High-intensity Electrical Stimulation Research Articles

Electroacupuncture at different intensities inhibits nociceptive discharges of wide dynamic range neurons in spinal dorsal horn of rats.

To observe the effect of electroacupuncture (EA) at different intensities on nociceptive discharges of wide dynamic range (WDR) neurons in the spinal dorsal horns (DHs) of rats, so as to explore its regulatory characteristics on nociceptive signals at the spinal level. A total of 25 male SD rats were used in the present study. A microelectrode array was used to record the discharge activity of WDR neurons in the lumbar spinal DHs of normal rats. After finding the WDR neuron, electrical stimulation (pulse width of 2 ms) was administered to the plantar receptive field (RF) for determining its response component of discharges according to the latency of action potential generation (Aβ ［0 to 20 ms］, Aδ ［20 to 90 ms］, C ［90 to 500 ms］ and post-discharge ［500 to 800 ms］). High-intensity electrical stimulation was continuously applied to the RF at the paw's plantar surface to induce DHs neuronal windup response. Subsequently, EA stimulation at different intensities (1 mA and 2 mA) was applied to the left "Zusanli"(ST36) at a frequency of 2 Hz/15 Hz for 10 min. The induction of WDR neuronal windup was then repeated under the same conditions. The quantity of nociceptive discharge components and the windup response of WDR neurons before and after EA stimulations at different intensities were compared. Compared to pre-EA, both EA1 mA and EA2 mA significantly reduced the number of Aδ and C component discharges of WDR neurons during stimulation, as well as post-discharge (P<0.01, P<0.001). The inhibitory rate of C component by EA2 mA was significantly higher than that by EA1 mA (P<0.05). Meanwhile, both EA1 mA and EA2 mA attenuated the windup response of WDR neurons (P<0.05, P<0.01), and the effect of EA2 mA was stronger than that of EA1 mA (P<0.05). Further analysis showed that when EA1 mA and EA2 mA respectively applied to both non-receptive field (non-RF) and RF, a significant reduction in the number of Aδ component, C component and post-discharge was observed (P<0.05, P<0.01). EA2 mA at the non-RF and RF demonstrated a significant inhibitory effect on the windup response of WDR neurons (P<0.01, P<0.05), but EA1 mA only at the non-RF showed a significant inhibitory effect on the windup response (P<0.01). EA can suppress nociceptive discharges of spinal DHs WDR neurons in rats. The inhibitory impact of EA is strongly correlated with the location and intensity of EA stimulation, and EA2 mA has a stronger inhibitory effect than EA1 mA.

Effects of High-intensity Training and Electrical Stimulation on Pain, Disability, Knee Kinematic and Performance in Patellofemoral Pain: A Randomized Controlled Trial

Patellofemoral pain (PFP) is a widespread problem in athletes who participate in jumping, cutting, and pivoting sports. Forty-four players participated in this study. They were divided into two groups: exercise plus EMS (G1) and exercise without EMS (G2), both with 12 women and 10 men. The exercise performed was 8 weeks of a high-intensity strength program for 45-60 minutes, plus cooling and a warm-up phase. Visual analogue scale (VAS), disability (Kujala patellofemoral score), knee valgus angle (KVA) and single-leg hop (SLH) were tested before (pre-test) and after training (post-test at 8 weeks) using a within-between group analysis (ANOVA 2×2). At baseline, no differences between groups were found (p &gt; 0.05). After the intervention, both groups improved VAS, KVA, SLH (p &lt; 0.001), and disability (p = 0.042). G1 showed more improvements than G2 for VAS (- 63.4 vs - 51.5 %, p = 0.021, 𝜂p2 = 0.13), disability (+ 32.6 vs + 18.4 %, p = 0.001, 𝜂p2 = 0.52), KVA (+ 4.2 vs + 2.2 %, p = 0.016, 𝜂p2 = 0.214) and SLH (+ 12.3 vs + 6.0 %, p = 0.003, 𝜂p2 = 0.20) respectively. No differences were found between the sexes for each group. Despite both interventions being valid, high-intensity strength training combined with EMS improved pain, disability, knee kinematics, and lower extremity performance more than exercise alone in professional handball athletes with PFP. Keywords: Electrical muscle stimulation, Rehabilitation, Musculoskeletal, Knee, Handball players

High-frequency, high-intensity transcutaneous electrical nerve stimulation compared with opioids for pain relief after gynecological surgery: a systematic review and meta-analysis.

