Transcutaneous Electrical Neural Stimulation Research Articles

(155) Transcutaneous Electrical Neural Stimulation Improves Overall Satisfaction in Patients with Erectile Dysfunction

Abstract Introduction Transcutaneous electrical neural stimulation (TENS) therapy has demonstrated the potential to augment peripheral blood flow towards the musculature, thereby enhancing oxygen supply to the working muscles. Erectile dysfunction (ED) is a pathological condition characterized by compromised blood flow to the penis. In theory, TENS therapy can enhance penile blood circulation and alleviate the symptoms associated with ED. Objective Therefore, we aimed to assess the effects of penile TENS therapy on reducing ED symptoms and improving erectile function (EF). Methods We conducted a pilot cohort trial following approval from the Institutional Review Board (IRB), in which we enrolled patients presenting with clinical ED at our clinic. The TENS therapy intervention comprised ten sessions lasting 20 min each, administered over a period of 5 weeks. Two TENS patches were used, with one patch positioned at the base of the penis and the second patch placed on the perineum. The intensity of TENS therapy was determined using a scale ranging from 0 to 10, with the patients selecting the maximum intensity that they could tolerate without experiencing pain. Baseline and post-therapy questionnaires were administered using the International Index of Erectile Function (IIEF) as the primary outcome measure. A paired t-test was conducted to assess the results, which are presented as the mean difference (MD) along with a 95% confidence interval. Results Ten patients, all of whom were already receiving oral PDE5i medications ED were enrolled. However, specific drugs, dosages, and regimens were not standardized across patients, although they maintained the same treatment regimen throughout the study period. The mean baseline total testosterone level was at 527.9 ng/dL. On average, the intensity of TENS therapy administered to the patients was 6.58. A statistically significant improvement in the IIEF total score was seen with an MD of 5.6 (95% CI:0.35, 10.85; p = 0.03). Additionally, a statistically significant difference was observed in the IIEF overall satisfaction domain, with an MD of 1.20 (95% CI:0.14, 2.26; p = 0.03). However, no significant differences were found in IIEF erectile function, desire, orgasm, and intercourse satisfaction subdomain scores. Furthermore, none of the patients reported any adverse effects associated with TENS therapy. Conclusions These findings suggest that TENS therapy has the potential to improve the overall satisfaction of patients with ED. Further research with larger sample sizes and randomized controlled trials are warranted to validate these initial findings and to elucidate the full potential of TENS therapy in ED management. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Disclosures: Consultant for AbbVie, Marius, Tolmar, Endo, Petros, Boston Scientific, Coloplast Investor: Sprout.

Parasacral transcutaneous electrical neural stimulation versusurotherapy in primary monosymptomatic enuresis: A prospective randomized clinical trial.

To evaluate the clinical response of parasacral transcutaneous electrical neural stimulation (parasacral TENS) associated with urotherapy in children with primary monosymptomatic nocturnal enuresis(PMNE) compared to urotherapy alone. This prospective controlled clinical trial enrolled 72 children over 5 years of age with PMNE. Children were randomly divided into twogroups, control group (CG), treated with urotherapy and scapular stimulation, and experimental group (EG), treated with urotherapy and parasacral TENS. In both groups, 20 sessions were performed, 3 times weekly, for 20 min each, with 10 Hz frequency, 700 μS pulse width and intesity determinated by the patient threshold. The percentages of dry nights were analyzed for 14 days before treatment (T0), after the 20th session (T1), 15 (T2), 30 (T3), 60 (T4), and 90 (T5) days after the end of the sessions. Patients of both groups were followed with intervals of 2 weeks in the first month and monthly for threeconsecutive months. Twenty-eight enuretic children, 14 girls (50%) with a mean age of 9.09 ± 2.23 years completed the study. There was no difference in mean age between groups. Mean percentage of dry nights in EG at T0 was 36%, at T1 49%, at T2 54%, at T3 54%, at T4 54%, and 57% at T5; while in CG, these percentages were 28%, 39%, 37%, 35%, 36%, and 36%, respectively. Parasacral TENS associated with urotherapy improves the percentage of dry nights in children with PMNE, although no patient had complete resolution of symptoms in this study.

