Motor Stimulation Research Articles

Percutaneous and Implanted Peripheral Nerve Stimulation for the Management of Pain: Current Evidence and Future Directions

The goal of this review is to summarize the current state of percutaneous and implanted peripheral nerve stimulation for the relief of pain. This article provides an overview of commercially available devices, the evidence supporting their use, and novel treatments being considered for the future. There are four peripheral nerve stimulators commercially available in multiple countries around the world. The stimulation may be used temporarily, with percutaneous placement of leads, or indefinitely with permanent implantation of the leads. Two stimulation paradigms are described in the literature for treatment of pain—stimulation of motor (efferent) nerve fibers to create muscle contraction and stimulation of sensory (afferent) nerve fibers to create paresthesia. Peripheral nerve stimulation has been studied in musculoskeletal pain syndromes, neuropathic pain syndromes, craniofacial pain, and in acute post-operative pain. This pain-relieving treatment is a promising treatment though many applications have not yet been well studied.

From behavior to circuit modeling of light-seeking navigation in zebrafish larvae.

Bridging brain-scale circuit dynamics and organism-scale behavior is a central challenge in neuroscience. It requires the concurrent development of minimal behavioral and neural circuit models that can quantitatively capture basic sensorimotor operations. Here, we focus on light-seeking navigation in zebrafish larvae. Using a virtual reality assay, we first characterize how motor and visual stimulation sequences govern the selection of discrete swim-bout events that subserve the fish navigation in the presence of a distant light source. These mechanisms are combined into a comprehensive Markov-chain model of navigation that quantitatively predicts the stationary distribution of the fish's body orientation under any given illumination profile. We then map this behavioral description onto a neuronal model of the ARTR, a small neural circuit involved in the orientation-selection of swim bouts. We demonstrate that this visually-biased decision-making circuit can capture the statistics of both spontaneous and contrast-driven navigation.

INCLUSION OF AN INTELLECTUAL DISABILITY STUDENT IN PHYSICAL EDUCATION CLASSES

Neurodevelopmental Disorders is a set of changes that has its onset in the child's developmental period. One of the manifestations of this disorder is Intellectual Disability, which occurs during the child's development, causing motor, speech and social failures. The stimuli are extremely important to have an evolution in the cognitive, motor, affective and social development, besides promoting inclusion. Objective of this study was to identify the effectiveness of motor stimulation in a student with intellectual disabilities in physical education classes. The present study is a case report that developed in a 15 years old with intellectual disability Intellectual Development Disorder. The Francisco Rosa Neto Motor Development Scale was used as an assessment instrument. The tests were applied in 50-minute sections to apply all the tests in the manual, namely fine motor skills, overall motor skills, balance, body scheme, organization. spatial, temporal organization and laterality. After initial evaluation, two further evaluations were performed during the 10-week stimulation period, one on the 5th and the 10th week. Having some evolutions in certain abilities such as fine motor coordination, balance, body schema, temporal organization, being verified statistically significant improvement already in the 5th week of stimulation, the spatial organization showed statistically significant improvement in the 10th week and the body schema skills, temporal organization presented statistically significant improvement on week 5 and 10, indicating that there was a statistically significant improvement in both periods evaluated. In the evaluation of laterality, it was found that the individual is complete right-handed. It is concluded that motor stimulation acts positively on the motor skills of children with intellectual disabilities.

In vitro virtual reality: an anatomically explicit musculoskeletal simulation powered by in vitro muscle using closed-loop tissue-software interaction.

Muscle force-length dynamics are governed by intrinsic contractile properties, motor stimulation and mechanical load. Although intrinsic properties are well characterised, physiologists lack in vitro instrumentation to account for combined effects of limb inertia, musculoskeletal architecture and contractile dynamics. We introduce in vitro virtual reality (in vitro-VR) which enables in vitro muscle tissue to drive a musculoskeletal jumping simulation. In hardware, muscle force from a frog plantaris was transmitted to a software model where joint torques, inertia and ground reaction forces were computed to advance the simulation at 1 kHz. To close the loop, simulated muscle strain was returned to update in vitro length. We manipulated (1) stimulation timing and (2) the virtual muscle's anatomical origin. This influenced interactions among muscular, inertial, gravitational and contact forces dictating limb kinematics and jump performance. We propose that in vitro-VR can be used to illustrate how neuromuscular control and musculoskeletal anatomy influence muscle dynamics and biomechanical performance.

