IFESS Conference Proceedings

@inproceedings{IFESS1998_092,

title = {JAPAN: FES PROJECTS: PART 2: LOWER EXTREMITY},

author = {Y Shimada},

editor = {Manfred Bijak and Winfried Mayr},

url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_092_Shimada.pdf},

isbn = {3-900928-04-5},

year  = {1998},

date = {1998-08-01},

pages = {092},

publisher = {IFESS_1998},

address = {Luzern, Switzerland},

abstract = {PURPOSE: In Japan, the NEC made the FES system with percutaneous intramuscular electrodes, and we have develped the FES system with closed-loop control for restoration of paralyzed lower extremities. The purpose of this paper is to introduce the clinical applications in Japan and describe the future trends of FES in the lower extremities. MATERIALS AND METHODS: The subjects included 21 cases who had implanted percutaneous intramuscular electrodes in the lower extremities. In complete paraplegia, we developed the closed-loop control system using stretch sensors for standing and used hybrid FES systems for walking. Therapeutic electrical stimualtion (TES) was applied to the patients with incomplte paraparesis and hemiplegia to reduce the spasticity and increase the muscle force. The FES systems with sensors were also used for restoration of walking in incomplete paraparesis and hemiplegia. RESULTS: Although standing was practical use, there were several problems to be resolved for restoration of walking in complete paraplegia. The closed-loop control system using the stretch sensors prevented falling due to knee buckling during standing and prolonged upright activities in complete paraplegia. TES using percutaneous intramuscular electrodes was very effective and some incomplete paraparesis patients became free from wheelchair. The FES system with sensors was superior to the orthosis with respect to ease to use and walking speed in hemiplegia. DISCUSSION: Completely implantable system with closed-loop control is nessesary to resolve the problems arised in the percutaneous intramuscular electrodes and to prevent serious complications due to muscle fatigue. In addition, sensors should be implanted in the future. The new hybrid orthosis, which is light, strong, and has power assisted function will be brought more practical functions on to paraplegics.},

keywords = {Abstracts},

pubstate = {published},

tppubtype = {inproceedings}

}

@inproceedings{IFESS1998_096,

title = {LESSONS LEARNED FROM USING FUNCTIONAL ELECTRICAL STIMULATION SYSTEMS TO ENHANCE GRASPING AND REACHING IN HUMANS WITH PARALYSIS},

author = {D Popovic and M Popovic},

editor = {Manfred Bijak and Winfried Mayr},

url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_096_Popovic.pdf},

isbn = {3-900928-04-5},

year  = {1998},

date = {1998-08-01},

pages = {096},

publisher = {IFESS_1998},

address = {Luzern, Switzerland},

abstract = {Purpose: In order to select the best suited control system for an assistive system to enhance reaching and graspingwe compared performances of various rehabilitation devices based on functional electrical stimulation (FES). Twenty years of using functional electrical stimulation assistance for control of reaching and grasping resulted in few commercial devices. A typical approach for designing of a grasp system is 1) to mimic natural prehension strategy; 2) to maximize the use of preserved neuro-muscular functions; 3) to simplify the complexity of daily usage; and 4) to modify, if necessary, the skeleto-muscular structure (surgical procedures). Control of the system is always left with the subject allowing him/her proportional or ramped on-off regulation. The control signal is obtained from electrical activity of muscles, position of two neighboring segments, voice, or suitably mounted switch. Method: The experience presented here was gained through the application of assistive systems provided by the investigators during the developmental phase of their devices (Freehand system, Bionic Glove, Ljubljana system), originally designed devices (EMG controlled system, Belgrade grasping system), references and discussions with users and researchers in the field. Conclusions: 1) open-loop control operates better than the closed-loop control due to the difficulties in sensory functioning and mounting; 2) trigger control system suited better the needs of most of the subjects involved in evaluations; 3) daily living functioning was improved in humans who have very limited hand and wrist control but functional elbow and shoulder movements (a small fraction of all subjects); 4) selectivity of stimulation is a problem for better functioning.},

keywords = {Abstracts},

pubstate = {published},

tppubtype = {inproceedings}

}

@inproceedings{IFESS1998_066,

title = {LOCATION OF POSTEROVENTRAL PALLIDUM DURING STEREOTACTIC SURGERY CAN BE OPTIMIZED BY TURNS-AMPLITUDE ANALYSIS OF ELECTRONEUROGRAMS AND VISUAL EVOKED POTENTIAL RECORDING},

author = {J P Lefaucheur and B Pollin and J P Nguyen},

editor = {Manfred Bijak and Winfried Mayr},

url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_066_Lefaucheur.pdf},

isbn = {3-900928-04-5},

year  = {1998},

date = {1998-08-01},

pages = {066},

publisher = {IFESS_1998},

address = {Luzern, Switzerland},

abstract = {Purpose: In order to determine the optimum site for electrode placement in the ventral part of the globus pallidus internus, we developed electrophysiological monitoring using electroneurogram quantitation by turns-amplitude analysis and visual evoked potentials. Method: Stereotactic surgery was carried under general anesthesia in 5 patients with levodopa-induced dyskinesia. After location of the pallidal target referring to intercommissural baseline, a recording electrode was introduced to a depth of 8 mm above the target. Then, the spontaneous electroneurographic activity was assessed every mm by means of turns-amplitude analysis. A turn is defined as a directional change of a waveform that exceeds 100uV. The number of turns per second, and the mean amplitude of each turn was automatically calculated at each mm-site. Since posteroventral pallidum is attempts to record visual evoked potentials from pallidal microelectrode following binocular stimulation by LED-goggles. Result: In all the patients, we observed a biphasic pattern in the turns-amplitude analysis of the pallidal electroneurographic activity, with two peaks of hyperactivity that corresponded with the two parts of the globus pallidus, as confirmed by post-operative MRI data. In addition, immediately beyond the target, we were able to record visual evoked potentials of 50 ms-latency. Conclusion: Turns-amplitude analysis of pallidal electroneurogram provided a reliable and accurate method to determine the site of the posteroventral pallidum, whereas the obtention of pallidal visual evoked potentials was useful to assess the vicinity of the to avoid visual complications of pallidal stimulation.},

keywords = {Abstracts},

pubstate = {published},

tppubtype = {inproceedings}

}

@inproceedings{IFESS1998_035,

title = {LUMBAR INTRATHECAL BACLOFEN FOR SUPRASPINAL SPASTICITY IN ADULTS},

author = {N Massager and P Voordecker and M Levivier and J Brotchi and B Pirotte},

editor = {Manfred Bijak and Winfried Mayr},

url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_035_Massager.pdf},

isbn = {3-900928-04-5},

year  = {1998},

date = {1998-08-01},

pages = {035},

publisher = {IFESS_1998},

address = {Luzern, Switzerland},

abstract = {Purpose: Lumbar intrathecal Baclofen (LIB) infused by implantable programmable pump is very efficient for treating spinal spasticity. However, the benefit and indications of LIB therapy for spasticity of supraspinal origin remain poorly defined. The aim of this study was to evaluate the symptomatic improvement and the functional benefit from LIB in severe supraspinal spasticity in adults. Method: We have tested 18 adult patients referred for severe spasticity following supraspinal lesions: 7 traumatic (5 limited trauma of the motor cortex, 2 diffuse brain injury), 5 cortical stroke, 4 multiple sclerosis, 1 cerebral palsy, 1 degenerative. Three patients were hemiplegic, 6 hemiparetic, 4 paraparetic and 5 tetraparetic. In all patients a L2- subarachnoid catheter was implanted with the tip at the D1O-level, and connected to a subcutaneous access-port. Patients were tested with increasing bolus doses of LIB. We assessed spastic symptoms (hypertonia, spasms, clonus) separately in upper and lower limbs, and the functional level (dressing, wheelchair, transfers, walking, pain) using appropriate scales. The nature, location and extent of the underlying brain lesion were assessed on magnetic resonance. Result: Spastic symptoms were significantly improved by LIB injections, particularly in lower limbs, as compared to NaCl injections in 15 patients. A significant functional benefit was observed in 12 of them Patients with a lesion limited to the motor cortex showed better results than others. Conclusion: LIB therapy. may provide functional benefit to patients with severe supraspinal spasticity, especially with lesion limited to the cortex.},

keywords = {Abstracts},

pubstate = {published},

tppubtype = {inproceedings}

}

@inproceedings{IFESS1998_135,

title = {MAPPING OF ENERGY FIELD FOR A TWO CHANNEL IMPLANTABLE NERVE STIMULATOR},

author = {C Childs and M Haugland and E M Nielsen},

editor = {Manfred Bijak and Winfried Mayr},

url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_135_Childs.pdf},

isbn = {3-900928-04-5},

year  = {1998},

date = {1998-08-01},

pages = {135},

publisher = {IFESS_1998},

address = {Luzern, Switzerland},

abstract = {Purpose: An implantable telemetrically controlled, two-channel nerve stimulator has been designed. This device (14x4x2 mm) will be implanted directly on the peroneal nerve and used to improve the gait of people suffering from foot drop. As the stimulator is very small and may be placed deep in the lower limb, the challenge is to get sufficient energy transferred from the external coils to the receiver. The research presented here shows the volume in which the stimulator receives the energy to stimulate the nerve properly, while keeping the power consumption of the transmitter acceptable for battery supply. Methods: Two transmitter coils (80 mm diameter) were arranged around a tube of diameter 100 mm (approximately the same as the author's calf). With a power requirement of 350 mW at maximum intensity, energy was transmitted to the receiver/stimulator. The effects on the pulse amplitude, of varying the position, orientation and load resistance of the stimulator were measured. Results: The stimulation current varied by 0.4 mA when the stimulator was moved 25 mm perpendicular to the coils and 0.5 mA when it was rotated 30textdegree,. Conclusions: The results indicate that the difference in output for each position and orientation of the stimulator is sufficiently small that if the coils should be displaced after application on a user of the system, no adverse effects will be seen. The transmitter coils provided the stimulator with sufficient energy with acceptable power consumption for application as a drop foot stimulator.},

keywords = {Abstracts},

pubstate = {published},

tppubtype = {inproceedings}

}

@inproceedings{IFESS1998_169,

title = {MATRIX-RHYTHM-THERAPY OF DYNAMIC ILLNESSES},

author = {U G Randoll and I Westner and F F Hennig},

editor = {Manfred Bijak and Winfried Mayr},

url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_169_Randoll.pdf},

isbn = {3-900928-04-5},

year  = {1998},

date = {1998-08-01},

pages = {169},

publisher = {IFESS_1998},

address = {Luzern, Switzerland},

abstract = {This study applies recent concepts from the fields of cybernetics, synergetics, and non-linear thermodynamics of irreversible processes to bioscientific problems in medicine. These concepts proceed on the prosumption of the existence of universal space-time structures (2,4,8,15). Within the field of medicine, this above all allows previouslyneglected temporal structures to regain their original significance. Rhythmic, temporal processes in the realms of substance-concentration and enzymatic activity influence the physiological events occurring within the body in an organizational manner (coherence). When such time-based sequences undergo chaotic mutation, they lose these organzing properties. From a cybernetic, control-technical aspect, chronic illnesses are condictions of decompensated regulatory mechanisms which occur subsequent to threshold-value reactions at micro levels. They are the consequences of phasic transition due to processes of adaptation to a chronically altered milieu or function, the ultimate result of which is the loss of temporal-rhythmic organization, i.e. chaotic mutation of cellular dynamics. Thus, chronic diseases are "dynamic diseases". Corresponding to the insight gained from this viewpoint, the apt objective is to identify such bodily-intrinsic organizers (attractor) and use them therapeutically. This therapeutic goal, therefore, is to regenerate and stabilize the basic autunomic rhythm of the organism and/or to change the amplitude and frequency values of the nutritional-flow density at the locality of the body's cells (the cell matrix) in such a manner as to exclude an existence of deterministic chaos. Ultimately, all bodily structures which recognize elctromagnetic, chemical or mechanical rhythms are to be considered organizers of that organism. On the example of the skeletal musculature, viewed as aneuromyogenous, rhythmic structure (and, with 40 % of the entire bodily mass, the largest organ of the body as well), the mode of action of matrix-rhythm therapy is first theoretically developed, then introduced in actual application. Muscular spectra's were measure in a screening test at 130 persons, examined and established as Matrix-Rhythm-Therapy in pro-sports and rehabilitation.},

