ISSN:1040-0435    

DOI:10.1080/10400435.2000.10132004

出版商:Taylor & Francis Group    

年代:2000

数据来源: Taylor

ISSN:1040-0435    

DOI:10.1080/10400435.2000.10132005

出版商:Taylor & Francis Group    

年代:2000

数据来源: Taylor

摘要:

Neural prostheses are a developing technology that use electrical activation of the nervous system to restore function to individuals with neurological impairment. Neural prostheses function by electrical initiation of action potentials in nerve fibers that carry the signal to an endpoint where chemical neurotransmitters are released, either to affect an end organ or another neuron. Thus, in principle, any end organ under neural control is a candidate for neural prosthetic control. Applications have included stimulation in both the sensory and motor systems and range in scope from experimental trials with single individuals to commercially available devices. Outcomes of motor system neural prostheses include restoration of hand grasp and release in quadriplegia, restoration of standing and stepping in paraplegia, restoration of bladder function (continence, micturition) following spinal cord injury, and electrophrenic respiration in high-level quadriplegia. Neural prostheses restore function and provide greater independence to individuals with disability.

ISSN:1040-0435    

DOI:10.1080/10400435.2000.10132006

出版商:Taylor & Francis Group    

年代:2000

数据来源: Taylor

摘要:

This paper briefly reviews the basic principles of several clinical applications of electrical stimulation for therapeutic purposes. It is intended to facilitate the integration of electrical stimulation into routine clinical practice by clarifying the terminology and standard conventions of the field, explaining the delivery capabilities of common electrical stimulators commercially available for clinical use, summarizing several examples of evidence-based therapeutic applications, and providing guidelines for selection of most commonly used treatment parameters. Rather than an exhaustive survey of the field, the presentation touches broadly on guidelines for use of transcutaneous electrical stimulation employing surface electrodes for the purposes of analgesia (TENS), drug delivery (iontophoresis), or neuromuscular rehabilitation (NMES), as well as other selected clinical applications. The paper is a general review of common clinical practices of electrotherapy and should serve as an introduction to the important factors for clinicians to consider when contemplating electrical stimulation as a treatment option.

ISSN:1040-0435    

DOI:10.1080/10400435.2000.10132007

出版商:Taylor & Francis Group    

年代:2000

数据来源: Taylor

摘要:

The purpose of this review is to critically assess the clinical efficacy of neuromuscular electrical stimulation in treating motor dysfunction in hemiplegia. Three distinct applications are reviewed in the areas of motor relearning, shoulder dysfunction, and neuroprostheses. Assessment of clinical efficacy and recommendations on clinical implementation are based on the weight of published scientific evidence. With respect to motor relearning, evidence supports the use of neuromuscular electrical stimulation to facilitate recovery of muscle strength and coordination in hemiplegia. However, effects on physical disability are uncertain. With respect to shoulder dysfunction, neuromuscular electrical stimulation decreases shoulder subluxation, at least in the short term. However, effects on shoulder pain and disability are also uncertain. With respect to neuroprosthesis systems, clinically deployable upper extremity systems must await the development of more sophisticated control methods and greater fundamental understanding of motor dysfunction in hemiplegia. The evidence for clinical feasibility of lower extremity neuroprostheses is stronger, and investigations on clinical efficacy should be pursued. In summary, the application of neuromuscular electrical stimulation for motor relearning and shoulder dysfunction are ready for more rigorous scientific and clinical assessment via large, multicenter, randomized clinical trials. However, additional investigations are needed to demonstrate the clinical feasibility of neuroprostheses applications.