Estimulação elétrica neural transcutânea (tens) na paroxismia do tronco cerebral: relato de caso

INTRODUÇÃO: A paroxismia de tronco encefálico, descrita em pacientes com esclerose múltipla (EM), caracteriza-se por episódios rápidos de vertigem e nistagmos evocados por movimentos cefálicos. A neuromodulação tem apresentado sucesso terapêutico em várias disfunções da EM, mas ainda não foi utilizada na paroxismia. OBJETIVO: Avaliar o efeito aditivo da neuromodulação por estimulação elétrica neural transcutânea (TENS) na musculatura periocular em paciente com EM e paroxismia de tronco encefálico não responsiva à reabilitação clássica associada à medicação. MATERIAL E MÉTODOS: Avaliação do nistagmo com videonistagmógrafo, da sensibilidade cutânea facial com estesiômetro, do blefaroclônus por gravação em vídeo e da sensação dolorosa de forma subjetiva (descrição pessoal da paciente); execução de 10 sessões consecutivas semanais de exercícios oculares associados à TENS na musculatura do oblíquo inferior e reto lateral direitos. RESULTADO: Melhora da algia, do blefaroclônus, da vertigem e do nistagmo ocular direito. CONCLUSÃO: A neuromodulação com TENS parece ser uma terapia complementar válida para pacientes com EM e paroxismia de tronco não responsivos aos demais tratamentos clínicos, porém mais estudos são necessários para confirmar esse achado.

The Effect of Early Hip-strengthening on Physical Function in Patients With Unilateral Total Knee Arthroplasty

Background and Aim: Conventional post-operative rehabilitation programs focus on quadriceps strengthening and knee range of motion. However, hip muscle weakness is evident in patients with knee osteoarthritis. The present trial study aimed to investigate the effects of adding early hip muscle strengthening exercises to conventional rehabilitation programs on pain, Range of Motion (RoM), Quality of Life (QoL), and physical function in patients with unilateral Total Knee Arthroplasty (TKA). Methods & Materials: The intervention was initiated from the second day after surgery and continued for 10 sessions, 3 times a week on 24 participants in the control and intervention groups. Both research groups received Transcutaneous Electrical Neural Stimulation (TENS) and Infra-Red (IR), followed by exercises. The control group performed knee extensor and flexor strengthening and RoM exercises. The intervention group conducted hip-strengthening exercises in addition. Outcome measures included pain, knee flexion, and extension RoM, and QoL using the 36-Item Short Form Survey (SF-36), Timed Up and Go (TUG) test, Step Test, Six-Minute Walk Test (6MWT), and Hip and Knee Muscle Strength test. Ethical Considerations: This research was approved by the Research Ethics Committee of Iran University of Medical Sciences (IR.IUMS.REC.1396.9511340012) and it was registered in the Clinical Trial Registration Center (Code: IRCT 20150314021459N6). Results: All outcome measures improved in both research groups. The improvement in the scores of pain (P=0.03), knee extension RoM (P=0.007), and TUG test (P=0.033) were significantly higher in the intervention group, compared to the control group. The strength of knee flexors (P=0.023), hip flexors (P=0.040), hip extensors (P=0.028), hip adductors (P=0.040), and hip external rotators (P=0.047) significantly improved higher in the intervention group. Conclusion: According to the present research results, both treatment approaches were effective on patients with unilateral total knee arthroplasty. Considering the better result of some of the outcome measures in the intervention group, the addition of hip strengthening exercises to knee exercises can be useful.

Role of Transcutaneous Electrical Nerve Stimulation in Treating Children With Overactive Bladder From Pooled Analysis of 8 Randomized Controlled Trials.

