scholarly journals Sensory stimulation enhances phantom limb perception and movement decoding

2020 ◽  
Author(s):  
Luke E. Osborn ◽  
Keqin Ding ◽  
Mark A. Hays ◽  
Rohit Bose ◽  
Mark M. Iskarous ◽  
...  
Keyword(s):  
Nerve Stimulation ◽  
Neural Activity ◽  
Sensory Stimulation ◽  
Phantom Limb ◽  
Before And After ◽  
Transcutaneous Nerve Stimulation ◽  
Sensory Mapping ◽  
Stimulation Experiments ◽  
Prosthesis Control ◽  
And Function

AbstractObjectiveA major challenge for controlling a prosthetic arm is communication between the device and the user’s phantom limb. We show the ability to enhance amputees’ phantom limb perception and improve movement decoding through targeted transcutaneous electrical nerve stimulation (tTENS).ApproachTranscutaneous nerve stimulation experiments were performed with four amputee participants to map phantom limb perception. We measured myoelectric signals during phantom hand movements before and after amputees received sensory stimulation. Using electroencephalogram (EEG) monitoring, we measure the neural activity in sensorimotor regions during phantom movements and stimulation. In one participant, we also tracked sensory mapping over 2 years and movement decoding performance over 1 year.Main resultsResults show improvements in the amputees’ ability to perceive and move the phantom hand as a result of sensory stimulation, which leads to improved movement decoding. In the extended study with one amputee, we found that sensory mapping remains stable over 2 years. Remarkably, sensory stimulation improves within-day movement decoding while performance remains stable over 1 year. From the EEG, we observed cortical correlates of sensorimotor integration and increased motor-related neural activity as a result of enhanced phantom limb perception.SignificanceThis work demonstrates that phantom limb perception influences prosthesis control and can benefit from targeted nerve stimulation. These findings have implications for improving prosthesis usability and function due to a heightened sense of the phantom hand.

Package Architecture and Component Design for an Implantable Peripheral Nerve Stimulation and Recording System for Advanced Prosthetics

2016 ◽  
Vol 2016 (1) ◽  
pp. 000144-000150
Author(s):  
Caroline K. Bjune ◽  
John R. Lachapelle ◽  
Andrew Czarnecki ◽  
Alexander L. Kindle ◽  
John R. Burns ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Nerve Stimulation ◽  
Sensory Feedback ◽  
Hand Movement ◽  
Phantom Limb Pain ◽  
Sensory Stimulation ◽  
Peripheral Nerve Stimulation ◽  
Phantom Limb ◽  
Component Design ◽  
Nerve Electrodes

Abstract One of the limitation of current prosthetics is the ability to provide sensory feedback to the human user. Due to this constraint, approximately 60–80 percent of amputees experience a phenomenon known as phantom limb pain, an ongoing painful sensations that to the individual, seems to be coming from the part of the limb that is no longer there. The lack of sensory feedback also limits the intuitive control of the user's hand movement, i.e. sense of grip or position. To address these limitations, we created am implantable system that could provide peripheral nerve stimulation, recording and motor control. The architecture of our Sensory-Stimulation Lead (SSL) system consist of multiple satellites connected to Draper's custom designed nerve electrodes. In this phase of the design, the implanted system is connected to a controller via percutaneous connections. The active electronics of the satellite is enclosed in a hermetic package approximately 14mm in diameter and less than 5mm thick. A custom ceramic feedthrough substrate provides the electrical connections of the internal electronics board to both the nerve electrodes and percutaneous leads. In this paper, we will describe the various packaging components of the system and the design, fabrication, and assembly considerations that drove our technology choices.

Pain Management after Lower Extremity Amputation

Neurosurgery ◽  
1987 ◽  
Vol 20 (3) ◽  
pp. 496-500 ◽  
Author(s):  
Robert P. Iacono ◽  
Jennifer Linford ◽  
Reuven Sandyk
Keyword(s):  
Spinal Cord ◽  
Nerve Stimulation ◽  
Phantom Limb Pain ◽  
Phantom Limb ◽  
Limb Amputation ◽  
Phantom Pain ◽  
Pharmacological Agents ◽  
Central Nervous Systems ◽  
Transcutaneous Nerve Stimulation ◽  
Deep Brain

Abstract Phantom pain may occur in up to 85% of patients after limb amputation. Although the pathophysiology of postamputation phantom pain is not well understood, it seems to be produced by a complex multifactorial interaction between the peripheral, sympathetic, and central nervous systems. The theoretical aspects of this are reviewed. Management of phantom limb pain may be both medical and surgical. Among the pharmacological agents proved effective against phantom pain are B-blockers, tricyclic antidepressants, and anticonvulsants. Surgical management includes peripheral nerve stimulation, thermocontrolled coagulation of the spinal cord, spinal cord stimulation, transcutaneous nerve stimulation, and stereotactic deep brain stimulation.

scholarly journals The value of revision surgery after initial amputation of an upper or lower limb

