Stimulation Program Research Articles

Prospective Connectomic-Based Deep Brain Stimulation Programming for Parkinson's Disease.

Efficacy of deep brain stimulation (DBS) relies on accurate lead placement as well as optimization of the stimulation parameters. Although clinical software tools are now available, programming still largely relies on a monopolar review, a tedious process for both patients and programmers. This study investigates the safety and feasibility of prospective automated connectomic DBS programming (automated connectomic programming [ACP]), focusing on the recruitment of specific white matter pathways. After DBS implantation, a detailed connectomic DBS model in patient-specific space was developed for each study participant. A driving-force model was used to quantify pathway recruitment across 2400 different DBS settings. Optimization algorithms maximized recruitment of therapeutic pathways while minimizing recruitment of side-effect pathways. Thirteen subjects were enrolled in two study phases that compared DBS settings derived from ACP to standard clinical DBS settings. Nine patients underwent reprogramming with ACP (5 globus pallidus interna [GPi], 4 subthalamic nucleus [STN]). Four patients underwent initial programming with ACP (3 GPi, 1 STN). All patients tolerated ACP without persistent side effects. In the reprogramming cohort, 3 patients preferred their ACP program, and 1 patient felt it was comparable to their clinical program. Unified Parkinson's Disease Rating Scale, Part III, scores for the initial ACP cohort (3 GPi, 1 STN) improved by an average of 43.5% (40.4-52.6 ± 5.6%). ACP appeared clinically safe and feasible. It provided reasonable motor improvement, which can be further optimized with subsequent clinical adjustment. Additional investigation is required to refine the optimization algorithm and to quantify the clinical benefit of ACP in a larger cohort. © 2024 International Parkinson and Movement Disorder Society.

Vagus nerve stimulation for epilepsy: A narrative review of factors predictive of response.

Vagus nerve stimulation (VNS) is an established therapy for drug-resistant epilepsy. However, there is a lack of reliable predictors of VNS response in clinical use. The identification of factors predictive of VNS response is important for patient selection and stratification as well as tailored stimulation programming. We conducted a narrative review of the existing literature on prognostic markers for VNS response using clinical, demographic, biochemical, and modality-specific information such as from electroencephalography (EEG), magnetoencephalography, and magnetic resonance imaging (MRI). No individual marker demonstrated sufficient predictive power for individual patients, although several have been suggested, with some promising initial findings. Combining markers from underresearched modalities such as T1-weighted MRI morphometrics and EEG may provide better strategies for treatment optimization.

The effects of deep TMS on purpose in life, quantitative EEG and event-related potentials in major depressive disorder

Background: Perceived purpose in life (PIL) is linked with many vital health outcomes, including Major Depressive Disorder (MDD). Methods: In this study, biomarkers associated with depression and PIL were investigated using Brain Network Activation (BNA) based quantitative electroencephalography (QEEG) and event-related potential (ERP) measures in a sample of individuals with MDD. Data were analyzed before and after a 36-session, Deep transcranial magnetic stimulation (TMS) program. Results: At baseline, the study observed that increased slow-frequency resting-state activity in the frontal and temporal regions correlated with higher levels of depression and reduced PIL. Additionally, a reduced P3b amplitude was found to predict elevated depressive symptoms. However, with the application of Deep TMS treatment notable improvements were observed in both depression (p < .001. d = 2.15) and PIL (p < .001, d = 1.59) levels. The treatment also successfully regulated resting-state QEEG (delta/beta) and ERP characteristics (P200 latency), bringing them closer to healthy levels. Conclusions: This attenuation of brain activity patterns relating to depression is encouraging as it suggests that effects were robust and are more likely to be sustained over time. This study represents the first exploration of the effects of Deep TMS on PIL and relevant QEEG and ERP biomarkers. The initial evidence suggests that Deep TMS holds promise in enhancing both PIL and neurophysiological health. Future investigations should continue exploring the utility of Deep TMS in targeting a wide range of neuropsychological and physical health conditions, leveraging objective biomarkers such as QEEG and ERP.