keywords = {Abstracts},

pubstate = {published},

tppubtype = {inproceedings}

}

@inproceedings{IFESS1998_128,

title = {MEDIAL BRANCH NEUROTOMY FOR CHRONIC LOW BACK PAIN: A PROSPECTIVE STUDY USING DUAL MEDIAL BRANCH BLOCKS},

author = {P Dreyfuss},

editor = {Manfred Bijak and Winfried Mayr},

url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_128_Dreyfuss.pdf},

isbn = {3-900928-04-5},

year  = {1998},

date = {1998-08-01},

pages = {128},

publisher = {IFESS_1998},

address = {Luzern, Switzerland},

abstract = {Purpose: No prospective studies exist on lumbar radiofrequency neurotomy (RFN) for facet pain using; 1) dual, prognostic medial branch blocks (MBBs), 2) serial multifidi electromyography (EMG), and 3) serial functional capacity assessments (FCAs). This pilot study addresses these limitations. Methods: Subjects with greater than or equal to 80% relief after 2% lidocaine and 0.5% marcaine MBBs for more than 1 and 2 hours, respectively were included. Those on Worker's Compensation/disability/litigation, with spondylolithesis or neurologic deficits were excluded. RF was performed with 16g Ray needles using parallel lesioning. Outcome tools included EMGs, FCAs, visual analog pain, McGill, Roland-Morris, work history, and expectation scales. Follow-up occurred at 1.5, 3, 6 and 12 months. Results: 15 subjects met criteria. 87% had pain >2 years. No complications, drop-out or co-interventions occurred. Average visual analog scale (VAS) pain reductions were 74%, 81%, 67% and 70% at 6 weeks, 3, 6 and 12 months, respectively. Statistical significance (p<0.05) was reached for the VAS, Roland-Morris, and McGill tests at all follow-up intervals using nonparametric Friedman ANOVA and Wilcoxan t-tests. Substantial multifidi denervation was seen post as compared to pre-RF. Conclusion: Lumbar MB RFN appears to provide sustained relief in chronic zjoint pain using prognostic dual MBBs. The parallel RF technique is technically sound resulting in adequate MB denervation. A randomized, controlled trial is justified.},

keywords = {Abstracts},

pubstate = {published},

tppubtype = {inproceedings}

}

@inproceedings{IFESS1998_038,

title = {MEDIAN EVOKED RESPONSES - STIMULATION MODALITIES FOR MIDLATENCY CORTICAL COMPONENTS},

author = {I Rundshagen and K Schnabel and amEsch Schulte},

editor = {Manfred Bijak and Winfried Mayr},

url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_038_Rundshagen.pdf},

isbn = {3-900928-04-5},

year  = {1998},

date = {1998-08-01},

pages = {038},

publisher = {IFESS_1998},

address = {Luzern, Switzerland},

abstract = {Purpose: Evoked responses are used for examining the sensory system, but stimulation modalities are not standardised. This study evaluates midlatency components of median nerve evoked responses in relation to stimulation intensity in healthy females. Methods: With IRB approval and informed consent 32 female patients (40textpm,1Oy) were included in the study. SEP recordings at C4' (N20, P25, N35, P45, N50) vs. Fz followed electrical stimulation of the median nerve (3Hz, 200/average, bandpass 0.02-2kHz). The levels of stimulation intensity were: threefold sensory threshold (INT1), sensory and motor threshold (INT2), level of tolerance (INT3). Effects of stimulation intensity on latencies and peakto- peak amplitudes were analysed by multivariate analysis of variance (Hotellings T-Square). Results: Increasing stimulation intensity from INT1 to INT2 enhanced midlatency cortical amplitudes (except N35P45) significantly without changing latencies. Increasing stimulation at INT3 did not change the primary cortical complex, but components > 35 ms became identifiable in the whole sample except one subject. The intensity was comfortable for all subjects. Conclusions: For monitoring midlatency components > 35 ms the authors suggest stimulation intensity close to individual tolerance level for optimal cortical responses. To increase knowledge about the sensory system further studies may electrophysiologically evaluate these components in combination with functional mapping techniques.},

keywords = {Abstracts},

pubstate = {published},

tppubtype = {inproceedings}

}

@inproceedings{IFESS1998_116,

title = {MODERN SIGNAL PROCESSING METHODS IN CONTROL OF FES-ASSISTED LOCOMOTION},

author = {A Kostov},

editor = {Manfred Bijak and Winfried Mayr},

url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_116_Kostov.pdf},

isbn = {3-900928-04-5},

year  = {1998},

date = {1998-08-01},

pages = {116},

publisher = {IFESS_1998},

address = {Luzern, Switzerland},

abstract = {Purpose: Development of universally safe control strategies for FES-assisted movement is one of the main problems in wider acceptance of functional electrical stimulation. Sensory feedback is considered to be a necessary part of any FES control system regardless of the target functionality. Sensory information can be generated either by external or implanted use of artificial sensors, or by recording signals from natural sources such as nerves or muscles. Extraction of relevant information from recorded signals often requires complex processing methods. This paper reports on the use of artificial intelligence methods for gait event detection and gait analysis in three independent projects. Methods: Adaptive Logic Networks (ALNs), a type of artificial neural networks for supervised learning, were used to generate FES control signals from sensory feedback signals by: 1) cloning the skill of the user controlling the stimulation manually; 2) cloning the operation of external heel switch; or 3) cloning the electromyographic signals recorded from normal muscles. Human subjects participated in the first two studies, while animal recordings were used in the third study. Sensory signals were recorded from external pressure sensors installed in the subject's shoes, from sensory nerves located in the subject's foot, and from cat's sensory nerves, respectively. All recordings from human subjects were performed during locomotion on a leveled ground, while the cat was recorded while walking on a powered treadmill. Results: FES control signals were obtained with high accuracy in all three projects. Conclusion: Cloning an inadequate but functional control system from sensory feedback signals by artificial intelligence methods can be a powerful method for quick patient fitting with new neuroprostheses.},

keywords = {Abstracts},

pubstate = {published},

tppubtype = {inproceedings}

}

@inproceedings{IFESS1998_077,

title = {A MODIFIED TECHNIQUE FOR IMPLANTATION OF SACRAL NEUROMODULATORS: THE TAILORED LAMINECTOMY OF THE OS SACRUM},

author = {J Boschert and P Braun and PandSchilling Juenemann and P Schmiedek},

editor = {Manfred Bijak and Winfried Mayr},

url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_077_Boschert.pdf},

isbn = {3-900928-04-5},

year  = {1998},

date = {1998-08-01},

pages = {077},

publisher = {IFESS_1998},

address = {Luzern, Switzerland},

abstract = {Purpose: In persistent detrusor contractility disorders and perineal pain sacral neuromodulation is a beneficial treatment option. Electrodes are usually implanted percutaneously, electrode displacement beeing a common complication. As a modification Sauerwein used a sacral laminectomy and placed electrodes bilaterally, achieving improved stimulation and lower displacement rates. However, the large approach can cause extensive postoperative fibrosis which may result in pain and in the need for higher stimulation currents. To minimize surgical trauma and still to have low displacement rates we used a tailored bilateral sacral laminectomy. Methods: In 7 patients the sacral spinous processes were exposed through a 10 cm long midline incision. Using a Rosen burr and rongeurs, a minimal sacral fenestration at levels S2 and S3 was performed. Similar to tack-up sutures in Craniotomies, a hole was drilled with a spiral burr at the edge of the bone window on each side, through which the electrodes (Medtronic, Netherlands) were fixed using non- absorbable suture material. Results: Bone removal was tailored according to the shape and dimensions of the electrodes, and, consequently, could be reduced to a minimum. No wound healing problems, and no electrode dislocations occurred so far. One system failed due to disruptured connection cords and could be reestablished by exchanging these cables, the electrodes remained untouched. Conclusions: Our technique of the tailored sacral approach is a fast, safe and easy modification of the currently used implantation method for neuromodulators, ensuring excellent electrode fixation combined with a minimal surgical trauma.},

keywords = {Abstracts},

pubstate = {published},

tppubtype = {inproceedings}

}

@inproceedings{IFESS1998_104,

title = {MOTOR POINT DELINEATION OF THE HIP MUSCLES FOR FUNCTIONAL ELECTRICAL STIMULATION USING PERCUTANEOUS INTRAMUSCULAR ELECTRODES: AN ANATOMIC STUDY},

author = {Y Tsutsumi and Y Shimada and K Sato and T Matsunaga and T Kashiwagura and A Misawa and M Sato and S Chida},

editor = {Manfred Bijak and Winfried Mayr},

url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_104_Tsutsumi.pdf},

isbn = {3-900928-04-5},

year  = {1998},

date = {1998-08-01},

pages = {104},

publisher = {IFESS_1998},

address = {Luzern, Switzerland},

abstract = {Purpose: The purpose of this study was to delineate the motor point of the hip muscles for the exact implantation of percutaneous intramuscular electrodes. Materials and Methods: Six extremities of three cadavers were dissected . The subjects consisted of one male and two females. The following muscles were dissected; gluteus maximus (GM), gluteus medius (Gm) and adductor magnus (ADD). Nerves and motor points were delineated. Motor point was regarded as the place where the ramus muscularis penetrates the fascia. Motor point was represented as the %distance from the line between following landmarks; spina iliaca posterior superior (SIPS), greater trochanter (GT), tuber ischiadicum (TI) and lateral epicondyle (LE). Lateral (lat.) or medial (med.) deviation from the line were also represented as the %deviation length. Results: The %distances and %deviation lengths of three motor points of GM were 46(lat.29), 63(lat.7) and 86(lat.18)% of the line SIPS-TI, respectively. The %distances and %deviation lengths of three motor points of Gm were 35(lat.1), 49(lat.9) and 61(lat.7) % of the line SIPS-GT, respectively. The %distance and %deviation length of one motor point of ADD was 58(med.8)% of the line SIPS-LE. Discussion: Botte, et al. have reported that the Gm motor point was one third of the line SIPS-GT. In this study, the Gm motor points were approximately from one third to two third of the line SIPS-GT. Other motor points shown in this study is useful to shorten operation time by exact insertion of percutaneous intramuscular electrodes.},

keywords = {Abstracts},

pubstate = {published},

tppubtype = {inproceedings}

}

@inproceedings{IFESS1998_105,

title = {MUSCLE FATIGUE DURING INTERMITTENT ELECTRICAL STIMULATION},

author = {T Matsunaga and Y Shimada and K Sato and T Kashiwagura and A Misawa and S Chida},

editor = {Manfred Bijak and Winfried Mayr},

url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_105_Matsunaga.pdf},

isbn = {3-900928-04-5},

year  = {1998},

date = {1998-08-01},

pages = {105},

publisher = {IFESS_1998},

address = {Luzern, Switzerland},

abstract = {PURPOSE: Muscle fatigue is the main limiting factor for the restoration of FES standing. Intermittent stimulation under closed-loop control is one of the methods to reduce muscle fatigue. The purpose of this study is to evaluate muscle fatigue during intermittent stimulation. METHODS: Twenty adult male Wister rats were used in this experiment. The sciatic nerve and the gastrocnemius muscle were exposed surgically under general anesthesia. The gastrocnemius muscle was connected to a strain gauge and stimulated through a nerve cuff electrode attached to the sciatic nerve. Stimulation frequencies were 20Hz, 50Hz, 70Hz, and 100Hz. The pulse amplitude was set at supramaximal voltage and the pulse width was 0.2 ms. The stimulation pattern was 4 seconds of stimulation at the beginning of every 30 second period. Intermittent stimulation lasted for 15 minutes, and the contraction forces of the stimulated muscle were measured isometrically during the stimulation phase. The Strength Decrement Index (SDI) was used to assess muscle fatigue. RESULTS: SDI were 53.4+-14.5 % (Mean+-SD) at 20Hz, 33.5+-7.5 % at 50Hz, 33.5+-20.6 % at 70Hz, and 21.2+-6.0 % at 100Hz. Muscle fatigue was significantly greater at 20Hz than at 50Hz, 70Hz and 100Hz (p < 0.05). During 4 seconds of stimulation, peak contraction force was sustained at 50Hz and 70Hz rather than at 100Hz. CONCLUSIONS: Muscle fatigue was greater at low (20Hz) than at high (50, 70 and 100Hz) frequencies during intermittent stimulation. The result of this study suggests that intermittent high-frequency stimulation (especially 50- 70Hz) is clinically useful for closed-loop control.},

keywords = {Abstracts},

pubstate = {published},

tppubtype = {inproceedings}

}

@inproceedings{IFESS1998_107,

title = {MUSCLE FATIGUE UNDER LOW FREQUENCY BLOCK STIMULATION},

author = {T Kashiwagura and Y Shimada and K Sato and T Matsunaga and A Misawa and M Sato and T Chida},

