Neuromodulation : journal of the International Neuromodulation Society
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This paper presents the use of multiple sensors for walking assessment and provision of cognitive feedback during early re-education of incomplete spinal cord injured (SCI) humans. The paper is focused on the swing phase estimation as an important part of the Functional Electrical Stimulation (FES) gait re-education system for incomplete spinal cord injured persons. The proposed sensory system comprises four accelerometers, one gyro placed at the shank of the paretic leg, and two goniometers placed at the knee and ankle joints, respectively. ⋯ The results showed that the timing of FES triggering played an important role in sensory-supported FES-assisted walking, that is, the auditory feedback was also a cue to the therapist controlling the FES. The swing quality estimation enabled patients to voluntarily improve their walking, consequently the intensity of FES assistance was decreased. This suggests that the use of an FES multisensor system for cognitive feedback is efficient rehabilitative method in early stage of rehabilitation of walking.
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Patients with refractory angina pectoris usually exhaust conventional treatment of ischemic heart disease. They frequently need opioids and still have angina pectoris despite earlier coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). In those cases, treatment strategies including neuromodulation techniques such as transcutaneous electrical neurostimulation (TENS) or spinal cord stimulation (SCS) often are successful. ⋯ This suggests that two electrodes implanted in the epidural space may stabilize each other mechanically. On the other hand the variety of program adjustments is enlarged, due to the additional poles on the second electrode. On the basis of these case reports, we suggest that implantation of a dual electrode SCS-device might be the solution in case of repeated displacement of a single SCS-electrode.
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This study was aimed to test whether the administration of transcutaneous electrical neural stimulation (TENS), heat or cold alone, or the coadministration of TENS in combination with heat or with cold may alter the thresholds of the sensory (algosity) and the affective (unpleasantness) dimensions of experimental pain. Mechanical pain induced by a pressure algometer was applied to the tibial shaft of 180 healthy volunteers before and after random application of one of the six following modalities: sham-stimulation, cold, heat, TENS, combination of TENS + cold, or combination of TENS + heat. ⋯ Only the combination of TENS + heat significantly elevated the thresholds of algosity (from 221 mmHg to 262 mmHg, p < 0.01) and of unpleasantness (from 134 ± 9 to 197 ± 9 mmHg; p < 0.001). These findings suggest that the coadministration of several physical modalities can be more efficacious in the treatment of pain than each modality alone.
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Reliability and ease of use of the Itrel 3 System (Medtronic Inc., Minneapolis, MN) were prospectively assessed over 5 years in patients with a range of pain syndromes (mainly low back and/or leg pain, or ischemic pain due to peripheral vascular disease). The longevity of the implantable pulse generator (IPG) battery, the frequency with which system settings were changed, and the ease of use of the EZ patient programmer were assessed. Data on adverse events, pain relief, and patient satisfaction with therapy were also collected. ⋯ The intensity and duration of pain were reduced significantly and patient satisfaction with therapy was high. We conclude that the Itrel 3 System performed well over 5 years and was easy to use. Its safety and effectiveness for the relief of chronic intractable pain of the trunk or limbs were also confirmed.
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The objective of this report is to describe a surgical technique used successfully when a flat or paddle type spinal cord stimulator electrode cannot be properly positioned via a single laminotomy. Different and innovative surgical techniques useful in placement of spinal cord stimulators and analgesic infusion pump systems have not been well described. ⋯ A dual laminotomy technique can be useful and successful in positioning a flat spinal cord stimulator electrode that cannot be properly positioned via a single laminotomy approach. We report two patients who have been treated successfully with a dual laminotomy technique.