Multisensory Stimulation in Amyotrophic Lateral Sclerosis Disease: Case Report of an Innovative Proposal through Immersive Virtual Reality

Physical–cognitive stimulation has emerged as a promising strategy for improving the quality of life of patients with amyotrophic lateral sclerosis (ALS). This case study reports on the use of immersive virtual reality (IVR) as a tool for multisensory stimulation in a woman with ALS (76 years old; 11 years since diagnosis; stage 2). The program consisted of IVR stimulation sessions (three sessions per week for 12 weeks). The results showed that the implementation of the program was feasible and safe (no adverse symptoms on the Simulator Sickness Questionnaire), as well as easy to execute (&gt;80% on the System Usability Scale). Additionally, the participant reported improvements in aspects related to her mental health (44% depression and 20% anxiety) and improvements in her quality of life, and she also maintained her values in her functional capacity. This study presents novel and important findings by demonstrating the feasibility of implementing physical–cognitive stimulation programs with IVR in a person with ALS, allowing for multisensory stimulation with commercially available hardware and software and the generation of benefits in their health-related quality of life and mental health.

ID: 318062 Assessment of lmage-Guided Programming (IGP) on Bilateral STN and GPi Deep Brain Stimulation Programming Time

ID: 318062 Assessment of lmage-Guided Programming (IGP) on Bilateral STN and GPi Deep Brain Stimulation Programming Time

MANUAL OROFACIAL STIMULATION AND ITS IMPACT ON CHILDREN WITH CEREBRAL PALSY

Orofacial education of children with cerebral palsy is a long-lasting process that requires perseverance especially from their families. The main methods based on active orofacial exercises and those from speech therapy continue to question the effectiveness of oral motor treatment, leaving a gap in the literature concerning the feeding skills improvements of the children diagnosed with cerebral palsy. Based on this concern, we ask ourselves the question: are there other better methods of oral motor rehabilitation for these children with special needs? In this study we aimed to investigate, within the complex rehabilitation programme for CP, the impact of manual orofacial stimulation in order to reduce sialorrhea and improve mandibular movements, which play an important role in the feeding process. The study included 10 participants (5 girls and 5 boys), aged 8-10 years, diagnosed with cerebral palsy, spastic tetraplegia form with severe orofacial impairment and the intervention protocol consisted of a manual orofacial stimulation programme 4 times a week. Statistical results revealed that the application of the proposed orofacial stimulation programme was highly effective for the 10 research participants, whose scores improved significantly at the final assessment compared to those achieved at the beginning of the study, reaching almost normal values even in the case of mandibular parameters.

THE IMPACT OF COGNITIVE STIMULATION IN OLDER ADULTS WITH DEMENTIA

This study evaluated the impact of a cognitive stimulation program on older adults diagnosed with dementia. The sample comprised 22 participants aged 73-95, randomly assigned to an experimental group (N = 12) and a control group (N = 10). While no statistically significant decreases were observed in the studied dimensions, clinically relevant gains were noted: 41.70% in cognition, 41.60% in quality of life, and 8.3% in functional skills. Although no therapeutic interventions have successfully reversed dementia, healthcare providers reported improvements in participants’ social interactions, behaviors, and engagement in daily institutional routines. These observations suggest tangible benefits from program participation. It’s important to note that staff working closely with these patients daily observed these improvements despite the lack of statistically significant results. This discrepancy highlights the potential limitations of relying solely on quantitative measures to assess such interventions’ effectiveness. In conclusion, the cognitive stimulation program shows promise as a potential tool for slowing dementia-associated degenerative processes, particularly in areas that standard quantitative assessments may not fully capture. Further research with larger sample sizes and more sensitive measures may be warranted to fully understand the program’s impact.