PurposeTranscutaneous electrical neural stimulation (TENS), as a non-invasive modality, has been clinically used as an alternative treatment for children with overactive bladder (OAB). We conducted a pooled analysis to explore the effect of TENS on OAB.MethodsThe Preferred Reporting Items for Systematic Reviews and Meta-analysis guideline was followed in this study. The MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases, as well as the reference lists of the retrieved studies, were used to find trials relevant for assessing the use of TENS to treat OAB.ResultsOf the 246 records identified, 8 publications were analyzed in our study. Our analysis found that TENS resulted in a greater decrease of wet days/wk, daily voiding frequency, daily incontinence episodes, and daily number of voids than was observed in the control group. Furthermore, TENS-treated patients showed similar visual analogue scale (VAS) scores to patients in the control group, demonstrating that the application of TENS did not increase patients’ discomfort and pain. TENS had a relative advantage in the number of partial responses, but no clear differences were found in frequency of no response or a full response compared to the control group. In urodynamic testing, TENS led to obvious improvements in average voided volume and maximum voided volume in children with OAB.ConclusionsTENS had a remarkable effect on the improvement of urodynamic indexes and objective OAB symptoms without a significant increase in VAS scores for children with OAB.

Design of a wearable pain management system with embroidered TENS electrodes

PurposeThe purpose of this paper is to develop a user friendly, wearable pain management system by optimizing CAD embroidery parameters for manufacturing high performance dry transcutaneous electrical neural stimulation (TENS) electrodes.Design/methodology/approachUser-centered design methodology is employed to identify user needs related to TENS devices. Optimization of CAD embroidery parameters was done by measuring and calculating resistance and signal-to-noise values for electrodes manufactured with different conductive thread, stitch pattern, and stitch density types.FindingsCharacteristics of the conductive thread such as thickness and irregularity, embroidery stitch pattern, stitch density therefore the amount of conductive thread used all effect resistance values and signal-to-noise values of TENS electrodes. Low resistance of TENS electrode surface does not mean high signal-to-noise ratio and high TENS signal quality. Satin stitch type with low stitch density provides the best resistance and signal-to-noise ratio for a TENS electrode.Originality/valueThis study reported the design process of a wearable pain management system with a focus on optimization of embroidery manufacturing parameters for development of TENS electrodes. The design process not only required technical optimization but also understanding user problems related to use of conventional TENS devices. Proposed end product is a user friendly, electronic textile based, wireless wearable pain management system in different forms suitable for major pain areas such as knee, elbow and neck.

Parasacral transcutaneous electrical neural stimulation (PTENS) once a week for the treatment of overactive bladder in children: A randomized controlled trial

Overactive bladder (OAB) is the most prevalent voiding disorder in childhood, and its main manifestation is urinary urgency. In general, urotherapy and anticholinergics are the first choices of treatment. Parasacral Transcutaneous Electrical Neural Stimulation (PTENS) was introduced as an alternative for the treatment of detrusor overactivity in children, but treatment protocols described to date require several sessions per week or long-lasting sessions, making it difficult for the child to adhere to the treatment. Thus, this study aims to evaluate the effectiveness of PTENS in single weekly sessions in the treatment of OAB in children. This prospective, randomized controlled trial included 16 children with OAB. Children were divided into two groups: CG (urotherapy and electrical stimulation placebo) and EG (urotherapy and PTENS). For both groups, therapy was delivered in 20 weekly sessions, of duration 20min each. Placebo electrical stimulation was done in the scapular area. The children were evaluated prior to treatment (T1), at the end of the 20 sessions (T2), and 60 days after the completion of treatment (T3), with a 3-day voiding diary, visual analogue scale (VAS), Rome III diagnostic criteria, and the Bristol Scale. The groups were similar in age, gender, and ethnicity. In the initial assessment, all children, in both groups, had urgency and incontinence, 50% in each group had constipation, and enuresis was present in seven children (87.5%) in the EG and six (75%) in the CG. No differences were found between the groups regarding the volumetric measurements made in the voiding diary, urinary frequency and constipation evaluated by the Rome III criteria and the Bristol Scale. Sixty days after treatment, a significant improvement was found in the EG group (p=0.03) regarding urgency (Table), as well as an increase in dry nights in those presenting with enuresis (p=0.03). No difference was noted regarding urinary incontinence (Table). At the end of 20 sessions and after 60 days of treatment, those responsible for the children in the EG perceived greater improvement in symptoms measured by the VAS (p=0.05 and 0.04, respectively). Our preliminary results demonstrate that PTENS performed in single weekly sessions is effective in treating the bladder for symptoms of urinary urgency and enuresis, and in the perception of those responsible for the children. Further studies with larger populations are needed to corroborate these results.