Opioids are important for postoperative analgesia but their use can be associated with numerous side effects. Transcutaneous electrical nerve stimulation (TENS) has been used for acute pain treatment and has dose-dependent analgesic effects, and therefore presents an alternative to intravenous (iv) opioids for postoperative pain relief. The aim of this meta-analysis was to compare high-frequency, high-intensity (HFHI or intense) TENS to iv opioids with regard to postoperative pain intensity, recovery time in the Post Anesthesia Care Unit (PACU) and opioid consumption after elective gynecological surgery. We searched Medline, Embase, Web of Science, Cochrane, Amed and Cinahl for RCTs and quasi-experimental studies (2010-2022), and WHO and ClinicalTrials.gov for ongoing/unpublished studies. Meta-analysis and subsequent Trial Sequential Analysis (TSA) was performed for all stated outcomes. Quality of evidence was assessed according to GRADE. Only three RCTs met the inclusion criteria (362 participants). The surgical procedures involved surgical abortion, gynecologic laparoscopy and hysteroscopy. The applied TENS frequency was 80 Hz and intensity 40-60 mA. There was no difference in pain intensity according to Visual Analogue Scale (VAS) at discharge from PACU between the TENS and opioid group (MD VAS-0.15, 95 % CI-0.38 to 0.09) (moderate level of evidence). Time in PACU was significantly shorter in the TENS group (MD-15.2, 95 %-22.75 to-7.67), and this finding was manifested by TSA (high-level of evidence). Opioid consumption in PACU was lower in the TENS group (MD Morphine equivalents per patient mg-3.42, 95 %-4.67 to-2.17) (high-level of evidence). There was no detectable difference in postoperative pain relief between HFHI TENS and iv opioids after gynecological surgery. Moreover, HFHI TENS decreases recovery time and opioid consumption in PACU. HFHI TENS may be considered an opioid-sparing alternative for postoperative pain relief after gynecological surgery. PROSPERO CRD42021231048.

Electrical Stimulation Intensity to Induce Sensory Reweighting Dynamics While Standing on Balance Board.

In human postural control, maladaptation of sensory reweighting to sudden environmental changes is one of the main causes of postural instability. Providing sensory cues for body motion by means of stimulation could induce the sensory reweighting dynamics. In this paper, we aimed to investigate the intensity level of electrical stimulation to induce sensory reweighting dynamics while standing on a balance board under three conditions: no stimulation (control), electrotactile stimulation (ETS) at a low-intensity level, and electrical muscle stimulation (EMS) at a high-intensity level. A total of 30 participants (ten for each condition) controlled their posture to keep the board horizontal in a balance-board task, which included a pre-test without stimulation, a stimulation test, and a post-test without stimulation. The EMS and ETS groups received electrical stimulation to the tibialis anterior or soleus muscles based on the board tilt. Before and after the balance-board task, participants performed static standing with their eyes open and also with their eyes closed to evaluate the visual reweighting. In the EMS group, the visual reweighting showed a strong negative correlation with the balance-board sway ratio between the pre- and stimulation tests, indicating that EMS induced a tendency that requires visual up-weighting to improve postural balance. However, there were no significant correlations between either parameter in the control and ETS groups. These results suggest that high-intensity electrical stimulation at the level of directly contracting muscles may be effective in reliably inducing sensory reweighting dynamics, while low-intensity electrical stimulation may be insufficient.Clinical relevance- These findings will be helpful for designing stimulus conditions to reliably induce the reweighting during balance training, and for establishing a new balance training method utilizing EMS to induce visual up-weighting.

Saying goodbye to an unwelcome guest: Towards robust methods for controlling multi-sensory confounds in TMS-EEG research.

Saying goodbye to an unwelcome guest: Towards robust methods for controlling multi-sensory confounds in TMS-EEG research.

