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Marquez-Chin M, Saadatnia Z, Sun YC, Naguib HE, Popovic MR. A dry polymer nanocomposite transcutaneous electrode for functional electrical stimulation. Biomed Eng Online 2024; 23:10. [PMID: 38279147 PMCID: PMC10811815 DOI: 10.1186/s12938-024-01200-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 01/04/2024] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND Functional electrical stimulation (FES) can be used in rehabilitation to aid or improve function in people with paralysis. In clinical settings, it is common practice to use transcutaneous electrodes to apply the electrical stimulation, since they are non-invasive, and can be easily applied and repositioned as necessary. However, the current electrode options available for transcutaneous FES are limited and can have practical disadvantages, such as the need for a wet interface with the skin for better comfort and performance. Hence, we were motivated to develop a dry stimulation electrode which could perform equivalently or better than existing commercially available options. METHODS We manufactured a thin-film dry polymer nanocomposite electrode, characterized it, and tested its performance for stimulation purposes with thirteen healthy individuals. We compared its functionality in terms of stimulation-induced muscle torque and comfort level against two other types of transcutaneous electrodes: self-adhesive hydrogel and carbon rubber. Each electrode type was also tested using three different stimulators and different intensity levels of stimulation. RESULTS We found the proposed dry polymer nanocomposite electrode to be functional for stimulation, as there was no statistically significant difference between its performance to the other standard electrodes. Namely, the proposed dry electrode had comparable muscle torque generated and comfort level as the self-adhesive hydrogel and carbon rubber electrodes. From all combinations of electrode type and stimulators tested, the dry polymer nanocomposite electrode with the MyndSearch stimulator had the most comfortable average rating. CONCLUSIONS The dry polymer nanocomposite electrode is a durable and flexible alternative to existing self-adhesive hydrogel and carbon rubber electrodes, which can be used without the addition of a wet interfacing agent (i.e., water or gel) to perform as well as the current electrodes used for stimulation purposes.
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Affiliation(s)
- Melissa Marquez-Chin
- KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada.
| | - Zia Saadatnia
- KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Department of Mechanical & Industrial Engineering, University of Toronto, Toronto, ON, Canada
- Department of Mechanical and Manufacturing Engineering, Ontario Tech University, Oshawa, ON, Canada
| | - Yu-Chen Sun
- Department of Mechanical & Industrial Engineering, University of Toronto, Toronto, ON, Canada
| | - Hani E Naguib
- KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Department of Mechanical & Industrial Engineering, University of Toronto, Toronto, ON, Canada
| | - Milos R Popovic
- KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
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Muscle contractions and pain sensation accompanying high-frequency electroporation pulses. Sci Rep 2022; 12:8019. [PMID: 35577873 PMCID: PMC9110404 DOI: 10.1038/s41598-022-12112-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 05/05/2022] [Indexed: 12/21/2022] Open
Abstract
To minimize neuromuscular electrical stimulation during electroporation-based treatments, the replacement of long monophasic pulses with bursts of biphasic high-frequency pulses in the range of microseconds was suggested in order to reduce muscle contraction and pain sensation due to pulse application. This treatment modality appeared under the term high-frequency electroporation (HF-EP), which can be potentially used for some clinical applications of electroporation such as electrochemotherapy, gene electrotransfer, and tissue ablation. In cardiac tissue ablation, which utilizes irreversible electroporation, the treatment is being established as Pulsed Field Ablation. While the reduction of muscle contractions was confirmed in multiple in vivo studies, the reduction of pain sensation in humans was not confirmed yet, nor was the relationship between muscle contraction and pain sensation investigated. This is the first study in humans examining pain sensation using biphasic high-frequency electroporation pulses. Twenty-five healthy individuals were subjected to electrical stimulation of the tibialis anterior muscle with biphasic high-frequency pulses in the range of few microseconds and both, symmetric and asymmetric interphase and interpulse delays. Our results confirm that biphasic high-frequency pulses with a pulse width of 1 or 2 µs reduce muscle contraction and pain sensation as opposed to currently used longer monophasic pulses. In addition, interphase and interpulse delays play a significant role in reducing the muscle contraction and/or pain sensation. The study shows that the range of the optimal pulse parameters may be increased depending on the prerequisites of the therapy. However, further evaluation of the biphasic pulse protocols presented herein is necessary to confirm the efficiency of the newly proposed HF-EP.
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Khzam AA. Transcutaneous neuromuscular electrical stimulation and hemiplegic shoulder pain: a clinical perspective. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2022. [DOI: 10.12968/ijtr.2022.0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Alaa Abou Khzam
- National Rehabilitation and Development Center, Semqaniye Al Chouf, Lebanon
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Cryoneurolysis and Percutaneous Peripheral Nerve Stimulation to Treat Acute Pain. Anesthesiology 2020; 133:1127-1149. [PMID: 32898231 DOI: 10.1097/aln.0000000000003532] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Two regional analgesic modalities currently cleared by the U.S. Food and Drug Administration hold promise to provide postoperative analgesia free of many of the limitations of both opioids and local anesthetic-based techniques. Cryoneurolysis uses exceptionally low temperature to reversibly ablate a peripheral nerve, resulting in temporary analgesia. Where applicable, it offers a unique option given its extended duration of action measured in weeks to months after a single application. Percutaneous peripheral nerve stimulation involves inserting an insulated lead through a needle to lie adjacent to a peripheral nerve. Analgesia is produced by introducing electrical current with an external pulse generator. It is a unique regional analgesic in that it does not induce sensory, motor, or proprioception deficits and is cleared for up to 60 days of use. However, both modalities have limited validation when applied to acute pain, and randomized, controlled trials are required to define both benefits and risks.
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Cleland T, Jain NB, Chae J, Hansen KM, Hisel TZ, Gunzler DD, Whitehair VC, Kim CH, Wilson RD. The protocol for a multisite, double blind, randomized, placebo-controlled trial of axillary nerve stimulation for chronic shoulder pain. Trials 2020; 21:248. [PMID: 32143732 PMCID: PMC7059286 DOI: 10.1186/s13063-020-4174-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 02/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Shoulder impingement syndrome is one of the most common causes of shoulder pain, accounting for approximately 30% of all shoulder pain. Approximately 35% of patients with shoulder impingement syndrome are refractory to conservative treatment. For patients who fail conservative treatment, there is no established treatment to successfully treat their chronic pain. Prior randomized control trials have demonstrated efficacy for the use of a single lead intramuscular peripheral nerve stimulation of the axillary nerve at the motor points of the deltoid muscle for treatment of hemiplegic shoulder pain. This is the first controlled trial to utilize the same novel technology to treat shoulder impingement syndrome outside of the stroke population. METHODS This is a dual-site, placebo-controlled, double-blinded, randomized control trial. Participants will be randomized to two treatment groups. The intervention group will be treated with active peripheral nerve stimulation of the axillary nerve of the affected shoulder and the control group will be treated with sham peripheral nerve stimulation of the axillary nerve of the affected shoulder. Both groups will receive a standardized exercise therapy program directed by a licensed therapist. DISCUSSION This study protocol will allow the investigators to determine if this novel, non-pharmacologic treatment of shoulder pain can demonstrate the same benefit in musculoskeletal patients which has been previously demonstrated in the stroke population. TRIAL REGISTRATION Clinicaltrials.gov, NCT03752619. Registered on 26 November 2018.