Assessment of Anemia Status on Physical Development Skills of Children Under Two Years Old in Aceh, Indonesia.

Anemia and iron deficiency can cause detrimental effects on brain development, and continued iron deficiency anemia is known to interfere with development which results in a permanent delay in mental and Motor development. This study investigated the impact of anemia on physical development skills of under two years children in aceh besar district. A cross-sectional study design was applied to 102 under-two years children selected using cluster random sampling technique using village as cluster. A structured questionnaire to determine general characteristics such as maternal age, maternal education, maternal occupational, family income, number of family members and toddlers. Anemia status was assessed by Hemocue 201+ tool, and physical motor development such as gross and fine motor development skills were determined using Denver II instrument. Almost two- thirds of children were anemia, as assessed by blood hemoglobin levels of <11 g/dL, while 34.3% of them were experienced delay in either fine development or gross development skills. The prevalence of children with fine and gross motor development delay was higher in children with suffering from anemia (27.1% and 17.1%) than non-anemia, respectively (3.2% and 9.4%). There was significant association anemia status on fine motor development (r=0.291; p=0.003), while not significant to gross motor development (r=0.092; p=0.357). The prevalence of anemia in children 12-24 mo old was very high, and has an impact on motor development delays, so anemia prevention programs and motor stimulation intervention for under two years children are needed.

The head fixation based on skull cap: An improved protocol used in single unit recording in the vestibular system

Single unit recording has an important application in neuroscience, especially in the vestibular system such as visual stabilization, posture maintenance, spatial orientation and cognition. However, single unit recording conducted in living animals is a demanding technique and non-ideal mechanical stability between the recording location of nerve tissues and the tip of microelectrode always results in failure to obtain successful recordings in the vestibular system. In order to improve the mechanical stability during single unit recording, we constructed a novel head fixation method based on skull cap. This article describes in detail how to construct this novel head fixation. Following the step-by-step procedure mentioned in this article will provide a high-quality mechanical stability for single unit recording in the vestibular system, allowing us to successfully record the nonlinear neural dynamic response over a big magnitude motion stimulation. This improvement of head fixation contributes to the in-depth understanding of the vestibular system.

The Effects of Motor Imagery Combined with Neuromuscular Electrical Stimulation on Using Transcranial Magnetic Stimulation in Stroke Patients

The purpose of this study was to investigate the effect of motor imagery combined with neuromuscular electrical stimulation (MI-NMES) on cerebral cortex excitability in stroke patients. We examined the effect of MINMES on cerebral cortex excitability using transcranial magnetic stimulation (TMS) of motor evoked potential (MEP) amplitude and latency, quantitative electroencephalography (QEEG) of δα ratio (DAR) and power ratio index (PRI) assessments. This study was to evaluate 30 stroke patients who were satisfied the selection criteria of the study. Experiments were divided into MI-NMES group, motor imagery (MI) group. This study showed that there was a significant difference for all evaluations within the MI-NMES group, with significant differences in MEP amplitude and latency, QEEG DAR, and PRI index values in the comparison that those of the MI group. MI-NMES is suggested to be an effective approach for cerebral cortex excitability in stroke patients.

Prenatal Intraamniotic Surfactant Administration Improves Lung Function at Birth and the Effects of Conventional Postdelivery Treatment in Animal Model. A Randomized Controled Trial

Introduction: Surfactant diluted in the pulmonary fluid at birth promove airway formation and prevents lung injury, for this reason some investigators have proposed that actual surfactant prophylaxis in high risk preterm deliveries, should be done before the first breath, perhaps in-uteri. Objetive: to evaluate if intraamniotic surfactant plus conventional neonatal instillation improves respiratory outcome outcome compared with only conventional neonatal instillation. Materials and Methods: randomized, controlled and double blinded protocol in a model of very immature born lambs. 125 days pregnant ewes received, with ultrasound guide, an intraamniotic injection of 240 mg of natural bovine surfactant or normal saline solution. After one hour of fetal breathing movement's stimulation with aminophylline the premature lamb’s fetuses were delivered by C-section, and a 3-mm endotracheal tube was placed by tracheotomy. Heart rate, aortic blood pressure, central temperature, respiratory rate and hemoglobin saturation, as well as mechanical ventilator settings, were continuously monitored. Variables under study were: Peak Inspiratory Pressure (PIP), Mean Airway Pressure (MAP), Oxygenation Index (OI) and Arterio-Alveolar Ratio (a/A). Conclusion: Prenatal intraamniotic surfactant instillation improves short-term respiratory outcome compared with conventional postpartum treatment in this animal model.