1987 ◽  
Vol 11 (1) ◽  
pp. 17-20 ◽  
Author(s):  
M. R. Wood ◽  
G. A. Hunter ◽  
S. G. Millstein
Keyword(s):  
Surgical Procedures ◽  
Nerve Stimulation ◽  
Revision Surgery ◽  
Lower Limb ◽  
Phantom Limb Pain ◽  
Surgical Revision ◽  
Phantom Limb ◽  
Limb Pain ◽  
Transcutaneous Nerve Stimulation ◽  
Amputation Surgery

The value of revision surgery when carried out more than six weeks after initial amputation of the upper or lower limb was assessed. When performed for stump and/or phantom limb pain alone, only 33/95 (35%) obtained satisfactory results after one revision; 25/95 (26%) of the patients required four or more surgical procedures without relief of pain. However, when carried out for local specific pathology, the results of surgical revision were 100% successful, even if the procedure had to be repeated once in 15% (28/189) of this group of patients. Transcutaneous nerve stimulation appeared to offer no long lasting relief of pain following amputation surgery.

EFEITOS DO DEEP RUNNING SOBRE A AMPLITUDE DE MOVIMENTO E A CAPACIDADE FUNCIONAL DOS MEMBROS SUPERIORES DE MULHERES MASTECTOMIZADAS: RELATO DE CASOS

2019 ◽  
pp. 121-131
Keyword(s):  
Range Of Motion ◽  
Upper Limb ◽  
Functional Capacity ◽  
External Rotation ◽  
Treatment Protocol ◽  
Range Of Movement ◽  
Flexion Extension ◽  
Before And After ◽  
In The Beginning ◽  
And Function

Introduction: Breast cancer is the most common type of cancer among women in Brazil and in the worl. The surgical treatment procedure may cause severe morbidity in the upper limb homolateral to surgery, including the reduction of the range of motion, with consequent impairment of function. A physiotherapeutic approach has an important role in the recover range of motion and the functionality of these women, guaranteeing the occupational, domestestic, familiar and conjugated activities, and, in this way, also improving the quality of life. Objectives: To analyse chances in the shoulder's range of motion and the functional capacity of the upper limbs, promoted by the deep running procedure in women with late postoperative mastectomy. Methods: All the patients were submitted to an evaluation in the beginning and end of the treatment, including: goniometry of flexion, extension, abduction, adduction, internal and external rotation of the shoulder joint; and function capacity analysis in activities that involve the upper members by DASH questionnaire. The treatment protocol includes twelve sessions of deep running, realized twice a week, in deep pool, for 20-minute during six weeks. Results: Were submitted to treatment a total of 4 patients. Despite the improvement in the numerical values, statistically significant differences were not found on the range of movements and in the functional capacity of upper members before and after the deep running sessions in post-mastectomy women. Conclusion: Deep running had effects on the numerical values of range of movement and upper limb functionality in women in the late postoperative period of the mastectomy procedure, but without statistically significant differences.

scholarly journals Are Three Weeks of Oral Anticoagulation Sufficient for Safe Cardioversion in Atrial Fibrillation?

Medicina ◽  
2021 ◽  
Vol 57 (6) ◽  
pp. 554
Author(s):  
Stefan Naydenov ◽  
Nikolay Runev ◽  
Emil Manov
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Oral Anticoagulation ◽  
Left Atrial ◽  
Left Atrial Volume ◽  
Open Label ◽  
Before And After ◽  
Individualized Approach ◽  
Baseline Factors ◽  
And Function

Background and Objectives: Patients with atrial fibrillation (AF), lasting >48 h, considered for cardioversion, are recommended ≥3 weeks of oral anticoagulation before sinus rhythm restoration because of high risk of development of left atrial thrombosis (LAT) and stroke. However, the optimal duration of anticoagulation in the presence of overt LAT is unknown. Materials and Methods: An open-label study aimed to investigate the prevalence of spontaneous echo contrast (SEC) and LAT before and after 3 weeks of direct oral anticoagulant (DOAC) treatment. We included 51 consecutive patients (50.9% males), mean age 69.3 ± 7.4 years with paroxysmal/unknown duration of AF, considered for cardioversion, who agreed to have transesophageal echocardiography at enrollment and 3 weeks later. Results: At baseline SEC was present in 26 (50.9%) and LAT in 10 (19.6%) of 51 patients. After 3 weeks on DOAC, SEC persisted in 12 (25.0%) and LAT in 7 (14.5%) of 48 patients, p < 0.05 vs. baseline. Factors, associated most strongly with persistence of SEC/LAT, were left atrial appendage (LAA) emptying velocity <20 cm/s (OR = 2.82), LAA lobes >2 (OR = 1.84), and indexed left atrial volume ≥34 mL/m2 (OR = 1.37). Conclusions: In our study the incidence of SEC/LAT, particularly in AF with unknown duration, was not as low as we expected. The prevalence of SEC/LAT seemed to be dependent on factors not routinely evaluated in AF patients planned for cardioversion (indexed LA volume, LAA morphology and number of lobules, LAA emptying velocity, etc.). Our data suggested an individualized approach for DOAC duration in AF patients before an attempt for restoration of sinus rhythm is made, taking into consideration the LAA morphology and function.