Positive impacts on child development of a home visiting program in Santiago del Estero, Argentina (2022–2023)

The present paper evaluates the impact of a home visiting program aimed at training mothers in aspects of stimulation of their 0–3-year-old children in contexts of social vulnerability in the province of Santiago del Estero, Argentina. This program was carried out by the Asociación Civil Haciendo Camino (ACHC) with mothers participating in the program who were trained and supervised by health professionals within the framework of a comprehensive intervention. The evaluation was conducted through a difference-in-differences (DiD) method between a treatment group and a control group and two measurements over time with a six-month lapse of intervention. The measurements were made with the tool Ages & Stages Questionnaires, Third Edition (ASQ-3), which assesses five areas of child development. In addition, sociodemographic, socioeconomic and parenting aspects were surveyed to estimate heterogeneous effects. The results of the present study indicate that the program achieved positive and significant effects in three areas of child development (communication, fine motor skills and problem solving), and positive but not significant effects in two other areas (gross motor skills and personal-social development). Among the positive heterogeneous effects, the increase in the child’s age and the mother’s age in different dimensions of development under the effects of the reference program stand out. These results add evidence on the relevance of early childhood stimulation programs in contexts of social vulnerability.

Video-Guided Optimization of Stimulation Settings in Patients with Parkinson's Disease and Deep Brain Stimulation.

Deep brain stimulation (DBS) for Parkinson's disease (PD) often necessitates frequent clinic visits for stimulation program optimization, with limited experience in remote patient management. Due to the resource-intensive nature of these procedures, we investigated a way to simplify stimulation optimization for these patients that allows for the continuous monitoring of symptoms while also reducing patient burden and travel distances. To this end, we prospectively recruited ten patients treated with DBS for PD to evaluate the feasibility of telemedicinal optimization in a home-based setting. Patients recorded daily videos of a modified Unified Parkinson's Disease Rating Scale (UPDRS) III, which experienced DBS physicians located at the clinic assessed to provide instructions on adjusting stimulation settings using a handheld programmer with previously set programs as well as patient amplitude control. This study concluded with significant improvements in participants' motor status as measured by the UPDRS-III (p = 0.0313) compared to baseline values. These findings suggest that remote video-guided optimization of DBS settings is feasible and may enhance motor outcomes for patients.

Efficacy of subthalamic deep brain stimulation programming strategies for gait disorders in Parkinson's disease: a systematic review and meta-analysis.

Patients with advanced Parkinson's disease often suffer from severe gait and balance problems, impacting quality of live and persisting despite optimization of standard therapies. The aim of this review was to systematically review the efficacy of STN-DBS programming techniques in alleviating gait disturbances in patients with advanced PD. Searches were conducted in PubMed, Embase, and Lilacs databases, covering studies published until May 2024. The review identified 36 articles that explored five distinct STN-DBS techniques aimed at addressing gait and postural instability in Parkinson's patients: low-frequency stimulation, ventral STN stimulation for simultaneous substantia nigra activation, interleaving, asymmetric stimulation and a short pulse width study. Among these, 21 articles were included in the meta-analysis, which revealed significant heterogeneity among studies. Notably, low-frequency STN-DBS demonstrated positive outcomes in total UPDRS-III score and FOG-Q, especially when combined with dopaminergic therapy. The most favorable results were found for low-frequency STN stimulation. The descriptive analysis suggests that unconventional stimulation approaches may be viable for gait problems in patients who do not respond to standard therapies.

Analysis of the effectiveness of a computerized cognitive stimulation program designed from Occupational Therapy according to the level of cognitive reserve in older adults in Primary Care: Stratified randomized clinical trial protocol

Normal aging presents subtle cognitive changes that can be detected before meeting the criteria for Mild cognitive impairment (MCI). Older people with low cognitive reserve and who receive limited cognitive stimulation are at greater risk of deterioration. In this regard, cognitive stimulation (CS) has been identified as an intervention that reduces this risk, provided that its design takes into account the differences in the level of cognitive reserve (CR) acquired throughout life and the baseline level of cognitive functioning. The general objective of this study is to evaluate, through a randomized clinical trial, the effectiveness of a computerized cognitive stimulation program, designed and adapted from Occupational Therapy based on the level of cognitive reserve in older adults in Primary Care. 100 participants will be randomized in a stratified manner according to the level of cognitive reserve (low/moderate/high), assigning 50 participants to the control group and 50 participants to the intervention group. The intervention group will carry out a computerized cognitive stimulation intervention designed and adapted from occupational therapy according to the level of cognitive reserve, through the “stimulus” platform. The main result expected to be achieved is the improvement of higher brain functions. As secondary results, we expect that those cognitive aspects most vulnerable to aging will decrease more slowly (in areas such as memory, executive function, attention and processing speed), and that the cognitive reserve of the participants will increase, in addition to being able to balance gender differences in these aspects. We think that these results can have a positive impact on the creation of adapted, meaningful and stimulating CS programs in older adults to prevent MCI and experience healthier aging.

