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World Journal of Clinical Cases Jun 2024Supernumerary phantom limb (SPL) sensation is the experience of additional limbs, either single or a pair of limbs. Unique to traumatic spinal cord injuries, we report...
BACKGROUND
Supernumerary phantom limb (SPL) sensation is the experience of additional limbs, either single or a pair of limbs. Unique to traumatic spinal cord injuries, we report effect of transcranial direct current stimulation (tDCS) on SPL pain in a patient with cervical cord injury.
CASE SUMMARY
The subject was a 57-year-old man who was diagnosed with complete spinal cord injury (C6/C5, motor level; C5/C5, sensory level; AIS-A) approximately three months ago. After a period of 2 wk, we administered anodal tDCS over the motor cortex for 15 minutes at an intensity of 1.5 mA. Following that treatment, the patient experienced a decrease of SPL pain intensity and frequency, which lasted for 1 week after the end of treatment.
CONCLUSION
Targeting the motor cortex through neuromodulation appears to be a promising option for the management of SPL pain.
PubMed: 38898872
DOI: 10.12998/wjcc.v12.i17.3177 -
Journal of Clinical Densitometry : the... Jun 2024Weight bearing computed tomography (WBCT) utilizes cone beam CT technology to provide assessments of lower limb joint structures while they are functionally loaded....
BACKGROUND
Weight bearing computed tomography (WBCT) utilizes cone beam CT technology to provide assessments of lower limb joint structures while they are functionally loaded. Grey-scale values indicative of X-ray attenuation that are output from cone beam CT are challenging to calibrate, and their use for bone mineral density (BMD) measurement remains debatable. To determine whether WBCT can be reliably used for cortical and trabecular BMD assessment, we sought to establish the accuracy of BMD measurements at the knee using modern WBCT by comparing them to measurements from conventional CT.
METHODS
A hydroxyapatite phantom with three inserts of varying densities was used to systematically quantify signal uniformity and BMD accuracy across the acquisition volume. We evaluated BMD in vivo (n = 5, female) using synchronous and asynchronous calibration techniques in WBCT and CT. To account for variation in attenuation along the height (z-axis) of acquisition volumes, we tested a height-dependent calibration approach for both WBCT and CT images.
RESULTS
Phantom BMD measurement error in WBCT was as high as 15.3% and consistently larger than CT (up to 5.6%). Phantom BMD measures made under synchronous conditions in WBCT improved measurement accuracy by up to 3% but introduced more variability in measured BMD. We found strong correlations (R = 0.96) as well as wide limits of agreement (-324 mgHA/cm to 183 mgHA/cm) from Bland-Altman analysis between WBCT and CT measures in vivo that were not improved by height-dependent calibration.
CONCLUSION
Whilst BMD accuracy from WBCT was found to be dependent on apparent density, accuracy was independent of the calibration technique (synchronous or asynchronous) and the location of the measurement site within the field of view. Overall, we found strong correlations between BMD measures from WBCT and CT and in vivo measures to be more accurate in trabecular bone regions. Importantly, WBCT can be used to distinguish between anatomically relevant differences in BMD, however future work is necessary to determine the repeatability and sensitivity of BMD measures in WBCT.
PubMed: 38897133
DOI: 10.1016/j.jocd.2024.101504 -
Principles and Practice of Clinical... Apr 2024
PubMed: 38894750
DOI: 10.21801/ppcrj.2024.101.10 -
Principles and Practice of Clinical... Apr 2024
PubMed: 38894749
DOI: 10.21801/ppcrj.2024.101.8 -
Cureus May 2024Major amputation of a lower limb is a traumatic experience that causes physical and psychosocial disabilities. This study set out to ascertain how anxiety and depression...
OBJECTIVE
Major amputation of a lower limb is a traumatic experience that causes physical and psychosocial disabilities. This study set out to ascertain how anxiety and depression symptoms changed during the three months following the amputation.
MATERIALS AND METHODS
A prospective longitudinal observational study was conducted between October 1, 2019, and January 1, 2021, in the Department of Vascular Surgery and the Department of Orthopedic Traumatology of the Ibn Sina Hospital Center in Rabat, Morocco. The study assesses symptoms of anxiety and depression in patients who have undergone a major lower limb amputation over a three-month interval.
