Добірка наукової літератури з теми "Neurostimulation tibiale"

Peripheral nerve disconnections cause severe muscle atrophy and consequently, paralysis of limbs. Reinnervation of denervated muscle by transplanting motor neurons and applying Functional Electrical Stimulation (FES) onto peripheral nerves is an important procedure for preventing irreversible degeneration of muscle tissues. After the reinnervation of denervated muscles, multiple peripheral nerves should be stimulated independently to control joint motion and reconstruct functional movements of limbs by the FES. In this study, a wirelessly powered two-channel neurostimulator was developed with the purpose of applying selective FES to two peripheral nerves—the peroneal nerve and the tibial nerve in a rat. The neurostimulator was designed in such a way that power could be supplied wirelessly, from a transmitter coil to a receiver coil. The receiver coil was connected, in turn, to the peroneal and tibial nerves in the rat. The receiver circuit had a low pass filter to allow detection of the frequency of the transmitter signal. The stimulation of the nerves was switched according to the frequency of the transmitter signal. Dorsal/plantar flexion of the rat ankle joint was selectively induced by the developed neurostimulator. The rat ankle joint angle was controlled by changing the stimulation electrode and the stimulation current, based on the Proportional Integral (PI) control method using a visual feedback control system. This study was aimed at controlling the leg motion by stimulating the peripheral nerves using the neurostimulator.

Category: Ankle Introduction/Purpose: The bifurcation of the sciatic nerve results in the common peroneal nerve, along with the tibial nerve. A commonly block used before foot and ankle surgery is the sciatic block. This block requires an ultrasound or neurostimulation for accurate placement and can take time to administer effectively. We believe that the common peroneal, or high fibular nerve block, may be equivalent in some clinical circumstances to the sciatic block and does not require additional imaging for accurate placement. Methods: In this study, a mixture comprised of 5 mL 0.5% bupivacaine and 5 mL 1% lidocaine was used for each patient. Certain surface anatomic landmarks were used to place the block without ultrasound or neurostimulation. The time spent administering the block was recorded. Patients were not given pain medicines in the recovery unit unless the block did not work. A follow-up questionnaire was completed within 24 hours following surgery, and this was used to assess aspects of the patient’s post-operative experience. These include the number of hours following surgery that the patient: 1) first felt pain, 2) first took pain medication, 3) first felt tingling, 4) fully regained feeling in his/her leg, and 5) could wiggle his/her toes. Also, any complications were recorded. Results: This study involved 21 patients with an average age of 51. The most common procedures used with the block were hardware removal of the fibula and open reduction internal fixation of the fibula. The block took on average less than 3 minutes to administer and ultrasound was not used in any cases. No patients were given pain medicines in the recovery unit. None of the patients reported any complications, specifically, there were no cases of foot drop or any persistent paresthesias. The average time it took for patients to first feel pain after the block was approximately 8 hours. On average, patients first took pain medication approximately 11 hours after surgery, and regained sensation in their leg 15 hours after surgery. Conclusion: The benefits of the common peroneal block are multifold, as their clinical outcomes were positive and patients did not experience any complications. Also, from a surgeon perspective, the block is quick to administer and does not require ultrasound or neurostimulation.