editor = {Manfred Bijak and Winfried Mayr},

url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_107_Kashiwagura.pdf},

isbn = {3-900928-04-5},

year  = {1998},

date = {1998-08-01},

pages = {107},

publisher = {IFESS_1998},

address = {Luzern, Switzerland},

abstract = {OBJECTIVE: In electrical stimulation, the muscles contract, in order, from the more fatigable motor units to the fatigue resistant motor units (reverse recruitment). Block stimulation is a method by which to set recruitment in the physiological order in electrical stimulation. The purpose of this study was to evaluate the effects of low frequency block stimulation on the medial gastrocnemius muscle of rats in an effort to reduce the muscle fatigue. MATERIALS: Ten extremities of nine Wistar rats were used in this study. We isometrically measured the contraction force of the medial head of the gastrocnemius muscle of the rats. METHODS: The frequency of drive stimulation was set at 100Hz. The block stimulation frequency was set at 20, 50 or 100Hz for each of three groups. Drive stimulation was applied for 20 sec, and then 2 sec later, block stimulation was superimposed for 15 sec. We measured maximal tetanic force at 2.4, 6, 10 and 14 sec, and calculated the strength decrement index at 6 , 10 and 14 sec to yield the attenuation of muscle force from 2.4 sec to each of 6, 10 and 14 sec. RESULTS: Block effect were seen in all three block stimulation frequencies. Muscle fatigue under block stimulation was significantly less at both 50 and 100Hz block stimulation frequencies than drive stimulation only (p<0.05). CONCLUSION: These results suggest that block stimulation is one of the favorable method by which to reduce muscle fatigue during clinical use of functional electrical stimulation.},

keywords = {Abstracts},

pubstate = {published},

tppubtype = {inproceedings}

}

@inproceedings{IFESS1998_025,

title = {NEAR INFRARED SPECTROSCOPY AND TRANSCRANIAL DOPPLER SONOGRAPHY CHANGES CORRELATES WITH THERAPEUTIC EFFECT DURING CERVICAL SCS IN MAN},

author = {M Visocchi and M Meglio and B Cioni and C D Cabezas and F Papacci},

editor = {Manfred Bijak and Winfried Mayr},

url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_025_Visocchi.pdf},

isbn = {3-900928-04-5},

year  = {1998},

date = {1998-08-01},

pages = {025},

publisher = {IFESS_1998},

address = {Luzern, Switzerland},

abstract = {Purpose: Since 1986 several modalities (SPECT, PET, TCD) have been utilized to evaluate spinal cord stimulation (SCS) induced effects on cerebral blood flow (CBF) in man. Personal experience is mainly based on transcranial velocitometry (TCD) as a reliable, simple, repeatable and safe indirect CBF recording method. Infrared spectroscopy (NIRS) is able to evaluate deoxyhemoglobin (HHb), oxyhemoglobin (HbO2) and citochrome aa3 (Cit. aa3) changes and has been shown to correlate with CBF. In this study we recorded the variations of NIRS parameters and compared them to TCD patterns in order to correlate the metabolic as well as the hemodynamic changes induced by SCS with the effectiveness of the procedure. Methods: 4 patients wearing an epidural electrode (C1-C2; C5; T8; T9 levels) implanted for pain control in different pathologies were asked to switch off the stimulator for 24 hours. NIRS and TCD were recorded bilaterally immediately before and during SCS; arterial blood pressure, heart and respiratory rate, end tidal CO2 were recorded as well. Results: In all the patients systemic parameters remained stable during SCS. An increase of CBF velocities (more than 90%) and HbO2 8more than 100%), along with a decrease of HHb and Cit. aa3 was observed only in one case (C1-C2), in whom SCS was effective in pain control. Such changes occurred only ipsilaterally to the lesion. Conclusions: Such datas are consistent with previous observations reporting both in animals and in men an increase in CBF mainly during cervical SCS. Many other observations are required in order to get conclusions. The possible role of combined TCD and NIRS increase during pain effective SCS will be discussed.},

keywords = {Abstracts},

pubstate = {published},

tppubtype = {inproceedings}

}

@inproceedings{IFESS1998_159,

title = {NED EFFORT SOLARIS: VISUAL PROSTHESIS BY SELECTIVE STIMULATION OF THE OPTIC NERVE IN PATIENTS WITH RETINAL DISEASES},

author = {B Fischer and K Deurloo and H Dinge and H Reinke and B Godde and D Jancke and R Leonhardt and S Boesing and W VonSeelen and J Holsheimer and W Wittkowski and J Bartha and H W Bothe},

editor = {Manfred Bijak and Winfried Mayr},

url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_159_Fischer.pdf},

isbn = {3-900928-04-5},

year  = {1998},

date = {1998-08-01},

pages = {159},

publisher = {IFESS_1998},

address = {Luzern, Switzerland},

abstract = {Every year many people become blind because of retinal degenerative diseases (retinitis pigmentosa and macular degeneration) or retinal ablation. Research groups try to develop retinal implants (subretinally or epiretinally) to save a remaining vision or restore visual function. These projects use the retina for stimulation and a technical system transforming light stimuli into electrical signals. The SOLARIS-project also uses a technical system to transform light inputs into electrical stimuli, but we developed a specific dualselective scanner-electrode to stimulate the optic nerve, not the retina. This self-sizing electrode consists of two external ring-electrodes and 6 single-electrodes between the ring-electrodes. While stimulating the cat optic nerve with this electrode local field potentials (LFP's) were measured by electrodes within the ipsilateral visual cortex (area 18) and compared with computer model simulation. Trying to release LFP's in defined areas of the visual cortex by stimulating selectively nerve-fibres within the nerve, we tested the following parameters: threshold currents, intensity of current, frequency and duration of stimulation, different electrode configuration (bipolar and tripolar stimulation) and prepuls stimulation (submaximal stimulus, rectangle prepuls). Using different parameters a spatial and temporal selective stimulation not only of specific segments within the nerve but also of nerve-fibres with different diameter in these segments is possible. These findings are prerequisites for a microprocessor, analysing incoming pictures, transforin them into different stimulation-parameters and activate the implanted scanner-electrode. This will stimulate optic nerve-fibres and induce a visual field consisting of perhaps 30-40 picture elements, enough for a rough orientation.},

keywords = {Abstracts},

pubstate = {published},

tppubtype = {inproceedings}

}

@inproceedings{IFESS1998_083,

title = {NERVE STIMULATION IN THE TREATMENT OF OCCIPITAL NEURALGIA},

author = {R L Weiner and K M Alo and C Feler and J Oakley and C Naumann and M Stepniewski and H Keller and V Redko and M J Yland},

editor = {Manfred Bijak and Winfried Mayr},

url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_083_Weiner.pdf},

isbn = {3-900928-04-5},

year  = {1998},

date = {1998-08-01},

pages = {083},

publisher = {IFESS_1998},

address = {Luzern, Switzerland},

abstract = {Purpose: To evaluate the effectiveness of occipital nerve stimulation using a novel percutaneous technique in the treatment of refractory occipital neuralgia. Methods: In 1992 Dr. Weiner began selective occipital nerve stimulator implants in occipital neuralgia patients. We performed a retrospective analysis of 28 consecutive patients who received occipital nerve stimulator implants. All patients had been diagnosed with occipital neuralgia after a positive response to an occipital or C2 nerve diagnostic blockade. Patients had remained unresponsive to medication. The implanted systems included both 4 and 8 electrode lead systems (Medtronic Inc., and Quest-ANS Inc. respectively). We collected patients satisfaction ratings, lead revision rates, and stimulator explantation rates. Results: Patient satisfaction ratings at the time of follow up were as follows: excellent relief of pain in 18 (61%) patients, good relief of pain in 9 (32%) patients, poor relief of pain in 2 (7%) patient. In one patient the lead had to be reimplanted because it was severed during an unrelated surgical procedure. Lead migration occurred in 3 patients. These 3 patients reported excellent and good results after their leads had been revised. We did not see lead migrations after we modified our surgical technique to include an anchoring loop. One patient requested explantation because the pain had resolved. One patient continued to have pain in the distribution of the lesser occipital nerve. Conclusions: In patients with occipital neuralgia, occipital nerve stimulation may be an effective treatment if other more conservative treatments have failed. A controlled trial as well as further study of the long-term efficacy of occipital nerve stimulation are indicated.},

keywords = {Abstracts},

pubstate = {published},

tppubtype = {inproceedings}

}

@inproceedings{IFESS1998_048,

title = {NEUROMODULATION DEVICE REGISTRY: A PILOT PROGRAM},

author = {E Buchser and Y Martin and I Coronado and DenAbeele Van and R Hirsch and P Wolf and D Bach},

editor = {Manfred Bijak and Winfried Mayr},

url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_048_Buchser.pdf},

isbn = {3-900928-04-5},

year  = {1998},

date = {1998-08-01},

pages = {048},

publisher = {IFESS_1998},

address = {Luzern, Switzerland},

abstract = {Introduction: Little is known about the practicalities involved in the care of patients carrying implanted devices for neuromodulation therapy. In collaboration with Medtronic Inc., a neuromodulation device registry (NDR) aimed at quantifying device related aspects of routine clinical care was designed. Method: The NDR was developed on a FileMaker 4.0 data base. Information is captured on scrolling menus and includes data from the screening phase, the implantation procedure, the follow-up and the device specification. A file is created for all devices that are used (including those for screening). The average time needed to enter the data for one patient is approximately 1 minute. Results:The current status of the NDR includes a total of 125 patients (81 entries in follow-up) collected from 6 European centres over a period of 4 months. Reports on outcome, cost, complications, patient profile and screening can be retrieved by each centre or by Medtronic who manages an anonymised central database with high confidentiality. Furthermore any combination of fields allows personalised database search. Discussion and conclusion: The NDR is still in its pilot phase and further development depends on current evaluation. It is intended to be part of an auditing process but it is not primarily designed to evaluate treatment efficacy. We believe that NDR will provide important information about the contingencies involved in the application of neuromodulation therapies. It will also provide each centre with a tool for auto-evaluation and the planning of resource allocation.},

keywords = {Abstracts},

pubstate = {published},

tppubtype = {inproceedings}

}

@inproceedings{IFESS1998_146,

title = {NEURONAL MECHANISMS OF SPASTICITY},

author = {M R Dimitrijevic and M Pinter},

editor = {Manfred Bijak and Winfried Mayr},

url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_146_Dimitrijevic.pdf},

isbn = {3-900928-04-5},

year  = {1998},

date = {1998-08-01},

pages = {146},

publisher = {IFESS_1998},

address = {Luzern, Switzerland},

abstract = {Muscle hypertonia characterized by a velocity-dependent increase of tonic stretch reflex is a well recognized clinical finding in movement disorders. Sherrington's discovery that the stretch reflex generates muscle contractions, which underlie posture, gave rise to numerous experimental studies aiming at defining the underlying mechanisms of muscle hypertonia or spasticity. Magoun and Rhines proposed that spasticity is of supraspinal origin and the result of an impaired balance between facilitatory and inhibitory descending influences through the spinal cord. Moreover, there is clear evidence in monkeys and humans that spasticity can be observed after lesions of the primary motor cortex or the premotor cortex. The development of the concept of "premotor center" of the spinal cord and the demonstration of convergency of different descending tracts to the "premotor center" led to the understanding that we should not place any emphasis on various neuronal descending systems since these are parallel channels, which converge upon the premotor center, including the propriospinal and segmental interneuronal pathways. In order to demonstrate how the propriospinal and segmental interneuronal systems are involved in generating muscle hypertonia and hypotonia, under simulated "supraspinal control", we shall present the results of our studies on externally controlled afferent input to the spinal cord in subjects with complete and incomplete chronic spinal cord injury. Epidural spinal cord stimulation can generate afferent input to the segmental interneuronal and propriospinal spinal cord systems. By delivering a train of stimuli of different frequencies and amplitudes to the posterior structures of the spinal cord, we have been able to demonstrate alteration in muscle tone and induce reflex responses and locomotorlike movement. Thus, we shall provide evidence that in order to generate spasticity it is essential to have additional supraspinal input.},

keywords = {Abstracts},

pubstate = {published},

tppubtype = {inproceedings}

}

@inproceedings{IFESS1998_043,

title = {NEUROPHYSIOLOGICAL AND BIOCHEMICAL CORRELATES TO THE PAIN RELIEVING EFFECT OF SPINAL CORD STIMULATION - Experimental studies in neuropathic rats},

author = {B Linderoth and J-G Cui and V Yakhnitsa and B A Meyerson},

editor = {Manfred Bijak and Winfried Mayr},

url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_043_Linderoth.pdf},

isbn = {3-900928-04-5},

year  = {1998},

date = {1998-08-01},

pages = {043},

publisher = {IFESS_1998},

address = {Luzern, Switzerland},

abstract = {Purpose: Neuropathic pain is often difficult to manage with pharmacotherapy but may be effectively alleviated by electric stimulation of the spinal cord (SCS). Though this mode of treatment has been extensively practised since more than two decades, little is known about the mechanisms involved in the pain relieving effect. Methods: In a serie of experimental studies performed on rat models of mononeuropathy we have explored various biochemical and neurophysiological correlates to the effect of SCS on tactile hypersensitivity (ällodynia"). In most cases the experiments have been performed on awake, freely moving animals. SCS was applied with stimulus parameters similar to those used clinically. Results: 1. SCS may effectively suppress tactile allodynia. This is in agreement with observations in patients where SCS may attenuate allodynia. Furthermore, SCS may normalize the abnormally low threshold of the first, Ab-mediated component of the flexor reflex. 2. In rats which do not respond to SCS with normalization of the withdrawal threshold to tactile stimuli, intrathecal administration of low-dose GABA, baclofen, mucimol or adenosine may markedly potentiate the effect of SCS. Conversely, intrathecal administration of receptor antagonists to GABA and adenosine counteracts the allodyniasuppressive effect of SCS. 3. In rats which respond to SCS with suppression of tactile allodynia there is a significantly increased release of GABA and a decrease of the release of excitatory amino acids in the dorsal horn as demonstrated by microdialysis. 4. In rats exhibiting tactile allodynia WDR-neurons in the dorsal horn exhibit hyperexcitability in response to peripheral innocuous stimuli. SCS applied in lightly anaesthetized animals markedly attenuates the hyperexcitability of most of these neurons. All behavioural, biochemical and electrophysiological effects of SCS outlasted the stimulation period (10-30 min) with 10-50 minutes. Conclusions: Our data supply a clue to the understanding of the mode of action of SCS when applied as treatment of pain due to peripheral nerve injury. Moreover, the results indicate that the therapeutic effect of SCS can be enhanced by adjuvant pharmacotherapy with baclofen and/or adenosine.},