Urodynamic outcome of parasacral transcutaneous electrical neural stimulation for overactive bladder in children.

ABSTRACTObjective:To evaluate the urodynamic changes immediately after the first session (acute effect) and after the last session of parasacral TENS in children with idiopathic OAB.Materials and methods:We performed urodynamic evaluation immediately before and after the first session of parasacral TENS and immediately after the last session (7 weeks later). Only children with idiopathic isolated OAB were included. Patients with dysfunctional voiding were not included.Results:18 children (4 boys and 14 girls, mean age of 8.7) were included in the first analysis (urodynamic study before and immediately after the first session) and 12 agreed to undergo the third urodynamic study. Urodynamic before and immediately after the first session: There was no change in the urodynamic parameters, namely low MCC, low bladder compliance, presence of IDC, the average number of IDC, or in the maximum detrusor pressure after the first exam. Urodynamic after the last session: The bladder capacity improved in most patients with low capacity (58% vs. 8%). Detrusor overactivity was observed in 11 (92%) before treatment and 8 (76%) after. There was not a significant reduction in the average number of inhibited contractions after TENS (p=0.560) or in the detrusor pressure during the inhibited contraction (p=0.205).Conclusion:There was no change in the urodynamic parameters immediately after the first session of stimulation. After the last session, the only urodynamic finding that showed improvement was bladder capacity.

The effectiveness of transcutaneous electrical neural stimulation therapy in patients with urinary incontinence resistant to initial medical treatment or biofeedback

While there are many options for children with treatment refractory urinary incontinence, there is no single accepted method. This study's aim was to prospectively evaluate the effect of transcutaneous electrical nerve stimulation in children with urinary incontinence resistant to standard medical, urological therapy and/or biofeedback. This study was performed at a university hospital. For inclusion, patients >5 years of age first underwent evaluation with urinary ultrasonography, uroflow-electromyogram and voiding diaries. Treatment with biofeedback, alpha adrenergic blockers, anticholinergics and/or urotherapy was commenced according to uroflow-EMG and voiding diary findings. Patients with partial or no response to this standard therapy were then included in this study, performed between April 2012 and February 2014. Patients with anatomical or neurological causes for urinary incontinence were excluded. TENS was performed on S3 dermatome, every day for 3 months. Each session lasted 20 min with a frequency of 10 Hz and generated pulse of 350 μs. Intensity was determined by the child's sensitivity threshold. Medical treatment and urological therapy was continued during TENS. Uroflow parameters (voiding volume as percentage of expected bladder capacity, Qmax, Qave, flow and voiding time, postvoiding residual urine) and urinary system symptoms (presence of urinary tract infection, frequency, urge incontinence, fractionated voiding and constipation) were compared immediately before commencement and immediately after the completion of 3 months of TENS. Twenty-seven patients were included in this study (4 males, 23 females). Patients' average age was 7.2 years, 11 had overactive bladder and 16 had dysfunctional voiding. Comparison of urinary system symptoms and uroflow parameters before and after TENS are shown in Table. After 3 months of TENS; a statistically significant decrease was observed in the number of patients with frequency, urge incontinence, urinary tract infections and constipation. There was a decrease in the number of patients with fractionated voiding, although this change was not statistically significant. Similarly, for uroflow-EMG parameters; bladder capacity, Qmax, Qave and flow time increased while voiding time and PVR decreased. Changes seen in bladder capacity, Qmax and PVR were statically significant, while other changes were not. Patients' response rates after 3 months of TENS were; complete response in 70.4%, partial response in 22.2% and no response in 7.4%. This study has shown that transcutaneous electrical nerve stimulation is a promising treatment option for standard-treatment refractory children with urinary incontinence.