Motion sickness: an overview.

BackgroundMotion sickness is a common phenomenon that affects almost everybody at some point in their lifetime. Clinicians should be familiar with the proper management of this condition.ObjectiveTo provide an update on the current understanding of the pathophysiology and management of motion sickness.MethodsA PubMed search was performed with Clinical Queries using the key term ‘motion sickness.’ The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews. The search was restricted to English literature. The information retrieved from the earlier search was used in the compilation of the present article.ResultsMotion sickness is typically triggered by low-frequency vertical, lateral, angular, rotary motion, or virtual stimulator motion, to which an individual has not adapted. Sine qua non for developing motion sickness is when the brain receives conflicting information from different sensors about real body movements or virtual environment. The principal sensors are the eyes, the vestibular apparatus, and proprioceptive receptors. The conflicting information is judged in relation to a pattern of expected associations formed under normal or experienced conditions stored in the brain. Motion sickness typically presents with malaise, anorexia, nausea, yawning, sighing, increased salivation, burping, headache, blurred vision, non-vertiginous dizziness, drowsiness, spatial disorientation, difficulty concentrating, and sometimes vomiting. Simple behavioral and environmental modifications can be effective in the prevention of motion sickness. Medications that are effective in the prophylaxis and/or treatment of motion sickness include anticholinergics, antihistamines, and sympathomimetics.ConclusionIn most cases, motion sickness can be prevented by behavioral and environmental modifications (avoidance, habituation, and minimization of motion stimuli). Pharmacotherapy should be considered in the prevention and/or treatment of more severe motion sickness and for patients who do not respond to conservative measures. Medications are most effective when combined with behavioral and environmental modifications. Drugs that are effective in the prophylaxis and/or treatment of motion sickness include anticholinergic agents and antihistamines.

Neuromusculoskeletal Modeling-Based Prostheses for Recovery After Spinal Cord Injury.

Concurrent stimulation and reinforcement of motor and sensory pathways has been proposed as an effective approach to restoring function after developmental or acquired neurotrauma. This can be achieved by applying multimodal rehabilitation regimens, such as thought-controlled exoskeletons or epidural electrical stimulation to recover motor pattern generation in individuals with spinal cord injury (SCI). However, the human neuromusculoskeletal (NMS) system has often been oversimplified in designing rehabilitative and assistive devices. As a result, the neuromechanics of the muscles is seldom considered when modeling the relationship between electrical stimulation, mechanical assistance from exoskeletons, and final joint movement. A powerful way to enhance current neurorehabilitation is to develop the next generation prostheses incorporating personalized NMS models of patients. This strategy will enable an individual voluntary interfacing with multiple electromechanical rehabilitation devices targeting key afferent and efferent systems for functional improvement. This narrative review discusses how real-time NMS models can be integrated with finite element (FE) of musculoskeletal tissues and interface multiple assistive and robotic devices with individuals with SCI to promote neural restoration. In particular, the utility of NMS models for optimizing muscle stimulation patterns, tracking functional improvement, monitoring safety, and providing augmented feedback during exercise-based rehabilitation are discussed.

Congruent audio-visual stimulation during adaptation modulates the subsequently experienced visual motion aftereffect

Sensory information registered in one modality can influence perception associated with sensory information registered in another modality. The current work focuses on one particularly salient form of such multisensory interaction: audio-visual motion perception. Previous studies have shown that watching visual motion and listening to auditory motion influence each other, but results from those studies are mixed with regard to the nature of the interactions promoting that influence and where within the sequence of information processing those interactions transpire. To address these issues, we investigated whether (i) concurrent audio-visual motion stimulation during an adaptation phase impacts the strength of the visual motion aftereffect (MAE) during a subsequent test phase, and (ii) whether the magnitude of that impact was dependent on the congruence between auditory and visual motion experienced during adaptation. Results show that congruent direction of audio-visual motion during adaptation induced a stronger initial impression and a slower decay of the MAE than did the incongruent direction, which is not attributable to differential patterns of eye movements during adaptation. The audio-visual congruency effects measured here imply that visual motion perception emerges from integration of audio-visual motion information at a sensory neural stage of processing.