Comparing the Effect of High-intensity and Low-intensity Transcutaneous Electrical Nerve Stimulation on Pain Relief and Functional Activity Improvement in Patients with Knee Osteoarthritis

Background: Osteoarthritis is a common musculoskeletal disorder in elderly people, and the most common form appears in the knee joint. These patients suffer from pain, joint stiffness, and problems with functional activities. So, it is essential to offer a proper treatment plan for these patients. Objectives: The goal of this research is to compare the effect of high- and low-intensity transcutaneous electrical nerve stimulation (TENS) therapy on reducing pain and improvement of functional activity. Methods: Using simple randomization method, a total of 36 patients were divided into two groups receiving high- and low-intensity TENS therapy. All patients received ten sessions of physiotherapy (three sessions per week). Pain and functional activities were measured and compared before and after the study. Results: Although there was a significant difference between the two groups in pain index (P &lt; 0.05), no difference in functional activity was observed between the two groups. Conclusions: Using both high- and low-intensity techniques can be effective in reducing the pain and improving the knee joint function. However, pain decreased more significantly in the high-intensity group compared to low-intensity group.

Regulation of cell differentiation via synergistic self-powered stimulation and degradation behavior of a biodegradable composite piezoelectric scaffold for cartilage tissue

The articular cartilage disorder at the junction mainly results from constantly repeated dynamic tension/compression effects with ageing and lack of intrinsic defect repairability. Therefore, the degradable piezoelectric scaffolds are very essential, which mimics the dynamic mechanical loading and optimizes the chondrocyte differentiation during the degradation. Here, a degradable aligned electrospun poly-L-lactic acid (PLLA) modified with graphene (rGO) and polydopamine (PDA) fibrous scaffolds with different orientations (0°, 90°) and surface morphologies (wrinkled and porous) was developed as a biocompatible and degradable piezoelectric scaffold with the self-powered tunable piezoelectricity to modulate cell behaviour and cell differentiation by tuning the degradation effect. The results show that the electrical output and mechanical properties of the composite fibrous scaffold can be improved by adding rGO and applying mechanical force along with the 90° orientation. With changing the degradation behavior, dynamic mechanical loading on the porous PLLA/rGO/PDA fibrous scaffold exhibits a significant increase in cell proliferation and secretion of extracellular matrix (ECM). More surprisingly, as extending the degradation periods to 21 days, a higher glycosaminoglycans (GAGs) synthesis was detected in prechondrogenic ATDC5 cells cultured on the degraded porous scaffold compared with that after 7 days’ culture. This indicated that long-term degradation favoured promoting cell differentiation of ATDC5 towards a chondrogenic phenotype due to dynamic mechanical loading, low-intensity electrical stimulation, and interconnected porous structural morphology. In contrast, on the wrinkled PLLA/rGO/PDA fibre with a high-intensity electrical stimulation, the ALP activity significantly increased after 21 days, inducing mineralization with the differentiation of ATDC5 into osteocytes. The modulation of the degraded environment and electrical stimulation of the piezoelectric scaffold offers an effective alternative to influence cell functions, significantly improving the ECM secretion and cell differentiation.

Transcutaneous Electrical Nerve Stimulation for Pain Management of Aspiration Abortion up to 83 Days of Gestation: A Randomized Controlled Trial.