Electrocortical Analysis of Patients with Intercostobrachial Pain Treated with TENS after Breast Cancer Surgery

[Purpose] Among the physical therapeutic procedures to decrease pain, there is transcutaneous electrical neural stimulation (TENS). There is no consensus about its efficacy for oncological patients, especially for post-mastectomy pain and eletrocortical changes in somatosensory areas. The aim of this study was to analyze acute electrocortical changes after TENS treatment of patients with intercostobrachial post mastectomy pain. [Subjects] Eighteen patients were divided into acupuncture (A) and burst (B) group. [Methods] In this pre and post-intervention study each group was measured for EEG analysis in absulte power in alpha band (8–14 Hz). Outcomes variables were the alpha waveband in the sensorymotor cortex and pain pre-and-post TENS intervention. Data were analyzed using ANOVA to compare times (rest, 10 and 15 min), group and electrodes. Pain was analyzed using percentual pain evaluation (PPE) in both groups. [Results] Outcomes indicate main effects of time and electrodes because of slow (8–10 Hz) and fast alpha (10–12 Hz) wavebands decreased. PPE reduced 88.4% in A and 66.3% in G. [Conclusion] TENS promoted electrical modification in the parietal region and a decrease in pain. Future studies should investigate other wave must be proposed for other bands and use different methods of EEG analysis to elucidate the actual mechanisms behind the efficacy of TENS treatment.

Prospective and randomized comparison of electrical stimulation of the posterior tibial nerve versus oxybutynin versus their combination for treatment of women with overactive bladder syndrome

To verify whether the combination of transcutaneous electrical neural stimulation (TENS) with oxybutynin in the treatment of women with overactive bladder (OAB) would be more effective than isolated treatments. We randomized 75 women with OAB, in three groups: GI--30 min TENS, twice a week; GII--daily slow release 10 mg oxybutynin; and GIII--TENS + oxybutynin (multimodal); all for 12 weeks. Patients were evaluated with validated questionnaires International Consultation on Incontinence-Short Form (ICIQ-SF), International Consultation on Incontinence-OAB (ICIQ-OAB), Symptom bother, and 3-day Voiding diary at weeks 0, 12, and 24. The groups were similar before treatment. After treatment, all groups significantly improved in OAB symptoms and quality of life (QoL). At week 12, ICIQ-OAB scores were 5.9, 4.6, and 2.9, in groups I, II, and III, respectively, p = 0.01. At week 24, GI and GIII kept the scores of the end of treatment (week 12), while GII increased ICIQ-OAB from 4.6 to 9.2, p = 0.0001, ICIQ-SF from 9.8 to 13.3, p = 0.0006, and Symptom bother score from 3.4 to 7.0, p = 0.0001. The multimodal treatment was more effective and TENS alone or in association presented longer lasting results for improvement of clinical symptoms of OAB and QoL.

Transcutaneous Parasacral Electrical Neural Stimulation in Children with Primary Monosymptomatic Enuresis: A Prospective Randomized Clinical Trial

