking delay.
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We modified a commercial indoor rowing machine (Concept 2 Inc., Morrisville, NJ, USA) for a functional electrical stimulation (FES) assisted indoor rowing exercise in which the rowers must repeatedly press the two switches on the handle that stimulate their paralyzed leg muscles. The objective of this study was to automate the delivery of electrical stimulation to prevent potential repetitive strain injuries and to expand the user base to clients with impaired hand function. The modifications for development of the FES rowing machine and clinical trials were all performed in the University of Alberta. ⋯ Two paraplegic users of the older manual control system tested the new automatic controller. The automatic FES controller spent more electrical stimulation per rowing cycle but it did not require repetitive thumb presses, required less concentration, and was preferred by the clients. We conclude FES rowing with the new automatic controller was easier and safer and expanded the user base of the FES rowing exercise to those with affected hand.