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Background Implantable vagus nerve stimulation (VNS) devices can be used to treat epilepsy in dogs. Adverse effects and short-term complications associated with delivering suggested therapeutic electrical stimulation (>1.5 mA) are not well-described. Objectives To compare complications and adverse effects observed with standard and rapid protocols of current increase. Animals Sixteen client-owned dogs with idiopathic epilepsy. Methods Nonrandomized, nonblinded prospective cohort study. Surgical complications, stimulation-related adverse effects, modifications to stimulator settings, number of hospital visits, and time to reach 1.5 mA stimulation current without intolerable adverse effects were described in dogs receiving current increases every 1 to 3 weeks (slow ramping) and dogs receiving current increases every 8 to 12 hours (fast ramping). Results Self-resolving surgery site seromas formed in 6 dogs. No other surgical complications were observed. Fourteen dogs reached 1.5 mA. Coughing (11/14 dogs; 5 slow, 6 fast ramping) was the most common adverse effect. Intolerable coughing that limited current increases despite changing other stimulus parameters occurred in 6/7 of the fast-ramping group and in none of the slow-ramping group. Median time to 1.5 mA was 72 days (range, 28-98) in the slow-ramping group and 77 days (range, 3-152) in the fast-ramping group. Median number of clinic visits was 6 for the slow-ramping group (range, 5-6) and 3 for the fast-ramping group (range, 1-7). Conclusions and clinical importance Coughing is a common adverse effect of VNS in dogs and generally is well tolerated, particularly if current is increased slowly and other stimulation parameters are adapted for effect.

Oxidized single walled carbon nanohorns (ox-SWCNH) were electrodeposited onto gold microelectrode arrays in conjunction with poly(3,4-ethylenedioxythiophene) (PEDOT) and polystirenesulfonate (PSS), and the properties of the new composite material for neural recording and stimulation were assessed. PEDOT/ox-SWCNH composites were compared with films prepared with one of the most notorious carbonaceous material in this field, the oxidized multi-walled Carbon Nanotubes (ox-MWCNT). The PEDOT/ox-SWCNH exhibited superior charge transfer capability, reflecting greater electroactive surface, as confirmed by SEM and EIS characterizations. As a consequence, a charge injection limit of 11.6mC/cm⁠2 was observed for the new composite, which is higher than the one of PEDOT/ox-MWCNT (8.7mC/cm⁠2). Having confirmed comparable neural recording performance, the PEDOT/ ox-SWCNH composite results very promising for improving therapeutic electrical stimulation in the central and peripheral nervous systems.

Introduction: This study aimed to explore the barriers and facilitators to implementing early therapeutic electrical stimulation (ES) treatment from both the patient and therapist perspectives as part of a feasibility study. Methods Design: Interviews were conducted with patients and their carers and focus groups with the therapists post-intervention period. Setting: Interviews were in the patient’s homes and for the focus groups in a specialist stroke unit in Nottinghamshire. Subjects: Fifteen patient participants (34% of sample) were interviewed (intervention n = 9; control group n = 3; carers n = 3). Sixteen therapists (9 occupational therapists; 7 physiotherapists) took part in the three focus groups. Intervention: Participants were randomized to receive usual care or usual care and ES to wrist flexors and extensors for 30 min, twice a day, 5 days a week for 3 months. Findings: The barriers to ES treatment cited by the therapists outweighed the barriers mentioned by patients. Therapists’ barriers included lack of confidence and staff knowledge regarding ES and time pressures of delivering the ES. No patients mentioned time as a barrier and considered the treatment regime to be acceptable; however, lack of staff support was mentioned 14 times by them. Conclusion: Although initially the perceived barrier for therapists was time restrictions, after analysing the data, it appears that confidence/knowledge is the real barrier, and time is the manifestation of this underlying self-doubt. Patients were able to confidently self-manage treatment, and although efficacy was not measured, patients volunteered information regarding its perceived benefit, and no adverse effects were reported.

