1/9. Bilateral extracorporeal shock wave lithotripsy in a spinal cord injury patient with a cardiac pacemaker.OBJECTIVES: To review the precautions to be observed before and during extracorporeal shock wave lithotripsy (ESWL) in spinal cord injury (SCI) patients with a cardiac pacemaker and the safety of bilateral ESWL performed on the same day. DESIGN: A case report of bilateral ESWL in a SCI patient with a permanent cardiac pacemaker. SETTING: The Regional spinal injuries Centre, Southport, the lithotripsy Unit, the Royal Liverpool University hospitals NHS trust, Liverpool, and the Department of cardiology, Manchester Royal Infirmary, Manchester, UK. SUBJECT: A 43-year-old male sustained a T-4 fracture and developed paraplegia with a sensory level at T-2. During the post-injury period, he developed episodes of asystole requiring implantation of a dual chamber (DDD) permanent pacemaker. Twenty-one months later, he developed a right ureteric calculus with hydronephrosis. A radio-opaque shadow was seen in the left kidney with no hydronephrosis. During right ureteric stenting, the ureteric stone was pushed into the renal pelvis. 1,500 shock waves were delivered to this stone on the right side, followed by ESWL to the left intra-renal stone with 1250 shock waves. RESULTS: The patient tolerated ESWL to both kidneys. The pacemaker was reprogrammed to a single chamber ventricular pacing mode at 30 beats per minute with a reduced sensitivity during lithotripsy. There were no untoward cardiac events during or after lithotripsy. The serum creatinine was 45 micromol/l before lithotripsy and 44 micromol/l two weeks after ESWL. CONCLUSION: SCI patients with a cardiac pacemaker may be able to undergo extracorporeal shock wave lithotripsy following temporary reprogramming of the pacemaker. Bilateral, simultaneous ESWL is safe in the vast majority of patients provided that there is no risk of simultaneous ureteric obstruction by stone fragments. However, it should be remembered that a decrease in renal function could occur following bilateral ESWL of renal calculi.- - - - - - - - - - ranking = 1keywords = programme (Clic here for more details about this article) |
2/9. New controller for functional electrical stimulation systems.A novel, self-contained controller for functional electrical stimulation systems has been designed. The development was motivated by the need to have a general purpose, easy to use controller capable of stimulating many muscle groups, thus restoring complex motor functions (e.g. standing, walking, reaching, and grasping). The designed controller can regulate the frequency, pulse duration, and charge balance on up to 16 channels, and execute pre-programmed and sensory-driven control operations. The controller supports up to eight analog and six digital sensors, and comprises a memory block for including history of the sensory data (time series). Five independent timers provide the basis for the multi-modal and multi-level control of movement. The PC compatible interface is realised via an IR serial communication channel. The PC based software is user friendly and fully menu driven. This paper also presents a case study where the controller was implemented to restore walking in a paraplegic subject. The assistive system comprised the novel controller, the power and output stages of an eight-channel FES system (IEEE Trans Rehabil Eng, TRE-2 (1994) 234), ankle-foot orthoses, and a rolling walker. Stimulation was applied with surface electrodes positioned over the motoneurons that innervate muscles responsible for the hip and knee flexion and extension. The sensory system included goniometers at knee and hip joints, force-sensing resistors built in the shoe insoles, and digital accelerometers at the hips. A rule-based control algorithm was generated following a two-step procedure: (1) simulation and (2) machine learning as described in earlier studies (IEEE Trans Rehab Eng, TRE-7 (1999) 69). The paraplegic subject walked faster, and with less physiological effort, when automatic control was applied as compared to hand-control. This case study, as well as a previous one for assisting grasping (The design and testing of a new programmable electronic stimulator. N. Fisekovic, MS thesis. University of Belgrade, Belgrade, 2000) indicate that the novel control unit is effectively applicable to FES systems.- - - - - - - - - - ranking = 1keywords = programme (Clic here for more details about this article) |