keywords = {Abstracts},

pubstate = {published},

tppubtype = {inproceedings}

}

@inproceedings{IFESS1998_009,

title = {NEUROPSYCHOLOGICAL EVALUATION OF DEEP-BRAIN-STIMULATION OF PATIENTS WITH PARKINSON DISEASE OR ESSENTIAL TREMOR},

author = {I Fresenborg and D Gruia and U Sander},

editor = {Manfred Bijak and Winfried Mayr},

url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_009_Fresenborg.pdf},

isbn = {3-900928-04-5},

year  = {1998},

date = {1998-08-01},

pages = {009},

publisher = {IFESS_1998},

address = {Luzern, Switzerland},

abstract = {The implantation of a deep brain electrode for functional deactivation of the nucleus ventralis intermedius (VIM) results in a suppression of tremor which is the main symptom disease or essential tremor. The permanent activation leads to a deactivation of the neurons due to depolarisation (Pollak et al., 1993). This elegant but not completely risc-free method is still in an experimental stage. In addition to complications as bleedings and hemiparesis, cognitive impairments have been described. Reductions of linguistic abilities have been reported especially in cases of implantations in the left cerebral hemisphere. Since february 1996 deep brain electrode-implantations have been performed in 15 cases in the neurosurgical ward of the Evangelical hospital in Oldenburg. A careful neuropsychological evaluation was undertaken: Preoperative an extensive neuropsychological diagnostic examination was performed. This was done to exclude patients with dementia. Additionally the cognitive capacity of the patients has to be determined, because cognitive impairments are described in literature for patients with parkinson disease. Special emphasis was placed on mnestic functions, attention and executive functions such as conzeption-development and "set-shifting". Postoperative neuropsychological tests were performed to examine the differential effects of the stimulation on the cognitive capacity respectively to detect undesirable side effects for example visual disorders. We do report our first results.},

keywords = {Abstracts},

pubstate = {published},

tppubtype = {inproceedings}

}

@inproceedings{IFESS1998_072,

title = {THE NEUROS PROJECT - NEUROMUSCULAR SENSING AND STIMULATION},

author = {P H Veltink and I Bante and T Sinkjaer and J Haase and H J Hermens and N Donaldson and C Veraart and S Salmons and M Granat and C Frigo and J McLaughlin},

editor = {Manfred Bijak and Winfried Mayr},

url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_072_Veltink.pdf},

isbn = {3-900928-04-5},

year  = {1998},

date = {1998-08-01},

pages = {072},

publisher = {IFESS_1998},

address = {Luzern, Switzerland},

abstract = {NEUROS is a project within the EU Training and Mobility of Researchers Program (TMR). The objective is to train young scientists throughout Europe in research in the area of artificial neuromuscular sensing and control and to further the knowledge in this area by the intensive cooperation and exchange or researchers in a network of expert groups. The main research objective is a collaborative effort in the field of neural prostheses to increase and to improve the applicability of FES systems using closed-loop control systems, deriving signals from natural sensors and developing electrodes and systems for selective stimulation and recording. The University of Twente coordinates the NEUROS network project. Effective cooperation with the SENSATIONS project (EU BIOMED2 program) has been established. Research topics within the NEUROS network are: recording of signals from physiological sensors, the design and application of inertial 3-axial sensors, biomechanics and control of FES-assisted mobility, the design and application of implantable stimulators and multichannel stimulation electrodes. Furthermore, the influence of stimulation protocols on energy expenditure, mechanical output, fatigue and damage of muscles is being investigated.},

keywords = {Abstracts},

pubstate = {published},

tppubtype = {inproceedings}

}

@inproceedings{IFESS1998_003,

title = {NEUROSTIMULATION OF PERIPHERAL NERVES},

author = {D Buschmann and F Oppel},

editor = {Manfred Bijak and Winfried Mayr},

url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_003_Buschmann.pdf},

isbn = {3-900928-04-5},

year  = {1998},

date = {1998-08-01},

pages = {003},

publisher = {IFESS_1998},

address = {Luzern, Switzerland},

abstract = {Objectives: We performed 56 peripheral nerve stimulation procedures since 1991. In addition to 52 patients with CRPS II (comple regional pain syndrome), 4 patients with phantom-limb pain were treated. Incomplete or complete lesion of the stimulated peripheral nerves was determined in all patients. Surgically treatment failed in all cases. All patients had been given extensive conservative pain therapy. Material and Method: The aim was to define a standardised method, which would be as objective as possible, to verify the success of treatment, by measuring the pain-related disability assessment the subjective intensity of pain and the subjective perception of pain. Long-term follow-up was arranged in addition to determine social and occupational reintegration after. The implantation of the stimulating electrode, proximal to the lesion, was performed after microsurgical neurolysis of the peripheral nerves. The patient carried out a stimulation trial after the operation. At the conclusion of the trial stimulation phase, a stimulator unit was permanently implanted in 50 cases, with a marked reduction in pain. Only in 6 cases, the success of the trial stimulation was unsatisfactory. Results: After implanting the stimulator unit an average pain-related disability of 10 % was achieved by the 50 patients fitted with a permanent implant. 46 patients have used the permanent stimulator implants with lasting, excellent to good success. The stimulator system was removed in only 4 cases, due to the need for stimulation having passed, or due to a lack of lasting success with stimulation. Conclusion: Neurostimulation of peripheral nerves should be considered as an established concept to treat surgically failed peripheral nerve lesions.},

keywords = {Abstracts},

pubstate = {published},

tppubtype = {inproceedings}

}

@inproceedings{IFESS1998_149,

title = {NEW THERAPEUTIC APPROACHES AND COMPLEX REGIONAL PAIN SYNDROME TECHNOLOGICAL ADVANCES IN DIFFICULT-TO-TREAT CASES: COMBINED PERIPHERAL NERVE STIMULATION AND SPINAL CORD STIMULATION},

author = {G B Racz},

editor = {Manfred Bijak and Winfried Mayr},

url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_149_Racz.pdf},

isbn = {3-900928-04-5},

year  = {1998},

date = {1998-08-01},

pages = {149},

publisher = {IFESS_1998},

address = {Luzern, Switzerland},

abstract = {Recent therapeutic evolution in treating complex regional pain syndrome has led to the concept that if a therapeutic modality fails to give improvement, one needs to move onto the next level of care, thus, the evolution in treating the sympathetically maintained pain, sympathetically independent pain as well as the central pain. The physical therapy and behavioral based therapeutic modalities usually result in approximately 50% improved clinical picture. From the remainder that are resilient for the Level I and Level II approaches, the more interventional techniques clearly have come into more accepted and significant therapeutic considerations. Our review from approximately 275 cases of peripheral nerve stimulator implants indicates a satisfaction rating of approximately 80%, and in this very difficult patient population over 50% of the males and over 30% of the females returned to work. The review of our cases has been even further refined as we have come to the realization that particularly in patients where the injury may have been, for example, the lower extremity and did not satisfactorily respond to peripheral nerve stimulation as evidenced by the disease spreading to the ipsilateral upper extremity, additional spinal cord stimulation has been utilized over the last several years. Additionally, in patients where the injury appeared not mononeuropathy, the therapy may have consisted of a spinal cord stimulator in lieu of peripheral nerve stimulation. Thus, we have had a number of patients where both peripheral nerve stimulation and spinal cord stimulation has been used in the same patients, additionally patients whereon the peripheral nerve stimulation was used, and in others where only spinal cord stimulation was used in the Level III type patients in the continuum of care. Our patients were combined with patients from Baylor University Medical Center in Houston and recently have been published by Calvillo, et al. The visual analog scores were maintained in a sustained manner at three years but the peripheral nerve stimulator outcome was better than that of spinal cord stimulation and the best results were obtained where spinal cord stimulation and peripheral nerve stimulation were utilized (Table 1.) Our approach in complex patients that failed multiple therapeutic modalities, for example spinal cord stimulation, is to attempt mapping regardless of the spinal cord stimulator that has been placed previously. We utilize the monopolar (Epimed International) stimulating catheter and attempt to find the entry zone on the spinal cord where the best stimulation can be obtained for one of the electrodes. The second electrode then is placed near midline. Alligator clips are used together with the Medtronic trial stimulator box for stimulation between the two monopolar electrode tips. If we are able to map out the satisfactory outcome, then we verify the position by anterior, posterior, and lateral radiological pictures and at a later date we place with a surgical laminotomy an 8-contact point electrode paddle where the electrodes can be programmed horizontally as well as vertically and the lateral most electrode is placed over the entry zone of the spinal cord where the best stimulation had been documented by the monopolar stimulating catheters. Because the animal model histopathology shows histological changes at that segment in the spinal cord, this therapeutic approach has produced favorable outcomes when single electrodes were simply not working. Additionally, the single electrode systems, regardless of the numbers of the contact points–four or eight–may migrate laterally and miss the entry zone of the spinal cord that needs to be stimulated for optimal outcome. This observation, while limited in numbers, appears to be clinically significant in those patients where we have used this technique. New Technology for Peripheral Nerve Stimulator Mapping Since the introduction of Peripheral Nerve Stimulators as a concept by Sweet and Wall and subsequently the work of Wepsick and Sweet have led to the cuff type electrodes which had a tapering off beneficial outcome possibly because of constrictive scar formation from the cuff type electrodes, the technique fell into disuse. Utilizing paddle electrodes with a fascial coverage ala an artificial dura, through which the nerve can be stimulated without direct contact with the nerve, the success rate has improved as well as the tapering off of the favorable outcome has not been noted in large series of patients. The next generation for better coverage in nerves has been the work of Nashold who attempted microelectrode suturing into the nerve through stimulation and mapping and subsequently anchoring the microelectrodes; because of the complexity of the technique it has failed to again wide acceptance. In 22 patients we have attempted the use of a concave "gutter" type electrode where the electrodes are distributed in such a way that the either end of the gutter in the hollow would be the zero and 3 electrodes, and in the mid portion on either side the 1 and 2 electrodes are located. Thus, one is able to stimulate the nerve longitudinally as well as across. Because the nerve bundles travel in a rotating spiral manner; therefore, if one is to place a paddle electrode on the lateral aspect of the sciatic nerve, it would not necessarily and appropriately be covering the peroneal bundles exclusively. For this reason, we use the curved electrode covered with a piece of fascia that is sutured to the paddle electrode, and a tetanic stimulus is placed on the zero and three electrodes. If the tibialis nerve is the primary injured nerve, we like to see an initial plantar flexion, and as we increase the amplitude for the tetanic contracture, biphasic and the plantar flexion to be followed by a dorsi flexion. When the ipsilateral lateral electrode on the paddle the 1 or 2 electrode is turned on, the cross fiber stimulation of the sciatic nerve will give the appropriate motor response in plantar or dorsal flexion. This electrode configuration has allowed a much better coverage especially when both components of the sciatic nerve are involved. For example, patient has heel pain as well as dorsum of the foot sole of the foot pain. Clearly, technological advances improve our therapeutic outcomes and the outcome experiences in our series have been duplicated by other major medical centers including Michael Stanton-Hicks, Samuel Hassenbusch,},

keywords = {Abstracts},

pubstate = {published},

tppubtype = {inproceedings}

}

@inproceedings{IFESS1998_007,

title = {NORMALIZATION OF NERVOUS CONDUCTIVITY IN A TREATMENT OF CANCER PAIN},

author = {A I Soukhanov},

editor = {Manfred Bijak and Winfried Mayr},

url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_007_Soukhanov.pdf},

isbn = {3-900928-04-5},

year  = {1998},

date = {1998-08-01},

pages = {007},

publisher = {IFESS_1998},

address = {Luzern, Switzerland},

abstract = {It is well known, the tumor could not develop in a healthy tissue and the definite conditions should be exist for it. As a rule, these conditions, usually, associate with distortion of immunogenesis of a distortions of metabolism, which locally take place in a tissues. Working with intervertebral ganglions we standardize the conductivity of electric impulses in a central nervous system, restore the normal blood circulation around tumor, standardize the normal electric impulse going to the place of the tumor appearance and diminish the pain. It allows us to stop tumor growth, decrease the squeezing of nervous fibers responsible for pain. I have worked out the method of tumor destruction, which combined with method of electric functional regulation of metabolism process in the place of tumor is allowed to remove it. It also helps to take off the tumors of thyroid gland, tumors of abdominal cavity. More than 1000 patients have obtained the treatment according to such methods. As a results the percentage of recovery is: hard cases-20%, intermediate cases-60%, light cases- 100%},