To evaluate high-frequency, high-intensity transcutaneous electrical nerve stimulation (TENS) as an inexpensive, noninvasive pain management approach for first-trimester aspiration abortion. We conducted a noninferiority, single-blind, randomized controlled trial of patients seeking aspiration abortion at up to 83 days of gestation. Participants received TENS (placed posteriorly, T10-L1 and S2-S4) or intravenous (IV) sedation (fentanyl, midazolam). The primary outcome was pain with aspiration, as self-reported by visual analog scale (VAS, 100 mm). To detect at least a 15 mm mean difference on the 100 mm VAS with 90% power and a significance level of .05, a total of 90 participants were required. Between January 2018 and October 2019, we enrolled 109 participants (55 TENS, 54 IV). Participant median gestation was 53 days (range 36-82) in the TENS group and 58 days (range 35-82) in the IV group (P=.65). Group demographics and clinical histories were similar. Intention-to-treat analysis (n=109) yielded noninferior results for the primary outcome (mean difference 4.8 mm, 95% CI -5.9 to 13.5 mm). In the per-protocol analysis, 9 (16%) in the TENS group were excluded after receiving IV sedation; 100 participants were included (46 TENS, 54 IV). Median (range) reported VAS for aspiration was 73 mm (13-97) and 66 mm (0-99) in the TENS and IV groups, respectively (P=.40). With a mean difference of 4.4 mm (95% CI -5.6 to 14.5 mm), we found TENS to be noninferior to IV. Physicians underestimated participant pain, perceiving pain to be 34 mm (6-91) in the TENS group and 25 mm (0-83) in the IV group (P=.003). We found TENS to be a noninferior alternative to IV sedation for aspiration pain during first-trimester abortion. Expanding pain management options can improve quality of and access to abortion. Transcutaneous electrical nerve stimulation could be a standalone or adjunct approach for abortion pain management for those without access to or are ineligible to receive IV sedation due to the lack of sedation practitioner, designated driver, or local restrictions. ClinicalTrials.gov, NCT03187002.

Cardiometabolic Effects of High-Intensity Hybrid Functional Electrical Stimulation Exercise after Spinal Cord Injury.

The prevalence of cardiometabolic disease following spinal cord injury is known to be high. However, it is unknown whether engaging in high-intensity exercise, which is advocated by recent guidelines, is beneficial or feasible for these individuals. To assess the effects of high-intensity, whole-body exercise on the prevalence of cardiometabolic disease in individuals with spinal cord injury. Combination of a randomized controlled trial and an open label intervention study of functional electrical stimulation legs plus arms rowing. Outpatient academic rehabilitation hospital. Forty individuals with spinal cord injury, with American Spinal Injury Association (ASIA) impairments scales A-D and neurological levels of injury C1-T12. Six months of high-intensity, hybrid-functional electrical stimulation rowing. Change in VO2max , serum lipids, and insulin resistance, prevalence of cardiometabolic disease. Individuals averaged 42.1± 22.0minutes of hybrid-functional electrical stimulation rowing a week over an average of 1.69 sessions per week over the 6months of intervention. This amounted to an average of 170.9± 100 km rowed, at a mean heart rate of 82.7% of individualized maximum. Only one of 40 individuals met current exercise guidelines for the full 6months. VO2max increased significantly (P< .001), yet prevalence of cardiometabolic disease did not change significantly (decrease from 22.5% to 20%, P= .70). Hemoglobin A1c did decrease significantly over this time (P= .01), although serum lipids and fasting glucose/insulin levels were unchanged. In exploratory subanalyses assessing individuals injured ≤12 months, those with more chronic injuries decreased their triglyceride-to-high-density lipoprotein (HDL) ratio (P= .04), a marker of cardiac mortality. Stratifying by neurological level of injury, individuals with paraplegia had worsened low-density lipoprotein (LDL) level (P= .02) and total cholesterol-to-HDL ratio (P= .04) over the 6-month intervention. Sustained high-intensity exercise with hybrid functional electrical stimulation rowing does not decrease the prevalence of cardiometabolic disease after spinal cord injury.

Effects of high-frequency, high-intensity transcutaneous electrical nerve stimulation versus intravenous opioids for pain relief after hysteroscopy: a randomized controlled study.

