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Electrical stimulation is a promising method for restoration of muscle and limb function for individuals with a variety of motor disabilities. Rehabilitation applications of functional electrical stimulation (FES) include restorat...
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Electrical stimulation is a promising method for restoration of muscle and limb function for individuals with a variety of motor disabilities. Rehabilitation applications of functional electrical stimulation (FES) include restoration of standing and gait, activation of rudimentary grasp, motor retraining and bladder management. Simple standing and gait systems are technically feasible and have been demonstrated in the laboratory and with at least one commercial product. Further development must address fatigue, control, and ease-of-use challenges. Systems to restore grasp can have a significant impact on the ability of an individual with quadriplegia to live independently. A variety of systems that use surface, percutaneous and implanted hardware are commercially available. Individuals with motor disabilities as a consequence of stroke represent the largest potential target population for FES systems. To date, applications have been limited because of the difficulty of demonstrating the efficacy in motor retraining or other applications when compared to conventional physical therapy methods. Recent research and development efforts have led to renewed activity in stroke applications and FES approaches to bladder management for those with spinal cord injury reveal great potential. First-generation implanted systems are in use and second generation systems are being researched. Many challenges must be addressed before FES systems can be used by large numbers of individuals with motor impairments. Among these challenges are the rapid fatigue of stimulated muscle, the limited pool of candidates who meet all of the ideal selection criteria for FES systems, and the need to demonstrate efficacy so that health insurance providers will cover FES systems.
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The conventional procedure in retraining a muscle has been physiotherapy, but persistence is required, which often proves to be a limitation in most patients. The electrical stimulation technique has great potential in comparison ...
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The conventional procedure in retraining a muscle has been physiotherapy, but persistence is required, which often proves to be a limitation in most patients. The electrical stimulation technique has great potential in comparison to conventional methods that are employed in retraining muscles. The neuromuscular electrical stimulation method uses a device that sends electrical impulses to neurones. This input causes the muscle to contract. It can be used to re-educate or retrain a muscle. In this review article, how different types of stimulation strategies can be used for re-educating muscles in different diseased conditions is studied. The force and quality of the muscle contraction depend upon several parameters such as frequency, amplitude, pulse duration and waveforms of stimuli. The Analysis of parameters involved in different stimulation techniques can help in understanding how a particular muscle can be stimulated in different diseased conditions. There are several studies that have reported the efficacy of muscle stimulation strategies. In this review, we investigated 30 research studies that used the muscle stimulation method for re-educating muscle and discussed many considerations in context to muscle stimulation techniques: the stimulation strategies and parameters, electrodes and results. With this review, we investigated a potential intervention for re-educating muscle and tried to recognise the limitations and benefits of the current strategies involved.
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Introduction: Spinal cord stimulation has emerged as a state-of-the-art evidence-based treatment for chronic neuropathic pain and mixed nociceptive-neuropathic pain. In recent years, several newer devices and treatment algorithms ...
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Introduction: Spinal cord stimulation has emerged as a state-of-the-art evidence-based treatment for chronic neuropathic pain and mixed nociceptive-neuropathic pain. In recent years, several newer devices and treatment algorithms have provided unique and effective ways of treating chronic pain by spinal cord stimulation. In a previous review, the authors commented on the 5-year forecast for high frequency and Burst waveforms, as the only two paresthesia independent SCS strategies. Over the last 5 years, there has been considerable addition to the outcome data related to these modalities. Additionally, new treatment algorithms and modalities for spinal cord stimulation have emerged. In this review, the authors provide an up to date summary of these modalities of treatment, indications, and evidence on all different modalities and programming paradigms that are available today. Areas covered: A literature review was performed using key bibliographic databases to find outcomes related studies pertaining to spinal cord stimulation, limited to the English language and human data, between 2010 and 2018. The literature search yielded the following based on our inclusion criteria; six articles on burst stimulation, three articled on high density/high dose stimulation, six articles on Dorsal Root Ganglion stimulation, nine articles on high-frequency stimulation, and one article on closed-loop stimulation. We have also included in the discussion some smaller and anecdotal studies. Expert commentary: The evidence to support outcomes of spinal cord stimulation has evolved considerably since our last review in 2014. New targets, frequencies and pulse trains, and feedback appear to have advanced the efficacy of spinal cord stimulation. Future developments aim to continue to refine patient selection and maintenance of patients in therapy.