RESULTS
In patients who had undergone a major lower limb amputation, the prevalence of anxiety and depression symptoms was very high immediately postoperatively (47.4% and 79.2%, respectively), with a significant decrease in these symptoms. Three months later, anxiety was reported in 24.4% of cases, and depressive symptoms in 65.1% of cases. Age, amputation level, stump pain, phantom limb pain, re-amputation, and emergency amputation were all associated with an increased risk of anxiety and depression. The patient's psychological preparation prior to the amputation, the anesthetic technique used during the procedure, the patient's mobility, and the patient's post-amputation professional status were all protective factors.
CONCLUSION
Our research findings bolster the necessity of promptly evaluating and managing anxiety and depression in the initial three months following major lower limb amputation. Thus, we believe that amputee patients ought to receive a formal psychological evaluation, which could be helpful, particularly for those whose anxiety or depression symptoms did not improve after three months.
PubMed: 38872678
DOI: 10.7759/cureus.60284 -
Frontiers in Human Neuroscience 2024
PubMed: 38868542
DOI: 10.3389/fnhum.2024.1426481 -
Journal of Neural Engineering Jun 2024. We intend to chronically restore somatosensation and provide high-fidelity myoelectric control for those with limb loss via a novel, distributed, high-channel-count,...
. We intend to chronically restore somatosensation and provide high-fidelity myoelectric control for those with limb loss via a novel, distributed, high-channel-count, implanted system.We have developed the implanted Somatosensory Electrical Neurostimulation and Sensing (iSens®) system to support peripheral nerve stimulation through up to 64, 96, or 128 electrode contacts with myoelectric recording from 16, 8, or 0 bipolar sites, respectively. The rechargeable central device has Bluetooth® wireless telemetry to communicate to external devices and wired connections for up to four implanted satellite stimulation or recording devices. We characterized the stimulation, recording, battery runtime, and wireless performance and completed safety testing to support its use in human trials.The stimulator operates as expected across a range of parameters and can schedule multiple asynchronous, interleaved pulse trains subject to total charge delivery limits. Recorded signals in saline show negligible stimulus artifact when 10 cm from a 1 mA stimulating source. The wireless telemetry range exceeds 1 m (direction and orientation dependent) in a saline torso phantom. The bandwidth supports 100 Hz bidirectional update rates of stimulation commands and data features or streaming select full bandwidth myoelectric signals. Preliminary first-in-human data validates the bench testing result.We developed, tested, and clinically implemented an advanced, modular, fully implanted peripheral stimulation and sensing system for somatosensory restoration and myoelectric control. The modularity in electrode type and number, including distributed sensing and stimulation, supports a wide variety of applications; iSens® is a flexible platform to bring peripheral neuromodulation applications to clinical reality. ClinicalTrials.gov ID NCT04430218.
Topics: Humans; Electromyography; Electrodes, Implanted; Wireless Technology; Telemetry; Equipment Design; Muscle, Skeletal
PubMed: 38861967
DOI: 10.1088/1741-2552/ad56c9 -
Journal of Pain Research 2024This multicenter, randomized, double-blinded, active sham-controlled pivotal study was designed to assess the efficacy and safety of high-frequency nerve block treatment... (Clinical Trial)
Clinical Trial
Primary 3-Month Outcomes of a Double-Blind Randomized Prospective Study (The QUEST Study) Assessing Effectiveness and Safety of Novel High-Frequency Electric Nerve Block System for Treatment of Post-Amputation Pain.
PURPOSE
This multicenter, randomized, double-blinded, active sham-controlled pivotal study was designed to assess the efficacy and safety of high-frequency nerve block treatment for chronic post-amputation and phantom limb pain.
PATIENTS AND METHODS
QUEST enrolled 180 unilateral lower-limb amputees with severe post-amputation pain, 170 of whom were implanted with the Altius device, were randomized 1:1 to active-sham or treatment groups and reached the primary endpoint. Responders were those subjects who received ≥50% pain relief 30 min after treatment in ≥50% of their self-initiated treatment sessions within the 3-month randomized period. Differences between the active treatment and sham control groups as well as numerous secondary outcomes were determined.