[Purpose] A case report in which we treated injured patellar cartilage using non-invasive electrical stimulation; we also used MRI to document the morphology of the patellar cartilage before and after the treatment. [Participant and Methods] A police officer suffered from right anterior knee pain that noticeably affected his firearms marksmanship in kneeling position. After a MRI scan he was diagnosed with grade I chondromalacia patella involving the lateral patellar facet. He received therapeutic electrical stimulation on right knee acupoints for four weeks. [Results] He responded positively to the treatment and his numerical rating scale reduced from 6 to 0 for the right knee pain. The MRI revealed that the signs of grade I chondromalacia patella disappeared. [Conclusion] The patellar cartilage is largely avascular; the chondrocytes in cartilage have a low metabolic rate due to limited nutrient supply. Mild cartilage repair may occur spontaneously but is undoubtedly slow. Although this is a case report, we believe that the micro-current stimulation may help enhance the local metabolism and repair process in the affected cartilage.

In their article “Nonpainful remote electrical stimulation alleviates episodic migraine pain,” Dr. Yarnitsky et al.1 investigated the use of nonpainful electrical stimulation of the skin of the arm in reducing migraine attacks. Therapeutic electrical stimulation has been widely used for pain treatment. It is believed to be effective when applying the stimulation next to the painful location. For example, the Food and Drug Administration has approved the first device for migraine prevention using electrical stimulation to the area above the eyes. A number of other neurostimulators are under investigation for migraine.2 The idea is to activate parts of the brain with connections to the spine. Triggering pain systems that are remote from the site of migraine pain can relieve pain. In this case, the authors used nonpainful stimulation as a trigger for relief. The idea was to create a conditioned response. This means that giving electrical stimulation at low intensity to a different part of the body will send signals to the brain that then stop or reduce the migraine attack. The authors thought it would be easier to apply electrical stimulation to the lower arm than the head (figure).

Advances in computation and neuronal modeling have enabled the study of entire neural tissue systems with an impressive degree of biological realism. These efforts have focused largely on modeling dendrites and somas while largely neglecting axons. The need for biologically realistic explicit axonal models is particularly clear for applications involving clinical and therapeutic electrical stimulation because axons are generally more excitable than other neuroanatomical subunits. While many modeling efforts can rely on existing repositories of reconstructed dendritic/somatic morphologies to study real cells or to estimate parameters for a generative model, such datasets for axons are scarce and incomplete. Those that do exist may still be insufficient to build accurate models because the increased geometric variability of axons demands a proportional increase in data. To address this need, a Ruled-Optimum Ordered Tree System (ROOTS) was developed that extends the capability of neuronal morphology generative methods to include highly branched cortical axon terminal arbors. Further, this study presents and explores a clear use-case for such models in the prediction of cortical tissue response to externally applied electric fields. The results presented herein comprise (i) a quantitative and qualitative analysis of the generative algorithm proposed, (ii) a comparison of generated fibers with those observed in histological studies, (iii) a study of the requisite spatial and morphological complexity of axonal arbors for accurate prediction of neuronal response to extracellular electrical stimulation, and (iv) an extracellular electrical stimulation strength-duration analysis to explore probable thresholds of excitation of the dentate perforant path under controlled conditions. ROOTS demonstrates a superior ability to capture biological realism in model fibers, allowing improved accuracy in predicting the impact that microscale structures and branching patterns have on spatiotemporal patterns of activity in the presence of extracellular electric fields.

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Every living cell releases extracellular vesicles (EVs) that are critical for cellular signaling and a wide range of biological functions. The potential diagnostic and therapeutic applications of EVs are well recognized, and rapidly expanding. While a complete understanding of the molecular mechanisms underpinning EVs release remains elusive, here we demonstrate a novel method for programmable control of the release of EVs and their cargo using external electric fields. As a proof of principle, we use cultured rat astrocytes to demonstrate how the frequency of external electrical stimulation selectively modulates EV release, their surface proteins, and microRNA profiles. This method could broadly impact biological science and medical applications. First, it raises an interesting question of how endogenous electrical activity could modulate EV production. Second, it provides a novel mechanism for tuning therapeutic electrical stimulation that may be useful for treating brain disorders. Third, it provides a new way to generate EVs carrying desired cargos by tuning electrical stimulation parameters. Unlike chemical methods for creating EVs, electrical stimulation is a clean physical method with adjustable parameters including stimulation frequency, field strength and waveform morphology.