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Affiliation(s)
- Travis Cleland
- MetroHealth Rehabilitation Institute, MetroHealth System, 4229 Pearl Rd, N5-27, Cleveland, OH 44109 USA
| | - Nitin B. Jain
- Vanderbilt University Medical Center, 3319 West End Ave, Nashville, TN 37203 USA
| | - John Chae
- MetroHealth Rehabilitation Institute, MetroHealth System, 4229 Pearl Rd, N5-27, Cleveland, OH 44109 USA
| | - Kristine M. Hansen
- MetroHealth Rehabilitation Institute, MetroHealth System, 4229 Pearl Rd, N5-27, Cleveland, OH 44109 USA
| | - Terri Z. Hisel
- MetroHealth Rehabilitation Institute, MetroHealth System, 4229 Pearl Rd, N5-27, Cleveland, OH 44109 USA
| | - Douglas D. Gunzler
- Center for Healthcare Research and Policy, MetroHealth System, 2500 MetroHealth Dr., Cleveland, OH 44109 USA
| | - Victoria C. Whitehair
- MetroHealth Rehabilitation Institute, MetroHealth System, 4229 Pearl Rd, N5-27, Cleveland, OH 44109 USA
| | - Chong H. Kim
- MetroHealth Rehabilitation Institute, MetroHealth System, 4229 Pearl Rd, N5-27, Cleveland, OH 44109 USA
| | - Richard D. Wilson
- MetroHealth Rehabilitation Institute, MetroHealth System, 4229 Pearl Rd, N5-27, Cleveland, OH 44109 USA
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Fujimura K, Kagaya H, Endou C, Ishihara A, Nishigaya K, Muroguchi K, Tanikawa H, Yamada M, Kanada Y, Saitoh E. Effects of Repetitive Peripheral Magnetic Stimulation on Shoulder Subluxations Caused by Stroke: A Preliminary Study. Neuromodulation 2019; 23:847-851. [PMID: 32840021 DOI: 10.1111/ner.13064] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 08/28/2019] [Accepted: 09/17/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Shoulder subluxation is a common problem after stroke. It causes shoulder pain that affects activities of daily living. This study aimed to investigate the effect of repetitive peripheral magnetic stimulation on shoulder subluxation after stroke. METHODS We enrolled 12 consecutive patients who, as a result of stroke, suffered shoulder subluxations, measuring at half of a fingerbreadth or more. All subjects underwent conventional rehabilitation, as well as repetitive peripheral magnetic stimulation of their supraspinatus, posterior deltoid, and infraspinatus muscles. We assessed the following parameters: shoulder subluxation, evaluated as the acromio-humeral interval using measurements taken from X-rays; shoulder pain, evaluated using the Numerical Rating Scale; the active range of motion of shoulder abduction; and the motor impairment of the upper extremities, evaluated using the upper extremity of the Fugl-Meyer Assessment scale. RESULTS The acromio-humeral interval before treatment was 22.8 ± 5.7 mm (mean ± SD). It significantly decreased to 19.6 ± 7.0 mm (p = 0.004) after treatment. Shoulder pain (p = 0.039), active range of motion of shoulder abduction (p = 0.016), and total (p = 0.005), subscale A (p = 0.005), and subscale C (p = 0.008) Fugl-Meyer Assessment scores also improved significantly after treatment. CONCLUSIONS Repetitive peripheral magnetic stimulation effectively reduced shoulder subluxations and shoulder pain caused by stroke and improved voluntary upper-limb movements in stroke patients.
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Affiliation(s)
- Kenta Fujimura
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Aichi, Japan
| | - Hitoshi Kagaya
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Chiharu Endou
- Department of Rehabilitation, Fujita Health University Hospital, Toyoake, Aichi, Japan
| | - Akihito Ishihara
- Department of Rehabilitation, Fujita Health University Hospital, Toyoake, Aichi, Japan
| | - Kozue Nishigaya
- Department of Rehabilitation, Fujita Health University Hospital, Toyoake, Aichi, Japan
| | - Kana Muroguchi
- Department of Rehabilitation, Fujita Health University Hospital, Toyoake, Aichi, Japan
| | - Hiroki Tanikawa
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Aichi, Japan
| | - Masayuki Yamada
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Aichi, Japan
| | - Yoshikiyo Kanada
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Aichi, Japan
| | - Eiichi Saitoh
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
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7
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Comparative effects of implanted electrodes with differing contact patterns on peripheral nerve regeneration and functional recovery. Neurosci Res 2019; 145:22-29. [DOI: 10.1016/j.neures.2018.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 07/24/2018] [Accepted: 08/15/2018] [Indexed: 11/19/2022]
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Gabriel RA, Swisher MW, Ilfeld BM. Percutaneous peripheral nerve stimulation for acute postoperative pain. Pain Manag 2019; 9:347-354. [PMID: 31099305 DOI: 10.2217/pmt-2018-0094] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Peripheral nerve stimulation or peripheral neuromodulation is a modality utilized for decades to manage chronic pain. There have been recent studies published describing its use in managing acute surgical pain for orthopedic surgery. The postoperative acute pain associated with several types of surgeries often outlasts the analgesia duration provided by single and continuous peripheral nerve blocks. Ultrasound-guided percutaneous peripheral nerve stimulation has the potential to provide much longer analgesia for acute pain while avoiding some limitations associated with local anesthetic-based peripheral nerve blocks. We summarize the current devices used in published studies to demonstrate feasibility with a focus on acute pain control.
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Affiliation(s)
- Rodney A Gabriel
- Department of Anesthesiology, Division of Regional Anesthesia & Acute Pain, Department of Medicine, Division of Biomedical Informatics, University of California, San Diego, 200 West Arbor Dr, MC 8770, San Diego, CA 92103, USA
| | - Matthew W Swisher
- Department of Anesthesiology, Division of Regional Anesthesia & Acute Pain, University of California, San Diego, 200 West Arbor Dr, MC 8770, San Diego, CA 92103, USA
| | - Brian M Ilfeld
- Department of Anesthesiology, Division of Regional Anesthesia & Acute Pain, University of California, San Diego, 200 West Arbor Dr, MC 8770, San Diego, CA 92103, USA
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Ilfeld BM, Finneran JJ, Gabriel RA, Said ET, Nguyen PL, Abramson WB, Khatibi B, Sztain JF, Swisher MW, Jaeger P, Covey DC, Meunier MJ, Hentzen ER, Robertson CM. Ultrasound-guided percutaneous peripheral nerve stimulation: neuromodulation of the suprascapular nerve and brachial plexus for postoperative analgesia following ambulatory rotator cuff repair. A proof-of-concept study. Reg Anesth Pain Med 2019; 44:310-318. [PMID: 30770421 DOI: 10.1136/rapm-2018-100121] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 11/04/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND OBJECTIVES Percutaneous peripheral nerve stimulation (PNS) is an analgesic modality involving the insertion of a lead through an introducing needle followed by the delivery of electric current. This modality has been reported to treat chronic pain as well as postoperative pain following knee and foot surgery. However, it remains unknown if this analgesic technique may be used in ambulatory patients following upper extremity surgery. The purpose of this proof-of-concept study was to investigate various lead implantation locations and evaluate the feasibility of using percutaneous brachial plexus PNS to treat surgical pain following ambulatory rotator cuff repair in the immediate postoperative period. METHODS Preoperatively, an electrical lead (SPR Therapeutics, Cleveland, Ohio) was percutaneously implanted to target the suprascapular nerve or brachial plexus roots or trunks using ultrasound guidance. Postoperatively, subjects received 5 min of either stimulation or sham in a randomized, double-masked fashion followed by a 5 min crossover period, and then continuous stimulation until lead removal postoperative days 14-28. RESULTS Leads (n=2) implanted at the suprascapular notch did not appear to provide analgesia, and subsequent leads (n=14) were inserted through the middle scalene muscle and placed to target the brachial plexus. Three subjects withdrew prior to data collection. Within the recovery room, stimulation did not decrease pain scores during the first 40 min of the remaining subjects with brachial plexus leads, regardless of which treatment subjects were randomized to initially. Seven of these 11 subjects required a single-injection interscalene nerve block for rescue analgesia prior to discharge. However, subsequent average resting and dynamic pain scores postoperative days 1-14 had a median of 1 or less on the Numeric Rating Scale, and opioid requirements averaged less than 1 tablet daily with active stimulation. Two leads dislodged during use and four fractured on withdrawal, but no infections, nerve injuries, or adverse sequelae were reported. CONCLUSIONS This proof-of-concept study demonstrates that ultrasound-guided percutaneous PNS of the brachial plexus is feasible for ambulatory shoulder surgery, and although analgesia immediately following surgery does not appear to be as potent as local anesthetic-based peripheral nerve blocks, the study suggests that this modality may provide analgesia and decrease opioid requirements in the days following rotator cuff repair. Therefore, it suggests that a subsequent, large, randomized clinical trial with an adequate control group is warranted to further investigate this therapy in the management of surgical pain in the immediate postoperative period. However, multiple technical issues remain to be resolved, such as the optimal lead location, insertion technique, and stimulating protocol, as well as preventing lead dislodgment and fracture. TRIAL REGISTRATION NUMBER NCT02898103.