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Neuromodulation is a field of science, medicine, and bioengineering that encompasses implantable and non-implantable technologies for the purpose of improving quality of life and functioning of humans. Brain neuromodulation involv...
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Neuromodulation is a field of science, medicine, and bioengineering that encompasses implantable and non-implantable technologies for the purpose of improving quality of life and functioning of humans. Brain neuromodulation involves different neurostimulation techniques: transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), vagus nerve stimulation (VNS), and deep brain stimulation (DBS), which are being used both to study their effects on cognitive brain functions and to treat neuropsychiatric disorders. The mechanisms of action of neurostimulation remain incompletely understood. Insight into the technical basis of neurostimulation might be a first step towards a more profound understanding of these mechanisms, which might lead to improved clinical outcome and therapeutic potential. This review provides an overview of the technical basis of neurostimulation focusing on the equipment, the present understanding of induced electric fields, and the stimulation protocols. The review is written from a technical perspective aimed at supporting the use of neurostimulation in clinical practice. (C) 2016 Elsevier Ltd. All rights reserved.
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Introduction: The International Neuromodulation Society (INS) has identified a need for evaluation and analysis of the practice of neurostimulation of the brain and extracranial nerves of the head to treat chronic pain. Methods: T...
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Introduction: The International Neuromodulation Society (INS) has identified a need for evaluation and analysis of the practice of neurostimulation of the brain and extracranial nerves of the head to treat chronic pain. Methods: The INS board of directors chose an expert panel, the Neuromodulation Appropriateness Consensus Committee (NACC), to evaluate the peer-reviewed literature, current research, and clinical experience and to give guidance for the appropriate use of these methods. The literature searches involved key word searches in PubMed, EMBASE, and Google Scholar dated 1970-2013, which were graded and evaluated by the authors. Results: The NACC found that evidence supports extracranial stimulation for facial pain, migraine, and scalp pain but is limited for intracranial neuromodulation. High cervical spinal cord stimulation is an evolving option for facial pain. Intracranial neurostimulation may be an excellent option to treat diseases of the nervous system, such as tremor and Parkinson's disease, and in the future, potentially Alzheimer's disease and traumatic brain injury, but current use of intracranial stimulation for pain should be seen as investigational. Conclusions: The NACC concludes that extracranial nerve stimulation should be considered in the algorithmic treatment of migraine and other disorders of the head. We should strive to perfect targets outside the cranium when treating pain, if at all possible.
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Spinal cord stimulation (SCS) is an approved treatment for intractable pain and has recently emerged as a promising area of research for restoring function after spinal cord lesion. This review will focus on the historical evoluti...
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Spinal cord stimulation (SCS) is an approved treatment for intractable pain and has recently emerged as a promising area of research for restoring function after spinal cord lesion. This review will focus on the historical evolution of this transition and the path that remains to be taken for these methods to be rigorously evaluated for application in clinical practice. New developments in SCS are being driven by advances in the understanding of spinal cord lesions at the molecular, cellular, and neuronal levels, as well as the understanding of compensatory mechanisms. Advances in neuroengineering and the computational neurosciences have enabled the development of new conceptual SCS strategies, such as spatiotemporal neuromodulation, which allows spatially selective stimulation at precise time points during anticipated movement. It has also become increasingly clear that these methods are only effective when combined with intensive rehabilitation techniques, such as new task-oriented methods and robotic aids. The emergence of innovative approaches to spinal cord neuromodulation has sparked significant enthusiasm among patients and in the media. Non-invasive methods are perceived to offer improved safety, patient acceptance, and cost-effectiveness. There is an immediate need for well-designed clinical trials involving consumer or advocacy groups to evaluate and compare the effectiveness of various treatment modalities, assess safety considerations, and establish outcome priorities.
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Introduction TMS has mainly been used- and is often believed to only be suitable for stimulation of superficial cortical areas. However, standard coils have also been used to target deeper volumes, alternatively specially designed...