ISSN:1040-0435    

DOI:10.1080/10400435.2000.10132008

出版商:Taylor & Francis Group    

年代:2000

数据来源: Taylor

摘要:

This paper reviews applications of therapeutic electrical stimulation (ES) specific to wound healing and pressure sore prevention. The application of ES for wound healing has been found to increase the rate of healing by more than 50%. Furthermore, the total number of wounds healed is also increased. However, optimal delivery techniques for ES therapy have not been established to date. A study of stimulation current effects on wound healing in a pig model has shown that direct current (DC) stimulation is most effective in wound area reduction and alternating current (AC) stimulation for wound volume reduction at current densities of 127 μA./cm2and 1,125 μA/cm2, respectively. Preliminary studies have been carried out at two research centers to assess the role of ES in pressure sore prevention. Surface stimulation studies have shown that ES can produce positive short-term changes in tissue health variables such as regional blood flow and pressure distribution. The use of an implanted stimulation system consisting of intramuscular electrodes with percutaneous leads has been found to produce additional long-term changes. Specifically, gluteal muscle thickness increased by 50% with regular long-term ES application concurrent with a 20% decrease in regional interface pressures and increased tissue oxygen levels. These findings indicate that an implantable ES system may have great potential for pressure sore prevention, particularly for individuals who lack sensation or who are physically unable to perform regular independent pressure relief.

ISSN:1040-0435    

DOI:10.1080/10400435.2000.10132009

出版商:Taylor & Francis Group    

年代:2000

数据来源: Taylor

摘要:

The lifetime costs associated with spinal cord injury are substantial. Assistive technology that reduces complications, increases independence, or decreases the need for attendant services can provide economic as well as medical or functional benefit. This study describes two approaches for estimating the economic consequences of implanted neuroprostheses utilizing functional electrical stimulation. Life care plan analysis was used to estimate the costs of bladder and bowel care with and without a device restoring bladder and bowel function and to compare these with the costs of implementing the device. For a neuroprosthesis restoring hand grasp, the costs of implementation were compared to the potential savings in attendant care costs that could be achieved by the use of the device. The results indicate that the costs of implementing the bladder and bowel system would be recovered in 5 years, primarily from reduced costs of supplies, medications, and procedures. The costs of the hand grasp neuroprosthesis would be recovered over the lifetime of the user if attendant time was reduced only 2 hours per day and in a shorter time if attendant care was further reduced. Neither analysis includes valuation of the quality of life, which is further enhanced by the neuroprostheses through restoration of greater independence and dignity. Our results demonstrate that implantable neuroprosthetic systems provide good health care value in addition to improved independence for the disabled individual.

ISSN:1040-0435    

DOI:10.1080/10400435.2000.10132010

出版商:Taylor & Francis Group    

年代:2000

数据来源: Taylor

摘要:

Functional electrical stimulation (FES) is a rehabilitation tool that has broad application in disability management for improving consumer health and independence. This review examines the availability and delivery of electrical stimulation equipment in a managed care environment, focusing particularly on recent advances and marketplace influences. New electrical stimulation products that are unique in their ability to improve function after disease or injury over conventional drug therapy, surgical intervention, or other rehabilitation techniques are described. Research directions, including new uses for existing products to expand patient indications, are discussed. Guidelines to assist providers and developers of FES technology with managing the reimbursement process are provided. The successful introduction of recent FES products should pave the way for even more exciting developments. However, reimbursement requires careful and early planning to ensure that FES technologies are available to people who may benefit from them.

ISSN:1040-0435    

DOI:10.1080/10400435.2000.10132011

出版商:Taylor & Francis Group    

年代:2000

数据来源: Taylor

摘要:

Societal perspective on functional electrical stimulation is colored by media influence, popular thought, and political climate as much as by the science that supports it. The purpose of this article is to examine how these influences facilitate or inhibit the application of electrical stimulation in today's world and to describe the challenges facing the use of electrical stimulation in the future. Emphasis will be placed on perceived need, cost, and available resources and how these factors must be addressed to utilize functional electrical stimulation successfully in society.

ISSN:1040-0435    

DOI:10.1080/10400435.2000.10132012

出版商:Taylor & Francis Group    

年代:2000

数据来源: Taylor

ISSN:1040-0435    

DOI:10.1080/10400435.2000.10132013

出版商:Taylor & Francis Group    

年代:2000

数据来源: Taylor