Electrical Stimulation Research Articles

Transcutaneous electrical nerve stimulation for fibromyalgia-like syndrome in patients with Long-COVID: a pilot randomized clinical trial

This study investigated the effect of Transcutaneous Electrical Nerve Stimulation (TENS) for fibromyalgia-like symptoms including chronic widespread musculoskeletal pain, fatigue, and/or gait impairment in twenty-five individuals with long-COVID. Participants were randomized to a high dose (intervention group, IG) or low dose (placebo group, PG) TENS device. Both groups received daily 3–5 h of TENS therapy for 4-weeks. The Brief Pain Inventory assessed functional interference from pain (BPI-I), and pain severity (BPI-S). The global fatigue index (GFI) assessed functional interference from fatigue. Wearable technology measured gait parameters during three 30-feet consecutive walking tasks. At 4-weeks, the IG exhibited a greater decrease in BPI-I compared to the PG (mean difference = 2.61, p = 0.008), and improved in gait parameters including stride time (4-8%, test condition dependent), cadence (4-10%, depending on condition), and double-support phase (12% in dual-task) when compared to baseline. A sub-group meeting the 2010 American College of Rheumatology Fibromyalgia diagnostic criteria undergoing high-dose TENS showed GFI improvement at 4-weeks from baseline (mean change = 6.08, p = 0.005). Daily TENS therapy showed potential in reducing functional interference from pain, fatigue, and gait alterations in long-COVID individuals. The study’s limited power could affect the confirmation of certain observations. Extending the intervention period may improve treatment effectiveness.

Effects of different types of high-definition transcranial electrical stimulation on visual working memory and contralateral delayed activity

Background and purposeWorking memory is critical for individuals and has been found to be improved by electrical stimulation of the left dorsolateral prefrontal cortex (DLPFC). However, the effects of different types of transcranial electrical stimulation on working memory are controversial, and the underlying mechanism remains uncertain. In this study, high-definition transcranial direct current stimulation (HD-tDCS) and high-definition transcranial random noise stimulation (HD-tRNS) were applied to the DLPFC to observe the different effects on visual working memory (VWM). The aim was to explore the causal relationship between the electrical activity of the DLPFC and the posterior parietal cortex (PPC) electrical activity and the contralateral delayed activity (CDA).MethodsThirty-three healthy subjects received HD-tDCS, HD-tRNS and sham stimulation in a random order. Stimulation was applied to the left DLPFC for 20 min. The subjects underwent a color change-detection task as our VWM task and an auditory digit span test (DST) immediately after stimulation. Event-related potential (ERP) data were collected during the VWM task.ResultsThe results revealed significant differences between the different types of HD-tES. There was a remarkable increase in VWM capacity following HD-tDCS compared with both HD-tRNS (pa = 0.038) and sham stimulation (pa = 0.038). Additionally, the CDA from the PPC differed after stimulation of the DLPFC. Both HD-tDCS and HD-tRNS expanded the maximum CDA amplitude from set size of 4 to 6, whereas after sham stimulation, the maximum CDA was maintained at a set size of 4. Compared with the sham condition, only HD-tDCS induced a noteworthy increase in CDA amplitude (pa = 0.012). Notably, a significant correlation emerged between the mean CDA amplitude and VWM capacity (p < 0.001, r = − 0.402).ConclusionThese findings underscore the ability of HD-tDCS to target the DLPFC to augment working memory capacity while concurrently amplifying CDA amplitudes in the PPC through the frontoparietal network.Trial registration ChiCTR2300074898.

Rehabilitation for complicated dysphagia after synchronous head-and-neck and esophageal cancer surgery: A case report

