Neuromodulation : journal of the International Neuromodulation Society
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Objectives. Motor cortex stimulation has been used as a treatment for intractable pain. However, the mechanisms underlying its effects remain unclear. In this study, neuroplasticity induced by chronic sensorimotor cortex stimulation was investigated experimentally on the basis of c-Fos expression. ⋯ We examined the neural activation in response to chronic stimulation using c-Fos immunopositivity. Results. The results are as follows: 1) c-Fos was significantly expressed immediately after the stimulation compared with that in the control; 2) c-Fos expression became extensive over the various regions with an increase in stimulation duration; and 3) after two months of stimulation, c-Fos was expressed not only on the stimulation side, but also within the contralateral cerebral hemisphere. Conclusions. Changes in c-Fos expression induced by long-term stimulation indicate the existence of a time-dependent neural plasticity.
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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.
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In neuromodulation treatment and research, the informed consent of the patient or research subject is considered to be a moral precondition. In order to be morally valid, the consent of the person should be informed and voluntarily given, and the person should have decision-making capacity. Decision-making capacity matters from a moral point of view because it enables the patient or research subject to make a well-considered decision about treatment or research participation. ⋯ In this paper, it is argued that full decision-making capacity in the context of neuromodulation is an illusion. This does not imply that we should do away with the moral ideals of decision-making capacity and valid informed consent. It is part of the responsibility of clinicians involved in neuromodulation to be aware of and sensitive to the different threats to the decision-making capacity of patients suffering from neurological and neuropsychiatric disorders, and to assist patients in making decisions that are as well considered as possible in the given circumstances.