Pressure ulcers (PU) are deep scars on the skin that cause pain, infections and severe health complications. Most movement-impaired subjects are vulnerable to PU, leading to permanent and irreversible skin damage. The system proposed in this paper aims to prevent PU formation with the design and implementation of a wirelessly controlled device that predicts PUs before their occurrence and attempts to prevent it using therapeutic feedback. A flexible pad that consists of multiple types of sensors is used, theses sensors continuously and non-invasively monitor ulcer-related vital signs in vulnerable areas, and uses these data to predict PU with a decision-making process. When PU is detected an electrical stimulation (ES) unit is automatically activated. Stimulation prevents PU formation by increasing local blood flow to the simulated area and eliminating the main factor that leads to PU formation. The system successfully monitored and predicted PU; tests were performed on three healthy volunteers and one volunteer with sacral ulcers. Results including readings of blood oxygenation, force, humidity and temperature were recorded as graphs to monitor decay/increase in values more efficiently.

Current solutions developed for the purpose of in and on body (IOB) electrical stimulation (ES) lack autonomous qualities necessary for comfortable, practical, and self-dependent use. Consequently, recent focus has been placed on developing self-powered IOB therapeutic devices capable of generating therapeutic ES for human use. With the recent invention of the triboelectric nanogenerator (TENG), harnessing passive human biomechanical energy to develop self-powered systems has allowed for the introduction of novel therapeutic ES solutions. TENGs are especially effective at providing ES for IOB therapeutic systems given their bioconformability, low cost, simple manufacturability, and self-powering capabilities. Due to the key role of naturally induced electrical signals in many physiological functions, TENG-induced ES holds promise to provide a novel paradigm in therapeutic interventions. The aim here is to detail research on IOB TENG devices applied for ES-based therapy in the fields of regenerative medicine, neurology, rehabilitation, and pharmaceutical engineering. Furthermore, considering TENG-produced ES can be measured for sensing applications, this technology is paving the way to provide a fully autonomous personalized healthcare system, capable of IOB energy generation, sensing, and therapeutic intervention. Considering these grounds, it seems highly relevant to review TENG-ES research and applications, as they could constitute the foundation and future of personalized healthcare.

Objectives: To investigate the effect of electrical stimulation of different anatomical variations of sacral surface on early recovery of urinary continence after radical prostatectomy. Methods: Twenty of 53 consecutive patients who underwent prostatectomy by a single surgeon were enrolled in this study. Ten patients were prospectively randomized to two groups; five patients in Sacral foramena stimulation group received postoperative surface electrical stimulation of sacral foramina area while five patients in control group did not received any electrical stimulation. Selection of remaining ten patients depended on sacral hiatus anatomical variations, assessed by plan X-rays. Of the ten patients, five patients with sacral hiatus subtotals were grouped under SHS1 while 5 patients with sacral hiatus totals were grouped as SHS2. Electrical stimulation for each group began 7 days after catheter removal, thrice a week for 8 weeks. Each of the 24 treatment sessions for each group composed of 20 minutes for sacral electrical stimulation. Continence was evaluated at baseline, 4 and 8 weeks using the 24-hour pad test and according to the incontinence section of the International Continence Society questionnaire. Results: After 2 weeks of treatment, the mean leakage weight was comparable between SFS group and SHS1 group while it was significantly lowered in SHS2 as compared to SFS and SHS1 groups. Comparing mean leakage weight at 8 weeks revealed further significant reduction in SHS2 group than in SFS and SHS1 groups. Moreover, percentage of continent patients was highest in SHS2 group after 8 weeks of treatment followed by SHS1, SFS and control respectively. Conclusions: Electrical stimulation of sacral hiatus surface area may provide better stimulation for sacral nerve than sacral foramena surface area and appears to be effective treatment for early recovery of urinary continence after radical prostatectomy.

The purpose of this study was to investigate the effect of electrical stimulation to the common peroneal nerve (CPN) on the spinal reflex and reciprocal inhibition (RI) during robot-assisted passive ground stepping (PGS) in healthy subjects. Five interventions were applied for 30 min in healthy subjects: PGS alone; strong CPN stimulation [50% of the maximal tibialis anterior (TA) M-wave, functional electrical stimulation (FES)] alone; weak CPN stimulation [just above the MT for the TA muscle, therapeutic electrical stimulation (TES)] alone; PGS with FES; and PGS with TES. FES and TES were applied intermittently to the CPN at 25 Hz. The soleus (Sol) H-reflex and RI, which was assessed by conditioning the Sol H-reflex with CPN stimulation, were investigated before (baseline), and 5, 15 and 30 min after each intervention. The amplitudes of the Sol H-reflex were not significantly different after each intervention as compared with the baseline values. The amounts of RI were significantly decreased 5 min after PGS with FES as compared with the baseline values, whereas they were significantly increased 5 and 15 min after PGS with TES. The other interventions did not affect the amount of RI. These results suggest that interventions that combined PGS with CPN stimulation changed the spinal RI in an intensity-dependent manner.