Rationale: Surgical intervention for synchronous head-and-neck and esophageal cancers often results in complex dysphagia, significantly affecting postoperative quality of life. Swallowing dysfunction may become permanent or worsen, with potential impacts on noncancer-related mortality. Patient concerns: We report a rare case of multiple synchronous squamous cell carcinomas of the head and neck (tonsillar and epiglottic cancer) along with esophageal cancer, presenting for dysphagia rehabilitation following surgery. Diagnoses: Comprehensive evaluations—including magnetic resonance imaging, laryngoscopy, gastroscopy, and histopathology—led to diagnoses of left tonsil cancer (squamous cell carcinoma, T2N2bM0), epiglottic cancer (squamous cell carcinoma, T1N2bM0), and lower esophageal cancer (squamous cell carcinoma, T2N0M0). Postoperative videofluoroscopic swallowing study identified an anastomotic stricture at the level of the fifth cervical vertebra. Interventions: The patient underwent an 8-week rehabilitation program incorporating stretching exercises, swallowing behavior therapy, super-supraglottic swallow techniques, catheter balloon dilation, electrical stimulation, and respiratory therapy. Outcomes: Following rehabilitation, the patient was able to resume partial oral intake without aspiration, with significant improvement in anastomotic stricture and swallowing function. Lessons: This case of dysphagia underscores the anastomotic stenosis resulting from oncological surgical intervention. Dysphagia is a frequent complication in patients with synchronous head-and-neck and esophageal cancers. Comprehensive rehabilitation and assessment of swallowing function enabled safe oral intake postoperatively in this patient.

Does age protect against loss of tonotopy after acute deafness in adulthood?

The mammalian auditory system develops a topographical representation of sound frequencies along its pathways, also called tonotopy. In contrast, sensory deprivation during early development results in no or only rudimentary tonotopic organization. This study addresses two questions: (1) How robust is the central tonotopy when hearing fails in adulthood? (2) What role does age play at time of deafness? To address these questions, we deafened young and old adult rats with previously normal hearing. One month after deafening, both groups were unilaterally supplied with cochlear implants and electrically stimulated for 2 h. The central auditory neurons, which were activated as a result of the local electrical intracochlear stimulation, were visualized using Fos staining. While the auditory system of young rats lost the tonotopic organization throughout the brainstem, the auditory system of the older rats mainly sustained its tonotopy. It can be proposed that plasticity prevails in the central auditory system of young adult rats, while network stability prevails in the brains of aging rats. Consequently, age may be an important factor in protecting a hearing-experienced adult auditory system from a rapid loss of tonotopy when suffering from acute hearing loss. Furthermore, the study provides compelling evidence that acute deafness in young adult patients should be diagnosed as early as possible to prevent maladaptation of the central auditory system and thus achieve the optimal hearing outcome with a hearing prosthesis.

Electrical Microneedles for Wound Treatment.

Electrical stimulation has been hotpot research and provoked extensive interest in a broad application such as wound closure, tissue injury repair, and nerve engineering. In particular, immense efforts have been dedicated to developing electrical microneedles, which demonstrate unique features in terms of controllable drug release, real-time monitoring, and therapy, thus greatly accelerating the process of wound healing. Here, a review of state-of-art research concerning electrical microneedles applied for wound treatment is presented. After a comprehensive analysis of the mechanisms of electrical stimulation on wound healing, the derived three types of electrical microneedles are clarified and summarized. Further, their applications in wound healing are highlighted. Finally, current perspectives and directions for the development of future electrical microneedles in improving wound healing are addressed.