The Function of Cadres in Putting Child Development Stimulation, Detection, and Early Intervention Programs into Practice

The East Java province's child health care coverage in 2020 was 83.3%, a decrease from 2019. In Surabaya, the coverage in 2019 was 91.59%, but it still did not meet the 2020 Minimum Service Standards (MSS) target of 100%. The inadequate implementation of programs for early detection, stimulation, and intervention in child growth and development (SDIDTK) is one factor contributing to the failure to meet this objective. For these initiatives to be successful at the Posyandu level, community health workers, or cadres, must be involved. The objective of this research is to look at how the SDIDTK programs use cadres. There were 71 respondents in the cross-sectional research, which used an observational analytic methodology. Out of the seven roles, only two were performed by all cadres (71 individuals): determining head circumference, weight, height, and upper arm circumference; providing the information into the early detection form for assessing newborn growth and creating a visual representation of the results. In the mother and child health book, two roles were not performed by any of the cadres. The first responsibility was to complete the Early Detection of Child Growth and Development form by providing the child's identity. The second role was to use the child development checklist to observe and mark the child's developmental abilities as appropriate (√) or not appropriate (-).

Impact of a cognitive training on reading of 6-year-old children

Numerous studies explore the effect of cognitive stimulation programmes on reading skills in children and adolescents, with mixed results. Although several studies support that the relationships established between executive functions and reading skills are more robust at early ages, when the process of formal reading acquisition is being consolidated, there are few studies that evaluate the impact of this type of interventions at the beginning of primary school. For this reason, the present pilot study investigates the possible effects of executive functions training on letter identification and decoding, as well as word and pseudoword reading. A cognitive training was carried out using the CogniFit platform in 12 typically developing 6-year-old children, comparing their performance with a control group of 28 children of the same age and similar socioeconomic status. This protocol took place over 8 weeks, with a mean of 19 minutes of training per week. The results obtained indicate that the experimental group showed a higher reading speed in letter recognition than the control group. However, no effect was found in the rest of the reading skills. These promising results indicate that additional research is needed to clarify the lack of convergence reported in the current scientific literature.

Cochlear implantation in a familial rare syndromic ossification-related deafness and literature review

Background Kenny-Caffey Syndrome type 2 (KCS2) is a genetic disease affecting bone metabolism. However, cochlear implantation (CI) results have yet to be published in detail. Objective This study presents the gene, clinical characteristics, surgical outcomes, and literature review of 2 patients with sensorineural hearing loss related to KCS2. To enhance diagnostic detection and accuracy, we also compare the differential diagnosis between KCS2, otosclerosis, and Cogan’s syndrome (CS). Methods Prior to CI, patients with KCS2 and CS underwent comprehensive audiological and radiological evaluations. Postoperative auditory speech outcomes and impedance values were recorded and analyzed statistically. A systematic search of the literature was conducted to summarize clinical characteristics. Results Patients diagnosed with KCS2 exhibit more pronounced changes in the inner ear. The impedance values in the KCS2 cohort were considerably higher (Mean = 12.13 kΩ) than those with CS (Mean = 8.8 kΩ) one year post-activation. The literature review exhibits the clinical manifestations associated with KCS2. Conclusion CI is an effective treatment for KCS2 to restore hearing loss. More frequent programming and accurate adjustment of stimulation is of great necessity. A thorough examination, including temporal bone HRCT, 3D-MRI, audiological evaluations, and whole-exome sequencing, is essential for the diagnosis and treatment of KCS2.

A Virtual Reality Cognitive Stimulation Program as an Effective Tool Against Residual/Prodromal Depressive Symptoms in Bipolar Disorders.