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Affiliation(s)
- Brian M Ilfeld
- Department of Anesthesiology, University of California San Diego, San Diego, California, USA .,The Outcomes Research Consortium, Cleveland, Ohio, USA
| | - John J Finneran
- Department of Anesthesiology, University of California San Diego, San Diego, California, USA.,The Outcomes Research Consortium, Cleveland, Ohio, USA
| | - Rodney A Gabriel
- Department of Anesthesiology, University of California San Diego, San Diego, California, USA.,The Outcomes Research Consortium, Cleveland, Ohio, USA
| | - Engy T Said
- Department of Anesthesiology, University of California San Diego, San Diego, California, USA
| | - Patrick L Nguyen
- Department of Anesthesiology, University of California San Diego, San Diego, California, USA
| | - Wendy B Abramson
- Department of Anesthesiology, University of California San Diego, San Diego, California, USA
| | - Bahareh Khatibi
- Department of Anesthesiology, University of California San Diego, San Diego, California, USA
| | - Jacklynn F Sztain
- Department of Anesthesiology, University of California San Diego, San Diego, California, USA
| | - Matthew W Swisher
- Department of Anesthesiology, University of California San Diego, San Diego, California, USA.,The Outcomes Research Consortium, Cleveland, Ohio, USA
| | - Pia Jaeger
- Department of Anesthesiology, University of California San Diego, San Diego, California, USA.,The Outcomes Research Consortium, Cleveland, Ohio, USA.,Department of Anesthesiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Dana C Covey
- Departments of Orthopaedic Surgery, University of California San Diego, San Diego, California, USA
| | - Matthew J Meunier
- Departments of Orthopaedic Surgery, University of California San Diego, San Diego, California, USA
| | - Eric R Hentzen
- Departments of Orthopaedic Surgery, University of California San Diego, San Diego, California, USA
| | - Catherine M Robertson
- Departments of Orthopaedic Surgery, University of California San Diego, San Diego, California, USA
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Ultrasound-Guided Percutaneous Peripheral Nerve Stimulation: Neuromodulation of the Sciatic Nerve for Postoperative Analgesia Following Ambulatory Foot Surgery, a Proof-of-Concept Study. Reg Anesth Pain Med 2019; 43:580-589. [PMID: 29905630 PMCID: PMC6092098 DOI: 10.1097/aap.0000000000000819] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND OBJECTIVES Percutaneous peripheral nerve stimulation (PNS) is an analgesic modality involving the insertion of a lead through an introducing needle followed by the delivery of electric current. This modality has been reported to treat chronic pain as well as postoperative pain the day following knee surgery. However, it remains unknown if this analgesic technique may be used in ambulatory subjects following foot procedures beginning within the recovery room immediately following surgery, and with only short series of patients reported to date, the only available data are derived from strictly observational studies. The purposes of this proof-of-concept study were to demonstrate the feasibility of using percutaneous sciatic nerve PNS to treat postoperative pain following ambulatory foot surgery in the immediate postoperative period and provide the first available data from a randomized controlled study design to provide evidence of analgesic effect. METHODS Preoperatively, an electrical lead (SPRINT; SPR Therapeutics, Inc, Cleveland, Ohio) was percutaneously inserted posterior to the sciatic nerve between the subgluteal region and bifurcation with ultrasound guidance. Following hallux valgus osteotomy, subjects received 5 minutes of either stimulation or sham in a randomized, double-masked fashion followed by a 5-minute crossover period and then continuous stimulation until lead removal on postoperative days 14 to 28. RESULTS During the initial 5-minute treatment period, subjects randomized to stimulation (n = 4) experienced a downward trajectory in their pain over the 5 minutes of treatment, whereas those receiving sham (n = 3) reported no such change until their subsequent 5-minute stimulation crossover. During the subsequent 30 minutes of stimulation, pain scores decreased to 52% of baseline (n = 7). Three subjects (43%) used a continuous popliteal nerve block for rescue analgesia during postoperative days 0 to 3. Overall, resting and dynamic pain scores averaged less than 1 on the numeric rating scale, and opioid use averaged less than 1 tablet daily with active stimulation. One lead dislodged, 2 fractured during use, and 1 fractured during intentional withdrawal. CONCLUSIONS This proof-of-concept study demonstrates that percutaneous sciatic nerve PNS is feasible for ambulatory foot surgery and suggests that this modality provides analgesia and decreases opioid requirements following hallux valgus procedures. However, lead dislodgement and fracture are concerns. CLINICAL TRIAL REGISTRATION This study was registered at Clinicaltrials.gov, identifier NCT02898103.
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Abstract
Maximizing analgesia is critical following joint arthroplasty because postoperative pain is a major barrier to adequate physical therapy. Continuous peripheral nerve blocks have been the mainstay for acute pain management in this population; however, this and similar techniques are limited by their duration of action. Cryoneurolysis and peripheral nerve stimulation are two methodologies used for decades to treat chronic pain. With the advent of portable ultrasound devices and percutaneous administration equipment, both procedures may now be suitable for treatment of acute pain. This article reviews these two modalities and their application to joint arthroplasty.
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Affiliation(s)
- Rodney A Gabriel
- Department of Anesthesiology, University of California, San Diego, 200 West Arbor Drive, MC 8770, San Diego, CA 92103, USA
| | - Brian M Ilfeld
- Department of Anesthesiology, University of California, San Diego, 200 West Arbor Drive, MC 8770, San Diego, CA 92103, USA.
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12
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Ilfeld BM, Said ET, Finneran JJ, Sztain JF, Abramson WB, Gabriel RA, Khatibi B, Swisher MW, Jaeger P, Covey DC, Robertson CM. Ultrasound-Guided Percutaneous Peripheral Nerve Stimulation: Neuromodulation of the Femoral Nerve for Postoperative Analgesia Following Ambulatory Anterior Cruciate Ligament Reconstruction: A Proof of Concept Study. Neuromodulation 2018; 22:621-629. [PMID: 30160335 PMCID: PMC6767389 DOI: 10.1111/ner.12851] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 06/06/2018] [Accepted: 06/19/2018] [Indexed: 01/08/2023]
Abstract
Objectives The purpose of this prospective proof of concept study was to investigate the feasibility of using percutaneous peripheral nerve stimulation of the femoral nerve to treat pain in the immediate postoperative period following ambulatory anterior cruciate ligament reconstruction with a patellar autograft. Materials and Methods Preoperatively, an electrical lead (SPRINT, SPR Therapeutics, Inc., Cleveland, OH, USA) was percutaneously implanted with ultrasound guidance anterior to the femoral nerve caudad to the inguinal crease. Within the recovery room, subjects received 5 min of either stimulation or sham in a randomized, double‐masked fashion followed by a 5‐min crossover period, and then continuous active stimulation until lead removal postoperative Day 14–28. Statistics were not applied to the data due to the small sample size of this feasibility study. Results During the initial 5‐min treatment period, subjects randomized to stimulation (n = 5) experienced a slight downward trajectory (decrease of 7%) in their pain over the 5 min of treatment, while those receiving sham (n = 5) reported a slight upward trajectory (increase of 4%) until their subsequent 5‐min stimulation crossover, during which time they also experienced a slight downward trajectory (decrease of 11% from baseline). A majority of subjects (80%) used a continuous adductor canal nerve block for rescue analgesia (in addition to stimulation) during postoperative Days 1–3, after which the median resting and dynamic pain scores remained equal or less than 1.5 on the numeric rating scale, respectively, and the median daily opioid consumption was less than 1.0 tablet. Conclusions This proof of concept study demonstrates that percutaneous femoral nerve stimulation is feasible for ambulatory knee surgery; and suggests that this modality may be effective in providing analgesia and decreasing opioid requirements following anterior cruciate ligament reconstruction. clinicaltrials.gov: NCT02898103.