ACTIVE, ACTUATED, AND ASSISTIVE: A SCOPING REVIEW OF EXOSKELETONS FOR THE HANDS AND WRISTS

BACKGROUND: Assistive technology is often incorporated into rehabilitation and support for those impacted by upper limb impairments. When powered, these devices provide additional force to the joints of users with muscle weakness. Actuated devices allow dynamic movement compared to splints, therefore improving the ability to complete activities of daily living. However, these devices are not often prescribed and are underrepresented in research and clinical settings. OBJECTIVE: This review examines the current body of literature concerning devices designed to aid the hands and wrists in daily activities. Focusing on active, powered, and actuated devices, to gain a clearer understanding of the current limitations in their design and prescription. METHODOLOGY: The scoping review was conducted using the PRISMA-ScR guidelines. A systematic search was done on MEDLINE, EMBASE, Scopus, Web of Science, and NHS the Knowledge Network from inception to May 2023. Articles were included if the device was portable; supported the hands and wrist actively using an actuator; and could be used for assistive living during or post-rehabilitation period. FINDINGS: A total of 135 studies were included in the analysis of which 34 were clinical trials. The design and control methods of 121 devices were analyzed. Electrical stimulation and direct mechanical transmission were popular actuation methods. Electromyography (EMG) and joint movement detection were highly used control methods to translate user intentions to device actuation. A total of 226 validation methods were reported, of which 44% were clinically validated. Studies were often not conducted in operational environments with 69% at technology readiness levels ≤ 6, indicating that further development and testing is required. CONCLUSION: The existing literature on hand and wrist exoskeletons presents large variations in validation methods and technical requirements for user-specific characteristics. This suggests a need for well-defined testing protocols and refined reporting of device designs. This would improve the significance of clinical outcomes and new assistive technology. Layman's Abstract Assistive devices are often incorporated into rehabilitation and support for those impacted by upper limb impairments. When powered, these devices provide additional force for users with muscle weakness. Unlike splints, these devices do not constrict movement, therefore improving the ability to complete activities of daily living. However, these devices are rarely prescribed or presented in research and clinical settings. This review examines the current literature concerning powered devices that aid the hands and wrists to investigate who uses them, how they are designed and how they are validated. The scoping review was conducted using a validated guideline. A systematic search was done on 5 databases up to May 2023. Articles were included if the device was portable; supported the hands and wrist using motors; and could be used for everyday tasks. A total of 135 studies were included in the analysis, of which 34 were clinical trials. The design and method of device function of 121 devices were analysed. Muscle and joint movement detection were highly used to control device movement. A total of 226 validation methods were reported, of which 44% were clinically validated. Studies were often conducted in research and clinical environments (69%) rather than at home settings. In conclusion, existing literature on hand and wrist exoskeletons presents large variations in design, control methods and validation practices. This suggests a need for well-defined testing protocols. This would improve the significance of clinical outcomes of new assistive technology. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/43827/33279 How To Cite: Galbert A, Buis A. Active, actuated, and assistive: A scoping review of exoskeletons for the hands and wrists. Canadian Prosthetics &amp; Orthotics Journal. 2024; Volume 7, Issue 1, No.9. https://doi.org/10.33137/cpoj.v7i1.43827 Corresponding Author: Professor Arjan Buis, PhDDepartment of Biomedical Engineering, Faculty of Engineering, University of Strathclyde, Glasgow, Scotland.E-Mail: arjan.buis@strath.ac.ukORCID ID: https://orcid.org/0000-0003-3947-293X

Holistic approaches to living well with endometriosis

Endometriosis is a common chronic non curable neuro-inflammatory condition, which can cause endometriosis-related pelvic pain (ERPP). Sufferers may struggle with side effects and/or risks from conventional medical and surgical treatments, or not get pain relief. Increasing numbers of endometriosis patients wish to explore holistic management with fewer side effects, however it is important that medical professionals maintain an evidence-based practice for recommended treatments. We present up-to-date evidence of holistic strategies used for managing ERPP including nutrition, body and mind therapies, acupuncture, traditional Chinese medicine (TCM) and the use of adjunct devices such as phallus length reducers and transcutaneous electrical nerve stimulation (TENS). Recent findings: Nutrition: Gluten-free, low-nickel and high intake of omega-3 polyunsaturated fatty acids diets improve ERPP. Low FODMAP (fermentable oligo-, di-, monosaccharides and polyols), plant-based diet and antioxidant vitamin supplementation is helpful including those with concurrent irritable bowel syndrome. Body and Mind: Cognitive behaviour therapy (CBT) is beneficial in postoperative pain reduction, whilst mindfulness has been shown to reduce pain scores and dyschezia. Progressive muscle relaxation therapy and regular yoga sessions improve ERPP and Quality of life. Acupuncture: Acupuncture and moxibustion show improved pain scores compared to conventional therapies alone. Adjunct devices: TENS improves deep dyspareunia and reduces the number of days pain is experienced. Summary: Holistic management strategies for ERPP should be incorporated into routine counselling when discussing conservative, medical and or surgical treatments for endometriosis. The growing evidence presented for the use of holistic management strategies gives hope to those patients who cannot have, or don’t respond to conventional approaches and as an adjunct alongside standard treatments. These findings should be incorporated into the routine counselling when seeing patients in the gynaecology outpatient setting presenting with chronic pelvic pain.

