Neuromodulation : journal of the International Neuromodulation Society
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Observational Study
Coordinating Upper and Lower Body During FES-Assisted Transfers in Persons With Spinal Cord Injury in Order to Reduce Arm Support.
The goal of this study is to minimize arm forces applied during sit-to-stand (STS) transfers in persons with spinal cord injury (SCI) by using functional electrical stimulation (FES) applied to lower limbs muscles. ⋯ Lowest arm forces values were obtained for STS motions that were similar to those of healthy persons in terms of trunk movements and beginning of lower limb movements in regards to maximal trunk acceleration signal. The FES system was able to mimic the rising motion of a healthy individual by triggering the FES at the appropriate moment. This method could prove useful for pivot transfer, therapeutic or functional verticalization.
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Spinal cord stimulation has now been used for four decades and has become an established treatment for neuropathic pain. Spinal cord compression by formation of excessive fibrous tissue at the level of an epidural neurostimulation electrode is a rare, delayed, but serious complication of neuromodulation for chronic neuropathic pain that may appear at various timings after the initial surgery, but is usually preceded by progressive tolerance and fading of the pain-relieving effect of the neurostimulation. ⋯ Careful surgical removal of the fibrous tissue can be performed to allow decompression of the spinal cord and may help to obtain a more efficient pain management. As large surgical electrodes could be specifically associated with compressive scar tissue formation, they should therefore be considered as a second line of treatment after percutaneous leads.
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The terms "anodal" and "cathodal" are widely used to describe transcranial direct current stimulation (tDCS) of opposing polarities, often interpreted as excitatory and inhibitory, respectively. However, high-definition tDCS allows for complex electrode configurations that may not be characterized accurately as "anodal" and "cathodal." ⋯ More research is warranted on the hypothesized inhibitory or excitatory effects of different electrode configurations. Moreover, conventional bicephalic 1 × 1 configurations using sponges or HD electrodes may not be accurately described by the terms "anodal" and "cathodal" either, as these terms only pertain to the desired effects over an area of interest, but not any other areas affected. Therefore, design and interpretation of (HD-)tDCS and conventional tDCS research studies should not be constrained by the anodal/cathodal dichotomy.
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Case Reports
Submammary Placement With Mastopexy for Implantable Pulse Generator Site Pain in Thin Women.
Implantable pulse generators for neurostimulation and other indications are becoming more widespread. Pain at the generator site, erosion through the subcutaneous issues, and migration of the generator are frequent post-operative complications that result in high rates of re-operation. We report a case where a submammary combined approach with plastic surgery for improved soft tissue coverage resulted in better esthetic and functional outcomes in a thin woman. ⋯ Submammary placement of implantable pulse generators in thin women combined with mastopexy may result in improved soft tissue coverage, decreased pain at the generator site, and a low rate of complications.
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High-frequency spinal cord stimulation (HF SCS) is a relatively new modality of SCS. The present general advice concerning pregnancy and SCS, in general, is to turn the device off because of insufficient knowledge concerning the impact on the developing fetus. As HF stimulation generates higher energies, potential adverse fetal effects could be theoretically stronger. ⋯ This case describes both a miscarriage and the birth of a healthy baby in a patient treated with HF SCS. It is not possible to rule out that the HF SCS could have caused the miscarriage. Also, the birth of the healthy baby after the second pregnancy in which HF SCS was used the whole period, is not a valid reason to declare HF SCS and SCS, in general, safe during pregnancy. As no sufficient data are available, we must remain cautious about any unknown possible adverse effects or delayed adverse events because of SCS and maybe especially HF stimulation. All outcome data on pregnancies during all types of SCS ideally should be collected and analyzed.