RESULTS
At 30-min, (primary outcome), 24.7% of the treatment group were responders compared to 7.1% of the control group (p=0.002). At 120-minutes following treatment, responder rates were 46.8% in the Treatment group and 22.2% in the Control group (p=0.001). Improvement in Brief Pain Inventory interference score of 2.3 ± 0.29 was significantly greater in treatment group than the 1.3 ± 0.26-point change in the Control group (p = 0.01). Opioid usage, although not significantly different, trended towards a greater reduction in the treatment group than in the control group. The incidence of adverse events did not differ significantly between the treatment and control groups.
CONCLUSION
The primary outcomes of the study were met, and the majority of Treatment patients experienced a substantial improvement in PAP (regardless of meeting the study definition of a responder). The significant in PAP was associated with significantly improved QOL metrics, and a trend towards reduced opioid utilization compared to Control. These data indicate that Altius treatment represents a significant therapeutic advancement for lower-limb amputees suffering from chronic PAP.
PubMed: 38860215
DOI: 10.2147/JPR.S463727 -
Plastic and Reconstructive Surgery Jun 2024Residual limb pain (RLP) and phantom pain can arise following amputation and may require additional treatment or surgery. This study aimed to determine the prevalence of...
BACKGROUND OBJECTIVE
Residual limb pain (RLP) and phantom pain can arise following amputation and may require additional treatment or surgery. This study aimed to determine the prevalence of neuropathic RLP following limb amputation and identify prognostic factors for the development of neuropathic RLP.
METHODS
A cross-sectional study was performed of patients who underwent upper or lower extremity amputation between 1990 and 2021 with a minimum of twelve months follow-up. The primary outcome was the prevalence of neuropathic RLP, defined as a 0-10 NRS pain score in the residual limb of ≥4, in combination with a score ≥4 on the short form DN4 questionnaire (s-DN4), validated for discriminating between nociceptive and neuropathic pain. The secondary outcome was quality of life for amputees with and without (neuropathic) RLP. A multivariable linear regression model was used to identify prognostic factors for neuropathic RLP development.
RESULTS
A total of 121 patients were included: 87 with lower extremity amputations, 29 with upper extremity amputations, and 5 with both. Neuropathic RLP was experienced by 21.5%, while 10.7% reported non-neuropathic RLP. Smoking status and Complex Regional Pain Syndrome as indication for limb amputation were associated with more severe neuropathic pain symptoms. Patients experiencing neuropathic RLP reported a significantly lower quality of life compared to patients without neuropathic RLP.
CONCLUSIONS
This study demonstrates that neuropathic RLP is common after limb amputation and impacts daily functioning. The absence of numerous manageable prognostic factors associated with neuropathic pain development emphasizes the importance of the consideration of prophylactic interventions at the time of amputation.
PubMed: 38857429
DOI: 10.1097/PRS.0000000000011568 -
Neurological Sciences : Official... Jun 2024Phantom Limb Syndrome (PLS) can be defined as the disabling or painful sensation of the presence of a body part that is no longer present after its amputation.... (Review)
Review
Phantom Limb Syndrome (PLS) can be defined as the disabling or painful sensation of the presence of a body part that is no longer present after its amputation. Anatomical changes involved in Phantom Limb Syndrome, occurring at peripheral, spinal and brain levels and include the formation of neuromas and scars, dorsal horn sensitization and plasticity, short-term and long-term modifications at molecular and topographical levels. The molecular reorganization processes of Phantom Limb Syndrome include NMDA receptors hyperactivation in the dorsal horn of the spinal column leading to inflammatory mechanisms both at a peripheral and central level. At the brain level, a central role has been recognized for sodium channels, BDNF and adenosine triphosphate receptors. In the paper we discuss current available pharmacological options with a final overview on non-pharmacological options in the pipeline.
PubMed: 38853232
DOI: 10.1007/s10072-024-07634-1