ObjectiveTo compare the time spent in the Post-Anesthesia Care Unit (PACU) and the pain-relieving effects of treatment with high-frequency, high-intensity transcutaneous electrical nerve stimulation (TENS) or intravenous (IV) opioids after hysteroscopy.MethodsAll patients who postoperatively reported a visual analogue scale (VAS) pain score of ≥3 were included in the study. TENS treatment was given with a stimulus intensity between 40 and 60 mA for 1 minute and repeated once if there was insufficient pain relief. In the opioid group, a fractionated dose of 5 mg morphine was administered. If the patient reported insufficient pain relief after the assigned treatment, the patient was reassigned to the other treatment group.ResultsSeventy-four women were randomized to TENS (n=38) or IV opioids (n=36) for treatment. Both groups reported significant pain relief after discharge from the PACU, with a decrease of VAS scores from 5.6 to 1.4 in the TENS group (P<0.001) and 5.1 to 1.3 in the opioid group (P<0.001). There were no significant differences between the groups. When only the responders in both groups, i.e., patients with VAS scores of <3 on respectively assigned treatments, were compared, the TENS responders (n=22) were found to have spent a significantly shorter time in the PACU (91 vs. 69 minutes, P=0.013) compared to the opioid responders (n=20).ConclusionUsing TENS as first line of pain relief may reduce the need for postoperative opioids. In addition, TENS appears preferable as the first line of treatment due to its association with a shorter time spent in the PACU if the patient responds to the treatment.Trial RegistrationVästra Götalandsregionen Identifier: 211261

Transcutaneous electrical nerve stimulation (TENS) for pain control during first-trimester abortion: A single-blinded randomized controlled trial

Introduction High-frequency, high-intensity transcutaneous electrical nerve stimulation (TENS), pulsating electrical currents that activate underlying nerves, is an inexpensive and non-invasive pain control approach. We sought to compare TENS to intravenous sedation (IV) for pain control in first-trimester surgical abortion. Method We conducted a non-inferiority, single-blinded, randomized controlled trial of participants undergoing surgical abortion up to 11 weeks’ gestation. Participants received TENS (electrodes parallel to the spinal cord at the T10-L1 and S2-S4 levels) or IV (100mcg fentanyl and 1mg versed). Providers administered the IV sedation and research staff administered the TENS and were therefore not blinded. The primary outcome was self-reported pain with aspiration (visual analogue scale, VAS 100mm, 0 “no pain” and 100 “worst pain imaginable”). Non-inferiority limit was defined as 15mm. We also assessed participant demographics and blinding. Results A total of 109 participants were enrolled (55 TENS, 54 IV) between January 2018 and October 2019. Participants had a mean gestational age of 56-days across groups (p = 0.88); groups were similar with regard to age, race and ethnicity, parity, and BMI. Nine (16%) in the TENS group were given IV sedation and excluded from the per-protocol analysis. 100 participants were included in the per-protocol analysis (46 TENS, 54 IV). Mean reported VAS for aspiration was 64.78 mm (SD24.16) and 60.35mm (SD26.06) in the TENS and IV groups, respectively, with a mean difference of 4.43mm (95% CI −5.6 to 14.47). One IV group participant received additional IV medications (2%). Post-procedure, in both groups the majority of participants identified their correct assignment (p = 0.96); one in five in both groups incorrectly identified their assignment (21.7%, n = 10 TENS; 22.2%, n = 12 IV). Intention-to-treat analysis (n = 109) yielded non-inferior results for the primary outcome. Conclusions TENS for pain control during first-trimester surgical abortion is non-inferior to IV sedation with respect to the primary outcome of pain with aspiration. TENS could be a pain control option for patients without access to IV sedation or for those who are ineligible to receive IV sedation due to additional cost, lack of sedation provider or restrictions, including the need for a designated driver. Expanding pain control options improves quality of care and access to abortion.

Frequency and Intensity of Electrical Stimulation of Human Sympathetic Ganglia Affect Heart Rate Variability and Pain Threshold

The study relates to the selection of effective clinical treatments based on the changes associated with each electrical stimulation condition. The aim was to investigate the effects of electrical stimulation on the autonomic nervous system by evaluating the heart rate variability (HRV) and pain threshold in response to different interferential current conditions applied to the sympathetic ganglia. Forty five participants were randomly assigned to receive high frequency-low intensity (HF-LI), low frequency-high intensity (LF-HI), or high frequency-high intensity (HF-HI) electrical stimulation. We then used bipolar adhesive pad electrodes to stimulate the thoracic vertebrae T1–T4 for 20 min, and changes were evaluated before, immediately after and 30 min after electrical stimulation. Results revealed significant HRV immediately after HF-LI and LF-HI electrical stimulations. This present study finding of a reduction in HRV immediately after HF-HI electrical stimulation confirms HRV measurement reliability based on electrical stimulation parameters. Results revealed a significant increase in the pain threshold with HF-HI electrical stimulation than for the other conditions; there was also a shorter pain duration. The present study also showed a significant effect of the HF-LI and LF-HI conditions on the pain threshold immediately after electrical stimulation, but the results after 30 min only revealed significant changes in the LF-HI group, indicating a maintenance of the pain control period immediately and 30 min after electrical stimulation. Different conditions of electrical stimulation resulted in distinct changes in HRV and pain control duration.

