Neuromodulation : journal of the International Neuromodulation Society
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Objective. To investigate the effect of interval training supported by Functional Electrical Stimulation (FES) on ambulation ability in complete spinal cord injury (SCI). Methods. We trained four men with sensorimotor-complete (ASIA A) SCI, who achieved gait through FES of the quadriceps femoris, gluteus maximus, and common peroneal nerve on each side on a motorized treadmill. Training involved progressive interval walking exercise, consisting of periods of activity followed by equal periods of rest, repeated until muscle fatigue. ⋯ Some subjects increased the total distance walked by as much as 300% with progressive improvement over the entire training period; however, others made more modest gains and appeared to reach a performance plateau within a few training sessions. Conclusions. FES-supported interval training offers a useful and effective strategy for strength-endurance improvement in the large muscle groups of the lower limb in motor-complete SCI. We believe that this training protocol offers a viable alternative to that of continuous walking training in people with SCI using FES to aid ambulation.
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Objectives. This technical report provides a detailed description of a method of transforaminal nerve root stimulation useful in the treatment of chronic pain conditions. Material and Methods. We describe a patient who presented with a medically refractory peripheral neuropathy and suffered from bilateral foot pain. We utilized transforaminal nerve root stimulation to provide robust stimulation paresthesias to the painful areas. ⋯ Results. The patient experienced appropriate pain relief after the stimulation and did not have any complications related to the procedure. Conclusions. We describe a method of transforaminal nerve root stimulation that can be easily implemented by providers using the standard tools available to them. Transforaminal nerve root stimulation may be appropriate for patients in whom more traditional approaches such as spinal cord stimulation or peripheral nerve stimulation are suboptimal.
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Objectives. To investigate the different approaches in the field of functional electrical stimulation (FES) control of gait and address fundamental perquisites to enable FES walking systems to become safer, more practical, and therefore clinically efficacious. Design. Systematic review was conducted from electronic data bases up to March 2008. Studies with innovative control strategies were highlighted for analysis, but all relevant literatures were described to deliver a broad viewpoint. ⋯ Finite state controllers based on a set of deterministic rules to process feedback signals seemed more suitable to provide accurate command-and-control compared with dynamic or neural network controllers. Conclusions. Progress in the development of closed-loop FES walking systems has been impeded by their lack of practicality. In the near future, this obstacle could be overcome via implanted systems, especially if using controllers based on deterministic rule sets derived from motion sensor feedback.
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Ultrasound-Guided Localization of Difficult-to-Access Refill Port of the Intrathecal Pump Reservoir.
Introduction. Ultrasound guidance is being increasingly utilized in many chronic pain interventions. This is a report of the use of ultrasound imaging for accessing an intrathecal pump. Case Report. A 56-year-old patient with a programmable implanted intrathecal drug delivery system for chronic non-malignant pain needed a pump refill of sufentanil. ⋯ As the patient continued to have a collection of fluid during his following visit, the collection was aspirated under ultrasound guidance. The specimen revealed a proteinaceous collection with minimal quantities of sufentanil. Conclusion. This is a successful demonstration of ultrasound guidance to facilitate access to a difficult-to-access refill port of a pump reservoir secondary to the formation of a seroma.
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Objectives. Post-herpetic neuralgia (PHN) is a painful complication of herpes zoster infection and a common cause of chronic severe pain in elderly and/or debilitated patients. Although a wide range of treatments have been tried, a substantial number of patients continue to experience pain which remains refractory to all therapies. Increasingly, studies have demonstrated that oral opioids can have a beneficial effect on neuropathic pain. ⋯ Patients most commonly reported improvement in the deep component of their pain, next allodynia, and less so superficial lancinating pain. Conclusions. In conclusion, while a complex therapy, long-term use of intrathecal opioids is well tolerated, doses are titratable, administration is safe, and may help relieve severe short- and long-term neuropathic pain in selected PHN patients. Whether the addition of newer investigational intrathecal agents could improve these results is yet to be determined.