Neuromodulation : journal of the International Neuromodulation Society
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We report on the use of a new percutaneous technique for peripheral nerve stimulation (PNS) treatment of chronic pain. A 56-year-old woman was diagnosed with algodystrophic syndrome, now called Complex Regional Pain Syndrome, type 2 (CRPS2), due to a lesion of the right medial nerve despite surgical revascularization, angioplasty and stent insertion. ⋯ After one year of follow-up, the patient was still experiencing good pain relief. We conclude that this novel percutaneous PNS technique offers the advantage of being a minimally invasive approach that can be easily adopted for the management of chronic pain.
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We had shown in our previous research that the stability assessment and control are essential for generation of faster and more energy efficient functional electrical stimulation (FES) and/or crutch-assisted gait. The objective of our recent research work has been to design a wearable and portable system for gait stability analysis with online capabilities that is also applicable to crutch-assisted gait modes. The developed wearable stability assessment system for as yet only biped gait consists of foot switches and goniometers attached to the leg joints. ⋯ The wearable system was tested on five healthy subjects and one above-knee amputee. It proved to be reasonably accurate if compared to the classical, motion analysis system based method. However, additional work is required to port the system to the FES assisted and/or crutch assisted gait.
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This study investigated the activation dynamics of electrical stimulation-evoked muscle contractions performed by individuals with spinal cord injury (SCI). The purpose was to determine whether electrical stimulation (ES) firing patterns during cycling exercise should be altered in response to fatigue-induced changes in the time taken for force to rise and fall with ES. Seven individuals with SCI performed isometric contractions and pedaled a motorized cycle ergometer with stimulation applied to the quadriceps muscles. ⋯ Cycling power output fell approximately 50% during the five minutes of exercise, however, there was no change in the time taken for torque to rise or fall. The magnitude of ES-evoked muscle torques decline substantially with fatigue, however, the overall pattern of torque production remained relatively unchanged. These results suggest there is no need to alter stimulation firing patterns to accommodate fatigue during ES-evoked exercise.
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Twenty patients with chronic intractable spinal spasticity were implanted with a totally implantable programmable pump for intrathecal administration of baclofen. The objective of this study was to evaluate the relationship between pump and the host. Clinical efficacy of the therapy was evaluated by the Ashworth Scale, the Spasms Frequency Scale, and the Functional Independence Measure (FIM) motor scores. ⋯ Fifty percent of the patients were afraid of pump failure and 30% were afraid of their alarm signals going off. The fact that most patients would undergo this therapy again and some would even pay for it directly in the absence of public insurance for the therapy were indices of patient satisfaction with the procedure. Because this was a small study, we believe that larger studies are necessary to corroborate our findings.
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Phantom limb pain (PLP) is a type of neuropathic pain syndrome that has evoked much interest in scientific and clinical fields. The condition is often intractable and severely debilitating. Though there are anecdotal reports in the literature of successful management of individual cases with brain and spinal cord stimulation, it has not been possible to develop a system of management that is consistently successful, mainly due to the paucity of basic neurophysiological data about PLP and its pathways in the central nervous system (CNS). ⋯ We describe two cases of PLP that have been satisfactorily treated with CNS stimulation (motor cortex and then periventricular gray in one and spinal cord in the other) and have been subjected to single photon emission computed tomography (SPECT) studies when in pain and then during stimulation with recorded pain relief. We found that regardless of the site of stimulation in the CNS, pain relief is associated with blood flow changes in similar areas of the brain, mainly the parietal and cingulate cortex and also in the thalamic nuclei and the central gray matter. Further studies of this kind should reveal more about the complex mechanisms of PLP and other forms of neuropathic pain.