keywords = {Abstracts},

pubstate = {published},

tppubtype = {inproceedings}

}

@inproceedings{IFESS1998_082,

title = {A NOVEL TECHNIQUE TO SELECTIVE NERVE ROOT CANNULATION IN THE TREATMENT OF CHRONIC PAIN},

author = {K M Alo and M J Yland and V Redko},

editor = {Manfred Bijak and Winfried Mayr},

url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_082_Alo.pdf},

isbn = {3-900928-04-5},

year  = {1998},

date = {1998-08-01},

pages = {082},

publisher = {IFESS_1998},

address = {Luzern, Switzerland},

abstract = {Purpose: The conventional approach to the epidural space involves cannulation in a cranial direction with insertion at the appropriate level. In this approach, the needle is placed inferior to the interlaminar space, advanced craniad and parallel to the angle of the lamina, and can be performed without fluoroscopy. However, this approach does not allow access to individual nerve roots or the lumbosacral plexus, because the anatomical branching off of the nerve roots is in a caudal direction. We investigated the possibility of performing selective nerve root cannulations using a novel percutaneous approach. In this approach a Tuohy type needle is inserted superior to the interlaminar space rather than inferior, and advanced in a caudal direction rather than a cranial direction while using fluoroscopic guidance. Methods: Since 1995 we have performed selective nerve root cannulations at the cervical, lumbar and sacral nerve root levels in patients. Recently, in 36 human cadavers, we studied the placement of selective nerve root stimulator electrodes at the lumbar and sacral levels. We tested various needles, catheters, electrodes, epiduroscopes, and guide wires. We collected radiographic images of the essential steps involved in this technique. Results: Successful placement was obtained in 67% of the cervical nerve root placements, 83% of the lumbar nerve root placements, and 89% of sacral nerve root placements. Conclusions: In human cadavers, a retrograde approach was successful in the selective cannulation of the, lumbar and sacral nerve roots. Clinical trials using temporary catheters are in progress, and safety in chronic cannulations is to be evaluated.},

keywords = {Abstracts},

pubstate = {published},

tppubtype = {inproceedings}

}

@inproceedings{IFESS1998_031,

title = {OPERATIVE PERIDUROSCOPY PERSONAL EXPERIENCE},

author = {W Raffaeli and L Visani and M Balestri},

editor = {Manfred Bijak and Winfried Mayr},

url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_031_Raffaeli.pdf},

isbn = {3-900928-04-5},

year  = {1998},

date = {1998-08-01},

pages = {031},

publisher = {IFESS_1998},

address = {Luzern, Switzerland},

abstract = {Purpose: We investigated the efficacy and limits of periduroscopy as investigation in order to determine quantity and quality of intrarachidian pathologies and as therapeutic approach to release the peridural site from connectivepathological fibres. Materials and Methods: 25 patients were submitted to an operative periduroscopy . Every patient was subjected to an evaluation to define both the pain syndrome and the etiogenetic condition. Follow up: 1 year. We made use of a Wolff and a Myelotec flexible endoscopy. Mixed anaesthetic technique. Repere peridural space: we used a paramedia approach at the lumbar level (10 pz) and caudal (15pz) .Saline ( 300- 1200 ml ) was used to obtaine a good vision of the epidural space. After check of liquids diffusion by contrast, we went on unbridling the fibrous lacinie with an instrumental pressure dilation. Administration in phlogosis sites of steroid- (120 mg) and antibiotic-action drugs 100 mg. Ciprofloxacina. Results:The correlation level among pain symptoms, predominance of neuropathic disorders and peridural fibrous lacinie quantity was high enough. Clinical efficacy : the procedure of peridurolisys was more efficacious in those patients whom we could effect a real release of the structure from the adhesion connective bridling, visualized by a preand post-lisi peridurography too. We had a persistent pain relief in patients affected by the more recent scars. In the 5 FBSS patients with SCS we could leave out the generator for at least 2- 3 months after the periduroscope procedure, and then re-start it with lower voltage parameter.- Anatomical abnormalities were found in patients without rachidian pathologies. Complications: All without sequelae. Intraoperative bradysistolia ( 1pz). Serious medulla-radicular irritation ( 2pz): an intraoperative case with dysesthesia-hypostenia and diffuse spasms at lower limbs. We had to interrumpt the procedure.Ad integrum recovered 3 hours later. 1 case with diffuse tonic-clonic spasms that appeared about 30 minutes after the end of the operation. Cerebral CAT: pneumoencephalon.Ad integrum rehabilitation 2 hours later. Conclusion: We think that the periduroscopy technique is an indispensable investigation in order to determine quantity and quality of intrarachidian pathologies, above all in negative MRI-CAT syndromes as differential diagno-sis vs. psychopathological attitudes. It can became elective in patient with controindications to MRI . Operative support during the placement of electrodes for spinal stimulation, especially for dual systems. Release of the peridural site from connective-pathological fibres, especially at the beginning with the cicatrization. Anyway, the periduroscopy technique requires many improvements both for material and methods.},

keywords = {Abstracts},

pubstate = {published},

tppubtype = {inproceedings}

}

@inproceedings{IFESS1998_157,

title = {OPIOIDS INTERFERENCE ON CYTOTOXIC ACTIVITY OF IMMUNE SYSTEM},

author = {W Raffaeli and G Pari and L Visani},

editor = {Manfred Bijak and Winfried Mayr},

url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_157_Raffaeli.pdf},

isbn = {3-900928-04-5},

year  = {1998},

date = {1998-08-01},

pages = {157},

publisher = {IFESS_1998},

address = {Luzern, Switzerland},

abstract = {Many researchers have reported that endogenous and exogenous opioids modify the immune function demonstrating the presence of specific receptors for opioids on monocytes on the complements and on the NK cells. It was proposed that psychoactive drug therapy may exert influences on the immune system through modifications in neuropeptide availability. It is known the importance of cellular cytotoxic against. tumors and the opioids interference on NK cell activity. So we had studied in humain morfine interference on immune system: difference among two different via of administration (sistemic - spinal) and which system modulates it. Materials and methods: Study 1 - 20 patients had histological confirmation of the cancer diagnosis. 5 patients did not receive antalgic therapy and were used as controls, 9 patients were treated with oral morphine (190 +/- 30 mg/day MSL Morphine Slow Released) and 6 with intratecal morphine (14 +/- 1.5 mg/day). 5 patients were observed during both oral and then intratecal morphine administration. Study 2 - This involved 20 patients with moderate low back pain NSAID's: 10 patients with piroxicam beta-cyclodextrine 20 mg/day and 10 with Ketorolac 20 mg/day. Study 3 - Lymphocytic populations were evaluated by measuring plasmatic levels of lymphocytes LB, CD3, CD, and CD8 as well as the CD4/CD8 ratio. NK and LAK activity was studied with fluorescence methods. Results: Morphine decreased the cytotoxic activity that was present in previously. untreated neoplastic patients. NK activity underwent a significantreduction during transfer from oral to intrathecal morphine in the same patients. LAK cell activity in untreated patients was greater than that found in healthy subjects. The administration of morphine increased this cytotoxic activity to a greater extent with oral than with intrathecal administration. The i.v. administration of morphine increased PRL and .reduced NK activity within 30 min, whilst there were no effects on LAX cells, and bromocryptine failed to influence these effects. NSAID's: Only drugs of the piroxicam category produced interference on the overall trend of increment in NK activity, whilst Ketorolac did not appear to modify this significantly. Ketotolac produced a stimulant effect on LAK activity. Conclusions: Inducibility of LAK cells suggests that the immunodeficiency found in these patients does not affect the potential of lymphoid cells to acquire high cytotoxic activity. Any interference seems to be mediate by a 2textdegree, messenger-RNA and suggest to study which antalgic model is to use during therapy with LAK cells and IL2,},

keywords = {Abstracts},

pubstate = {published},

tppubtype = {inproceedings}

}

@inproceedings{IFESS1998_061,

title = {OPTIMIZATION OF PARAMETERS OF ABDOMINAL MUSCLES STIMULATION FOR AUGMENTATION OF PULMONARY VENTILATION IN TETRAPLEGI},

author = {F Kandare and U Stanie and J Jeraj and J Sorli and R Jaeger},

editor = {Manfred Bijak and Winfried Mayr},

url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_061_Kandare.pdf},

isbn = {3-900928-04-5},

year  = {1998},

date = {1998-08-01},

pages = {061},

publisher = {IFESS_1998},

address = {Luzern, Switzerland},

abstract = {The main goal of abdominal muscles stimulation is augmentation of pulmonary ventilation to a level appropriate to metabolic demands of the patient. In preliminary experiments in patients with spinal cord injury, abdominal muscles stimulation (FES) produced an approximately 50% increase over baseline ventilation. This was achieved in experiments where the duration of the stimulation was 10 minutes. For clinical application, durations of FES supported ventilation will probably need to be effective for on the order of several hours. This might allow temporary substitution for invasive modes of ventilation support e.g. mechanical ventilation or phrenic pacing, thus enabling better quality of activities of daily living. One of the limiting factor could be the fatigue of stimulated muscles. This paper presents results of experiments in which the duration of stimulation sequence, the parameters of stimulation and different combinations of abdominal muscle groups were tested. The optimal duration of stimulation sequence was one second. The intermittent stimulation mode of rectus abdominis and lateral group of abdominal muscles seems to offer maximum increase of ventilation. The amplitude of stimulation has to be individually adjusted to get effective contractions at acceptable levels of sensation. The results offer a possibility of a new design of implantable stimulator, exploiting the effects of augmented ventilation by abdominal FES.},

keywords = {Abstracts},

pubstate = {published},

tppubtype = {inproceedings}

}

@inproceedings{IFESS1998_164,

title = {OPTIMIZING MACHINE LEARNING IN FUNCTIONAL ELECTRICAL STIMULATICN ASSISTED FOOT-DROP CORRECTION BASED ON NATURAL SENSORS: A CASE STUDY},

author = {M Hansen and A Kostov and M K Haugland and T Sinkjaer},

editor = {Manfred Bijak and Winfried Mayr},

url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_164_Hansen.pdf},

isbn = {3-900928-04-5},

year  = {1998},

date = {1998-08-01},

pages = {164},

publisher = {IFESS_1998},

address = {Luzern, Switzerland},

abstract = {Purpose: We applied machine learning (ML) techniques to sensory nerve signals for accurate detection of gait events needed to assure safe stimulation timing for foot-drop correction using Functional Electrical Stimulation. Method: Adaptive Logic Networks (ALN) were used as a gait event discriminator using sensory electroneurogram (MG) as input in an off line system. The ENG signal was recorded from the Sural nerve in a hemiplegie male participant. One typical data set was chosen for ML training and one for testing ML detection performance. Parameters for signal processing, feature extraction, and ML training were optimized running large numbers of training and test sessions using variations of parameter values. Adaptive statistical restriction rules were developed and applied to the ALN output variable to eliminate erroneous transitions between stance and swilng phases. Result: Parameters were optimized and for the data sets included in the study, detection rates approached 100 % after applying restriction rules. Conclusion: We have demonstrated that ALN detection of gait events can be a useful method for detecting heel strike and lift-off. The simple processing and feature extraction methods used in this study along with the relative low computational requirements of ALNs make it feasible to implement an ALN based foot-drop correction system in real time.},

keywords = {Abstracts},

pubstate = {published},

tppubtype = {inproceedings}

}

@inproceedings{IFESS1998_106,

title = {THE OPTIMUM STIMULUS FREQUENCY FOR THERAPEUTIC ELECTRICAL STIMULATION},

author = {A Misawa and Y Shimada and K Sato and T Matsunaga and Y Tsutsumi and T Kashiwagura and M Sato and T Chida},