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Affiliation(s)
- Brian M Ilfeld
- Department of Anesthesiology, University of California, San Diego, San Diego, CA, USA.,Outcomes Research consortium, Cleveland, OH, USA
| | - Engy T Said
- Department of Anesthesiology, University of California, San Diego, San Diego, CA, USA
| | - John J Finneran
- Department of Anesthesiology, University of California, San Diego, San Diego, CA, USA.,Outcomes Research consortium, Cleveland, OH, USA
| | - Jacklynn F Sztain
- Department of Anesthesiology, University of California, San Diego, San Diego, CA, USA
| | - Wendy B Abramson
- Department of Anesthesiology, University of California, San Diego, San Diego, CA, USA
| | - Rodney A Gabriel
- Department of Anesthesiology, University of California, San Diego, San Diego, CA, USA.,Outcomes Research consortium, Cleveland, OH, USA
| | - Bahareh Khatibi
- Department of Anesthesiology, University of California, San Diego, San Diego, CA, USA
| | - Matthew W Swisher
- Department of Anesthesiology, University of California, San Diego, San Diego, CA, USA.,Outcomes Research consortium, Cleveland, OH, USA
| | - Pia Jaeger
- Outcomes Research consortium, Cleveland, OH, USA.,Department of Anesthesiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Dana C Covey
- Department of Orthopedic Surgery, University of California, San Diego, San Diego, CA, USA
| | - Catherine M Robertson
- Department of Orthopedic Surgery, University of California, San Diego, San Diego, CA, USA
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13
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Shellock FG, Zare A, Ilfeld BM, Chae J, Strother RB. In Vitro Magnetic Resonance Imaging Evaluation of Fragmented, Open-Coil, Percutaneous Peripheral Nerve Stimulation Leads. Neuromodulation 2017; 21:276-283. [PMID: 29057550 DOI: 10.1111/ner.12705] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 09/03/2017] [Accepted: 09/06/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Percutaneous peripheral nerve stimulation (PNS) is an FDA-cleared pain treatment. Occasionally, fragments of the lead (MicroLead, SPR Therapeutics, LLC, Cleveland, OH, USA) may be retained following lead removal. Since the lead is metallic, there are associated magnetic resonance imaging (MRI) risks. Therefore, the objective of this investigation was to evaluate MRI-related issues (i.e., magnetic field interactions, heating, and artifacts) for various lead fragments. METHODS Testing was conducted using standardized techniques on lead fragments of different lengths (i.e., 50, 75, and 100% of maximum possible fragment length of 12.7 cm) to determine MRI-related problems. Magnetic field interactions (i.e., translational attraction and torque) and artifacts were tested for the longest lead fragment at 3 Tesla. MRI-related heating was evaluated at 1.5 Tesla/64 MHz and 3 Tesla/128 MHz with each lead fragment placed in a gelled-saline filled phantom. Temperatures were recorded on the lead fragments while using relatively high RF power levels. Artifacts were evaluated using T1-weighted, spin echo, and gradient echo (GRE) pulse sequences. RESULTS The longest lead fragment produced only minor magnetic field interactions. For the lead fragments evaluated, physiologically inconsequential MRI-related heating occurred at 1.5 Tesla/64 MHz while under certain 3 Tesla/128 MHz conditions, excessive temperature elevations may occur. Artifacts extended approximately 7 mm from the lead fragment on the GRE pulse sequence, suggesting that anatomy located at a position greater than this distance may be visualized on MRI. CONCLUSIONS MRI may be performed safely in patients with retained lead fragments at 1.5 Tesla using the specific conditions of this study (i.e., MR Conditional). Due to possible excessive temperature rises at 3 Tesla, performing MRI at that field strength is currently inadvisable.
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Affiliation(s)
- Frank G Shellock
- Departments of Radiology and Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Armaan Zare
- Loyola Marymount University, Los Angeles, CA, USA
| | - Brian M Ilfeld
- Department of Anesthesiology, University of California San Diego, San Diego, San Diego, CA, USA
| | - John Chae
- Department of Physical Medicine and Rehabilitation, Case Western Reserve University, Cleveland, OH, USA
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Wiest MJ, Bergquist AJ, Collins DF. Torque, Current, and Discomfort During 3 Types of Neuromuscular Electrical Stimulation of Tibialis Anterior. Phys Ther 2017; 97:790-789. [PMID: 28789468 DOI: 10.1093/ptj/pzx053] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 05/03/2017] [Indexed: 11/14/2022]
Abstract
BACKGROUND The benefits of neuromuscular electrical stimulation (NMES) for rehabilitation depend on the capacity to generate functionally relevant torque with minimal fatigability and discomfort. Traditionally, NMES is delivered either over a muscle belly (mNMES) or a nerve trunk (nNMES). Recently, a technique that minimizes contraction fatigability by alternating pulses between the mNMES and nNMES sites, termed "interleaved" NMES (iNMES), was developed. However, discomfort and the ability to generate large torque during iNMES have not been explored adequately. OBJECTIVE The study objective was to compare discomfort and maximal torque between mNMES, nNMES, and iNMES. METHODS Stimulation trains (12 pulses at 40 Hz) were delivered to produce dorsiflexion torque using mNMES, nNMES, and iNMES. Discomfort was assessed using a visual analogue scale for contractions that generated 5-30% of a maximal voluntary isometric contraction (MVIC), and for the maximal tolerable torque. RESULTS Discomfort scores were not different between NMES types when torque was ≤20% MVIC. At 30% MVIC, mNMES produced more discomfort than nNMES and iNMES. nNMES produced the most torque (65% MVIC), followed by iNMES (49% MVIC) and mNMES (33% MVIC); in these trials, mNMES produced more discomfort than nNMES, but not iNMES. LIMITATIONS The present results may be limited to individuals with no history of neuromusculoskeletal impairment. CONCLUSIONS In terms of discomfort, there were no differences between mNMES, nNMES, or iNMES for contractions between 5-20% MVIC. However, mNMES produced more discomfort than nNMES and iNMES for contractions of 30% MVIC, while for larger contractions, mNMES only produced more discomfort than nNMES. The advantages and disadvantages of each NMES type should be considered prior to implementation in rehabilitation programs.
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Affiliation(s)
- Matheus J Wiest
- Human Neurophysiology Laboratory, Faculty of Physical Education and Recreation, University of Alberta and Biomechanics Laboratory, Department of Physical Education, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Austin J Bergquist
- Rehabilitation Engineering Laboratory, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - David F Collins
- Human Neurophysiology Laboratory, Faculty of Physical Education and Recreation, University of Alberta, 4-218 Van Vliet Complex, Edmonton, Alberta, Canada T6G 2H9
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Ultrasound-Guided Percutaneous Peripheral Nerve Stimulation for Postoperative Analgesia: Could Neurostimulation Replace Continuous Peripheral Nerve Blocks? Reg Anesth Pain Med 2017; 41:720-722. [PMID: 27685345 PMCID: PMC5084632 DOI: 10.1097/aap.0000000000000481] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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16
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Ilfeld BM, Gilmore CA, Grant SA, Bolognesi MP, Del Gaizo DJ, Wongsarnpigoon A, Boggs JW. Ultrasound-guided percutaneous peripheral nerve stimulation for analgesia following total knee arthroplasty: a prospective feasibility study. J Orthop Surg Res 2017; 12:4. [PMID: 28086940 PMCID: PMC5234248 DOI: 10.1186/s13018-016-0506-7] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 12/19/2016] [Indexed: 11/10/2022] Open
Abstract
Background Peripheral nerve stimulation has been used for decades to treat chronic pain but has not been used for postoperative analgesia due to multiple limitations, beginning with invasive electrode placement. With the development of small-diameter/gauge leads enabling percutaneous insertion, ultrasound guidance for accurate introduction, and stimulators small enough to be adhered to the skin, neurostimulation may now be provided in a similar manner to continuous peripheral nerve blocks. Here, we report on the use of ultrasound-guided percutaneous peripheral nerve stimulation to treat postoperative pain. Materials and methods Subjects within 60 days of a total knee arthroplasty with pain insufficiently treated with oral analgesics had a 0.2-mm-diameter electrical lead (pre-loaded into a 20 gauge needle) introduced percutaneously using ultrasound guidance with the tip located approximately 0.5–1.0 cm from the femoral nerve (a second lead was inserted approximately 1.0–3.0 cm from the sciatic nerve for posterior knee pain). An external stimulator delivered current. Endpoints were assessed before and after lead insertion and the leads subsequently removed. Due to the small sample size for this pilot/feasibility study, no statistics were applied to the data. Results Leads were inserted in subjects (n = 5) 8–58 days postoperatively. Percutaneous peripheral nerve stimulation decreased pain an average of 93% at rest (from a mean of 5.0 to 0.2 on a 0–10 numeric rating scale), with 4 of 5 subjects experiencing complete resolution of pain. During passive and active knee motion pain decreased an average of 27 and 30%, respectively. Neither maximum passive nor active knee range-of-motion was consistently affected. Conclusions Ultrasound-guided percutaneous peripheral nerve stimulation may be a practical modality for the treatment of postoperative pain following orthopedic surgical procedures, and further investigation appears warranted.