Même s'il correspond à l'alternance entre une phase de remplissage et une phase de vidange de la vessie, le cycle mictionnel ne peut se résumer à une opération binaire mais implique bien la prise en compte constante de multiples facteurs : le niveau de remplissage du réservoir vésical, la sécurité de l'environnement dans lequel nous vivons, le contexte émotionnel dans lequel nous évoluons et les contraintes sociales auxquelles nous sommes soumis.On sait aujourd'hui qu'il existe des altérations et/ou des modifications de l'activité et de la connectivité cérébrales, ainsi que des changements dans la régulation du système nerveux autonome (SNA), dans certains types de troubles vésico-sphinctériens- notamment dans l'hyperactivité vésicale ou l'incontinence urinaire par urgenturie et dans certains types de troubles de la vidange vésicale.Parmi les thérapies disponibles aujourd'hui, les thérapies de modulation/stimulation électrique (neurostimulation tibiale et neuromodulation sacrée) semblent capables de normaliser et/ou de modifier l'activité et la connectivité cérébrales,ainsi que l'équilibre du SNA. Elles pourraient donc apporter, au moins, une réponse partielle à certaines des étiopathogénies sous-jacentes à ces troubles vésico-sphinctériens.Cependant, le déploiement et le positionnement de ces thérapies de modulation/stimulation électrique sont encore limités par une compréhension incomplète de leurs mécanismes d'action, une identification imparfaite des indications et des populations les plus susceptibles de bénéficier de ces thérapies, un manque de consensus sur le réglage du courant électrique délivré, et un manque d'évaluation à moyen et long terme.Dans la première partie, nous nous sommes interrogés sur les indications de ces thérapies, et notamment sur leur place dans l'approche préventive des dysfonctionnements vésico-sphinctériens secondaires à une lésion médullaire. Nous nous sommes également interrogés sur la relation, en termes d'efficacité, entre la neurostimulation tibiale transcutanée et la neuromodulation sacrée, afin de mieux soutenir les patients dans le processus de décision médicale partagée. Enfin, nousavons mis au point le premier outil permettant de prédire le succès de la neuromodulation sacrée en tant que traitement du trouble de la vidange vésicale.Dans la deuxième partie, nous nous sommes interrogés sur les mécanismes d'action, et plus particulièrement sur les changements dans l'équilibre du SNA en réponse à une stimulation aiguë de la racine sacrée.Dans la troisième partie, nous nous sommes interrogés sur le suivi à moyen terme (5 ans) après l'implantation définitive de la neuromodulation sacrée dans un bassin de population géographique, en recherchant les facteurs de risque d'abandon du suivi. Ces données, bien que devant encore être complétées par de futurs projets de recherche, nous permettront d'optimiser davantage les thérapies de modulation/stimulation électrique dans la prise en charge des troubles vésico-sphinctériens neurogènes et non neurogènes<br>Even if it involves alternating between a filling phase and an emptying phase, the normal micturition cycle cannot be summed up as a binary operation but involves the constant consideration of multiple factors: the filling level of the bladder reservoir, the safety of the environment in which we live, the emotional context in which we evolve and the social constraints to which we are subjected.We now know that there are alterations and/or modifications in brain activity and connectivity, as well as changes in the regulation of the autonomic nervous system, in certain types of lower urinary tract dysfunction - notably in overactive bladder or urge urinary incontinence and in certain types of voiding dysfunctions. Among the therapies available today, electrical modulation/stimulation therapies (tibial neurostimulation and sacral neuromodulation) appear able to normalize and/or modify brain activity and connectivity, as well as ANS balance. They could thus provide at least a partial response to some of the etiopathogenies underlying these lower urinary tract dysfunctions. However, the deployment and positioning of these electrical modulation/stimulation therapies are still limited by an incomplete understanding of their mechanisms of action, imperfect identification of the indications and populations most likely to benefit from these therapies, a lack of consensus on the setting of the electrical current delivered, and a lack of medium and long-term evaluation. In the first part, we questioned the indications for these therapies, and particularly their place as a preventive approach for lower urinary tract dysfunctions due to spinal cord injury. We also questioned the relation, in terms of efficacy, between transcutaneous tibial neurostimulation and sacral neuromodulation, to better support patients in shared medical decision-making processe. Finally, we developed the first tool to predict the success of sacral neuromodulation as a treatment for voiding dysfunction. In the second part, we questioned the mechanisms of action, and more specifically the changes in the balance of the autonomic nervous system in response to an acute S3 sacral root stimulation.In the third part, we questioned the mid-term follow-up (5 years) after definitive implantation of sacral neuromodulation in a geographic population pool, looking for risk factors for discontinuation of follow-up. These data, although still to be supplemented by future research projects, will enable us to further optimize electrical modulation/stimulation therapies in the management of neurogenic and non-neurogenic lower urinary tract dysfunctions

Head trauma is a traumatic injury to the skull and, when it reaches the brain, it can produce bleeding and clots. Depending on the severity of the trauma, it can generate physical sequelae and behavioral changes, which may appear soon after the trauma or in the medium term.PURPOSE: to verify the effects of electrical stimulation (NMES) and exercise in post-traumatic brain injury patients. A non-systematic review was performed based on randomized clinical trials in the PEDro and PubMed databases, published between 2009 and 2020. The articles with the highest score in the PEDro score were selected. The following keywords were used: traumatic brain injury. Six studies were selected. In one RCT, NMES induced reductions in chronaxis in the tibialis anterior, with a 1.5-day reduction in MV. An RCT, high-frequency or low-frequency NMES equally improved balance, dynamic gait and sleep quality, falls and headache frequency. In home patients, exercise increased functional reach testing and reduced Time Up and Go time. NMES improved post-void residual urine volume, void volume, maximum urinary flow rate, and Barthel Index scores after 8 weeks. Continuous cardiovascular reconditioning and moderate intensity improved cardiovascular fitness. There was no difference between groups in psychosocial functioning in either group. Rehabilitation of 4 h/day for 5 days/week improved functional independence. Intensive rehabilitation improves the early functional outcome of patients with TBI, but it must be continuous. Neurostimulation and exercise achieved significant improvements in strength, balance and gait, with different types of intervention in patients with head trauma. There is also an improvement in the cardiovascular response.