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Introduction TMS has mainly been used- and is often believed to only be suitable for stimulation of superficial cortical areas. However, standard coils have also been used to target deeper volumes, alternatively specially designed coils have been developed for this purpose. We aimed to validate the use of standard coils for the stimulation of deep volumes. We used a system for navigated TMS where the stimulus induced electrical field strength in any location of the brain can be estimated. In the process, we also studied if the use of a midline parieto-occipital location as site for sham-stimulation could be justified. Methods Healthy adults were stimulated using a standard figure-of-eight coil in the Eximia system (Nexstim Ltd). The RMT for activation of the APB and AH muscles on the dominant side were defined. Four scalp locations were stimulated, each with three different intensities in relation to the RMTs: Three scalp locations with shortest Euclidian distance to dACC, insular and hippocampal cortices respectively, one location at the proposed site for sham-stimulation. Results All locations could be stimulated in all subjects. The intensity at the superficial cortical area under the coil, needed to produce sufficient (as compared to the RMTs) electrical field strengths at the deep locations dACC and insula were within a reasonable range (1.5–2 RMT), whereas hippocampal structures were not possible to stimulate using this set up. The sham stimulation location seems to be adequate in terms of not producing significant field strengths over motor cortices. Discussion If navigated stimulation and estimation of electrical field strengths are utilised, a standard TMS setup can be used to stimulate deep structures such as the dACC and insular cortex in a biologically reasonable fashion. A midline parieto-occipital location may be used as a locus for sham-stimulation in studies investigating motor cortex stimulation. ]]>
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In recent years, software development has been key to the next generation of neuromodulation devices. In this review, we will describe the new strategies for electrical waveform delivery for spinal cord stimulation. A systematic l...
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In recent years, software development has been key to the next generation of neuromodulation devices. In this review, we will describe the new strategies for electrical waveform delivery for spinal cord stimulation. A systematic literature review was performed using bibliographic databases, limited to the English language and human data, between 2010 and 2014. The literature search yielded three articles on burst stimulation and four articles on high-frequency stimulation. High-frequency and burst stimulation may offer advantages over tonic stimulation, as data suggest improved patient tolerance, comparable increase in function and possible success with a subset of patients refractory to tonic spinal cord stimulation. High-frequency and burst stimulation are new ways to deliver energy to the spinal cord that may offer advantages over tonic stimulation. These may offer new salvage strategies to mitigate spinal cord stimulation failure and improve cost-effectiveness by reducing explant rate.
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The effective treatment of many diseases requires the use of multiple treatment strategies among which neuromodulation is playing an increasingly important role. Neuromodulation devices that act to normalize or modulate nerve acti...
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The effective treatment of many diseases requires the use of multiple treatment strategies among which neuromodulation is playing an increasingly important role. Neuromodulation devices that act to normalize or modulate nerve activity through the targeted delivery of electrical stimuli will be the focus of this review. These devices encompass deep brain stimulators, vagus nerve stimulators, spinal cord simulators and sacral nerve stimulators. Already neuromodulation has proven successful in the treatment of a broad range of conditions from Parkinson’s disease to chronic pain and urinary incontinence. Many of these approaches seek to exploit the activities of the autonomic nervous system, which influences organ function through the release of neurotransmitters and associated signalling cascades. This review will outline existing and emerging applications for each of these neuromodulation devices, proposed mechanisms of action and clinical studies evaluating both their safety and therapeutic efficacy. The neuromodulation market is growing rapidly with an estimated worth of $3.65 billion in 2015, which is projected to reach $6.20 billion by 2020, a compound annual growth rate of 11.2% [1]. In neuromodulation, small devices are implanted under the skin and electrical pulses used to deliver a therapeutic effect. For patients who have shown a limited response or severe adverse effects to conventional biological therapies, neuromodulation may offer a potential alternative or may be used in conjunction with their current treatment. Emerging indications for neuromodulation at various stages of clinical development include epilepsy, depression, rheumatoid arthritis (RA), Crohn’s disease, irritable bowel syndrome, type II diabetes, obesity, tinnitus, heart failure (HF) and in the treatment of chronic pain (Table 1). Those devices on the market can broadly be divided into deep brain, vagus nerve, sacral nerve and spinal cord stimulators.
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Background Migraine is one of the most disabling neurological disorders. The current pharmacological armamentarium is not satisfying for a large proportion of patients because the responder rate does not exceed 50% on average and ...
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Background Migraine is one of the most disabling neurological disorders. The current pharmacological armamentarium is not satisfying for a large proportion of patients because the responder rate does not exceed 50% on average and the most effective drugs often induce intolerable side effects. During recent years, noninvasive central and peripheral neuromodulation methods have been explored for migraine treatment.
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