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Affiliation(s)
- Brian M Ilfeld
- Department of Anesthesiology, University of California San Diego, 200 West Arbor Drive, MC 8770, San Diego, CA, 92103-8770, USA.
| | - Christopher A Gilmore
- Department of Anesthesiology, Wake Forest University Baptist Medical Center, 145 Kimel Park Drive, Ste 330, Winston-Salem, NC, 27103, USA.,The Center for Clinical Research, Winston-Salem, NC, USA.,Carolinas Pain Institute, Winston-Salem, NC, USA
| | - Stuart A Grant
- Department of Anesthesiology, Duke University Medical Center, DUMC 3094, Durham, NC, 27710, USA
| | - Michael P Bolognesi
- Department of Orthopedic Surgery, Duke University Medical Center, 200 Trent Dr. #5216, Durham, NC, 27710, USA
| | - Daniel J Del Gaizo
- Department of Orthopedic Surgery, University of North Carolina, 3147 Bioinformatics Building, 130 Mason Farm Road, Chapel Hill, NC, 27599-7055, USA
| | - Amorn Wongsarnpigoon
- SPR Therapeutics, LLC, 22901 Millcreek Blvd, Suite 110, Cleveland, OH, 44122, USA
| | - Joseph W Boggs
- SPR Therapeutics, LLC, 22901 Millcreek Blvd, Suite 110, Cleveland, OH, 44122, USA
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17
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Ilfeld BM, Grant SA, Gilmore CA, Chae J, Wilson RD, Wongsarnpigoon A, Boggs JW. Neurostimulation for Postsurgical Analgesia: A Novel System Enabling Ultrasound-Guided Percutaneous Peripheral Nerve Stimulation. Pain Pract 2016; 17:892-901. [PMID: 27910257 PMCID: PMC5637916 DOI: 10.1111/papr.12539] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 08/25/2016] [Accepted: 10/16/2016] [Indexed: 12/21/2022]
Abstract
While neurostimulation—stimulation of the nervous system using electrical current—has been used to treat chronic pain, its use treating postsurgical pain has been limited. Here, we report on the clinical application of a novel investigational lead to provide analgesia following total knee arthroplasty. In 5 subjects, leads were inserted percutaneously using ultrasound guidance within 0.5 to 3.0 cm of the femoral and/or sciatic nerve(s). With the delivery of current, pain decreased an average of 63% at rest, with 4 of 5 subjects having relief of > 50%. During passive and active knee flexion, pain decreased an average of 14% and 50%, with 0/3 and 1/2 subjects attaining > 50% relief, respectively. Ultrasound‐guided percutaneous peripheral nerve stimulation may be a practical modality for the treatment of postsurgical pain.
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Affiliation(s)
- Brian M Ilfeld
- Department of Anesthesiology, University of California San Diego, San Diego, California, U.S.A
| | - Stuart A Grant
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, U.S.A
| | - Christopher A Gilmore
- Department of Anesthesiology, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina, U.S.A.,The Center for Clinical Research, Winston-Salem, North Carolina, U.S.A.,Carolinas Pain Institute, Winston-Salem, North Carolina, U.S.A
| | - John Chae
- Department of Physical Medicine and Rehabilitation, Case Western Reserve University, Cleveland, Ohio, U.S.A.,Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, U.S.A.,MetroHealth Rehabilitation Institute, MetroHealth System, Cleveland, Ohio, U.S.A.,Cleveland Functional Electrical Stimulation Center, Cleveland, Ohio, U.S.A
| | - Richard D Wilson
- Department of Physical Medicine and Rehabilitation, Case Western Reserve University, Cleveland, Ohio, U.S.A.,MetroHealth Rehabilitation Institute, MetroHealth System, Cleveland, Ohio, U.S.A.,Cleveland Functional Electrical Stimulation Center, Cleveland, Ohio, U.S.A
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18
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Winstein CJ, Stein J, Arena R, Bates B, Cherney LR, Cramer SC, Deruyter F, Eng JJ, Fisher B, Harvey RL, Lang CE, MacKay-Lyons M, Ottenbacher KJ, Pugh S, Reeves MJ, Richards LG, Stiers W, Zorowitz RD. Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2016; 47:e98-e169. [PMID: 27145936 DOI: 10.1161/str.0000000000000098] [Citation(s) in RCA: 1502] [Impact Index Per Article: 187.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE The aim of this guideline is to provide a synopsis of best clinical practices in the rehabilitative care of adults recovering from stroke. METHODS Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association (AHA) Stroke Council's Scientific Statement Oversight Committee and the AHA's Manuscript Oversight Committee. The panel reviewed relevant articles on adults using computerized searches of the medical literature through 2014. The evidence is organized within the context of the AHA framework and is classified according to the joint AHA/American College of Cardiology and supplementary AHA methods of classifying the level of certainty and the class and level of evidence. The document underwent extensive AHA internal and external peer review, Stroke Council Leadership review, and Scientific Statements Oversight Committee review before consideration and approval by the AHA Science Advisory and Coordinating Committee. RESULTS Stroke rehabilitation requires a sustained and coordinated effort from a large team, including the patient and his or her goals, family and friends, other caregivers (eg, personal care attendants), physicians, nurses, physical and occupational therapists, speech-language pathologists, recreation therapists, psychologists, nutritionists, social workers, and others. Communication and coordination among these team members are paramount in maximizing the effectiveness and efficiency of rehabilitation and underlie this entire guideline. Without communication and coordination, isolated efforts to rehabilitate the stroke survivor are unlikely to achieve their full potential. CONCLUSIONS As systems of care evolve in response to healthcare reform efforts, postacute care and rehabilitation are often considered a costly area of care to be trimmed but without recognition of their clinical impact and ability to reduce the risk of downstream medical morbidity resulting from immobility, depression, loss of autonomy, and reduced functional independence. The provision of comprehensive rehabilitation programs with adequate resources, dose, and duration is an essential aspect of stroke care and should be a priority in these redesign efforts. (Stroke.2016;47:e98-e169. DOI: 10.1161/STR.0000000000000098.).
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19
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Esin RG, Sitnova MA, Esin OR. [The principles of pharmacotherapy of poststroke shoulder pain]. Zh Nevrol Psikhiatr Im S S Korsakova 2015; 115:41-45. [PMID: 26356159 DOI: 10.17116/jnevro20151155141-45] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To analyze the results of examination and treatment of patients with poststroke shoulder pain. MATERIAL AND METHODS The study included 213 patients who have had a stroke, including 16.4% patients with poststroke shoulder pain in early recovery period and 35.9% patients with poststroke shoulder pain in late recovery period. Therapeutic efficacy of amitriptyline, lidocaine (intravenously), pregabalin, tizanidine and non-steroid anti-inflammatory drugs was assessed. RESULTS AND CONCLUSION Dysfunction of nervous system plays the main role in this pain syndrome. The efficacy of the drugs in the early/late recovery period was estimated as follows: nonsteroidal anti-inflammatory drugs - 33%/12%, amitriptyline - 24%/42%, gabapentin - 10%/13%, lidocaine - 95%/100%, tizanidine - 29%/33%. Seventy-six percent of patients were free of pain after treatment using a regimen suggested by the authors.
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Affiliation(s)
- R G Esin
- Kazan State Medical Academy, Kazan; Hospital for war veterans
| | | | - O R Esin
- Kazan (Volga Region) Federal University, Kazan
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20
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Khadilkar A, Phillips K, Jean N, Lamothe C, Milne S, Sarnecka J. Ottawa Panel Evidence-Based Clinical Practice Guidelines for Post-Stroke Rehabilitation. Top Stroke Rehabil 2015; 13:1-269. [PMID: 16939981 DOI: 10.1310/3tkx-7xec-2dtg-xqkh] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of this project was to create guidelines for 13 types of physical rehabilitation interventions used in the management of adult patients (>18 years of age) presenting with hemiplegia or hemiparesis following a single clinically identifiable ischemic or hemorrhagic cerebrovascular accident (CVA). METHOD Using Cochrane Collaboration methods, the Ottawa Methods Group identified and synthesized evidence from comparative controlled trials. The group then formed an expert panel, which developed a set of criteria for grading the strength of the evidence and the recommendation. Patient-important outcomes were determined through consensus, provided that these outcomes were assessed with a validated and reliable scale. RESULTS The Ottawa Panel developed 147 positive recommendations of clinical benefit concerning the use of different types of physical rehabilitation interventions involved in post-stroke rehabilitation. DISCUSSION AND CONCLUSION The Ottawa Panel recommends the use of therapeutic exercise, task-oriented training, biofeedback, gait training, balance training, constraint-induced movement therapy, treatment of shoulder subluxation, electrical stimulation, transcutaneous electrical nerve stimulation, therapeutic ultrasound, acupuncture, and intensity and organization of rehabilitation in the management of post stroke.