GUIDELINES FOR THE APPLICATION OF ELECTROTHERAPY AND LASER THERAPY IN BURN PATIENTS

This article addresses the importance of electrotherapy and laser therapy in the treatment of burn patients, justifying their need due to the complexity involved in the recovery of these individuals and the recent advances in these therapeutic modalities. Burns cause deep damage to the skin and underlying tissues, generating complications such as intense pain, hypertrophic scars, and functional loss. Despite the conventional use of medications, grafts, and topical care, there is a growing demand for complementary treatments that accelerate healing, control pain, and promote more effective rehabilitation. The objective of this study is to review and analyze the effects of electrotherapy and laser therapy on the healing process, pain control, and functional recovery of burn patients. The methodology used was a literature review in scientific databases, including articles published between 2015 and 2023, focusing on research that examined the use of these therapies in the context of burns. The results indicate that electrotherapy favors tissue healing by increasing blood flow and stimulating cell regeneration, in addition to providing pain relief through transcutaneous electrical nerve stimulation (TENS). Laser therapy, in turn, accelerates healing by stimulating the production of ATP in cells, reducing inflammation and improving the quality of scars, minimizing the risk of hypertrophic scars and keloids. Studies that combine both therapies show a faster and more effective recovery, with a lower incidence of complications. The conclusion highlights that the combined application of electrotherapy and laser therapy presents significant benefits, being an effective alternative to optimize healing, reduce pain and improve the functionality of burn patients. Dissemination of these results is essential to improve clinical care and encourage future research that expands the use of these therapies in clinical practice.

Does Post-Tetanic Transcranial Stimulation Augment the Wave Amplitudes of Spinal Cord Evoked Potential (Tc-SCEP)?

Prospective within-subjects study. Although motor-evoked potential (MEP) amplitude can reportedly be increased by tetanic stimulation of the peripheral nerves before transcranial electrical stimulation (TES), no reports have described on whether tetanic transcranial stimulation augments the wave amplitudes of spinal cord-evoked potentials (Tc-SCEP). The primary purpose of this study was to investigate whether tetanic stimulation induces waveform amplification of Tc-SCEP. The secondary purpose was to elucidate the mechanism of the amplification effect of tetanic stimulation. We recruited 20 patients who underwent cervical or thoracic spine surgeries. We compared the compound muscle active potentials (CMAPs) of Tc-MEP and Tc-SCEP before and after tetanic stimulation of the median or tibial nerve. Although the CMAP wave amplitudes of the abductor pollicis brevis (APB) and abductor hallucis (AH) showed significant enlargement on Tc-MEP following tetanic stimulation of the median and tibial nerves, an augmentation effect regarding Tc-SCEP (203μV [without tetanic stimulation], 212μV [tetanic stimulation of the median nerve], and 208μV [tetanic stimulation of tibial nerve]) could not be demonstrated. Although MEP amplitudes can be enlarged by tetanic stimulation of the peripheral nerves, the amplification mechanism may not involve the lateral corticospinal tract from the brain stem to the anterior horn.

Dermal macrophages control tactile perception under physiological conditions via NGF signaling

We demonstrated previously that sorting nexin 25 (SNX25) in nerve-associated macrophages plays critical roles in pain sensation by regulating tissue NGF content under both physiological and neuropathic conditions. In the present study, we apply the SNX25–NGF paradigm to tactile perception by showing that Snx25+/- mice or macrophage-specific Snx25 conditional knock-out (mcKO) mice had weaker responses to tactile stimuli in normal conditions. Snx25 mcKO mice responded poorly to transcutaneous electrical stimuli at a frequency of 5 Hz (C fiber responses), but normally to stimuli at a frequency of 250 Hz (Aδ fiber responses) or of 2000 Hz (Aβ fiber responses). CX3CR1-positive dermal macrophages were frequently found near calcitonin gene–related peptide (CGRP)- positive nerves and, less frequently, tyrosine hydroxylase (TH)-positive nerves. We confirmed that the tissue content of NGF was lower in Snx25 mcKO mice than in wild-type mice, and in turn, dermal NGF injection restored tactile sensitivity in Snx25+/- mice and Snx25 mcKO mice to normal levels. These results indicate that CGRP-positive C-nociceptors (possibly also TH-positive C-LTMRs) associated dermal macrophages control tactile perception by producing NGF and secreting it into the dermis.