Effects of Neuromuscular Electrical Stimulation in People with Spinal Cord Injury.

Muscle force production is usually impaired in people with spinal cord injury (SCI). The use of high-intensity neuromuscular electrical stimulation (NMES) strength training can help promote metabolically active lean muscle mass and, thus, increase muscle mass and improve physical health and quality of life (QoL). Nonetheless, NMES is usually used at low-stimulation intensities, and there is limited evidence on the effects of high-intensity NMES strength training into improving muscle force and mass, symptoms of spasticity, or physical health and QoL in people with SCI. Five individuals with chronic SCI completed five 10-repetition sets of high-intensity knee extension NMES strength training sessions for 12 wk in both quadriceps muscles. Quadriceps femoris (QF) knee extensor torque was measured on a dynamometer, and cross-sectional area (CSAQF) was measured with extended field-of-view ultrasonography. Venous blood samples were collected for blood lipid profiling and C-reactive protein analyses. The Spinal Cord Injury Spasticity Evaluation Tool was used to assess symptoms of spasticity, and the QoL index SCI version III was used for QoL measures. QF tetanic knee extensor torque increased on average by 35% (2%-92%), and CSAQF increased by 47% (14%-145%). A significant increase in the HDL/LDL cholesterol ratio (P < 0.001) and a mean significant improvement of 4.8% ± 2.3% (absolute value = 0.26) in the Spinal Cord Injury Spasticity Evaluation Tool score was observed, whereas QoL showed a near-significant improvement in the health and functioning domain (15.0 ± 4.2 and 17.3 ± 5.1; P = 0.07). High-intensity NMES strength training in people with SCI may improve muscle strength, mass, physical health, and QoL. However, replication of these results is necessary before clinical implementation.

Near Infrared Spectroscopy Study of Cortical Excitability During Electrical Stimulation-Assisted Cycling for Neurorehabilitation of Stroke Patients.

In addition to generating functional limb movement via electrical stimulation, other research proposed lower intensity stimulation for stroke patients from proprioceptive and neuro-biofeedback aspects. This paper investigates the effects of different intensity levels of electrical stimulation during passive cycling on cortical activation using multichannel near infrared spectroscopy (NIRS) covering premotor cortex, supplementary motor area, sensorimotor cortex (SMC), and secondary sensory cortex (S2) regions. Sixteen subjects, including nine stroke patients and seven normal subjects, were instructed to perform passive cycling driven by an ergometer at a pace of 50 rpm under conditions without electrical stimulation (NES) and with low-intensity electrical stimulation (LES) at 10 mA and high-intensity electrical stimulation (HES) at 30 mA. Changes in oxyhemoglobin in different brain regions and the derived interhemispheric correlation coefficient (IHCC) representing the symmetry in response of two hemispheres were evaluated to observe cortical activation and cerebral autoregulation. Our results showed that cortical activation of normal subjects exhibited overall deactivations in HES compared with that under LES and NES. In stroke patients, bilateral S2 activated significantly greater under LES compared with those under NES and HES. The IHCC of the normal group displayed a significant higher value in SMC compared with that of the stroke group. This paper utilized noninvasive NIRS to observe hemodynamic changes and bilateral autoregulation symmetry from IHCC suggesting that passive cycling with LES could better facilitate cortical activation compared with that obtained with NES or HES. The results of this paper could provide general guidelines to simplify the settings of electrical stimulation-assisted-passive cycling in clinical use.