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21
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Aoyagi Y, Tsubahara A. Therapeutic Orthosis and Electrical Stimulation for Upper Extremity Hemiplegia After Stroke: A Review of Effectiveness Based on Evidence. Top Stroke Rehabil 2015; 11:9-15. [PMID: 15480949 DOI: 10.1310/6q5q-69pu-nlq9-avmr] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Upper extremity hemiplegia after stroke is common and disabling. Apart from conventional physical and occupational therapy, a number of additional approaches that use devices such as orthoses, prostheses, electrical stimulation, and robots have been introduced. The purpose of this review was to assess the clinical efficacy of such devices used for the affected upper extremities of acute, subacute, and chronic stroke patients. Assessments of their effectiveness and recommendations were based on the weight of published scientific evidence. The amount of evidence with respect to hand splints and shoulder slings is limited. Further study with a well-designed randomized controlled trial (RCT) is required to investigate accurately their short- and long-term efficacy. A number of studies suggested that the use of electrical stimulation for reducing shoulder subluxation or improving the function of wrist and finger extensors is effective during or shortly after the daily treatment period. The robotic approach to hemiplegic upper extremities appears to be a novel therapeutic strategy that may help improve hand and arm function. However, the longer term effectiveness after discontinuation as well as the motor recovery mechanism of electrical stimulation or robotic devices remains unclear. More research is needed to determine the evidence-based effectiveness of electrical stimulation or other devices for stroke survivors.
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Affiliation(s)
- Yoichiro Aoyagi
- Department of Rehabilitation Medicine, Kawasaki Medical School, Okayama, Japan
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22
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Chae J, Yu DT. Neuromuscular Electrical Stimulation for Motor Restoration in Hemiparesis. Top Stroke Rehabil 2015; 8:24-39. [PMID: 14523728 DOI: 10.1310/rexb-akv9-2xbe-u5qa] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article assesses the clinical efficacy of established neuromuscular electrical stimulation (NMES) technologies for motor restoration in hemiparesis and provides an overview of evolving technologies. Transcutaneous NMES facilitates motor recovery. However, its impact on physical disability remains uncertain. Transcutaneous NMES also decreases shoulder subluxation, but its effect on shoulder pain remains uncertain. Clinically deployable upper extremity neuroprosthesis systems will not be available until sometime in the distant future. However, there is stronger evidence for the clinical utility of lower extremity neuroprosthesis systems. Evolving technology utilizes semi-implanted or fully implanted systems with more sophisticated control paradigms. Initial experiences with these systems are reviewed and directions for future research are discussed in this article.
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Affiliation(s)
- John Chae
- Physical Medicine and Rehabilitation and Biomedical Engineering, Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio, USA
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23
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Richards L, Hanson C, Wellborn M, Sethi A. Driving Motor Recovery After Stroke. Top Stroke Rehabil 2015; 15:397-411. [DOI: 10.1310/tsr1505-397] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Wilson RD, Harris MA, Gunzler DD, Bennett ME, Chae J. Percutaneous peripheral nerve stimulation for chronic pain in subacromial impingement syndrome: a case series. Neuromodulation 2014; 17:771-6; discussion 776. [PMID: 24512114 DOI: 10.1111/ner.12152] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 11/20/2013] [Accepted: 12/02/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The objective of this study was to determine the effect of peripheral nerve stimulation (PNS) on pain reduction for those with refractory subacromial impingement syndrome (SIS) and to evaluate the association with reduced disability, impairment, and safety. Our hypotheses are that PNS will be associated with a reduction in pain, impairment and disability, and improvement in quality of life while demonstrating safety. MATERIAL AND METHODS Adults with shoulder pain of at least six months duration were recruited for a three-week treatment of percutaneous PNS applied through a percutaneous electrode to the axillary motor points of the deltoid muscle. Subjects were followed for 12 weeks after treatment. The primary outcome was the worst pain in the last week, and secondary outcomes included pain interference, the Disabilities of the Arm, Shoulder, and Hand questionnaire, shoulder abduction range of motion, and safety. Analysis was with a linear mixed model. RESULTS Ten subjects were recruited. Longitudinal analysis demonstrated significant reduction in pain relative to baseline (F(1, 66) = 12.9, p < 0.01). After correcting for multiple comparisons, there were significant reductions at explantation and all follow-up time points when compared with baseline. There were also significant improvements in pain interference (F(1,65) = 15.0, p < 0.01), the Disabilities of the Arm, Shoulder, and Hand questionnaire (F(1,35) = 7.0, p = 0.01), and shoulder abduction range of motion (F(1,35) = 6.3, p = 0.02). CONCLUSION Intramuscular PNS for chronic shoulder pain due to SIS is a safe treatment associated with pain reduction, lower pain interference with activities of daily living, reduced disability, and improved shoulder abduction. Pain reduction is maintained for at least 12 weeks after treatment.
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Affiliation(s)
- Richard D Wilson
- Cleveland FES Center, Case Western Reserve University, Cleveland, OH (Wilson, Chae), USA; Department of Physical Medicine and Rehabilitation, Case Western Reserve University at MetroHealth Medical Center, Cleveland, OH (Wilson, Harris, Chae), USA
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25
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Maxwell AMW, Nguyen VQC. Management of Hemiplegic Shoulder Pain. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2013. [DOI: 10.1007/s40141-012-0001-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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26
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Stolzenberg D, Siu G, Cruz E. Current and future interventions for glenohumeral subluxation in hemiplegia secondary to stroke. Top Stroke Rehabil 2012; 19:444-56. [PMID: 22982832 DOI: 10.1310/tsr1905-444] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Poststroke shoulder pain is a common issue and can be caused by glenohumeral subluxation. This entity hinders function and quality of life and is caused by changes in tone and loss of fi ne control of the shoulder joints' supporting structures after a stroke. Current treatments are limited in number and effectiveness and have significant problems and limitations to their use. Furthermore, prior to percutaneous implantable neuromuscular electrical stimulation, there was no evidence for any treatment to provide relief for chronic hemiplegic shoulder pain from glenohumeral subluxation. This clinical review provides a comprehensive review of the anatomy, pathogenesis, clinical features, management, and clinical efficacy of current treatment modalities.
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Affiliation(s)
- David Stolzenberg
- Department of Physical Medicine and Rehabilitation, Temple University Hospital/ MossRehab, Philadelphia, Pennsylvania
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27
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Single-lead percutaneous peripheral nerve stimulation for the treatment of hemiplegic shoulder pain: a case report. Arch Phys Med Rehabil 2011; 92:837-40. [PMID: 21530732 DOI: 10.1016/j.apmr.2010.11.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Revised: 10/29/2010] [Accepted: 11/03/2010] [Indexed: 11/24/2022]
Abstract
Previous studies demonstrated the efficacy of 6 weeks of a 4-lead percutaneous, peripheral nerve stimulation system in reducing hemiplegic shoulder pain. This case report describes the first stroke survivor treated for 3 weeks with a less complex, single-lead approach. The participant was a 59-year-old male who developed hemiplegic shoulder pain shortly after his stroke 7.5 years prior to study enrollment and was treated with multiple modalities without sustained pain relief. After study enrollment, a single intramuscular lead was placed percutaneously into the deltoid muscle. He was treated 6 hours per day for 3 weeks and the lead was removed. The primary outcome measure was the Brief Pain Inventory (Short-Form) Question 3 (BPI-3), which queries the worst pain in the last week on a 0 to 10 numeric rating scale. At baseline, BPI 3 was an 8. At the end of treatment and at 1 and 4 weeks after treatment was completed, BPI 3 scores were 3, 2, and 2, respectively. Substantial improvements in quality of life measures were also observed. The participant remained infection-free and the lead was removed fully intact. After completing the study protocol, the participant was followed clinically for 13 months posttreatment with complete resolution of hemiplegic shoulder pain. This case report demonstrates the feasibility of a single-lead peripheral nerve stimulation for the treatment of chronic hemiplegic shoulder pain. Additional studies are needed to further demonstrate safety and efficacy, determine optimal dose, define optimal prescriptive parameters, expand clinical indications, and demonstrate long-term effect.