3/9. Computer added locomotion by implanted electrical stimulation in paraplegic patients (SUAW).paraplegia means a live long sentence of sensory loss, paralysis and dependence with approximately 1000 new victims in every European country every year and 11.500 new traumatic SCI cases in the US. respectively. Sixty percent are injured before age 30. More than 90% of SCI victims may survive with nearly normal experience of live. Most patients will recover somewhat from SCI over time but no patient who remained plegic for one year regains voluntary motor function after that time period. Despite remarkable efforts and recent achievements in rehabilitation no treatment can be recommended so far to enhance functional recovery and restoring locomotion in paraplegic humans. FES as a technical compensation has become therefore a challenging treatment to restore muscle function and to prevent atrophy and to improve mobility and quality of life at the same time. In paraplegics FES could be the basis to restore locomotion. One of the advantages of an implanted FES version (neuroprosthesis) is that the FES system, electrodes, and cables remain permanently implanted within the body, so that the patient can stay without cables, the programmer attached to the crutches. The SUAW project, supported under BIOMED II Programme by the European Community was aimed to finalize and to put into practice the results of previous research and development. The novel implant with an ASCI-Chip has 16 channels, 8 on each side, 20 mA for monopolar and 2 mA for bipolar stimulation, only one electrode can be stimulated at a given time. Stimulation of 6 muscle groups of both legs are known to be sufficient for locomotion: M. ileopsoas (erector of the body, hip flexor), M. gluteus maximus (hip extensor), M. gluteus medius (lateral hip stabilisator, knee abductor), Mm. hamstrings (knee flexor) stimulated by epimysial electrodes, Mm. sartorius and rectus femoris (knee extensor) stimulated by neural, bipolar electrodes. Patient's selection criteria were: stable spinal cord lesion between T7 and T11, minimum 1 year after the accident without deformity of the spine, the muscle groups for locomotion responding to external FES with the EXOSTIM programmer with the same programme used later for the neuroprosthesis. Two paraplegic male patients, T8, 38 and 31 years old respectively, were operated on by an international group of surgeons according to the protocol in 09/1999, respectively 7/2000. The postop. course was uneventful. Because the threshold of the primary implant was too low regarding scare tissue around the electrodes, this implant was changed in 01/2000 and worked perfectly. Both patients are happy with the success of the novel treatment modalities.- - - - - - - - - - ranking = 3keywords = programme (Clic here for more details about this article) |
4/9. Electrical muscle stimulation in combination with a reciprocating gait orthosis for ambulation by paraplegics.Commercially available electrical muscle stimulators (EMS) provide functional electrical stimulation and are interfaced with reciprocating gait orthosis (RGO). The system which has been developed is described here as an EMS-RGO. Advantages of the system include: medically prescriptable subsystems available from manufacturers, and commercially recommended subsystems for applications such as gait training. The system itself employs four EMS units worn on a belt. It is controlled by remote switches and is interfaced to electrodes placed over the quadriceps, hamstring and gluteal muscle groups of each leg. Two EMS units (for quadriceps stimulation) function primarily for stand-up and sit-down. Two other EMS units (for stimulation of the hip extensors) function primarily for ambulation. Each EMS unit is powered by a nine volt alkaline transistor battery which provides about 36 stand-uphs and sit-down's and approximately 3.1 km of walking before replacement is necessary. The system has been evaluated on a T-5 level paraplegic individual who sustained a motor complete lesion (Frankel Class B) of the spinal cord over seven years ago. It is emphasized that successful EMS-RGO walking exercise must be preceded by a physical conditioning programme of active physical therapy. New battery technology (such as lithium batteries) may improve the useful lifespan of the system, and new electrode technology (such as TTGs) may improve patient acceptance of the system.- - - - - - - - - - ranking = 1keywords = programme (Clic here for more details about this article) |
5/9. Use of functional electrical stimulation in the rehabilitation of patients with incomplete spinal cord injuries.When patients enter the rehabilitation Centre a therapeutic electrical stimulation programme is immediately initiated. Three groups of patients were identified: (i) those in whom an improvement of both voluntary and stimulated muscle force was observed, (ii) those with an increase in stimulation response only, and (iii) patients in whom no effect of electrical stimulation training could be recorded. Isometric measurement of voluntary and stimulated knee joint torque revealed that in a great number of patients one leg was severely paralysed while the other leg was under sufficient voluntary control. Unilateral two-channel stimulation of knee extensors and the peroneal nerve was proposed as an orthotic aid for this group of patients. Exaggerated extensor tone was observed by assessment of spasticity around the knee joint. A two-channel peroneal stimulator was found to be a useful approach in order to inhibit this tone and thereby help the patients to initiate a step.- - - - - - - - - - ranking = 1keywords = programme (Clic here for more details about this article) |