Co-existence of ethanol-related respiratory and motivational learning processes based on a tactile discrimination procedure in neonatal rats.

In rats, high ethanol doses during early postnatal life exert deleterious effects upon brain development that impact diverse social and cognitive abilities. This stage in development partially overlaps with the third human gestational trimester, commonly referred to as the brain growth spurt period. At this stage in development, human fetuses and rat neonates (postnatal days [PD] 3-9) exhibit relatively high respiratory rates that are affected by subteratogenic ethanol doses. Recent studies suggest conditioned breathing responses in the developing organism, given that there are explicit associations between exteroceptive stimuli and the state of ethanol intoxication. Furthermore, studies performed with near-term rat fetuses suggest heightened sensitivity to ethanol's motivational effects. The present study was meant to analyze the unconditioned effects of ethanol intoxication and the possible co-occurrence of learning mechanisms that can impact respiratory plasticity, and to analyze the preference for cues that signal the state of intoxication as well as the effects of the drug, related with motor stimulation. Neonatal rats were subjected to differential experiences with salient tactile cues explicitly paired or not paired with the effects of vehicle or ethanol (2.0g/kg). A tactile discrimination procedure applied during PDs 3, 5, 7, and 9 allowed the identification of the emergence of ethanol-derived non-associative and associative learning processes that affect breathing plasticity, particularly when considering apneic disruptions. Ethanol was found to partially inhibit the disruptions that appeared to be intimately related with stressful circumstances defined by the experimental procedure. Tactile cues paired with the drug's effects were also observed to exert an inhibitory effect upon these breathing disruptions. The level of contingency between a given tactile cue and ethanol intoxication also resulted in significant changes in the probability of seeking this cue in a tactile preference test. In addition, the state of intoxication exerted motor-stimulating effects. When contrasting the data obtained via the analysis of the different dependent variables, it appears that most ethanol-derived changes are modulated by positive and/or negative (anti-anxiety) reinforcing effects of the drug. As a whole, the study indicates co-existence of ethanol-related functional changes in the developing organism that simultaneously affect respiratory plasticity and preference patterns elicited by stimuli that signal ethanol's motivational effects. These results emphasize the need to consider significant alterations due to minimal ethanol experiences that argue against "safe" levels of exposure in a critical stage in brain development.

The striatal-enriched protein Rhes is a critical modulator of cocaine-induced molecular and behavioral responses

Previous evidence pointed out a role for the striatal-enriched protein Rhes in modulating dopaminergic transmission. Based on the knowledge that cocaine induces both addiction and motor stimulation, through its ability to enhance dopaminergic signaling in the corpus striatum, we have now explored the involvement of Rhes in the effects associated with this psychostimulant. Our behavioral data showed that a lack of Rhes in knockout animals caused profound alterations in motor stimulation following cocaine exposure, eliciting a significant leftward shift in the dose-response curve and triggering a dramatic hyperactivity. We also found that Rhes modulated either short- or long-term motor sensitization induced by cocaine, since lack of this protein prevents both of them in mutants. Consistent with this in vivo observation, we found that lack of Rhes in mice caused a greater increase in striatal cocaine-dependent D1R/cAMP/PKA signaling, along with considerable enhancement of Arc, zif268, and Homer1 mRNA expression. We also documented that lack of Rhes in mice produced cocaine-related striatal alterations in proteomic profiling, with a differential expression of proteins clustering in calcium homeostasis and cytoskeletal protein binding categories. Despite dramatic striatal alterations associated to cocaine exposure, our data did not reveal any significant changes in midbrain dopaminergic neurons as a lack of Rhes did not affect: (i) DAT activity; (ii) D2R-dependent regulation of GIRK; and (iii) D2R-dependent regulation of dopamine release. Collectively, our results strengthen the view that Rhes acts as a pivotal physiological “molecular brake” for striatal dopaminergic system overactivation induced by psychostimulants, thus making this protein of interest in regulating the molecular mechanism underpinning cocaine-dependent motor stimulatory effects.