Parasacral transcutaneous electrical neural stimulation is widely used to treat hyperactive bladder in children and adults. Its use in nonmonosymptomatic enuresis has demonstrated improvement in number of dry nights. We assessed the effectiveness of parasacral transcutaneous electrical neural stimulation in the treatment of monosymptomatic primary enuresis. This prospective randomized clinical trial included 29 girls and 16 boys older than 6 years with primary monosymptomatic enuresis. Children were randomly divided into 2 groups consisting of controls, who were treated with behavioral therapy, and an experimental group, who were treated with behavioral therapy plus 10 sessions of parasacral transcutaneous electrical neural stimulation. Neural stimulation was performed with the electrodes placed in the sacral region (S2/S3). Sessions always followed the same pattern, with duration of 20 minutes, frequency of 10 Hz, a generated pulse of 700 μs and intensity determined by the sensitivity threshold of the child. Sessions were done 3 times weekly on alternate days. Patients in both groups were followed at 2-week intervals for the first month and then monthly for 6 consecutive months. Rate of wet nights was 77% in controls and 78.3% in the experimental group at onset of treatment (p = 0.82), and 49.5% and 31.2%, respectively, at the end of treatment (p = 0.02). Analyzing the average rate of improvement, there was a significantly greater increase in dry nights in the group undergoing neural stimulation (61.8%) compared to controls (37.3%, p = 0.0038). At the end of treatment percent improvement in children undergoing electrical stimulation had no relation to gender (p = 0.391) or age (p = 0.911). Treatment of primary monosymptomatic enuresis with 10 sessions of parasacral transcutaneous electrical neural stimulation plus behavioral therapy proved to be effective. However, no patient had complete resolution of symptoms.

Rehabilitation of a Completely Edentulous Patient using TENS to record Functional Borders and Cheek Plumpers for Esthetics

ABSTRACT The facial disfigurement associated with the loss of teeth has greater psychological effect on the patient than the actual loss of teeth. Presented herein, is a novel, precise and accurate technique of performing border molding using transcutaneous electric nerve stimulation (TENS). The electronic stimulator is programed to deliver precisely controlled, uniform stimuli transmitted by transcutaneous electrical neural stimulation through fifth and seventh cranial nerves. Plumping the cheeks by using cheek plumpers attached to the conventional complete denture using magnets was also done. The greatest advantage lies in the fact that they are completely detachable. How to cite this article Bulbule NS, Shah J, Kulkarni S, Kakade D. Rehabilitation of a Completely Edentulous Patient using TENS to record Functional Borders and Cheek Plumpers for Esthetics. Int J Prosthodont Restor Dent 2013;3(2):78-82.

DENAS-Vertebra--an innovative step in transcutaneous electrical neural stimulation in the realm of evidence-based medicine

Despite data of numerous original investigations giving evidence of the high pain-relieving efficacy of transcutaneous electrical neural stimulation (TENS), the authors of the Cochraine reviews avoid definitive conclusions with respect to this issue. This discrepancy is a result of antagonism between the requirements of maximum possible degree of standardization of the method in question and the principle of necessary personification of preventive measures. Certain technological characteristics of the DENAS-Vertebra apparatus allows the acceptable level of consensus to be reached for the solution of the standardization/personification problem pertinent to TCNS procedures.

Ultrasound‐Guided Transversus Abdominis Plane Catheter for Chronic Abdominal Pain

Neural blockade of the thoracolumbar nerves supplying the anterior abdominal wall through transversus abdominis plane (TAP) has been investigated for different applications mainly for the acute pain management following abdominal surgical procedures. The role of this block for chronic pain syndromes is still to be discovered, and its value in chronic abdominal pain needs to be studied. We are presenting new application of the TAP technique for management of chronic abdominal pain syndrome using the continuous infusion. We present a case of an 18-year-old girl who underwent an uneventful laparoscopic cholecystectomy. Postoperatively, patient complained of chronic pain at the site of the surgery. All diagnostic and imaging studies were negative for a surgical or a medical cause. Multiple interventions including epidural blocks, transcutaneous electrical neural stimulation, and celiac plexus blocks had failed to relieve the pain. After discussion with the patient about the diagnostic nature of the procedure and the likelihood of recurrence of pain, TAP block was performed on the right side with significant improvement of pain for about 24 hours. The degree of pain relief experienced by the patient was very dramatic, which encouraged us to proceed with an indwelling TAP catheter to allow for continuous infusion of a local anesthetic. The patient was sent home with the continuous infusion through a TAP catheter for 2 weeks. From the day of catheter insertion and up to 9 months of follow-up, patient had marked improvement of her pain level as well as her functional status and ability to perform her daily activities, after which our acute pain team stopped following the patient. A successful TAP block confirmed the peripheral (somatic) source of the abdominal pain and provided temporary analgesia after which an indwelling catheter was inserted, which provided prolonged pain relief.