We have previously shown that surface interferential current (IFC) stimulation at the sensory threshold significantly increases the number of swallows. In the present study, we evaluated the effects of IFC stimulation at the sensory threshold on the swallowing reflex of dysphagic patients (7 male and 5 female, Age, 75.8 ± 5.3 years) by videofluoroscopic (VFS) measurements. Each subject underwent three series of VFS examination, before, during, and after the IFC stimulation. We tested three food types, juice, jelly, and biscuits, however, only juice consistency resulted in significant changes in temporal measurements of VFS parameters before, during and after IFC stimulation. For juice consistency, IFC stimulation shortened the pharyngeal response duration (the duration from the hyoid bone beginning maximum elevation to its return to the resting position, before IFC: 1.37 ± 0.31(SD) s vs. during IFC: 1.17 ± 0.29 s, p

Neuromuscular electrical stimulation (NMES), specifically functional electrical stimulation (FES) that compensates for voluntary motion, and therapeutic electrical stimulation (TES) aimed at muscle strengthening and recovery from paralysis are widely used in stroke rehabilitation. The electrical stimulation of muscle contraction should be synchronized with intended motion to restore paralysis. Therefore, NMES devices, which monitor electromyogram (EMG) or electroencephalogram (EEG) changes with motor intention and use them as a trigger, have been developed. Devices that modify the current intensity of NMES, based on EMG or EEG, have also been proposed. Given the diversity in devices and stimulation methods of NMES, the aim of the current review was to introduce some commercial FES and TES devices and application methods, which depend on the condition of the patient with stroke, including the degree of paralysis.

SummaryUrinary incontinence is a highly prevalent yet largely ignored condition that affects older women. Conservative treatment options are widely under-used and containment methods more widely prescribed. This study sought to review the efficacy of conservative approaches and identify which should be recommended. It was found that there is a strong evidence base in support of pelvic floor muscle and behavioural training with biofeedback as a useful adjunctive treatment. The use of therapeutic electrical stimulation was difficult to evaluate due to the different combinations of treatment available and a paucity of evidence of its use with older women. Lifestyle intervention and complementary therapies both demonstrated some positive outcomes. In conclusion it was felt that there is a place for conservative treatments in the management of urinary incontinence rather than relying on containment products. A combination of different treatment approaches is felt to be the most beneficial.

Miyasaka H, Ohnishi H, Hieda C, Kawakami K, Tanino G, Okuyama Y, Tomita Y, Sonoda S. A study of the training method of sub-acute stroke patients of the upper extremity: decision tree analysis. Jpn J Compr Rehabil Sci 2014; 5: 117-124. Objective: We examined how differences in training method affected the improvement of paralysis. Methods: One hundred and thirty-one patients with stroke were admitted to Nanakuri Sanatorium, Fujita Health University. We divided the patients randomly into five groups, mirror therapy (MT), integrated volitional control electrical stimulation (IVES), therapeutic electrical stimulation (TES), repetitive facilitative exercises (RFEs), and conventional training (control group). Each group performed an assigned exercise for 20 minutes. Decision tree analysis was performed to identify the effectiveness of rehabilitation training for improving motor function. The predicted variables were the FMA upper extremity items at 4 weeks. The explanatory variables were age, days after stroke onset, treatment technique, and evaluation test results. Results: When patients had scores of FMA-finger < 3 and FMA-shoulder < 3, MT, TES, and RFEs were chosen as favorable determinants. If FMA-finger ≥ 8 and FMA-wrist < 8, MT, IVES, TES, and RFEs were chosen as favorable determinants. Conclusion: Decision tree analysis appears to be a valid mean for deciding the best rehabilitation method for sub-acute stroke patients.