THE RELATIONSHIP BETWEEN THE IMPLEMENTATION OF STIMULATIONS BY PARENTS AND THE DEVELOPMENT OF TODDLER AGED 24-36 MONTHS

Background. Stimulations are important in the golden period (age 0-3). Children who receive directional stimulation will develop more quickly than children who have less or no stimulation. Purpose. The purpose of this study was to determine the relationship between the implementation of stimulations by parents and the development of toddlers aged 24-36 months in Bungursari Village. Methods. This research was an observational quantitative research with cross-sectional approach. The populations were mothers and toddlers aged 24-36 months as many as 92 respondents. The sampling technique was simple random sampling, with a total sample of 42 respondents. Results. The results showed that the largest percentage in the implementation of gross motor stimulation, fine motor skills, speech and language skills, social skills and independence by parents were in the frequent category, the largest percentage of toddler development aged 24-36 months according to the appropriate category. Spearman rank statistical test results obtained rho value of 0.417 with p value of 0.006, where p value was less than α (0.006 <0.05), this showed that there was a positive relationship between the implementation of stimulations by parents on the development of toddler. Conclusion. There was a relationship between the implementation of stimulations by parents and the development of the toddlers. It is suggested to involve parents in conducting stimulation and development screening in order to improve their growth and development.

Dopamine and norepinephrine transporter inhibition for long-term fear memory enhancement

Psychostimulants are highly effective cognitive-enhancing therapeutics yet have a significant potential for abuse and addiction. While psychostimulants likely exert their rewarding and addictive properties through dopamine transporter (DAT) inhibition, the mechanisms of their procognitive effects are less certain. By one prevalent view, psychostimulants exert their procognitive effects exclusively through norepinephrine transporter (NET) inhibition, however increasing evidence suggests that DAT also plays a critical role in their cognitive-enhancing properties, including long-term memory enhancement. The present experiments test the hypothesis that combined strong NET and weak DAT inhibition will mimic the fear memory-enhancing but not the addiction-related effects of psychostimulants in mice. We examined the effects of the high affinity NET inhibitors atomoxetine or nisoxetine and the low affinity DAT inhibitor bupropion, either alone or in combination, on short- and long-term memory of Pavlovian fear conditioning. We also examined the addiction-related effects of combined strong NET and weak DAT inhibition using conditioned place preference and a locomotor activity test. While atomoxetine or nisoxetine alone enhanced short-term fear memory, the addition of bupropion was required to significantly enhance long-term fear memory. Additionally, combined atomoxetine and bupropion did not produce substantial motor stimulation or place preference. These findings suggest that combining strong NET and weak DAT inhibition could lead to the development of a highly effective cognitive enhancer that lacks the potential for addiction.

Determination of magnetic motor evoked potential latency time cutoff values for detection of spinal cord dysfunction in horses.

BackgroundTranscranial magnetic stimulation (TMS) and recording of magnetic motor evoked potentials (MMEP) can detect neurological dysfunction in horses but cutoff values based on confirmed spinal cord dysfunction are lacking.ObjectivesTo determine latency time cutoff for neurological dysfunction.AnimalsFive control horses and 17 horses with proprioceptive ataxia.MethodsCase‐control study with receiver operating characteristic curve analysis, based on diagnostic imaging, TMS, and histopathological findings. Horses were included if all 3 examinations were performed.ResultsDiagnostic imaging and histopathology did not show abnormalities in the control group but confirmed spinal cord compression in 14 of 17 ataxic horses. In the remaining 3 horses, histopathological lesions were mild to severe, but diagnostic imaging did not confirm spinal cord compression. In control horses, latency time values of thoracic and pelvic limbs were significantly lower than in ataxic horses (20 ± 1 vs 34 ± 16 milliseconds, P = .05; and 39 ± 1 vs 78 ± 26 milliseconds, P = .004). Optimal cutoff values to detect spinal cord dysfunction were 22 milliseconds (sensitivity [95% CI interval], 88% [73%‐100%]; specificity, 100% [100%‐100%]) in thoracic and 40 milliseconds (sensitivity, 94% [83%‐100%]; specificity, 100% [100%‐100%]) in pelvic limbs. To detect spinal cord dysfunction caused by compression, the optimal cutoff for thoracic limbs remained 22 milliseconds, while it increased to 43 milliseconds in pelvic limbs (sensitivity, 100% [100%‐100%]; specificity, 100% [100%‐100%] for thoracic and pelvic limbs).Conclusions and Clinical ImportanceMagnetic motor evoked potential analysis using these cutoff values is a promising diagnostic tool for spinal cord dysfunction diagnosis in horses.