Application of percutaneous neurostimulation in treatment complexes for psychosomatic pathology

The article is devoted to the combined use of psychological relaxation and transcutaneous electrical stimulation in post-stress disorders in persons of hazardous professions.Materials and methods. There were 90 men with a high level of stress aged 40 to 55 years, whose clinical picture was distinguished by the interweaving of neuropsychiatric and cardiovascular disorders. The assessment of the mental status of patients was supplemented by the results of testing; the reserve capabilities of the body were assessed based on a test of dosed physical activity. Electro- and echocardiography were used to analyze cardiovascular activity. The patients were divided into three treatment groups, in which, in addition to the previously prescribed drug treatment in a third of cases, respiratory relaxation training and percutaneous neurostimulation were used. In the first two groups, these methods were used separately, in the 3rd group – in combination.Research results. Initially, the features of neuropsychic and somatic manifestations in the observed contingent were specified. At the same time, in most of the observations, neurotic manifestations prevailed, combined with somatic disorders, mainly in the form of arterial hypertension and angina pectoris. In the course of assessing the results of treatment, the proposed complex was significantly more effective than the compared groups in terms of improving indicators of mental status and cardiovascular activity. The catamnesis analysis confirmed the stability of the results achieved even in the case of combined exposure.Conclusion. The therapeutic complex of psychorelaxation and hardware equipment provides the effectiveness and therapeutic reliability of the effect due to the addition of several therapeutic mechanisms, and the work itself opens up prospects for optimizing corrective programs for the pathology under study.

Bioelectrical stimulation therapy for muscle injuries in aerobics athletes

This article aims to explore the recovery effect of the bioelectrical stimulation therapy on muscle injuries in aerobics athletes. Non-invasive medical techniques are adopted to activate muscle tissue through electrical currents, promoting muscle contraction ability and functional recovery. This article selects 100 aerobics athletes with muscle injuries through questionnaire surveys and interviews. The Modulo Plus electrical stimulation device is used, and personalized treatment plans are set. Muscle changes before and after treatment are monitored using electromyography and ultrasound technology. In the single-blind experiment, in the fourth week, the pain score of the experimental group decreases to 2.4 points; the functional recovery score increases to 75.2 points; the flexibility measurement reaches 19.2 cm. In the case-control study, the bioelectrical stimulation therapy cures all athletes in the sixth week, exceeding the conventional therapy’s 35 patients, and has a lower recurrence rate. In the cohort study, athletes who use the bioelectrical stimulation therapy for a long time have a shorter average recovery time of 15.3 days and a recurrence rate of 16%. In the muscle recovery experiment, in the eighth week after treatment, the electromyographic activity level of the experimental group increases to 58.6 μV; the muscle thickness increases to 4.3 mm; the echo intensity increases to 63.1 dB; the fatigue characteristic score drops to 2.1. These data indicate that the bioelectrical stimulation therapy has significant effects in reducing pain, promoting functional recovery, improving flexibility, shortening recovery time, and reducing recurrence rates and pain scores, thereby providing an effective treatment option for the recovery of muscle injuries in aerobics athletes.

Physical therapy approach and non-invasive modalities in treatment of vaginal laxity: a literature review.

Pelvic floor physical therapy (PFPT) and noninvasive modalities can be more safe and available treatments for vaginal laxity (VL) with less risk of postsurgical complications. The purpose of this review is to define the concepts of PFPT and noninvasive modalities, examine the evidence supporting those modalities as a treatment for VL, and evaluate their effectiveness. Between 2002 and 2023, clinical studies including women diagnosed with VL were examined in the Web of Science, Cochrane Library, Scopus, and PubMed databases. Exclusion criteria included studies with no outcomes or inadequate data, procedures, suggestions, editorials, book chapters, letters to editors, reviews, meta-analyses, animal research, and articles in languages other than English. Only seventeen studies have been identified. Four studies have demonstrated the impact of PFPT (low- and medium-energy radiofrequency (RF), ultrasound, low-energy laser treatment, par sacral stimulation, the knack method, and pelvic floor exercises), and thirteen studies have discussed the impact of noninvasive modalities (RF, combined multipolar RF with pulsed electromagnetic, combined RF and pulsed electromagnetic field, high-intensity focused ultrasound, CO2 laser, combining multipolar RF and hybrid fractional laser, microfocused ultrasound, and the VIVEVE surface-cooled RF) on vaginal laxity. This review indicates many knowledge areas that must be attempted in order to understand the influence of nonstrengthening physical therapy and noninvasive methods on vaginal laxity. In addition to the mechanisms behind their impacts. In addition, we strongly recommend that more clinical trials of high methodological and interventional quality are required to investigate the efficacy of various physical therapy approaches, including electrical stimulation, biofeedback exertion, acupressure, manual therapy, neuromodulation, core exercise therapy, hydrotherapy, well-designed ultrasound therapy protocols, and vaginal weight training.