Magnetoencephalography (MEG) was used to measure the somatosensory evoked fields in six healthy males undergoing sacral surface therapeutic electrical stimulation, a recently introduced treatment for chronic urinary dysfunction. This study was performed to investigate the utility of MEG to optimize the stimulation parameters. Strong or weak electrical stimuli were applied to small or large surface electrodes placed over the bilateral sacral surfaces. The peak latency and strength of the equivalent current dipole were evaluated at the first peak originating from the primary somatosensory cortex (M30). There was no difference in M30 latency in response to stimulation intensity or electrode size. However, a larger equivalent current dipole strength was obtained in response to higher stimulus intensities, which indicated a more effective stimulus on the sacral surface. The present MEG study shows that stronger stimuli given through large electrodes evoke larger responses than small stimuli through small electrodes. The study also suggests that MEG can be used as an objective tool to monitor whether therapeutic stimulation parameters are appropriate.

Objective: To describe the effects and indications of sacral surface therapeutic electrical stimulation (SS-TES) for refractory urinary incontinence. Design: Evaluation before and after therapy. Setting: On clinical site and at nursing home. Subjects: Seven neurogenic bladder, five unstable bladder and six nocturia cases were investigated. Twelve were outpatients and six were residents. Interventions: Surface electrodes were placed at the posterior sacral foramens of S2 and S4. Stimulation conditions were duration 0.3 ms, frequency 20 Hz and maximum intensity. The stimulation was continued for 15 min twice daily for over one month. Main outcome measures: Therapeutic effects were evaluated on the basis of voiding charts as subjective findings and urodynamic study as objective findings before and after therapy. Results: Subjective findings showed incontinence frequency significantly decreased from 2.39±1.4 times/day before therapy to 1.39±2.0 times/day after therapy (p≤0.01); 55.5% of patients were improved or greatly improved. Objective findings showed that maximum vesical capacity (MVC) significantly increased from 208.29±94.5 ml before therapy to 282.19±66.8 ml (p≤0.001). Uninhibited contraction significantly decreased from 40.4±31.4 cmH2O before therapy to 25.79±23.9 cmH2O (p≤0.01); 44% of patients were improved or greatly improved. This therapy was effective in particular for cases whose MVC was small before applying SS-TES. Conclusion: SS-TES was effective in some patients with refractory urinary incontinence.

Summary of the BION Shoulder Subluxation and Knee Osteoarthritis Studies. Subacute Shoulder Subluxation Knee OsteoarthritisLocation Kingston, Canada Milan, ItalyDesign Randomized, cross-over Longitudinal, repeated measuresBaseline No Yes, 12 weeksStimulation period 6 weeks 12 weeksOff-stim. period 6 weeks NoStimulation frequency 5 Hz 2 HzAssessment Subluxation, active/passive ROM, strength, arm function, VAS pain, muscle thickness (ultrasound).WOMAC, Knee Function, VAS pain,muscle cross-sectional area (MRI).# subjects (July 2002) 10 (5 TES; 5 control initially) 5# control subjects 3 (out of 5, above) N/Acrossed-over to TES# total TES 8 (5 initial; 3 cross-over from control) 5# noncompliant TES 3 (out of 8, above) 0Final subject distribution 5 compliant TES; 3 noncompliant N/ATES; 5 control# BIONs implanted (July 2002)17 (8 TES subjects—one has two BIONs in the supraspinatus because of technical failure)8 (subjects 1–3 have 2 BIONs each; subjects 4–5 have one BION each) Fig. 3. Top: BION being removed from Subject 1 in theshoulder subluxation study (trapezius). Bottom: histologicsection of excised muscle (left: muscle cells; right: scar tissuearound device).