F173. Seizure risk from intraoperative motor evoked potential stimulation

Introduction Intraoperative Neurophysiologic Monitoring (IONM) tests the function of the brain and spine to help prevent new neurological deficits during surgery. IONM modalities can include electroencephalography (EEG) and motor evoked potentials (MEPs). MEPs involve high-intensity electrical stimulation to the scalp (transcranial) or brain (direct cortical) to test responses through the motor pathways. Transcranial stimulation can provoke a seizure, and previous studies have estimated that risk to be 0.8%. Methods 1175 adult IONM cases, in 605 females and 570 males, between July 1, 2015 and June 30, 2016 were retrospectively examined. There were 394 craniotomies, 178 interventional neuroradiology procedures, 509 spinal, 5 trans-nasal, 71 vascular, 1 neck, and 18 peripheral nerve cases with patients 18 to 95 years old. Seizures were identified through EEG, clinical observation of movement, and electronic medical chart review. Results Only two (0.170%) intraoperative seizures occurred. Electrographic seizure and clinical movement were observed in both. One was during an awake craniotomy with direct cortical stimulation for the resection of a left temporal metastasis. The other was a craniotomy for brainstem tumor resection under general anesthesia with transcranial MEPs. Although 98 cases (8.340%) involved a patient with one or more pre-operative seizures, usually from a new brain lesion, 0% of these patients experienced intraoperative seizures. Out of 14 awake craniotomy cases, only one (7.143%) had an intraoperative seizure. Conclusion The rate of intraoperative seizures in cases involving IONM is very low; and in this review, lower than previously published data. Having a seizure prior to surgery does not seem to confer added risk when using MEPs.

Effects of training intensity in electromyostimulation on human skeletal muscle.

High-intensity neuromuscular electrical stimulation (NMES) training can induce muscle hypertrophy at the whole muscle and muscle fiber levels. However, whether low-intensity NMES training has a similar result is unknown. This study aimed to investigate whether low-intensity NMES training could elicit muscle hypertrophy at the whole muscle and muscle fiber levels in the human skeletal muscle. Eight untrained young males were subjected to 18min of unilateral NMES training for 8 weeks. One leg received NMES at maximal tolerable intensity (HIGH); the other leg received NMES at an intensity half of that in the HIGH condition (LOW). Quadriceps muscle thickness (MT), muscle fiber cross-sectional area (CSA), and knee extension strength were measured before and after the training period. The average training intensity throughout the intervention period in the HIGH and LOW conditions were 62.5 ± 4.6% maximal voluntary contraction (MVC) and 32.6 ± 2.6% MVC, respectively. MT, CSA, and muscle strength increased in both exercise conditions (p < 0.05); however, training effects in the LOW condition were lower than those in the HIGH condition (p < 0.05). The average training intensity showed a positive correlation with percent changes in muscle strength (r = 0.797, p = 0.001), MT (r = 0.876, p = 0.001), type I fiber CSA (r = 0.730, p = 0.01), and type II fiber CSA (r = 0.899, p = 0.001). Low-intensity NMES could increase MT, muscle fiber CSA, and muscle strength in healthy human skeletal muscles. However, the magnitude of increase is lower in low-intensity than in high-intensity NMES training.

Effects of high-frequency, high-intensity transcutaneous electrical nerve stimulation versus intravenous opioids for pain relief after gynecologic laparoscopic surgery: a randomized controlled study.

BackgroundThe aim of the study was to compare the pain relieving effect and the time spent in the recovery unit after treatment with high frequency, high-intensity transcutaneous electrical nerve stimulation (TENS) or intravenous (IV) opioids after gynecologic laparoscopic surgery.MethodsAll patients who postoperatively reported visual analogue scale (VAS) pain score ≥ 3 were consecutively included in the study. The TENS treatment was given with a stimulus intensity between 40–60 mA during 1 minute, repeated once if insufficient pain relief. In the opioid group, a maximum dose of 10 mg morphine was given IV. If the patient reported insufficient pain relief (VAS ≥ 3) on the assigned treatment, the patient crossed over to the other treatment group.ResultsNinety-three women were randomized to TENS (n = 47) or IV opioids (n = 46). Both groups reported significant pain relief at leave from the recovery unit (TENS group: VAS 5.4 to 1.0, P < 0.001; IV opioid group: VAS 5.2 to 1.1, P < 0.001) with no differences between the groups. When only responders, i.e. patients with VAS < 3 after assigned treatment, were compared the TENS responders spent significantly shorter time in the recovery unit (90 vs. 122 minutes, P = 0.008) compared to the responders in the opioid group.ConclusionsTENS and IV opioids are both effective treatments for pain relief after gynecologic laparoscopic surgery. TENS seems to be preferable for first choice of treatment as the treatment is associated with shorter time spent in recovery unit if the patient responds to the treatment.