Background: Bipolar disorder (BD) is a severe psychiatric illness characterized by a chronic course and recurrent episodes, including residual depressive symptoms even during euthymic phases. These symptoms, although not meeting criteria for a depressive episode, are linked to relapse risk and impaired social functioning. This study aims to assess whether Virtual Reality Cognitive Remediation Training reduces depressive symptoms below the clinical threshold in individuals with BD. Methods: This post hoc analysis focuses on the secondary outcome (PHQ9) of a randomized-controlled trial. Participants were recruited from the Center of Liaison Psychiatry and Psychosomatics in Italy. The experimental group received Virtual Reality Cognitive Remediation, while the control group received standard treatment Results: Data from 39 individuals in the experimental group and 25 in the control group were analyzed. A greater reduction in PHQ-9 scores (>9) was observed in the experimental group (71.8% to 48.7%) compared to the control group. Significant improvements in total PHQ-9 scores and specific symptoms were noted in the experimental group compared to the control group. Conclusions: The study highlights the significant impact of virtual reality intervention on reducing depressive symptoms in bipolar disorder. This promising outcome underscores the potential preventive role of cognitive stimulation in relapse prevention. The intervention could offer valuable benefits for both treatment and prevention strategies in bipolar disorder.

Comparison of beta peak detection algorithms for data-driven deep brain stimulation programming strategies in Parkinson’s disease

Oscillatory activity within the beta frequency range (13–30 Hz) serves as a Parkinson’s disease biomarker for tailoring deep brain stimulation (DBS) treatments. Currently, identifying clinically relevant beta signals, specifically frequencies of peak amplitudes within the beta spectral band, is a subjective process. To inform potential strategies for objective clinical decision making, we assessed algorithms for identifying beta peaks and devised a standardized approach for both research and clinical applications. Employing a novel monopolar referencing strategy, we utilized a brain sensing device to measure beta peak power across distinct contacts along each DBS electrode implanted in the subthalamic nucleus. We then evaluated the accuracy of ten beta peak detection algorithms against a benchmark established by expert consensus. The most accurate algorithms, all sharing similar underlying algebraic dynamic peak amplitude thresholding approaches, matched the expert consensus in performance and reliably predicted the clinical stimulation parameters during follow-up visits. These findings highlight the potential of algorithmic solutions to overcome the subjective bias in beta peak identification, presenting viable options for standardizing this process. Such advancements could lead to significant improvements in the efficiency and accuracy of patient-specific DBS therapy parameterization.

Early intensive rehabilitation reverses locomotor disruption, decrease brain inflammation and induces neuroplasticity following experimental Cerebral Palsy

BackgroundCerebral Palsy (CP) is a major cause of motor and cognitive disability in children due to injury to the developing brain. Early intensive sensorimotor rehabilitation has been shown to change brain structure and reduce CP symptoms severity. We combined environmental enrichment (EE) and treadmill training (TT) to observe the effects of a one-week program of sensorimotor stimulation (EETT) in animals exposed to a CP model and explored possible mechanisms involved in the functional recovery. MethodsPregnant Wistar rats were injected with Lipopolysaccharide (LPS − 200 µg/kg) intraperitoneally at embryonic days 18 and 19. At P0, pups of both sexes were exposed to 20′ anoxia at 37 °C. From P2 to P21, hindlimbs were restricted for 16 h/day during the dark cycle. EETT lasted from P21 to P27. TT − 15 min/day at 7 cm/s. EE − 7 days in enriched cages with sensorimotor stimulus. Functional 3D kinematic gait analysis and locomotion were analyzed. At P28, brains were collected for ex-vivo MRI and histological assessment. Neurotrophins and key proteins involved in CNS function were assessed by western blotting. ResultsCP model caused gross and skilled locomotor disruption and altered CNS neurochemistry. EETT reversed locomotor dysfunction with minor effects over gait kinematics. EETT also decreased brain inflammation and glial activation, preserved myelination, upregulated BDNF signaling and modulated the expression of proteins involved in excitatory synaptic function in the brain and spinal cord. ConclusionsUsing this translational approach based on intensive sensorimotor rehabilitation, we highlight pathways engaged in the early developmental processes improving neurological recovery observed in CP.

Randomized Controlled Trials for Post-COVID-19 Conditions: A Systematic Review.