Precise control of neural activity using dynamically optimized electrical stimulation.

Neural implants have the potential to restore lost sensory function by electrically evoking the complex naturalistic activity patterns of neural populations. However, it can be difficult to predict and control evoked neural responses to simultaneous multi-electrode stimulation due to nonlinearity of the responses. We present a solution to this problem and demonstrate its utility in the context of a bidirectional retinal implant for restoring vision. A dynamically optimized stimulation approach encodes incoming visual stimuli into a rapid, greedily chosen, temporally dithered and spatially multiplexed sequence of simple stimulation patterns. Stimuli are selected to optimize the reconstruction of the visual stimulus from the evoked responses. Temporal dithering exploits the slow time scales of downstream neural processing, and spatial multiplexing exploits the independence of responses generated by distant electrodes. The approach was evaluated using an experimental laboratory prototype of a retinal implant: large-scale, high-resolution multi-electrode stimulation and recording of macaque and rat retinal ganglion cells ex vivo. The dynamically optimized stimulation approach substantially enhanced performance compared to existing approaches based on static mapping between visual stimulus intensity and current amplitude. The modular framework enabled parallel extensions to naturalistic viewing conditions, incorporation of perceptual similarity measures, and efficient implementation for an implantable device. A direct closed-loop test of the approach supported its potential use in vision restoration.

Multifunctional Neural Probes Enable Bidirectional Electrical, Optical, and Chemical Recording and Stimulation In Vivo.

Recording and modulation of neuronal activity enables the study of brain function in health and disease. While translational neuroscience relies on electrical recording and modulation techniques, mechanistic studies in rodent models leverage genetic precision of optical methods, such as optogenetics and fluorescent indicator imaging. In addition to electrical signal transduction, neurons produce and receive diverse chemical signals which motivate tools to probe and modulate neurochemistry. Although the past decade has delivered a wealth of technologies for electrophysiology, optogenetics, chemical sensing, and optical recording, combining these modalities within a single platform remains challenging. This work leverages materials selection and convergence fiber drawing to permit neural recording, electrical stimulation, optogenetics, fiber photometry, drug and gene delivery, and voltammetric recording of neurotransmitters within individual fibers. Composed of polymers and non-magnetic carbon-based conductors, these fibers are compatible with magnetic resonance imaging, enabling concurrent stimulation and whole-brain monitoring. Their utility is demonstrated in studies of the mesolimbic reward pathway by interfacing with the ventral tegmental area and nucleus accumbens in mice and characterizing the neurophysiological effects of a stimulant drug. This study highlights the potential of these fibers to probe electrical, optical, and chemical signaling across multiple brain regions in both mechanistic and translational studies.

Comparison of nonimplantable electrical stimulation in women with urinary incontinence: a systematic review and network meta-analysis of randomized controlled trials.

This study examined the effectiveness of various electrical stimulation methods in alleviating symptoms and enhancing the quality of life for women with urinary incontinence. We conducted a systematic search of PubMed, Cochrane Library, PEDro, EMBASE, and ClinicalTrials.gov from inception to August 2024. Randomized controlled trials (RCTs) that meet following criteria were included, urinary continence in women, using various electric stimulation treatments and evaluated outcomes related to symptoms, quality of life. Thirty RCTs were subjected to risk of bias assessment, certainty of evidence, and network meta-analysis. Statistical analysis was performed using a random-effects model, with continuous variables expressed as standardized mean difference (SMD) and 95% confidence interval (CI). Percutaneous tibial stimulation (SMD - 1.86, 95% CI - 2.77 to - 0.96) and intravaginal stimulation (SMD - 0.97, 95% CI - 1.55 to - 0.38) significantly reduced symptom severity. Additionally, percutaneous tibial, intravaginal, transcutaneous tibial, and trans-sacral stimulations improved quality of life. Percutaneous tibial stimulation was the most effective, followed by intravaginal stimulation. Despite moderate to low confidence in the evidence, large-scale RCTs are needed to evaluate long-term benefits of these treatment.

