Neuromodulation : journal of the International Neuromodulation Society
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Objective. In a randomized controlled trial comparing manual with automated computerized adjustment of spinal cord stimulators in patients with implanted power generators, automated adjustment conferred the following advantages: 1) more settings tested in a given time, 2) significantly greater pain/paresthesia overlap, 3) increased battery life, and 4) a $303,756 (95% confidence intervals = $116,503-491,009) reduction in lifetime per patient cost. The current study analyzes the sensitivity of this cost-savings to usage time/day, inflation, discount rate, and years of use. ⋯ This savings is attributable to increased battery life. Conclusion. Sensitivity analyzes reveal that the significant cost-savings achieved with computerized, patient-directed adjustment of spinal cord stimulation in selected patients with chronic pain is robust across a representative range of parameters.
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Long-term outcomes of 115 patients treated with continuous intrathecal baclofen infusion are reported. A prospective follow-up study was conducted in eight centers. Patients were followed up over a 12-month period. ⋯ Types of adverse events reported were wound complications (22%), catheter problems (36%), cerebrospinal fluid leakage (25%), and other complications (17%). Intrathecal baclofen reduces spasticity and severity of patient-reported problems but its effect on quality of life and functionality is less apparent. Improvements are desired in selection criteria, design of spinal catheters, and outcome scales.
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The aim of this study was to perform a preliminary evaluation of a new method for therapeutic exercise of grasping in patients with upper limb disability. The new method combines active voluntary exercise augmented with electrical stimulation and controlled by using force feedback. The feedback has two functions: automatic control of the intensity of electrical stimulation by minimizing the tracking error, and biofeedback to the patient on the computer screen. ⋯ Results in healthy subjects were used for reference and for stimulation controller evaluation. The therapy in incomplete tetraplegic subjects of 45-min daily session delivered during four weeks. The results of pilot study show that augmentation of voluntary grip force control with presented system is possible.
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Objective. Classically, a decerebrated animal by mesencephalic lesioning is considered the paradigm for experimental study of spasticity that accompanies cerebral palsy, but, the model does not actually correspond with anatomical and pathologic realities. Therefore, a new and novel animal model is needed. Our objective was to create a more adapted animal model to be used in neuromodulation and functional electrical stimulation research. ⋯ Conclusions. This animal model presents anatomic similarities to lesions currently present in cerebral palsy and related diseases. The model also shows electrophysiologic differences that signal chronic brain damage. Therefore, this method is useful in research when spastic syndromes produced by upper motor lesions need to be modeled.
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Evidence-based medicine is gaining increasing penetrance in the United States. Neuromodulation providers need to know how to use this resource and how to get what we do appropriately evaluated and included in structured reviews and meta-analyses. Randomized clinical trials are not the only form of evidence for patient care activities; other, equally valid strategies are available and should be used for interventions that may preclude blinding and randomization. Those who determine payment are going to use evidence-based medicine to make decisions that may not be in the best interests of our patients or our profession.