Neuromuscular electrical stimulation (NMES) is the action of therapeutic electrical stimulation on muscle tissue in order to contract the muscle and consequently improve the muscle status. Objective: To evaluate the muscle damage stemming from isometric muscle contraction induced by NMES of low frequency (30 Hz) and high frequency (100 Hz). Methods: Experimental crossover study, randomized, unblinded. The study included 10 male college students, age 24.4 ± 6.0 years, weight 77.1 ± 11.8 kg, height 176.1 ± 5.6 cm, and BMI of 24.8 ± 3 4 kg/m2. Two protocols (A) and (B) with an interval of 7 days between them. (A) - 20 minutes of NMES in the quadriceps at a frequency of 30 Hz (B) - 20 minutes of NMES at a frequency of 100 Hz. Measured lactate, creatine phosphokinase and lactate dehydrogenase before, immediately after, and 6 and 48 hours after the protocols. Results: Comparing 30 Hz vs. 100 Hz the following were observed: lactate (23.7 ± 6.7 vs. 13.4 ± 3.0 mg/dl, p = 0.001); CPK (195.4 ± 116.1 vs. 262.9 ± 153.6 IU, p = 0.022); LDH (374.3 ± 64 vs. 366.6 ± 84.1 IU, ns). The perception of contractile efficiency decreased significantly (p = 0.016) in the 100 Hz Protocol. Conclusion: Both the low-frequency NMES (30 Hz) and the high-frequency (100 Hz) elevate blood markers of muscle damage, most strikingly at the higher frequency. However, the achieved values reflect a normal response to a moderate-intensity exercise.

Background: Therapeutic electrical stimulation (TES) is a therapeutic strategy aimed at improving impairments of the upper extremity in stroke. Objective: Assessment of the available evidence on the effect of TES of the affected upper extremity in improving motor control and functional abilities after stroke. Methods: A systematic literature search was performed to identify randomized controlled trials (RCTs) that have studied the effect of TES on motor control and functional abilities. The methodological quality of the studies was assessed systematically by two raters. The reported outcomes were examined to evaluate the effect of TES and to identify a possible relationship with patient characteristics, method of stimulation and methodological quality. When possible, effect sizes were calculated (Hedges’ g). Results: Six RCTs were included. The methodological scores ranged from 7 to 16 (maximum 19). All studies assessed the effect on motor control, and four reported a positive effect. Effect sizes calculated in three studies ranged from 0.55 to 1.46. Only two studies assessed the effect on functional ability, one reported a positive effect. Subgroup analyses in two studies suggest a better response to stimulation in less severely affected patients. Apart from this, no relationship between effect and patient characteristics, method of stimulation or methodological quality could be detected. Conclusions: The present review suggests a positive effect of electrical stimulation on motor control. No conclusions can be drawn with regard to the effect on functional abilities.

Article, 信州医学雑誌 49(6): 325-334(2001)

After a program of therapeutic electrical stimulation, 3 groups of incomplete spinal cord injured (SCI) patients were identified, those in whom an improvement of both voluntary and stimulated muscle force was observed, those with an increase in stimulation response only, and patients in whom no effect of electrical stimulation training could be recorded. As it is difficult to predict the outcome of the electrical stimulation rehabilitation process, a diagnostic procedure was developed to predict soon after accidents which incomplete SCI patients are candidates for permanent use of a functional electrical stimulation (FES) orthotic aid. The candidates for chronic use of FES are patients with weak ankle dorsiflexors and sufficiently strong knee extensors. These patients are equipped with a single channel peroneal stimulator augmenting dorsiflexion and knee and hip flexion in a total lower limb flexion response. By applying FES to the ankle plantar flexors, the swing phase of walking can be significantly shortened and faster walking obtained.

OBJECTIVEElectrical stimulation of peripheral nerve tissue has been shown to accelerate axonal regeneration. Yet existing methods of applying electrical stimulation to injured peripheral nerves have presented significant barriers to clinical translation. In this study, the authors examined the use of a novel implantable wireless nerve stimulator capable of simultaneously delivering therapeutic electrical stimulation of injured peripheral nerve tissue and providing postoperative serial assessment of functional recovery.METHODSFlexible wireless stimulators were fabricated and implanted into Lewis rats. Thin-film implants were used to deliver brief electrical stimulation (1 hour, 20 Hz) to sciatic nerves after nerve crush or nerve transection-and-repair injuries.RESULTSElectrical stimulation of injured nerves via implanted wireless stimulators significantly improved functional recovery. Brief electrical stimulation was observed to increase the rate of functional recovery after both nerve crush and nerve tran...