editor = {Manfred Bijak and Winfried Mayr},

url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_106_Misawa.pdf},

isbn = {3-900928-04-5},

year  = {1998},

date = {1998-08-01},

pages = {106},

publisher = {IFESS_1998},

address = {Luzern, Switzerland},

abstract = {OBJECTIVE: In order to restore ambulatory function in paralyzed lower limbs, the force of atrophied quadriceps muscles must be increased. Therapeutic electrical stimulation(TES) has been performed to increase the force of these muscles, however, the optimal stimulus frequency for TES has not been determined. The purpose of this study is to compare the muscle weight of tibialis anterior(TA) and extensor digitorum longus(EDL) of rats after stimulation at different frequencies. MATERIALS: TA and EDL muscles of male Wistar rats (n=16) were used in this study. The muscles were atrophied through suspension. METHODS: Electrodes were implanted unilaterally in the vicinity of the peroneal nerve, and led under the skin towards the back of rats. TA and EDL were stimulated for 30min/day, at either 20, 75 or 100Hz, for up to 3weeks. Pulse width was 0.2ms and voltage was adjusted to give maximal contraction force on palpation. After stimulation studies were completed, the TA and EDL muscles from both legs were surgical removed and weighed. RESULTS: A comparison between stimulated muscle and non-stimulated muscle was done. The muscle weight of TA and EDL stimulated at 20Hz was significantly lower(TA:p<0.01, EDL:p<0.05). There was no significant difference between muscles stimulated at 75 and 100Hz. CONCLUSION: These results suggest that high frequency stimulation for atrophied muscles may be useful in avoid muscle atrophy and increasing muscle weight.},

keywords = {Abstracts},

pubstate = {published},

tppubtype = {inproceedings}

}

@inproceedings{IFESS1998_141,

title = {THE ORDER OF PARESTHESIAS IN TRANSVERSE TRIPOLAR FIELD STEERING IS DETERMINED BY DORSAL COLUMN TOPOGRAPHY},

author = {J Holsheimer and W A Wesselink and G W King},

editor = {Manfred Bijak and Winfried Mayr},

url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_141_Holsheimer.pdf},

isbn = {3-900928-04-5},

year  = {1998},

date = {1998-08-01},

pages = {141},

publisher = {IFESS_1998},

address = {Luzern, Switzerland},

abstract = {Purpose: The aim is to test whether the order of initial paresthesias, when steering the stimulation field from left to right over the dorsal columns, can be predicted by the topography of this spinal pathway. Transverse steering in SCS is enabled by a transversely positioned tripole (central cathode) driven by a dual channel pulse generator. In the dorsal columns the dermatomes are represented by the corresponding fibres in an orderly way from medial to lateral. The most caudal dermatomes (S4-S5) are at midline, followed laterally by the successive rostral dermatomes up to the segmental level where the transverse tripole is situated. Method: Chronic pain patients having a transverse tripolar SCS system implanted at thoracic levels T6-T12 were used to locate the initial paresthesia when steering was varied between the extreme 'left' and 'right' settings. Results: In most patients a substantial steering of paresthesia was observed. Starting at the extreme 'right' balance setting, the initial paresthesia was at the right anterior thigh, or rostrally. At consecutive balance settings towards 'left', the initial paresthesias were at the right anterior leg, foot, posterior leg, posterior thigh, buttock, and perineum, successively, and followed by the left buttock, left posterior thigh, etc., up to the most rostral dermatome at the left side. Conclusions: Paresthesia steering relates well to dorsal column topography. In contrast to conventional SCS systems, the transverse tripolar system enables paresthesia to be steered and focused at the painful area in a predictable way.},

keywords = {Abstracts},

pubstate = {published},

tppubtype = {inproceedings}

}

@inproceedings{IFESS1998_015,

title = {PAIN AND ITS DIFFERENTIAL NEUROMODULATION FROM THE POINT OF INFORMATION THEORY AND FUNCTIONAL SYSTEMS},

author = {V F Gulik and A B Mullov and S S Mainagashev and V D Slepushkin},

editor = {Manfred Bijak and Winfried Mayr},

url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_015_Gulik.pdf},

isbn = {3-900928-04-5},

year  = {1998},

date = {1998-08-01},

pages = {015},

publisher = {IFESS_1998},

address = {Luzern, Switzerland},

abstract = {Pain is viewed as a regulatory information signal, caused by modulation of sensory signals, coming to central nervous system (CNS). Physiological modulation of pain signal can be presented in four stages, the whole of which is thought as a pain conceptual model: the stages of efferent synthesis, decision making, efferent synthesis and reverse efferent. Purpose: development of indications for differential prescription of ways and methods of neuromodelling therapy on the basis of evaluation of an organism slow regulation. Method: With 5000 women at different delivery periods and 300 patients with osteochondrosis of different localisation slow regulation has been evaluated within frequency ranges 0,004-0,08; 0,09-0,16 and 0,17-0,5 Hz informational entropy (informational quantity) has been calculated. Result: we found out different combination types of changes of slow regulation of organism and clinical signs of pain. Indices of slow regulation and clinical signs will help to reduce pain by different information neuromodulators - electric, wave, pharmacological, refectory, verbal and others. Conclusion: Pain is an information signal, the result of discoordination between sensomotor and metabolic relations. Under the influence of this signal dominating functional system of pain is formed, which affects other functional systems of an organism. Pain, being a dynamic synthesising information signal, it should be modulated by ways and methods allowing for pain system composition and peculiarities of its formation. Without neuromodelling therapy is not effective information system of pain is not distructed and is not blocked, and as a result, a pathological system of pain is formed.},

keywords = {Abstracts},

pubstate = {published},

tppubtype = {inproceedings}

}

@inproceedings{IFESS1998_008,

title = {PARAVERTEBRAL STRUCTURES AS A MAIN SUBJECT FOR PAIN MANAGEMENT},

author = {A I Soukhanov},

editor = {Manfred Bijak and Winfried Mayr},

url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_008_Soukhanov.pdf},

isbn = {3-900928-04-5},

year  = {1998},

date = {1998-08-01},

pages = {008},

publisher = {IFESS_1998},

address = {Luzern, Switzerland},

abstract = {Purpose: I have worked out the conceptions of fighting with the pain. If the pain syndrome has a large duration the secondary disorders spring up, but already in a hardest degree, than basic diseases. A pain springs up in that part of a tissue where the ischemia exists. Ischemia springs up in a place of the spasm of a vessels. Spasm is arising as a result of the irritation of nervous going along vessels. The pathological changing resulting in a pain is provoked by a squeezing of roots and ganglions going out between vertebras. A ganglion is twice or more thick as a root and it, its supplying suffer first of all when any kind of damage takes place. As a result of squeezing of ganglion the distortion of electric information, going further from ganglion springs up. Method: I have worked out the method of liquidation of squeezing syndrome and upsetting of nervous structures supplying with restoration of a tissue supplying on the periphery, liquidation of commissural complex forming as a result of development of a local pathological process. Result: The amount of patients cured according to our method within the last ten years was more than 5000. Among them the percentage of curing is: hard cases-95%, middle and light cases-100% . Statistic researches were carried out according to a principle of division an expression of a pain syndrome on the three degrees of hardness. Finding was determined according to the value of reduction and disappearance of a pain.},

keywords = {Abstracts},

pubstate = {published},

tppubtype = {inproceedings}

}

@inproceedings{IFESS1998_087,

title = {PELVIC NERVE AND SACRAL ROOT ACTIVITY DURING BLADDER DISTENSIONS AND CONTRACTIONS},

author = {J Saso and W Jianguo and N J M Rijkhoff and W M Grill and J C Djurhuus and T Sinkjaer},

editor = {Manfred Bijak and Winfried Mayr},

url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_087_Saso.pdf},

isbn = {3-900928-04-5},

year  = {1998},

date = {1998-08-01},

pages = {087},

publisher = {IFESS_1998},

address = {Luzern, Switzerland},

abstract = {Purpose: Electrodes implanted on suitable lower urinary tract (LUT) nerves might be used to record neural activity and provide sensory information from the bladder receptors as well as information about the activation of the detrusor and sphincter muscles. They can also be used for electrical nerve stimulation and blocking of the neural traffic. All these options of neural control could allow restoration of the normal LUT function in neuropathic patients. Methods: Cuff electrodes were used to measure activity from different sacral roots and pelvic nerve in pigs and cats during bladder fillings/emptyings, rapid injections of fluid into the bladder and quasi-periodic reflex bladder contractions. Bladder and rectal pressures were monitored continuously. Results: We observed slow neural activity increases during bladder filling, and sudden phasic increases during fast bladder injections, which were both mainly due to increased firing of bladder wall receptors. Withdrawal of fluid caused a decrease in recorded activity. Before and during the onset of reflex bladder contractions there was an increase in the nerve activity presumably caused by the activation of efferent parasympathetic fibers innervating the detrusor, but also by the increased activity in bladder afferents during increased bladder pressure. Decrease in the activity responsible for bladder contractions was followed by bladder relaxation. Conclusions: Efferent and afferent information from the LUT is present in the sacral roots and pelvic nerve and can be extracted from the cuff electrode recordings from these nerves. Applications of recording include detection of the onset and duration of bladder contractions and determination of the bladder volume.},

keywords = {Abstracts},

pubstate = {published},

tppubtype = {inproceedings}

}

@inproceedings{IFESS1998_158,

title = {PERIDUROSCOPY: PRELIMINARY REPORTS - TECHNICAL NOTES},

author = {W Raffaeli},

editor = {Manfred Bijak and Winfried Mayr},

url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_158_Raffaeli.pdf},

isbn = {3-900928-04-5},

year  = {1998},

date = {1998-08-01},

pages = {158},

publisher = {IFESS_1998},

address = {Luzern, Switzerland},

abstract = {PURPOSE: Evaluation of epiduroscopy as technique for treatment of FBSS. METHODS: Patients: 12 FBSS - 4 spinal stenosis and epidural scar -4 hernia - 4 LBP - 1 diabetic neuropathy. Scheduled by clinical and instrumental evaluation Repere peridural space: a paramedia approach at the lumar level in 6 cases caudal in and 19 cases. A 14 G. needle was put above the pathological site to treat. Visualitation by introduction of physiological solution (vols. from 300 ml to 1200 ml). Check of liquids diffusion by contrast. Unbridling of the fibrous lacinie with an instrumental pressure dilation. Administration in phlogosis sites of drugs. RESULTS: No alterations in 2 patients with FBSS. Pathological structures in 2 patients scheduled as depress . High enough correlation among pain symptom predominance of neuropathic disorders and peridural fibrous lacinie quantity . Relashionship among the period of time since the operation and fibrosis resistance to the unbridling. Hernia with sciatica only 1 patient was subjected to intervention. Presence, also in the normal epidural space, of anatomical abnormality. COMPLICATIONS 1 : intraoperative bradysistolia 2: serious intraoperative medulla-radicular irritation 1 : diffuse tonic-clonic spasms at lower limbs and at parachidian musculature, after (30 m) the end of the operation. CAT: pneumoencephalon. 1 intraoperative dysesthesia at lower limbs . All ad integrum in few hours. DISCUSSION Diagnostic To determine quantity and quality of intrarachidian pathologies, above all In negative NMR syndromes differential diagnosis vs. psychopathological attitudes Therapeutic Release Of the peridural site from connective - pathological fibres, especially at the beginning with the cicatrization.},

keywords = {Abstracts},

pubstate = {published},

tppubtype = {inproceedings}

}

@inproceedings{IFESS1998_075,

title = {PERIPHERAL NEUROSTIMULATION IN THE CONTROL OF ESSENTIAL TREMOR},

author = {L M Silverstone and J A Cella and S R Nusinow and A Mossanen},

editor = {Manfred Bijak and Winfried Mayr},

url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_075_Silverstone.pdf},

isbn = {3-900928-04-5},

year  = {1998},

date = {1998-08-01},

pages = {075},

publisher = {IFESS_1998},

address = {Luzern, Switzerland},

abstract = {Purpose: Essential Tremor (E.T) is the most common adult movement disorder. Good results have been obtained using the thalamus implant for deep brain stimulation but it is expensive and the effect is unilateral. We are carrying out studies on the treatment of E.T. using the neuromodulator Synaptic(R) 2000 to assess efficacy of a non-invasive and inexpensive approach. Method: This neuromodulator employs "SEA" technology (Synaptic Electronic Activation) having an electrical waveform with a fast rise time and a slow decay. Adhesive electrodes are placed in the "central location"; one pair bilateral to the spine at C 6 and the second pair bilateral to the spine at L5. Treatment is carried out for 45 minutes by the patient using a hand-held remote controller. A frequency of 30K Hertz is used and as treatment progresses it is adjusted downwards to 2.5K Hertz with the amplitude kept constant. The device delivers this pattern of treatment over ten intensity increments. Result: Using this device bilateral hand tremors are controlled for up to five hours after the first treatment. Weekly treatments have resulted in bilateral control of hand and head tremor by the fourth session. A greater degree of bilateral control was achieved with daily treatments. One E.T. patient has been under treatment for fifteen months and on a scale of 1 -10, with 1 being tremor-free and 10 being the pre-treatment level, this patient is rated a 2 and uses the device three times a week. Conclusion: Good bilateral control of E.T. has been obtained using this non-invasive and relatively inexpensive device. Neurochemical assays show post-treatment neuromodulation.},

keywords = {Abstracts},

pubstate = {published},

tppubtype = {inproceedings}

}

@inproceedings{IFESS1998_133,

title = {A POSSIBILITY OF USING M-WAVES EVOKED BY DOUBLE PULSES FOR EVALUATING MUSCLE FATIGUE ON FES CONTROL},

author = {T Watanabe and N Miura and T Kamimura and S Ohba and R Futami and N.andHanda Hoshimiya},