Application value of simple exercise provocation test combined with small airway function test in early diagnosis of cough variant asthma

Objective To explore the value of simple exercise provocation test (6-minute running test) combined with small airway function test in early diagnosis of cough variant asthma (CVA) in children. Methods Ninety-four children with chronic cough from September 2017 to September 2018 in the pediatric clinic of the Affiliated Hospital of Xuzhou Medical University were selected for routine pulmonary ventilation function examination, simple exercise stimulation test and questionnaire survey.The differences of pulmonary function, clinical manifestations and allergens between positive and negative children with simple exercise stimulation test were compared and analyzed. Results The forced expiratory volume in one second (FEV1) of 94 children with chronic cough were all more than 70% by routine pulmonary function test, and the exercise provocation test was successfully completed.Among them, 32 (34.04%) were positive in simple exercise provocation test.Among the positive patients, 30 cases (93.75%) were diagnosed as CVA after further examination, clinical treatment and follow-up.In CVA group, FEV1 (81.52±14.22)%, forced vital capacity (FVC) (89.00±14.31)%, peak expiratory flow (PEF) (65.05±15.10)%, one-second rate (FEV1/FVC) (92.18±13.59)%, and instantaneous flow at 50% forced expiratory flow were observed after exercise.The vital capacity (FEF50) (57.57±22.49)%, forced expiratory flow at 75% vital capacity (FEF75) (41.15±18.28)%, maximum expiratory flow (MMEF75/25) (53.14±22.53)% were significantly lower than those before exercise ((94.07±9.69)% , (92.30±13.60)% , (80.73±17.85)% , (101.07±13.79)% , (66.71±19.29)% , (51.32±18.38)% , (63.75±19.43)% ), (t values were 8.592 , 2.617 , 10.246 , 5.428, 3.590 , 3.646 , 3.687 , respectively, all P<0.05)) In routine examination of pulmonary ventilation function, FEF50 (66.71±19.29)% and FEF75 (51.32±18.38)% in the positive group were significantly lower than those in the negative group ((79.75±21.94)% 、(69.08±29.28)%), (t values were -2.841, -3.123, all P<0.01). The proportion of night cough, morning cough and severe dry cough in positive group was significantly higher than that in negative group, while the proportion of day cough and wet cough was significantly lower than that in negative group (P<0.01). The proportion of eczema history in positive group was significantly higher than that in negative group (P<0.01). Conclusion Patients with CVA have high airway responsiveness and small airway dysfunction.Combination of simple motor stimulation test and small airway function test has important clinical value in the early diagnosis of CVA. Key words: Cough variant asthma; Simple exercise provocation test; Small airway function; Children; Chronic cough

Responder Analysis of a Multicomponent Non-Pharmacological Intervention (MAKS) for People With Cognitive Impairment in the German Day-Care Study (DeTaMAKS).