Post-coronavirus disease 2019 (COVID-19) syndrome or condition (PCS) is defined as new onset symptoms for at least three months following COVID-19 infection that has persisted for at least two months. Given the global sequelae of COVID-19, there is an urgent need for effective PCS interventions. The aim of this study was to systematically review all interventions for PCS tested in randomized controlled trials.In this International Prospective Register of Systematic Reviews (PROSPERO) registered (CRD42023415835) systematic review, PubMed, Google Scholar, and ClinicalTrials.gov databases were searched between 1st January 2020 and 30th April 2023. Inclusion criteria were (1) randomized controlled trials that tested interventions for (2) PCS as defined above. Studies were independently reviewed, and final decisions regarding extracted data and risk of bias were made by consensus. Trial findings were summarized qualitatively.The review included 23 trials with 1,916 subjects (mean age 44.9, 25.8% males) from 10 countries. The predominant symptom or function targeted by the interventions were general long COVID-19 symptoms (35%), fatigue (30%), breathlessness (17%), olfactory (17%), and brain function (9%). Overall, the majority of trials (74%) were at high risk of bias. A range of interventions were identified, including physical therapies, dietary and regenerative treatments, electrical stimulation, and digital wellness programs with variable effects.While a diverse range of interventions for PCS have been tested, their effectiveness varies, with threats to validity in most studies. Trials focusing on PCS mental health disorders, musculoskeletal complaints, and children are needed. Well-designed RCTs are needed to establish definitive interventions for PCS.

Programa de estimulación cognitiva en línea para pacientes adultos mayores con deterioro cognitivo leve: estudio de factibilidad

BackgroundMild Cognitive Impairment (MCI) is considered a decline in cognitive functions, which becomes more pronounced with age. These patients may benefit from cognitive treatments that help attenuate or slow down a potential progression towards dementia. ObjectiveTo assess the feasibility, fidelity, satisfaction, and effectiveness of the Memory Training and Cognitive Stimulation Program (PEMEC, by its Spanish acronym) in individuals with MCI in an online setting. MethodA non-probabilistic convenience sample of 14 patients with MCI received the PEMEC (PEMEC online) through an electronic device, were assessed with MoCA, NEUROPSI Brief, Yesavage Geriatric Depression Scale before and after treatment, comparing these measurements with those of a waiting list control group. Results92,85% completed the treatment; with an average of 92% fidelity to the original intervention, an average of 91,61% for satisfaction with the activities of each session and the perceived usefulness was 97,98%. Statistically significant differences were found in the NEUROPSI Brief and the MoCA, before and after treatment in the intervention group and, when comparing the scores with the waiting list control group, a statistically significant difference was found in the MoCA scores. ConclusionFollowing the cultural adaptation of the program (from a Spanish to a Mexican treatment group), these results establish a precedent that systematic group cognitive interventions are feasible and effective in virtual tele-neuropsychology contexts for older adults.

Novel Technologies to Address the Lower Motor Neuron Injury and Augment Reconstruction in Spinal Cord Injury.

Lower motor neuron (LMN) damage results in denervation of the associated muscle targets and is a significant yet under-appreciated component of spinal cord injury (SCI). Denervated muscle undergoes a progressive degeneration and fibro-fatty infiltration that eventually renders the muscle non-viable unless reinnervated within a limited time window. The distal nerve deprived of axons also undergoes degeneration and fibrosis making it less receptive to axons. In this review, we describe the LMN injury associated with SCI and its clinical consequences. The process of degeneration of the muscle and nerve is broken down into the primary components of the neuromuscular circuit and reviewed, including the nerve and Schwann cells, the neuromuscular junction, and the muscle. Finally, we discuss three promising strategies to reverse denervation atrophy. These include providing surrogate axons from local sources; introducing stem cell-derived spinal motor neurons into the nerve to provide the missing axons; and finally, instituting a training program of high-energy electrical stimulation to directly rehabilitate these muscles. Successful interventions for denervation atrophy would significantly expand reconstructive options for cervical SCI and could be transformative for the predominantly LMN injuries of the conus medullaris and cauda equina.