editor = {Manfred Bijak and Winfried Mayr},

url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_133_Watanabe.pdf},

isbn = {3-900928-04-5},

year  = {1998},

date = {1998-08-01},

pages = {133},

publisher = {IFESS_1998},

address = {Luzern, Switzerland},

abstract = {Purpose: A new method of using M-wave in evaluating muscle fatigue in detail for FES control are proposed in this study. The method uses M-waves evoked by double pulses with various inter-pulse intervals which are inserted into a stimulus pulse train at a fixed interval Methods: M-waves and the isometric muscle force was measured with three healthy subjects when the vastus lateralis was stimulated at maximum amplitude with 0.3msec of pulse width and 20Hz of stimulus frequency. Results: We have found that the peak-to-peak amplitude of the M-wave, which was evoked by the stimulus pulse just after the double pulse, decreased earlier and sharper than that by the stimulus pulse just before the double pulse. The stimulus pulse just before the double pulse is equivalent to the stimulus pulse in a pulse train without double pulses. The amplitude of the M-wave evoked by the stimulus pulse just after the double pulse had a larger correlation coefficient (0.923) with the isometric muscle force than that by the stimulus pulse just before the double pulse (0.783). The peak-to-peak amplitude of M-wave evoked by the second pulse of the double pulse decreased sharply with decreasing inter-pulse intervals of double pulse. Conclusions: It has been suggested from the results that the method of using double pulses with various inter-pulse intervals in a pulse train has the ability to evaluate muscle fatigue in more detail.},

keywords = {Abstracts},

pubstate = {published},

tppubtype = {inproceedings}

}

@inproceedings{IFESS1998_024,

title = {THE POST-STIMULATION ANALGESIC EFFECT OF TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION (TENS) IS MORE PROFOUND THAN DURING STIMULATION},

author = {G L Y Cheing and C W Y Hui-Chan},

editor = {Manfred Bijak and Winfried Mayr},

url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_024_Cheing.pdf},

isbn = {3-900928-04-5},

year  = {1998},

date = {1998-08-01},

pages = {024},

publisher = {IFESS_1998},

address = {Luzern, Switzerland},

abstract = {Purpose: Spinal cord stimulation (SCS) has been used for the treatment of intractable angina pectoris unresponsive to other treatments since 1985. Numerous peer-reviewed journal articles have documented the effectiveness of this technique. All previous articles have been studies published by European and Austrailian centers. The United States has an estimated population of 30,000 patients with intractable angina. This is the first report to describe the treatment of an American patient and compares the cost of care for two years prior to and two years after implantation. Methods: Hospital and outpatient clinical and billing records were reviewed. Treatment costs before and after the implant were compared. Results: SCS therapy provided an immediate improvement in the quality of life and requirements for medical care. In the two years prior to the implantation the patient had 11 hospitalizations totaling 90 days for treatment of angina. In the first two years of SCS treatment the patient had 3 hospital admissions for a total of 8 days for arrhythmia treatment but no admissions for chest pain. Outpatient records documented a resolution of intractable angina. Conclusion: Treatment of intractable angina pectoris with SCS is a cost-effective and proven therapy under utilized in the USA. It is estimated that approximately 1000 angina patients are currently under treatment with SCS worldwide. Although, SCS is a popular treatment for chronic neuropathic pain in the USA, it has not been used for cardiac pain. Adding intractable angina pectoris to SCS indications in the USA would provide a significant cost-benefits.},

keywords = {Abstracts},

pubstate = {published},

tppubtype = {inproceedings}

}

@inproceedings{IFESS1998_074,

title = {POTENTIAL USES OF INJECTABLE MICROSTIMULATORS AND MICROSENSORS},

author = {P Meadows and C Mann and J Schulman},

editor = {Manfred Bijak and Winfried Mayr},

url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_074_Meadows.pdf},

isbn = {3-900928-04-5},

year  = {1998},

date = {1998-08-01},

pages = {074},

publisher = {IFESS_1998},

address = {Luzern, Switzerland},

abstract = {A novel class of microminiature electrical stimulators is being developed that can provide single to multiple channels of electrical stimulation to persons with neural impairment. A single external controller delivers power and command signals to up to 256 implanted devices, without percutaneous leads or interconnecting wires between devices, and in hermetic packages that will function for many applications for decades. The placement of these devices within the body and their cost compares favorably to traditionally larger single and multichannel stimulation devices. These microstimulators may be used to excite peripheral and central nerve for a myriad of applications, including spinal cord stimulation, bowel and bladder dysfunction, hemi-, para-, and quadriplegic limb advancement and shoulder subluxation, to name but a few. are being developed which will report joint angles, tendon tension, electromyographic and other biomechanical and bioelectrical information as well as stimulator supply, electrode voltages and other pertinent system status information to the external controller. The technology behind these developments and the clinical applications which could benefit from that technology will be described.},

keywords = {Abstracts},

pubstate = {published},

tppubtype = {inproceedings}

}

@inproceedings{IFESS1998_021,

title = {PRELIMINARY RESULTS OF PERIPHERAL NERVE STIMULATION FOR INTRACTABLE LOWER EXTREMITY NERVE PAIN},

author = {L C Schon and PW-C. Lam and C D Anderson and M E Easley and H J Trnka},

editor = {Manfred Bijak and Winfried Mayr},

url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_021_Schon.pdf},

isbn = {3-900928-04-5},

year  = {1998},

date = {1998-08-01},

pages = {021},

publisher = {IFESS_1998},

address = {Luzern, Switzerland},

abstract = {Purpose: To report the preliminary results of using peripheral nerve stimulation to reduce symptoms and improve function in patients with intractable lower extremity nerve pain. Method: We retrospectively reviewed the records of 19 patients (22 lower extremities) with intractable lower extremity nerve pain managed with peripheral nerve stimulation at our institution between November 1995 and March 1998. Mechanisms of original nerve compromise included 8 crush, 4 stretch, 3 surgical scarring, 3 repetitive trauma, 2 metabolic, and 2 idiopathic etiologies. Duration of symptoms before stimulator implantation averaged 33 months (range, 7 to 108 months). All 22 extremities had failed previous nonoperative measures and had undergone an average of 2 (range, 0 to 12) unsuccessful nerve-related surgical procedures before implantation. Postimplantation follow-up averaged 14 months (range, 9 to 36 months). A single-lead system was used in 14 limbs; a dual-lead system was used in 8. Patients subjectively evaluated pain and functional levels pre- and postoperatively. Result: On a scale of 0 (no pain; total function) to 10 (pain severe enough to prompt request for amputation; use of wheelchair), pain and function improved an average of 4 points (range, 0 to 6 points) and 3 points (range, 0 to 6 points), respectively. One extension wire broke and required replacement. There were no deep infections; one superficial wound infection resolved uneventfully. One patient required revision of lead placement for loss of effective stimulation. Conclusion: This procedure appears to reduce symptoms and improve function in patients with intractable lower extremity nerve pain.},

keywords = {Abstracts},

pubstate = {published},

tppubtype = {inproceedings}

}

@inproceedings{IFESS1998_090,

title = {PROLONGED STANDING IN PARAPLEGIA USING CLOSED-LOOP FES AND ANDREWS ANKLE-FOOT ORTHOSIS},

author = {R Davis and T Houdayer and B Andrews},

editor = {Manfred Bijak and Winfried Mayr},

url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_090_Davis.pdf},

isbn = {3-900928-04-5},

year  = {1998},

date = {1998-08-01},

pages = {090},

publisher = {IFESS_1998},

address = {Luzern, Switzerland},

abstract = {One T-10 paraplegic male (CS) is able to achieve safe, closed-loop uninterrupted standing for over 1 hour with the Nucleus FES-22 stimulator (Cochlear Ltd., Lane Cove, N.S.W., Australia). Closed-loop control is achieved by monitoring the bilateral knee angles using electro-goniometers (Penny & Giles Ltd.), resulting in the stimulation time being reduced to less than 10%. Stance stability is achieved by the Andrews' anterior Ankle-Foot Orthosis. Using accelerometers (Analog Devices) for trunk inclination and vertical acceleration, controlled stand to sit diminishes slamming onto the seatCS is able to do one-handed tasks including reaching and holding at arm's length a 2.2 kg object. This has demonstrated the long-term use (6 1/2 years) of an implant for FES standing. In another T-10 paraplegic male (FR), we have been able to stimulate the both femoral nerves at the groin area by surface stimulation for conditioning and prolonged standing. He has been conditioning his quadriceps muscles daily for over 1 year and is able to produce up to 55 Nm at 45 degrees of knee flexion. With the anterior AFO and closed-loop knee monitoring, FR can stand uninterrupted for over 1 hour and perform one-handed tasks.},

keywords = {Abstracts},

pubstate = {published},

tppubtype = {inproceedings}

}

@inproceedings{IFESS1998_057,

title = {PROSPECTIVE RANDOMIZED TRIAL COMPARING INTRATHECAL NARCOTIC INFUSION TO BEST MEDICAL MANAGEMENT FOR BENIGN PAIN},

author = {J P Gorecki and L Rubin and J Lefevre and A Villavincencio},

editor = {Manfred Bijak and Winfried Mayr},

url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_057_Gorecki.pdf},

isbn = {3-900928-04-5},

year  = {1998},

date = {1998-08-01},

pages = {057},

publisher = {IFESS_1998},

address = {Luzern, Switzerland},

abstract = {Chronic intraspinal narcotic delivery is clearly a useful modality for the management of pain in patients with malignancy. This modality is also FDA approved for use in pain that is not associated with malignancy and is being used with increasing frequency. To date most reports are retrospective and involve relatively short follow up. There is some concern expressed over the possibility of tolerance developing over time in patients with benign pain. The cost effectiveness of this modality in this group of patients remains to be proven. The risks in this group of patients needs to be better defined with long term follow up. We have initiated a randomized prospective trial of intraspinal narcotics for the treatment of patients with benign pain. The control arm receives best medical management in a multidisciplinary pain clinic and may obtain ablative and anatomically corrective surgical interventions. Patients will be followed for 5 years allowing a steady state to be achieved and an effective analysis of the impact of tolerance. Each group will contain 272 patients to achieve statistical significance. We present an early progress report and review our proposed outcomes analysis tools. A special effort is incorporated to evaluate cost effectiveness of this modality that involves relatively high initial outlay. Patient selection is reviewed in detail including several psychological screening tools.},

keywords = {Abstracts},

pubstate = {published},

tppubtype = {inproceedings}

}

@inproceedings{IFESS1998_151,

title = {PROSPECTIVE STUDY ON THE EFFECT ON THE NEUROMODULATION ON THE WALKING PATTERN IN THE TREATMENT OF THE PATIENT WITH THE FAILED BACK SURGERY SYNDROME (FBSS)},

author = {L Jacques and T DelDuca and P Allard},

editor = {Manfred Bijak and Winfried Mayr},

url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_151_Jacques.pdf},

isbn = {3-900928-04-5},

year  = {1998},

date = {1998-08-01},

pages = {151},

publisher = {IFESS_1998},

address = {Luzern, Switzerland},

abstract = {Objective and Importance The role of the neuromodulation in the pain management for the FBSS is well known and recognize. The aim of this presentation is to study the walking pattern before and after the implantation of the neurostimulator and evaluate the consequences related to it . Methods 15 patients has been studied with detailed neurological examinations, measurement of the articulations amplitude, video camera and questionnaires before and at one, three, six and twelve months after the implantation. Results and Conclusions The pattern of walk of the patient improves very shortly even at one month post operatively. We think that with a better posture and better pattern of walk the patient could avoid further back injury as well as further orthopedic complications.},

keywords = {Abstracts},

pubstate = {published},

tppubtype = {inproceedings}

}

@inproceedings{IFESS1998_134,

title = {A PURPOSE FOR EMIPLEGIC PATIENT},

author = {D Rosselli and M Magliano},

editor = {Manfred Bijak and Winfried Mayr},

url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_134_Rosselli.pdf},

isbn = {3-900928-04-5},

year  = {1998},

date = {1998-08-01},

pages = {134},

publisher = {IFESS_1998},

address = {Luzern, Switzerland},

abstract = {The quick recovery of the functional limitations owing to ischemic attach is the subject of this report. The approach considers: the shoulder block, the elbow rigidity that often limit the carpal functionality and the fingers moviments (for upper limb; the iper- extension or forced flexion of the knee with wowing walk due to the limitation (flection) of the hip (for lower limb).The therapeutic method, In those cases, is an operative battery unit, a functional orthosys with built in electrodes and high frequency magnetical diffuser: to the shoulder (like a cuf) and a functional orthosys; to the wrist (extension or flection according to the cases; another dynamic one to the knee for the volountary extension or flection.The magnetical stimoulus works during the electrical stimoulus stop and vice verse. This kind of electrical and electromagnetical stimulation can help also in the reabilitation exercises. We have treated 100 patients: 80 male, 20 female from 48 to 70 years old. A remarkable shoulder, wrist, and fingers functionality improvement occurs at the 60th day after the therapy; a volountary knee articoularity control (also without functional orthosys) at 90th day.The final result was a remarkable articoular, muscoular, nervous activity improvement. In conclusion, the tutored electrical and high frequency electromagnetical stimulation,can help the emiplegic patients,in rehabilitation exercises and during his daily activity, with a reduction of the recovery time.},

