Neuromodulation : journal of the International Neuromodulation Society
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The Prospective Italian Register of spinal cord stimulation (SCS) was designed to evaluate the clinical outcome of patients with severe peripheral arterial occlusive disease (PAOD) treated with SCS. Baseline data were collected for all patients with PAOD undergoing SCS treatment (September 1998 to February 2001) at 34 participating centers. If, after a 2- to 3-week trial, SCS demonstrated significant clinical benefits, a permanent implantable pulse generator was implanted. ⋯ All PAOD parameters improved significantly during follow-up. At 12 months postimplantation, 76.1% of patients were responsive to SCS therapy. The reduction in the use of analgesics and the number and duration of hospital stays offers clear economic advantages.
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We performed bilateral PNE (peripheral nerve evaluation) tests to identify which diagnostic groups are the most likely to profit from bilateral sacral neuromodulation since the results published so far have been obtained exclusively on the basis of unilateral sacral root stimulation. In contrast to the original unilateral technique, we performed bilateral PNE test stimulation in 62 patients (36 with urinary retention symptoms and 26 with overactive detrusor; 21 with idiopathic and 41 with neurogenic bladder dysfunction) over 3-4 days. We used an advanced electrode, model #3057 (Medtronic, Inc. ⋯ Of these, 27 suffered from neurogenic bladder dysfunction; in five cases the cause was idiopathic. We conclude that bilateral PNE test stimulation with side-specific amplitude adjustment and the use of advanced PNE electrodes led to a positive PNE result in 51.6% of the patients, which is a substantially increased response rate compared to previous studies. Of the diagnostics groups, the group with neurogenic bladder dysfunctions showed the highest response rate.
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The aim of the present study was to investigate the modulation and functional importance of nociceptive withdrawal reflexes elicited from the sole of the foot and recorded from the soleus (SOL) and tibialis anterior (TA) muscles during gait. Cutaneous electrical stimulation delivered at four locations of the sole of the foot was used to elicit the withdrawal reflex. Reflexes were recorded from eight healthy subjects during treadmill walking. ⋯ The TA reflex, expressed as a proportion of the electromyogram during unperturbed gait, was smallest during swing (p < 0.05, compared with stance) whereas the SOL reflex was maximal during swing (p < 0.05, compared with stance). The results suggest that the modulation of the reflex promotes an appropriate withdrawal while preserving balance and continuity of motion. These results may have applications in assisting gait of hemiplegics.
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Results from a clinical evaluation of Functional Electrical Therapy (FET) in chronic hemiplegic subjects are presented. FET is an intensive exercise that integrates voluntary maximized manipulation and augmented grasping by electrical stimulation of forearm and hand muscles. A total of 16 chronic hemiplegic subjects participated in a six-month long study. ⋯ The trends of UEFT and DT scores during the therapy (three weeks) were steeper when compared with the trend during follow-up (23 weeks). The changes of the trends during the study suggest that prolonged treatment could lead to bigger gains. We found standard deviations were increased towards the end of follow-up suggesting individual differences in response to either the treatment or the disablement process.