Background: Multicomponent non-pharmacological therapies have been shown to be effective at reducing cognitive symptoms and slowing deterioration in abilities to perform activities of daily living (ADL) in individuals with cognitive impairment. However, little is known about response rates and predictors of response. Methods: We used data from the German day-care study (DeTaMAKS; De = dementia, Ta = Tagespflege/day-care, M = motor stimulation, A = activities of daily living stimulation, K = k/cognitive stimulation, S = social stimulation; n = 362), which was based on a cluster-randomized trial of the non-pharmacological, multicomponent, anti-dementia MAKS therapy for people with cognitive impairment in day-care centers. We investigated response (defined as improvement or no deterioration) for three different response criteria: cognition via Mini-Mental State Examination (MMSE) score, ADL via Erlangen Test of Activities of Daily Living in Persons with Mild Dementia or Mild Cognitive Impairment (ETAM) score, and behavioral and psychological symptoms of dementia (BPSD) via Neuropsychiatric Inventory Questionnaire (NPI-Q) score. In addition, we calculated the number needed to treat (NTT) and response rates according to net gain analyses. Results: For all three criteria, the response rates were higher in the intervention group than in the control group (chi2 test: p = 0.058 to p = 0.003). Compared with non-responders, responders according to cognition had higher ETAM scores (= better ADL abilities) at baseline; responders according to ADL had lower ETAM scores (= poorer ADL abilities) at baseline; and responders according to BPSD had higher NPI-Q scores (= more BPSD) at baseline. Classification rates based on these predictors ranged from 60.6 to 68.3%. Discussion: The response rates to the non-pharmacological MAKS therapy were greater than those reported for anti-dementia drugs. There were only a few differences between responders and non-responders. Because of the low classification rates, these variables had only a small impact on response predictions. Therefore, there are no empirically substantiated selection criteria for the application of MAKS therapy in facilities. Clinical Trial Registration: www.ClinicalTrials.gov, identifier ISRCTN16412551.

Efeito da estimulação elétrica periférica e cerebral na força isométrica máxima dos extensores do joelho: ensaio clínico aleatorizado

INTRODUÇÃO: Recentes evidências têm demonstrado resultados bastante promissores para o uso de estratégias não invasivas de neuromodulação na melhora de habilidades físicas ou esportivas. A estimulação elétrica periférica (EEP) e a estimulação transcraniana por corrente contínua (ETCC) são técnicas não invasivas e não farmacológicas bastante utilizadas para modular a excitabilidade neuronal de áreas cortico-motoras e estimular a recuperação funcional. No entanto, poucos estudos têm investigado o efeito dessas técnicas na melhora do desempenho muscular. OBJETIVO: Investigar o efeito da estimulação elétrica periférica sensorial (EEPs) seguida de estimulação elétrica periférica motora (EEPm) ou estimulação transcraniana por corrente contínua (ETCC) na força isométrica máxima dos extensores do joelho em indivíduos saudáveis. MÉTODO: 20 universitários saudáveis foram distribuídos aleatoriamente em dois blocos distintos de 10 participantes cada: Bloco n°1 EEPs real + EEPm real ou EEPs simulada + EEPm real e bloco n°2 EEPs real + ETCC real ou EEPs simulada + ETCC real em uma única sessão. A contração voluntária isométrica máxima (CVIM) dos extensores do joelho foi avaliada por meio da dinamometria manual antes, durante e 10 min pós-estimulação. RESULTADOS: A CVIM dos extensores do joelho aumentou significativamente 10 minutos pós-ETCC isolada (diferença média = 0,23 N/Kg; IC 95% = 0,01 a 0,44 N/Kg; p = 0,04). A ETCC isolada também apresentou maior proporção cumulativa de respondedores seguido de EEPs+ETCC. CONCLUSÃO: A estimulação transcraniana por corrente contínua induz a aumentos significativos na CVIM em indivíduos saudáveis. No entanto, a aplicação prévia de estimulação elétrica periférica sensorial não impulsiona os efeitos da estimulação elétrica periférica motora ou cerebral na CVIM.

A Comprehensive Review of Trigeminal Neuralgia.

Trigeminal neuralgia (TN) is characterized by recurrent attacks of lancinating facial pain in the dermatomal distribution of the trigeminal nerve. TN is rare, affecting 4 to 13 people per 100,000. Although there remains a debate surrounding the pathogenesis of TN, neurovascular compromise is the most currently accepted theory. Minimal stimulation caused by light touch, talking, or chewing can lead to debilitating pain and incapacitation of the patient. Pain may occur sporadically, though is primarily unilateral in onset. The diagnosis is typically determined clinically. Treatment options include medications, surgery, and complementary approaches. Anti-epileptic and tricyclic antidepressant medications are first-line treatments. Surgical management of patients with TN may be indicated in those who have either failed medical treatment with at least three medications, suffer from intolerable side-effects, or have non-remitting symptoms. Surgical treatment is categorized as either destructive or non-destructive. Deep brain and motor cortex neuro-modulatory stimulation are off label emerging techniques which may offer relief to TN that is otherwise refractory to pharmacological management and surgery. Still, sufficient data has yet to be obtained and more studies are needed.