Temporomandibular Disorders: A Position Paper of the International College of Cranio-Mandibular Orthopedics (ICCMO)

Purpose: Two principal schools of thought regarding the etiology and optimal treatment of temporomandibular disorders exist; one physical/functional, the other biopsychosocial. This position paper establishes the scientific basis for the physical/functional. The ICCMO Position: Temporomandibular disorders (TMD) comprise a group of musculoskeletal disorders, affecting alterations in the structure and/or function of the temporomandibular joints (TMJ), masticatory muscles, dentition and supporting structures. The initial TMD diagnosis is based on history, clinical examination and imaging, if indicated. Diagnosis is greatly enhanced with physiologic measurement devices, providing objective measurements of the functional status of the masticatory system: TMJs, muscles and dental occlusion. The American Alliance of TMD organizations represent thousands of clinicians involved in the treatment of TMD. The ten basic principles of the Alliance include the following statement: Dental occlusion may have a significant role in TMD; as a cause, precipitant and /or perpetuating factor. Therefore, it can be stated that the overwhelming majority of dentists treating TMD believe dental occlusion plays a major role in predisposition, precipitation and perpetuation. While our membership believes that occlusal treatments most frequently resolve TMD, it is recognized that TMD can be multi faceted and may exist with co-morbid physical or emotional factors that may require therapy by appropriate providers. The International College of Cranio-Mandibular Orthopedics (ICCMO), composed of academic and clinical dentists, believes that TMD has a primary physical/functional basis. Initial conservative and reversible TMD treatment employing a therapeutic neuromuscular orthosis that incorporates relaxed, healthy masticatory muscle function and a stable occlusion is most often successful. This is accomplished using objective measurement technologies and ultra low frequency transcutaneous electrical neural stimulation (TENS). Conclusion: Extensive literature substantiates the scientific validity of the physical/functional basis of TMD, efficacy of measurement devices and TENS and their use as aids in diagnosis and in establishing a therapeutic neuromuscular dental occlusion. Clinical Implications: A scientifically valid basis for TMD diagnosis and treatment is presented aiding in therapy.

Evaluation of Tensile Strength of the Superficial Digital Flexor Tendon in Horses Subjected to Transcutaneous Electrical Neural Stimulation Therapeutic Regimen

Evaluation of Tensile Strength of the Superficial Digital Flexor Tendon in Horses Subjected to Transcutaneous Electrical Neural Stimulation Therapeutic Regimen

Evaluation of Tensile Strength of the Superficial Digital Flexor Tendon in Horses Subjected to Transcutaneous Electrical Neural Stimulation Therapeutic Regimen

We would like to sincerely express our gratitude to the university of Tehran and faculty of veterinary medicine research council for approval and financial support for this extensive evaluation of tensile strength of the superficial digital flexor tendon in horses subjected to Transcutaneous Electrical Neural Stimulation (TENS) therapeutic regimen Problems statement: The purpose of this study was to determine the effect of TENS on the tensile strength of experimentally traumatized SDFT in horses. Approach: Eight adult castrated horses between 4-9 years-old and 310-395 Kg body-weight were considered. The left fore-limb superficial digital flexor tendon of each horse was splitted longitudinally in the middle portion in full thickness of 10 cm in length using B.P. blade (15 Times strike), then the connective tissue and skin were approximated using No 2 Nylon. Horses were divided into two groups of control and treated with 4 horses each. No treatment was given to control one, whereas treated group was subjected to the transcutaneous electrical neural stimulation (Newtens 900c) therapeutic regimens10 min daily with intensity of 80 µs, 100 Hz frequency for 14 days. After 60 days, the full length of SDFT (20 cm) was removed from the right normal countralaleral and left traumatized tendon of control and treated limbs of all horses to be subjected to test of tensile strength using Zwick/Roell MDTL Machine with speed of 0.07 mM sec−1 having Proportional Integral Deferential (PID) controller. In assessing the variation obtained data was analyzed using paired-t-test. Results: Data of the tensile strength was revealed an average 0.6625 KN for normal SDFT, 0.6375 KN for treated tendon and 0.6175 KN for control tendon .There was significant improvement in regaining tensile strength in treated tendons comparison to control ones in Conclusion: TENS significantly accelerated healing and remodeling of traumatized tendon to regain its tensile strength.