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28
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Merrill DR. Review of electrical stimulation in cerebral palsy and recommendations for future directions. Dev Med Child Neurol 2009; 51 Suppl 4:154-65. [PMID: 19740224 DOI: 10.1111/j.1469-8749.2009.03420.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Electrical stimulation (ES) for treatment of neuromuscular disorders is introduced. Various forms of ES are defined. Characteristics of cerebral palsy (CP) and treatment options are given. The clinical objectives of ES for CP treatment are stated. A review of the literature for treatment in CP is given. Several common themes within the literature and limitations in prior studies are explored. The majority of studies have used surface stimulation, which has several inherent limitations. To address these limitations, implanted devices may be used. Implanted device systems include percutaneous stimulation systems, and fully implantable leaded systems. While both of these technologies have advantages over surface stimulation, they also have their own limitations. To further address the limitations of percutaneous and fully implantable leaded systems, the Alfred Mann Foundation has developed a completely implantable, telemetered device known as the Radio Frequency Microstimulator (RFM). Results from a study using the RFM for arm rehabilitation in poststroke patients are given. A list of desirable design features for an ES system for CP is given. The next generation microstimulator device under development at the Alfred Mann Foundation is presented. This device may well serve the needs for ES in CP.
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Affiliation(s)
- Daniel R Merrill
- Alfred E Mann Foundation for Scientific Research, Santa Clarita, CA, USA.
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29
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Chae J, Sheffler L, Knutson J. Neuromuscular electrical stimulation for motor restoration in hemiplegia. Top Stroke Rehabil 2008; 15:412-26. [PMID: 19008202 DOI: 10.1310/tsr1505-412] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Clinical applications of neuromuscular electrical stimulation (NMES) in stroke rehabilitation provide both therapeutic and functional benefits. Therapeutic applications include upper and lower limb motor relearning and reduction of poststroke shoulder pain. There is growing evidence that NMES, especially those approaches that incorporate task-specific strategies, is effective in facilitating upper and lower limb motor relearning. There is also strong evidence that NMES reduces poststroke shoulder subluxation and pain. Functional applications include upper and lower limb neuroprostheses. Lower limb neuroprostheses in the form of peroneal nerve stimulators is effective in enhancing the gait speed of stroke survivors with foot-drop. The development of hand neuroprostheses is in its infancy and must await additional fundamental and technical advances before reaching clinical viability. The limitations of available systems and future developments are discussed.
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Affiliation(s)
- John Chae
- Department of Physical Medicine and Rehabilitation, Case Western Reserve University, Cleveland, Ohio, USA
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30
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Alon G, McBride K, Ring H. Improving selected hand functions using a noninvasive neuroprosthesis in persons with chronic stroke. J Stroke Cerebrovasc Dis 2007; 11:99-106. [PMID: 17903863 DOI: 10.1053/jscd.2002.127107] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2002] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND AND PURPOSE Loss of upper extremity function following stroke remains a major rehabilitation challenge. The purpose of this investigation was to determine whether the Handmaster system (NESS Ltd., Ra'anana, Israel) could improve selected hand functions in persons with chronic upper extremity paresis following stroke. METHODS Twenty-nine poststroke subjects consented to participate in a home-based, 3-week, nonrandomized case series trial. Main outcome measures included 3 activities of daily living (ADL) tasks: (1) lifting a 2-handled pot, (2) holding a bag while standing with a cane, and (3) a subject-selected-ADL. Secondary outcomes included lifting a 600-g weight, grip strength, electrically induced finger motion, Fugl-Meyer spherical grasp, and perceived pain scale. RESULTS Comparing baseline to study end point with the neuroprosthesis, the percent of successful trials with lifting the pot, weight, and bag (0% v 93%, 14% v 100%, and 17% v 93%, respectively) increased significantly. All subjects performed successfully their selected ADL and improved their Fugl-Meyer scores using the neuroprosthesis. Grip strength (6.4 +/- 7.3N v 17.7 +/- 6.2N) and active finger motion (0.5 +/- 1.2 cm v 8.4 +/- 2.6 cm) also improved with the neuroprosthesis. Pain scores significantly decreased in subjects reporting pain at baseline. Responses to questionnaire were favorable regarding the utility and therapeutic benefits of the device. CONCLUSIONS We conclude that the Handmaster is a safe and effective noninvasive neuroprosthesis for improving the studied hand functions and impairments in selected persons with chronic hemiplegia secondary to stroke.
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Affiliation(s)
- Gad Alon
- University of Maryland, School of Medicine, Department of Physical Therapy, Baltimore, MD 21201-1082, USA
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31
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Chae J, Ng A, Yu DT, Kirsteins A, Elovic EP, Flanagan SR, Harvey RL, Zorowitz RD, Fang ZP. Intramuscular Electrical Stimulation for Shoulder Pain in Hemiplegia: Does Time From Stroke Onset Predict Treatment Success? Neurorehabil Neural Repair 2007; 21:561-7. [PMID: 17369520 DOI: 10.1177/1545968306298412] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. A randomized clinical has shown the effectiveness of intramuscular electrical stimulation for the treatment of poststroke shoulder pain. Objective. Identify predictors of treatment success and assess the impact of the strongest predictor on outcomes. Method. This is a secondary analysis of a multisite randomized clinical trial of intramuscular electrical stimulation for poststroke shoulder pain. The study included 61 chronic stroke survivors with shoulder pain randomized to a 6-week course of intramuscular electrical stimulation (n = 32) versus a hemisling (n = 29). The primary outcome measure was Brief Pain Inventory Question 12. Treatment success was defined as ≥ 2-point reduction in this measure at end of treatment and at 3, 6, and 12 months posttreatment. Forward stepwise regression was used to identify factors predictive of treatment success among participants assigned to the electrical stimulation group. The factor most predictive of treatment success was used as an explanatory variable, and the clinical trials data were reanalyzed. Results. Time from stroke onset was most predictive of treatment success. Subjects were divided according to the median value of stroke onset: early (<77 weeks) versus late (> 77 weeks). Electrical stimulation was effective in reducing poststroke shoulder pain for the early group (94% vs 7%, P < .001) but not for the late group (31% vs 33%). Repeated-measure analysis of variance revealed significant treatment ( P < .001), time from stroke onset ( P = .032), and treatment by time from stroke onset interaction ( P < .001) effects. Conclusions. Stroke survivors who are treated early after stroke onset may experience greater benefit from intramuscular electrical stimulation for poststroke shoulder pain. However, the relative importance of time from stroke onset versus duration of pain is not known.
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Affiliation(s)
- John Chae
- Cleveland Functional Electrical Stimulation Center, Cleveland, Ohio, USA.
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Abstract
OBJECTIVE The objective of this study was to compare pain induced by magnetic stimulation of the quadriceps femoris (QF) muscle with that induced by transcutaneous neuromuscular electrical stimulation (NMES). DESIGN Magnetic stimulation and transcutaneous NMES were applied to QF muscles of 17 normal volunteers. The intensity of each mode of stimulation was increased in a stepwise manner. Peak torque values of isometric contractions of QF muscles and visual analog scale (VAS) scores were recorded at each intensity level. The VAS scores of the two stimulating modalities were compared at the intensity-generating same peak torque values. RESULTS The median VAS scores for electrical and magnetic stimulation were 5.7 and 0.3, respectively. The median difference between the VAS scores for electrical and magnetic stimulation was 3.7 (range, 1.7-8.5). The mean of the maximum peak torque obtained from each subject was higher in magnetic stimulation than in electrical stimulation (9.5 +/- 4.8 vs. 4.4 +/- 2.9 Nm). CONCLUSIONS Magnetic stimulation of the QF muscle produced less pain at the same level of isometric peak torque than did transcutaneous NMES. Magnetic stimulation is a potential alternative to transcutaneous NMES, especially for persons with intact or residual sensory function.