Case report: A novel transcutaneous electrical nerve stimulation improves dysesthesias and motor behaviors after transverse myelitis

PurposeTransverse myelitis (TM)-associated dysesthesia is diverse and frequently resistant to treatment. This study explored the comprehensive effects of a novel transcutaneous electrical nerve stimulation (TENS) approach tailored to an individual’s specific dysesthesia profile in a patient with TM.Patient and methodA 52-year-old woman with severe dysesthesias in the left C8 sensory area caused by TM underwent an A-B-A-B-A design intervention. The baseline (phase A) and intervention (phase B) phases were both 7 days. Tingling and allodynia were scored on an 11-point numerical rating scale pre-, post-, and 1 h post-treatment. Upper limb activities during daily living were assessed using a wrist-worn accelerometer. The intervention phase consisted of 60-min sessions of TENS two times daily. Furthermore, the intervention and carry-over effects of TENS were evaluated using Tau-U and Bayesian unknown change point models.ResultsThe effects of TENS resulted in the immediate improvement in tingling, allodynia, and upper limb activity. Long-term effects of TENS affected tingling and upper limb activity; however, no impacts on allodynia were observed.ConclusionThis novel TENS approach shows promise as an effective treatment, even in rare and treatment-resistant dysesthesia associated with TM.

Improvement in Persistent Post-Concussive Symptoms After Treatment with Neuromodulation: A Case Study

AbstractUp to 30% of youth with concussion experience persistent post-concussive symptoms (PPCS) impacting cognitive, social, mental, and physical health. Limited evidence-based therapies exist to treat PPCS. We present a case of an adolescent female with multiple sports-related concussions with persistent symptoms, including headache, nausea, dizziness, brain fog, and anxiety. After 4 weeks of treatment with an auricular percutaneous electrical nerve field stimulation (PENFS) device, she had near-complete resolution of her symptoms, allowing a return to her previous level of academic achievement, as well as physical activity. Emerging evidence suggests that various forms of neuromodulation, such as repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), can benefit patients with post-concussive symptoms. This adolescent female’s improvement with PENFS contributes to this expanding field.

Explaining key stakeholders’ preferences for potential policies governing psychiatric electroceutical intervention use

In recent years, legislators in many states have proposed laws governing the use of psychiatric electroceutical interventions (PEIs), which use electrical or magnetic stimulation to treat mental disorders. To examine how the PEI views of relevant stakeholder groups (e.g., psychiatrists, patients, caregivers, and general public) relate to preferences for proposed policies governing PEI use, we analyze data from a survey on using one of four PEIs to treat major depressive disorder administered to national samples of the stakeholder groups above. We find that the three non-clinician groups’ similar PEI policy preferences differ significantly from those of psychiatrists—with the greatest divide on policies governing the use of electroconvulsive therapy. This divide between psychiatrists’ and non-clinicians’ PEI policy preferences was greater with access-reducing than with access-expanding policies. We advise policymakers to consider such variation in the preferred availability of PEIs across modalities and stakeholder groups when crafting legislation on these interventions.

The vestibular implant: effects of stimulation parameters on the electrically-evoked vestibulo-ocular reflex

IntroductionThe vestibular implant is a neuroprosthesis which offers a potential treatment approach for patients suffering from vestibulopathy. Investigating the influence of electrical stimulation parameters is essential to improve the vestibular implant response. Optimization of the response focuses on the electrically evoked vestibulo-ocular reflex. It aims to facilitate high peak eye velocities and adequate alignment of the eye movement responses. In this study, the basic stimulation parameters of the vestibular implant were tested for their effect on the electrically evoked vestibulo-ocular reflex.MethodsFour stimulation parameters, including the stimulation amplitude, phase duration, stimulus rate and speed of change of stimulation, were systematically tested in a cohort of nine subjects with a vestibulo-cochlear implant. These parameters were tested to evaluate their effect on fitting settings (i.e., threshold of activation, upper comfortable limit and dynamic range) as well as on the electrically evoked vestibulo-ocular reflex (peak eye velocity and alignment).ResultsIt was confirmed that, in addition to current amplitude, the peak eye velocity of the response can be increased by increasing the phase duration and pulse rate. Both parameters have little effect on the alignment of the eye response. However, a longer phase duration decreased the range between the threshold of activation and the upper comfortable limit of the electrical stimulation (i.e., dynamic range). Furthermore, these results show that next to the amplitude of the stimulation, the speed of change in stimulation has a determinative positive effect on the peak eye velocity.ConclusionThe observations in this study imply that the vestibular implant response, in terms of peak eye velocity, can be optimized with a higher pulse rate and longer phase duration. However, this comes at a trade-off between the dynamic range and power consumption. This study provides essential insights for fitting strategies in future vestibular implant care.