Complementary and Alternative Medicine Use Was Associated With Higher Perceived Physical and Mental Functioning in Early Systemic Sclerosis

This study assessed the use of complementary and alternative medicine (CAM) therapies in patients with early systemic sclerosis (scleroderma, SSc). At the annual visit, SSc patients enrolled in the Genetics versus Environment in Scleroderma Outcomes Study (GENISOS) were queried about their use of CAM therapies and intended symptom target, including herbal or nutraceutical therapy, acupuncture, transcutaneous electrical neural stimulation, and mind-body therapy (relaxation, meditative, imagery). The CAM-user SSc patients were compared with matched non-CAM users over two years for database results of demographic, clinical, and health-related quality of life SF-36 questionnaires by using analysis of covariance. Twenty-five percent of the University of Texas Medical Branch GENISOS group were CAM users, with an average age of 54 years, 89% female, 47% diffuse cutaneous involvement, 13.5 total skin score, and a Medsger severity index of 5.8. Over 70% of patients used more than one CAM therapy for over one year, independent of health insurance. Symptoms targeted included arthritis/arthralgia, pain, gastrointestinal dysmotility, and fatigue. Complementary and alternative medicine users had significantly higher mean mental component summary scores on SF-36 at baseline and year 2, (49 and 49.9, respectively), compared with non-CAM users (42 and 40.2, respectively; P < .01). At year 2, the CAM user group had significantly higher scores of SF-36 domains physical component, role physical, bodily pain, and vitality, whereas scores declined in the non-CAM user group. In SSc, 70% of those in the CAM user group reported a long-term commitment to CAM therapies. Higher perceived mental functioning in CAM users might reflect more self-motivation to manage symptoms, and subsequently, promote practices that result in higher perceived physical functioning.

Establishment of a Temporomandibular Physiological State with Neuromuscular Orthosis Treatment Affects Reduction of TMD Symptoms in 313 Patients

The objective of this investigation was to test the hypothesis that alteration of the occlusions of patients suffering from temporomandibular disorders (TMD) to one that is neuromuscularly, rather than anatomically based, would result in reduction or resolution of symptoms that characterize the TMD condition. This hypothesis was proven correct in the present study, where 313 patients with TMD symptoms were examined for neuromuscular dysfunction, using several electronic instruments before and after treatment intervention. Such instrumentation enabled electromyographic (EMG) measurement of the activities of the masticatory muscles during rest and in function, tracking and assessment of various movements of the mandible, and listening for noises made by the TMJ during movement of the mandible. Ultra low frequency and low amplitude, transcutaneous electrical neural stimulation (TENS) of the mandibular division of the trigeminal nerve (V) was used to relax the masticatory muscles and to facilitate location of a physiological rest position for the mandible. TENS also made it possible to select positions of the mandible that were most relaxed above and anterior to the rest position when the mandible was moved in an arc that began at rest position. Once identified, the neuromuscular occlusal position was recorded in the form of a bite registration, which was subsequently used to fabricate a removable mandibular orthotic appliance that could be worn continuously by the patient. Such a device facilitated retention and stabilization of the mandible in its new-found physiological position, which was confirmed by follow up testing. Three months of full-time appliance usage showed that the new therapeutic positions achieved remained intact and were associated with improved resting and functioning activities of the masticatory muscles. Patients reported overwhelming symptom relief, including reduction of headaches and other pain symptoms. Experts consider relief of symptoms as the gold standard for assessment of effectiveness of TMD treatment. It is evident that this outcome has been achieved in this study and that taking patients from a less to a more physiological state is an effective means for reducing or eliminating TMD symptoms, especially those related to pain, most notably, headaches.