Changes in lower limb muscle function and muscle mass following exercise-based interventions in patients with chronic obstructive pulmonary disease: A review of the English-language literature.

Chronic obstructive pulmonary disease (COPD) patients often experience lower limb muscle dysfunction and wasting. Exercise-based training has potential to improve muscle function and mass, but literature on this topic is extensive and heterogeneous including numerous interventions and outcome measures. This review uses a detailed systematic approach to investigate the effect of this wide range of exercise-based interventions on muscle function and mass. PUBMED and PEDro databases were searched. In all, 70 studies (n = 2504 COPD patients) that implemented an exercise-based intervention and reported muscle strength, endurance, or mass in clinically stable COPD patients were critically appraised. Aerobic and/or resistance training, high-intensity interval training, electrical or magnetic muscle stimulation, whole-body vibration, and water-based training were investigated. Muscle strength increased in 78%, muscle endurance in 92%, and muscle mass in 88% of the cases where that specific outcome was measured. Despite large heterogeneity in exercise-based interventions and outcome measures used, most exercise-based trials showed improvements in muscle strength, endurance, and mass in COPD patients. Which intervention(s) is (are) best for which subgroup of patients remains currently unknown. Furthermore, this literature review identifies gaps in the current knowledge and generates recommendations for future research to enhance our knowledge on exercise-based interventions in COPD patients.

Temporal profile of the effects of regional anesthesia on the cutaneous reflexes of foot muscles

We analyzed the effects of an anesthetic sciatic nerve block on the cutaneomuscular reflex (cMR) and the cutaneous silent period (cSP) of foot muscles, in order to investigate further the type of fibers involved in their generation. In 14 neurologically normal patients with indication for surgical treatment of hallux valgus, we recorded from the extensor digitorum brevis muscle the reflex responses elicited by high-intensity electrical stimulation of the big toe at various time periods, ranging from 0 to 20 min, after ultrasound-guided sciatic nerve popliteal anesthetic block. The first effect was a delay in cSP onset latency, with no changes in end latency. The cMR remained unaltered up to when subjects were no longer able to maintain the contraction. The effects of local anesthetics on peripheral nerves allow for recognition of the different types of fibers contributing to the cMR and the cSP in muscles of the lower limb.

The excellent pain-relief effect of high-intensity transcutaneous electrical nerve stimulation (TENS) revealed by subjective and objective indicators

absence of control. Two physiotherapists carried out tests and retests and scored the child in the live situation as well as on the basis of video recordings. Wilcoxon Signed-Rank Test, ICC [2,1] and a descriptive measure for absolute reliability were used in the statistical analyses. Results: No systematic differences were found in scores between tests and retests with the exception of one rater’s reactive scores. All ICC values were excellent (ICC≥ 0.9) with the exception of one rater’s reactive scores. Complete agreements were seen in 73% of all scores between raters, days or between live versus video. In themajority of cases the scores with disagreement showed an absolute difference corresponding to one SATCo level for static, active and reactive scores respectively. Conclusion(s): This study shows that the relative reliability of the SATCo test is generally excellent. However, scores between raters, days or between live versus video differ by one or more levels in 27% of all separate analyses. This should be considered when using SATCo as a clinical outcome measure. Implications: SATCo is a relevant assessment tool with potential for implementation in clinical practise. Further refinements could increase the reliability of themeasure. This would increase the value of this test in research and in clinical practise.