Botzinger complex region role in phrenic-to-phrenic inhibitory reflex of cat

1989 ◽  
Vol 67 (4) ◽  
pp. 1364-1370 ◽  
Author(s):  
D. F. Speck
Keyword(s):  
Nerve Stimulation ◽  
Phrenic Nerve ◽  
Inhibitory Response ◽  
Phrenic Nerve Stimulation ◽  
Bötzinger Complex ◽  
Before And After ◽  
Pass Through ◽  
Bilateral Lesions ◽  
Decerebrate Cats ◽  
Inhibitory Reflex

Neuronal recordings, microstimulation, and electrolytic and chemical lesions were used to examine the involvement of the Botzinger Complex (BotC) in the bilateral phrenic-to-phrenic inhibitory reflex. Experiments were conducted in decerebrate cats that were paralyzed, ventilated, thoracotomized, and vagotomized. Microelectrode recordings within the BotC region revealed that some neurons were activated by phrenic nerve stimulation (15 of 69 expiratory units, 9 of 67 inspiratory units, and 19 nonrespiratory-modulated units) at average latencies similar to the onset latency of the phrenic-to-phrenic inhibition. In addition, microstimulation within the BotC caused a short latency transient inhibition of phrenic motor activity. In 17 cats phrenic neurogram responses to threshold and supramaximal (15 mA) stimulation of phrenic nerve afferents were recorded before and after electrolytic BotC lesions. In 15 animals the inhibitory reflex was attenuated by bilateral lesions. Because lesion of either BotC neurons or axons of passage could account for this attenuation, in eight experiments the phrenic-to-phrenic inhibitory responses were recorded before and after bilateral injections of 5 microM kainic acid (30–150 nl) into the BotC. After chemical lesions, the inhibitory response to phrenic nerve stimulation remained; however, neuronal activity typical of the BotC could not be located. These results suggest that axons important in producing the phrenic-to-phrenic reflex pass through the region of the BotC, but that BotC neurons themselves are not necessary for this reflex.

Concomitant increase in nociceptive flexion reflex threshold and plasma opioids following transcutaneous nerve stimulation

Pain ◽  
1984 ◽  
Vol 19 (3) ◽  
pp. 295-303 ◽  
Author(s):  
Fabio Facchinetti ◽  
Giorgio Sandrini ◽  
Felice Petraglia ◽  
Enrico Alfonsi ◽  
Giuseppe Nappi ◽  
...  
Keyword(s):  
Nerve Stimulation ◽  
Concomitant Increase ◽  
Flexion Reflex ◽  
Nociceptive Flexion Reflex ◽  
Transcutaneous Nerve Stimulation ◽  
Reflex Threshold

Abstract 17266: Right Atrial Volumes Changes in Tetralogy of Fallot

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Ashish Patel ◽  
Divya Shakti ◽  
Chad Blackshear
Keyword(s):  
Diastolic Dysfunction ◽  
Diastolic Function ◽  
Tetralogy Of Fallot ◽  
Surgical Repair ◽  
Left Ventricular ◽  
Right Atrial ◽  
Before And After ◽  
Ventricular Diastolic Dysfunction ◽  
And Function ◽  
Averaged Model

Introduction & Hypothesis: There is limited information on right atrial (RA) function in the congenital heart defects. RA volume and function may give insight into the right ventricle (RV) diastolic function. We sought to assess RA function in tetralogy of Fallot (TOF) patients prior to and after complete surgical repair. Methods: Infants with TOF prior to complete repair were included for retrospective chart review and offline analysis of 2-dimensional echocardiograms (echo) before and after surgical repair. RA phasic volumes and stroke volumes were calculated. All volumes were indexed to body surface area. Results: There were 40 infants with TOF (45% females), of which 70% had pulmonary stenosis, 30% pulmonary atresia. Roughly 85% and 60% had 3, or more, echo available pre- and postoperatively. Table 1 (attached) shows the patient characteristics and phasic RA volumes. The indexed RA phasic volumes were in normal range in initial echo prior to surgery. We used normal index RA phasic volumes published by European Society of Echocardiography. There was the increasing trend of indexed RA phasic volume on follow up echo immediately before TOF repair. These phasic volumes continued to remain elevated after complete surgical repair (Table 1). Trends in RA stroke volumes for all available echos before and after surgery were modeled using a population-averaged model with an exchangeable within-panel correlation structure (Figure 2), showing no statistically significant difference after surgery. But there was statistical significance noted in RA ejection fraction. Please see attached image for statistical analysis and results of the study. Conclusions: The indexed RA phasic volumes in children with TOF are normal initially and increases before TOF repair and it continued to increase after TOF repair. The increase RA phasic volumes suggest RV diastolic dysfunction similar to the findings of LA phasic volumes and left ventricular diastolic dysfunction. Our findings indicate slow worsening RV diastolic function in patients with TOF after surgical repair. RA volume and function can be the novel marker to diagnose and monitor right ventricular diastolic dysfunction.

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