keywords = {Abstracts},

pubstate = {published},

tppubtype = {inproceedings}

}

@inproceedings{IFESS1998_137,

title = {QUANTITATIVE ASSESSMENT OF RESULTS OF SPINAL CORD STIMULATION (SCS) IN REFLEX SYMPATHETIC DYSTROPHY BY AUTONOMIC FUNCTION TESTS},

author = {R Segal and M Giuliani and B Stacey and M-B Ott},

editor = {Manfred Bijak and Winfried Mayr},

url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_137_Segal.pdf},

isbn = {3-900928-04-5},

year  = {1998},

date = {1998-08-01},

pages = {137},

publisher = {IFESS_1998},

address = {Luzern, Switzerland},

abstract = {PURPOSE: Spinal cord stimulation (SCS) for reflex sympathetic dystrophy (RSD) is still sparsely used. Quantitative assessment of improvement is needed to demonstrate usefulness of SCS in RSD. METHODS: In this prospective study, 32 consecutive patients referred for RSD to a neurosurgeon (RS) since 1992 were evaluated with autonomic function tests: resting sweat output (RSO), Quantitative Sudomotor Axon Test (QSART), and thermography. RESULTS: Eleven out of 12 patients failing non-interventional management succeeded an SCS trial and underwent implantation of a Resume lead in 5 patients (4 cervical, 1 thoracic) and Pisces-Quad in 6 (2 cervical, 4 thoracic) and Itrel II generator. Follow up ranged from 1 to 54 mos, mean 16 mos. Only one patient requested removal of hardware; she demonstrated objective evidence of improvement of her causalgia, but complained of worsening of her failed back surgery syndrome. Autonomic function tests improved in all SCS patients. Rest sweating decreased 0.58 microliters (0.9-1.71) in 4 cases and increased 0.2 microliters (0.18-0.23) in 5. Stimulation sweating increased 3.01 microliters (0.58-7.55) in three cases while decreasing 2.33 microliters (0.28-7.76) in seven. Temperature increased in 10/11 cases, average 2.5 degrees C (0.5-7C). The autonomic tests deteriorated in one patient who experienced recurrence of symptoms with exhaustion of the SCS generator. Patients reporting worsening of symptoms coinciding with litigation in thw absence of objective findings on exam did not have changes in autonomic testing. Migration of RSD occurred in five patients and was confirmed with autonomic testing. CONCLUSION: We conclude SCS is helpful in RSD and that objective measurement of improvements are obtained with autonomic function tests.},

keywords = {Abstracts},

pubstate = {published},

tppubtype = {inproceedings}

}

@inproceedings{IFESS1998_142,

title = {QUANTITATIVE CLINICAL EVALUATION OF A TRANSVERSE TRIPOLAR SCS SYSTEM},

author = {W A Wesselink and J Holsheimer and G W Kingand},

editor = {Manfred Bijak and Winfried Mayr},

url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_142_Wesselink.pdf},

isbn = {3-900928-04-5},

year  = {1998},

date = {1998-08-01},

pages = {142},

publisher = {IFESS_1998},

address = {Luzern, Switzerland},

abstract = {Purpose: The aim is to validate the predicted performance of a transverse tripolar system for SCS in a clinical study. This system, including three transversely oriented electrode contacts and a dual channel pulse generator, is expected to give an increased usage range and thus an improved paresthesia coverage. Moreover, it is predicted that the initial paresthesia can be varied by electrically changing the focus of stimulation at the dorsal columns. Method: Data from 30 patients with primarily lower limb pain and electrodes placed at T6-T12 were analyzed. Testing with a dual channel pulse generator was performed just after implantation. The usage range was defined as the ratio of discomfort threshold and perception threshold, whereas steering was quantified by a normalized score between 0 (no steering) and 1 (perfect steering). Results: The average measured perception threshold was 2.6 Volts, whereas the average usage range was 1.8. The average normalized steering score was 0.63. The steering score was >0.5 in 73% of the patients, whereas 30% had a steering score >0.8. Conclusions: The transverse tripolar system gives a 30% higher average usage range than conventional electrodes, and enables substantial electrical steering of paresthesia. However, the average perception threshold is almost 90% higher than for conventional systems.},

keywords = {Abstracts},

pubstate = {published},

tppubtype = {inproceedings}

}

@inproceedings{IFESS1998_166,

title = {QUANTITATIVE COMPARISONS OF SPINAL CORD STIMULATION ELECTRODE DESIGNS},

author = {R North},

editor = {Manfred Bijak and Winfried Mayr},

url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_166_North.pdf},

isbn = {3-900928-04-5},

year  = {1998},

date = {1998-08-01},

pages = {166},

publisher = {IFESS_1998},

address = {Luzern, Switzerland},

abstract = {Purpose: The results of surgical treatment of the patients with nerve injury frequently remain unsatisfactory, especially in combined nerve and vessel damage. To improve the quantity of regenerating axons and restoration of function of the extremity direct electrostimulation of the operated nerves and hyperbaric oxygenation were carried out. Methods: 76 patients with injured cubital, medial, radial, peroneal nerves and brachial plexus trunks were examined. All the patient underwent neurolysis (removal of the scars compressing the nerve trunk). During the operation platinum electrodes were implanted into the nerve to execute direct electrostimulation postoperatively. Nerve blood flow measurements using hydrogen clearance method were performed via the same electrodes. Hyperbaric oxygenation therapy was performed postoperatively. The control group comprised 35 patients, in whom the operation of neurolysis was not followed by direct electrostimulation and hyperbaric oxygenation. Functional state of the nerve was estimated clinically (using 5-point scale of muscular strength and skin sensitivity and electrophysiologically (intensity-duration curve). Results: Direct electrostimulation of the nerves resulted in "normalization" of nerve blood flow (P < 0,01 Wilcockson criterion). Nerve function was restored better in the patients with direct electrostimulation of the nerves and hyperbaric oxygenation (p < 0,05). Conclusion: Additional direct electrostimulation of the nerve and hyperbaric oxygenation in postoperative period normalize disturbed nerve trunk blood flow and promote more complete restoration of function of the extremity.},

keywords = {Abstracts},

pubstate = {published},

tppubtype = {inproceedings}

}

@inproceedings{IFESS1998_073,

title = {RE-CONDITIONING OF PARETIC WRIST EXTENSOR MUSCLES BY FUNCTIONAL ELECTRICAL STIMULATION IN TETRAPLEGIC INDIVIDUALS - CONTRACTILE AND METABOLIC PROPERTIES},

author = {A Hartkopp and M Mizuno and B Quistorff and M Kjaer and F Biering-Sorensen},

editor = {Manfred Bijak and Winfried Mayr},

url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_073_Hartkopp.pdf},

isbn = {3-900928-04-5},

year  = {1998},

date = {1998-08-01},

pages = {073},

publisher = {IFESS_1998},

address = {Luzern, Switzerland},

abstract = {Purpose: Two different conditioning protocols, high resistance type (Hr) vs. low resistance type (Lr), in 12 C5/6 tetraplegics were evaluated. Methods: The stimulation was performed 30 min. per day, 5 day a week for 12 weeks, and involved dynamic loaded contractions. The Hr-regimen employed a frequency of 30 Hz and the duty circle was fixed to 5 sec on / 20 sec off. The Lr-regimen employed a frequency of 15 Hz and the duty circle was gradually changed from 5/20 to 5/5 sec. The nontrained arm was used as an internal control. Before and after training, maximal voluntary contraction (MVC), as well as electrically stimulated peak tetanic tensions at 15, 30 and 50 Hz (Po15, Po30 and Po50), and fatigue resistance (FR) were measured. The metabolism of the paretic muscle were evaluated by use of 31 phosphorus nuclear magnetic resonance spectroscopy, (31P-NMRS). This method evaluates the relative amount of phosphorus metabolites in the in vivo situation during electrically induced contractions, for example the phosphocreatine, (PCr), and the ATP. Results: FR improved with 42% and 41% (Student t-test, p<0.01, for both groups) in response to training, in the Hrgroup and Lr-group. In the Hr-group, Po15 the cumulated Po50+Po30+Po15 and MVC improved significantly with 19%, 18% and 34% (p<0.05), respectively. During, 40 sec of maximal stimulation at 10 Hz, in the magnet, the time tension integral tended to improve in the Hr-group and the anaerobic ATP-production rates decreased with 29% (p<0.05). The contractile efficiency, i.e. ATP consumption divided by the time tension integral, improved after training in the Hr-group with 38% (p<0.05) and the half-time of PCr recovery was shortened with of 52% (p<0.05). In contrast no changes in strength or 31P-NMRS figures were observed in the Lr-group after training. Conclusion: Increased FR of the paretic wrist extensor muscles in tetraplegic individuals was demonstrated with both protocols. However, only the Hr-group was able to demonstrate increased muscle force and improved muscle metabolism after training, indicating that the Hr-protocol is superior to the Lr-protocol for conditioning of paretic muscles.},

keywords = {Abstracts},

pubstate = {published},

tppubtype = {inproceedings}

}

@inproceedings{IFESS1998_064,

title = {RELIEF OF NEUROPATHIC PAIN WITH CARBAMAZEPINE (CMZ)and EXTENDED-RELEASE MORPHINE (MO) AND SPINAL CORD STIMULATION (SCS). A DOUBLE-BLIND CROSSOVER STUDY},

author = {H Harke and H U Ladleif and P Gretenkort},

editor = {Manfred Bijak and Winfried Mayr},

url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_064_Harke.pdf},

isbn = {3-900928-04-5},

year  = {1998},

date = {1998-08-01},

pages = {064},

publisher = {IFESS_1998},

address = {Luzern, Switzerland},

abstract = {Purpose: Pain due to chronic nerve injury is often resistent to conventional analgesics. The aim of the present study was to assess the responsiveness of neuropathic pain (NP) to SCS in comparison to CMZ and MO in a placebo controlled, double-blind randomized trial. Methods: 43 SCS patients suffering from NP more than 10 years were randomly allocated during a stimulation free period to receive either CMZ (600 mg/d), MO (90 mg/d) or placebo. In case of lack of analgesic effects, the patients were authorized to reactivate their SCS. Results: CMZ provided slightly significant pain relief, whereas MO as well as placebo were ineffective (p = 0,005). In general NP increased despite medical treatment from 2 to 8.5 NAS. In contrast, patients (n=35) who had reactivated their SCS showed significant relief of the NP (p=0,001). Conclusion: Different therapeutic strategies are necessary in the management of NP. However, in case of failure of medical treatment SCS might be an effective alternative.},

keywords = {Abstracts},

pubstate = {published},

tppubtype = {inproceedings}

}

@inproceedings{IFESS1998_102,

title = {RESTORATION OF STANDING AND WALKING ABILITY IN PARAPLEGIA BY FES WITHOUT ORTHOTICS},

author = {K Ihashi and R Yagi and S Tanaka and T.Handa Fujii},

editor = {Manfred Bijak and Winfried Mayr},

url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_102_Ihashi.pdf},

isbn = {3-900928-04-5},

year  = {1998},

date = {1998-08-01},

pages = {102},

publisher = {IFESS_1998},

address = {Luzern, Switzerland},

abstract = {Purpose: We are studying restoration of standing and walking function in patients with paraplegia by means of FES without orthotics. Percutaneous intramuscular wire electrodes and a portable multi-channel stimulator which we developed have been using to restore both functions. The purpose of this study was to investigate the benefit of our FES system for restoration of standing and walking ability in paraplegic patients. Methods The patients were 5 paraplegics at T2 to T12 levels of lesion due to spinal cord injury or spinal vascular accident. The patients underwent electrodes implantation at 15 to 120 months after the on set. Training stimulation for muscle strengthening was performed for 5 to 12 months. The quadriceps femoris, gluteus maximus, gluteus medius, adductor magnus, peroneal nerve and tbial nerve were stimulated to restore the standing. Walking was tried out for two patients who had T12 level of lesion. Results: All patients were able to maintain standing posture for more than 15 minutes with FES. The support of upper extremity was required to maintain balance, but any orthotics for lower extremity were not needed. Furthermore, two T12 lesion patients were able to do reciprocal gait in a parallel bar. Conclusions: Standing and walking in the paraplegics were restored by the FES without the aid of orthotics. The restored walking ability had a limitation. But, our FES system which is not use orthotics was considered a practical way to reestablish standing and walking ability in paraplegics.},

keywords = {Abstracts},

pubstate = {published},

tppubtype = {inproceedings}

}