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Affiliation(s)
- Tai-Ryoon Han
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, South Korea
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Chae J, Yu DT, Walker ME, Kirsteins A, Elovic EP, Flanagan SR, Harvey RL, Zorowitz RD, Frost FS, Grill JH, Fang ZP. Intramuscular Electrical Stimulation for Hemiplegic Shoulder Pain. Am J Phys Med Rehabil 2005; 84:832-42. [PMID: 16244520 DOI: 10.1097/01.phm.0000184154.01880.72] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Assess the effectiveness of intramuscular electrical stimulation in reducing hemiplegic shoulder pain at 12 mos posttreatment. DESIGN A total of 61 chronic stroke survivors with shoulder pain and subluxation participated in this multiple-center, single-blinded, randomized clinical trial. Treatment subjects received intramuscular electrical stimulation to the supraspinatus, posterior deltoid, middle deltoid, and upper trapezius for 6 hrs/day for 6 wks. Control subjects were treated with a cuff-type sling for 6 wks. Brief Pain Inventory question 12, an 11-point numeric rating scale was administered in a blinded manner at baseline, end of treatment, and at 3, 6, and 12 mos posttreatment. Treatment success was defined as a minimum 2-point reduction in Brief Pain Inventory question 12 at all posttreatment assessments. Secondary measures included pain-related quality of life (Brief Pain Inventory question 23), subluxation, motor impairment, range of motion, spasticity, and activity limitation. RESULTS The electrical stimulation group exhibited a significantly higher success rate than controls (63% vs. 21%, P = 0.001). Repeated-measure analysis of variance revealed significant treatment effects on posttreatment Brief Pain Inventory question 12 (F = 21.2, P < 0.001) and Brief Pain Inventory question 23 (F = 8.3, P < 0.001). Treatment effects on other secondary measures were not significant. CONCLUSIONS Intramuscular electrical stimulation reduces hemiplegic shoulder pain, and the effect is maintained for > or =12 mos posttreatment.
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Affiliation(s)
- John Chae
- Cleveland Functional Electrical Stimulation Center, Cleveland, OH 44109, USA
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Pierce SR, Orlin MN, Lauer RT, Johnston TE, Smith BT, McCarthy JJ. Comparison of percutaneous and surface functional electrical stimulation during gait in a child with hemiplegic cerebral palsy. Am J Phys Med Rehabil 2004; 83:798-805. [PMID: 15385791 DOI: 10.1097/01.phm.0000137318.92035.8c] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of this brief report was to compare the immediate effects of surface functional electrical stimulation (S-FES) and percutaneous functional electrical stimulation (P-FES) of the tibialis anterior applied during gait in a child with hemiplegic cerebral palsy. A three-dimensional gait analysis was conducted while an 11-yr-old girl with right hemiplegia walked with S-FES, P-FES, and no stimulation. The results indicated that both P-FES and S-FES increased dorsiflexion at initial contact, peak dorsiflexion in swing, and mean dorsiflexion in swing compared with walking without stimulation. The increase in dorsiflexion was greater with P-FES as compared with S-FES. Ankle absorption work was improved with both types of stimulation, whereas ankle generation work increased only with P-FES. This report suggests that S-FES and P-FES may have different immediate effects on gait due to issues such as muscle contraction strength, sensory feedback, and control systems for stimulation.
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Affiliation(s)
- Samuel R Pierce
- Shriners Hospitals for Children, Philadelphia, Pennsylvania 19140, USA
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Abstract
Shoulder pain is a common complication in poststroke hemiplegia that reduces functional recovery. Many types of shoulder pathology have been suggested as causes of shoulder pain in hemiplegia,including shoulder subluxation, capsulitis, tendinitis, rotator cuff injury, bursitis, impingement syndrome, spasticity, complex regional pain syndrome, brachial plexus injury, and proximal mononeuropathies. More than one type of pathology may exist in a given patient. Shoulder pain improves in many cases with prompt diagnosis and appropriate management. Although the relationship between subluxation and pain is controversial, upper limb support to reduce subluxation is the standard of care and may prevent the development of pain and secondary complications. Further work is needed to elucidate the natural history of shoulder pain in hemiplegia, including the identification of physiologic common denominators that can lead to improved strategies to treat and prevent shoulder pain.
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Affiliation(s)
- David Yu
- Department of Rehabilitation Medicine, University of Washington, and Rehabilitation Medicine, Harborview Medical Center, Seattle, USA.
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Yu DT, Chae J, Walker ME, Kirsteins A, Elovic EP, Flanagan SR, Harvey RL, Zorowitz RD, Frost FS, Grill JH, Feldstein M, Fang ZP. Intramuscular neuromuscular electric stimulation for poststroke shoulder pain: A multicenter randomized clinical trial 11A commercial party with a direct financial interests in the results of the research supporting this article has or will confer a benefit on the author or 1 or more of the authors. NeuroControl Corp, Valley View, OH, intends to commercialize the device evaluated in this article and has submitted a premarket 510(K)application, which is currently pending US Food and Drug Administration review. Chae and Feldstein are consultants to NeuroControl. Walker was an employee of NeuroControl, and is now a consultant to NeuroControl. Fang is an employee of NeuroControl. During this study, Yu served as a consultant to NeuroControl and Grill was an employee of NeuroControl, but neither now has an affiliation with NeuroControl. Arch Phys Med Rehabil 2004; 85:695-704. [PMID: 15129391 DOI: 10.1016/j.apmr.2003.07.015] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To assess the effectiveness of intramuscular neuromuscular electric stimulation (NMES) in reducing poststroke shoulder pain. DESIGN Multicenter, single-blinded, randomized clinical trial. SETTING Ambulatory centers of 7 academic rehabilitation centers in the United States. PARTICIPANTS Volunteer sample of 61 chronic stroke survivors with shoulder pain and subluxation. INTERVENTION Treatment subjects received intramuscular NMES to the supraspinatus, posterior deltoid, middle deltoid, and trapezius for 6 hours a day for 6 weeks. Control subjects were treated with a cuff-type sling for 6 weeks. Main outcome measure Brief Pain Inventory question 12 (BPI 12), an 11-point numeric rating scale administered in a blinded manner at the end of treatment, and at 3 and 6 months posttreatment. RESULTS The NMES group exhibited significantly higher proportions of success based on the 3-point or more reduction in BPI 12 success criterion at the end of treatment (65.6% vs 24.1%, P<.01), at 3 months (59.4% vs 20.7%, P<.01), and at 6 months (59.4% vs 27.6%, P<.05). By using the most stringent "no pain" criterion, the NMES group also exhibited significantly higher proportions of success at the end of treatment (34.4% vs 3.4%, P<.01), at 3 months (34.4% vs 0.0%, P<.001), and at 6 months (34.4% vs 10.3%, P<.05). CONCLUSIONS Intramuscular NMES reduces poststroke shoulder pain among those with shoulder subluxation and the effect is maintained for at least 6 months posttreatment.
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Affiliation(s)
- David T Yu
- Departments of Physical Medicine and Rehabilitation, Case Western Reserve University, Cleveland, OH 44109, USA
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Abstract
The Stroke Rehabilitation Evidence-Based Review revealed a wide range of quality scores across primary studies. The aim of this section is to determine what differences there are across studies and to provide a detailed examination of methodological issues in the stroke rehabilitation literature. Methodology of each article was assessed using the Physiotherapy Evidence Database (PEDro) quality scale. Mean PEDro scores and percentage of studies meeting individual PEDro criteria were determined for all studies, for therapy-based studies only, and for drug-based studies only. It was noted that the stroke rehabilitation literature lacked rigor in the area of concealed allocation, blinding of the assessor, and intention-to-treat analysis. Investigation of the methodological quality of stroke rehabilitation literature emphasizes the need for improved treatment protocols, taking into account previous deficits, during research.
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Affiliation(s)
- Sanjit K Bhogal
- St. Joseph's Health Care London, Parkwood Site, London, Ontario, Canada
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Abstract
The purpose of this study was to assess the feasibility of a percutaneous hand neuroprosthesis system for stroke survivors. Case reports of 4 chronic stroke survivors who were implanted with percutaneous intramuscular electrodes in various muscles of the forearm for hand grasp and release are presented. A percutaneous hand neuroprosthesis was able to open a spastic hemiparetic hand as long as the upper limb was in a resting position, the wrist and proximal forearm were supported, participants did not try to assist the stimulation, and an individual other than the participant modulated the stimulation. However, when participants tried to assist the stimulation or complete a functional task, hand opening was significantly reduced due to increased finger flexor hypertonia, even with increased stimulation intensity. Similarly, electrically stimulated hand opening was significantly reduced following voluntary hand closure. Techniques that provide real-time modulation of hypertonia with closed loop control, control strategies that are independent of the contralateral limb, and methods to enhance proximal control must be developed to demonstrate the feasibility of a hand neuroprosthesis system for persons with hemiparesis.
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Affiliation(s)
- John Chae
- Center for Physical Medicine and Rehabilitation, Department of Biomedical Engineering, Case Western Reserve University, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109, USA.
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