6/9. Assisted fertility in complete paraplegia: case report.A 34-year-old paraplegic man with a spinal cord injury complete below the 6th thoracic segment fathered a child by artificial insemination using semen obtained by electro-ejaculation. A long fertility programme culminated in the delivery of a healthy male child weighing 3665 g in April 1987. Guidelines for a comprehensive fertility programme are discussed briefly.- - - - - - - - - - ranking = 2keywords = programme (Clic here for more details about this article) |
7/9. A case study of a female ultramarathon wheelchair road user.This unique report contains selected physical and structural characteristics of a female ultramarathon wheelchair road racer. When tested, this 25-year-old athlete weighed 65.6 kilograms, with a height of 171.4 centimetres. The resting heart rate was 57 beats per minute, which rose to a maximum of 161 during a progressive, arm-cranking, maximal work task. Maximum oxygen uptake was 21.0 ml X kg-1 X min-1. These values are significant, considering that this individual had traumatic paraplegia at the T-3/T-4 spinal level. She also had slight weakness of the upper extremities. It is suggested that with a graduated and intelligently structured training programme, greatly enhanced endurance capacity can be achieved. With the type of training outlined in this paper, an athlete who performs in a wheelchair can be conditioned to race successfully over distances of 26 to 50 miles.- - - - - - - - - - ranking = 1keywords = programme (Clic here for more details about this article) |
8/9. Supraventricular tachycardia as a presenting sign of pulmonary embolism in paraplegia. Case report and review.pulmonary embolism is a major complication after spinal cord injury and difficult to diagnose in any patient. Supraventricular tachycardia (SVT) is an unusual presentation for pulmonary embolism (PE). This article documents the records of a 60-year-old patient who was undergoing comprehensive rehabilitation after traumatic spinal cord injury and multitrauma. His treatment programme was interrupted by a PE with SVT as the only presenting symptom. This article outlines the clinical approach to the diagnosis of pulmonary embolism. A high index of suspicion of PE should always be kept in mind when SVT occurs in a spinal cord injured patient.- - - - - - - - - - ranking = 1keywords = programme (Clic here for more details about this article) |
9/9. Implantation of a 16-channel functional electrical stimulation walking system.A 16-channel electrical stimulation system was implanted in a 39-year-old patient with T10 paraplegia to restore sit to stand, walking, and exercise functions. System implantation required two surgical sessions. In the first session, the posterior muscle set consisting of bilateral semimembranosus, adductor magnus, and gluteus maximus muscles were exposed and epimysial electrodes sutured at the point of greatest muscle contraction. Closed double helix intramuscular electrodes were implanted in the erector spinae. Two weeks later, epimysial electrodes were attached to the eight anterior muscles consisting of the tibialis anterior, sartorius, tensor fasciae latae, and vastus lateralis with all 16 electrode leads passed to the anterior abdominal wall. The electrodes were connected to two eight-channel stimulators placed in the iliac fossae, and the system was checked by activating the individual muscles. The implanted stimulators received stimulation instructions and power via a radio frequency link to an external control. Stimulation patterns for standing, walking, sitting, and exercise functions were chosen from a preprogrammed menu via a finger key pad. After 3 weeks of restricted patient activity, all electrodes stimulated either the target muscle or had an acceptable spillover pattern. The patient is undergoing a 16-week rehabilitation course of stimulated exercises gradually increasing in intensity. At the conclusion, the goal is to discharge the patient with the system for spontaneous use. Although long term followup is required to determine system reliability, preliminary clinical results indicate that targeted, repeatable, functional muscle contractions in the lower extremity can be achieved with a system consisting of epimysial electrodes.- - - - - - - - - - ranking = 1keywords = programme (Clic here for more details about this article) |