Neuromodulation : journal of the International Neuromodulation Society
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Since their initial development, the performance gains in functional electrical stimulation (FES) systems have been modest. Conceptually, the replacement of normal neural function by artificial electronic systems is attractive, considering the continued technologic advancements in electronics, communication, and control. It is likely that efficacious FES systems will require complete implantation and activation of large numbers of motor units. ⋯ While an engineer might be pleased to design a system that functions, as intended, 99% of the time, if a user falls down 1 time out of every 100, this is likely to be unacceptable. The minimal threshold of functional utility for FES systems is unclear, and will not be addressed here. Rather, we consider the issues of what features and capabilities are desirable for next generation implantable systems, and to what degree these desires approach engineering feasibility.
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This paper discusses the use of electrical stimulation for cardiac assist and control of bladder and bowel. It describes the state of the art, what progress there will be in the coming 10 years and what problems need to be solved in order to make that progress. The paper speculates that within 10 years, there will be patients whose cardiac function is augmented by the pumping function of skeletal muscle assist devices, and furthermore that within 10 years new implantable devices will be available to improve both bladder and bowel emptying by electrical stimulation. Yet another implantable device may become available which allows treatment of detrusor hyperreflexia without the need for a dorsal sacral rhizotomy.
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Intraspinal drug delivery systems are becoming increasingly utilized for the management of patients with pain or spasticity. Numerous potential complications associated with the use of this technology have previously been described in the literature. We have had experience with a new complication of the internal alarm being triggered by the instillation of cold solution into the pump resevoir. This new finding could have implications for patients with respect to unnecessary reevaluations of the pump, or possible premature scheduling of pump replacement surgery.
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Objective. To evaluate changes in Minnesota Multiphasic Personality Inventory (MMPI) profiles pre- and post-treatment involving intrathecal opioid therapy. Patients and Methods. ⋯ Indeed, patients with the more normal profile pretreatment did not fare as well as those with the more elevated profile. A positive change in MMPI profile from pre- to post-treatment was associated with a higher level of pain reduction. Patient selection therefore should be based not on a single test such as the MMPI, but on consistency across multiple sources of information including physical examination, complaints of pain and disability, behavioral observations, and psychological testing.