Changes in muscle force following therapeutic electrical stimulation (TES) in 5 patients with complete paraplegia were evaluated by computed tomography, Cybex II, a strain-gauge transducer, and manual muscle testing. The stimulation parameters included a frequency of 20 Hz, a pulse width of 0.2 ms, and an output voltage of -15 V. The cross-sectional areas of muscles, the muscle torques, and the muscle forces increased after TES, though the increased ratio differed in each muscle. The reasons why it differed are as follows: (1) The possibility of peripheral nerve injury; (2) The different patterns of nerve distribution in the muscles; (3) Implantation techniques; and (4) The possibility of breakage, movement, or changes in the impedance of electrodes. This study demonstrates that TES increases muscle force during electrical stimulation in paralyzed muscle, but that an initial TES-induced muscle force greater than a poor-minus level on manual muscle testing is necessary for practical use. TES treatment should be started as soon as possible after the onset of paralysis, in order to maintain muscle quality.

This paper describes the effects of therapeutic electrical stimulation (TES) on the wasting muscles in a patient with amyotrophic lateral sclerosis. The patient is a 47-year-old male, and he has a history of progressive muscle weakness and atrophy, affected more in the right side. Percutaneously indwelling intramuscular electrodes were implanted to the affected muscles in the right upper and lower extremities but no electrode in the corresponding left region. Within a month of TES therapy, a rapid improvement of extremity motion appeared in the TES treated side. Long-term application of TES more than 3 months increased the strength of the muscle which had been evidently weaker than the non-treated side. CT findings of both the upper and lower extremities with TES therapy showed an increase in the density and a reduction in the moth-eaten image. An increase in the thickness of the muscles was also observed in the TES treated side while deterioration was observed in the muscles on the non-treated side.

Summary Objective To determine if low frequency (≤100 Hz) pulsed subsensory threshold electrical stimulation produced either through pulsed electromagnetic field (PEMF) or pulsed electrical stimulation (PES) vs sham PEMF/PES intervention is effective in improving pain and physical function at treatment completion in adults with knee osteoarthritis (OA) blinded to treatment. Method The relevant studies were identified by searching eight electronic databases and hand search of the past systematic reviews on the same topic till April 5, 2012. We included randomized controlled trials (RCTs) of people with knee OA comparing the outcomes of interest for those receiving PEMF/PES with those receiving sham PEMF/PES. Two reviewers independently selected studies, extracted relevant data and assessed quality. Pooled analyses were conducted using inverse-variance random effects models and standardized mean difference (SMD) for the primary outcomes. Results Seven small trials (459 participants/knees) were included. PEMF/PES improves physical function (SMD = 0.22, 95% confidence interval (CI) = 0.04, 0.41, P = 0.02, I 2 = 0%), and does not reduce pain (SMD = 0.08, 95% CI = −0.17, 0.32, P = 0.55, I 2 = 43%). The strength of the body of evidence was low for physical function and very low for pain. Conclusion Current evidence of low and very low quality suggests that low frequency (≤100 Hz) pulsed subsensory threshold electrical stimulation produced either through PEMF/PES vs sham PEMF/PES is effective in improving physical function but not pain intensity at treatment completion in adults with knee OA blinded to treatment. Methodologically rigorous and adequately powered RCTs are needed to confirm the findings of this review.

Spinal cord stimulation has been used successfully for more than 40 years. The application of an electrical impulse field on to the spinal cord is used with a battery generator source and a variety of either cylindrical or paddle/plate leads. Energy is delivered from either a conventional internal programmable generator or a rechargeable style battery. Many clinical conditions such as complex regional pain syndrome, failed back spinal syndrome, and extremity neuropathic pain involving the trunk and limbs are approved for its use. This device allows patients to live a successful life without pain.

Objectives. To investigate whether sacral surface therapeutic electrical stimulation (SSTES) initiated during the early postoperative period would be effective towards early recovery of postprostatectomy urinary continence.Methods. A total of 35 consecutive patients who underwent radical prostatectomy by a single surgeon were enrolled in this study. Twenty early patients began pelvic floor muscle exercise (PME). Fifteen subsequent patients received SSTES postoperatively with no instruction for PME provided. Immediate urinary function just after catheter removal was evaluated with frequency-volume chart and 24-hour pad test.Results. There were no differences between the SSTES and PME groups in maximum voided volume capacity (MVV) and urine loss ratio (ULR) on the first day after removal of urethral catheter. However, on day 3 MVV was significantly larger and ULR was also significantly lower in the SSTES group.Conclusions. SSTES treatment is feasible and appears to be effective for early recovery of urinary continence after radical prostatectomy.