This is a report of methods and tools for selection of task and individual configurations targeted for voluntary movement, standing, stepping, blood pressure stabilization, and facilitation of bladder storage and emptying using tonic-interleaved excitation of the lumbosacral spinal cord.This study aimed to present strategies used for selection of stimulation parameters for various motor and autonomic functions.Tonic-interleaved functionally focused neuromodulation targets a myriad of consequences from spinal cord injury with surgical implantation of the epidural electrode at a single location. This approach indicates the sophistication of the human spinal cord circuitry and its important role in the regulation of motor and autonomic functions in humans. 

/pdf/targeted-selection-of-stimulation-parameters-for-restoration-1ra00nor.pdf

Targeted Selection of Stimulation Parameters for Restoration of Motor and Autonomic Function in Individuals With Spinal Cord Injury.

A review on the complexities of brain activity: insights from nonlinear dynamics in neuroscience

Surface electromyography (sEMG) has emerged as a valuable tool for assessing muscle activity in various clinical and research settings. This review focuses on the application of sEMG specifically in the context of paraspinal muscles. The paraspinal muscles play a critical role in providing stability and facilitating movement of the spine. Dysfunctions or alterations in paraspinal muscle activity can lead to various musculoskeletal disorders and spinal pathologies. Therefore, understanding and quantifying paraspinal muscle activity is crucial for accurate diagnosis, treatment planning, and monitoring therapeutic interventions. This review discusses the clinical applications of sEMG in paraspinal muscles, including the assessment of low back pain, spinal disorders, and rehabilitation interventions. It explores how sEMG can aid in diagnosing the potential causes of low back pain and monitoring the effectiveness of physical therapy, spinal manipulative therapy, and exercise protocols. It also discusses emerging technologies and advancements in sEMG techniques that aim to enhance the accuracy and reliability of paraspinal muscle assessment. In summary, the application of sEMG in paraspinal muscles provides valuable insights into muscle function, dysfunction, and therapeutic interventions. By examining the literature on sEMG in paraspinal muscles, this review offers a comprehensive understanding of the current state of research, identifies knowledge gaps, and suggests future directions for optimizing the use of sEMG in assessing paraspinal muscle activity.

The Application of Surface Electromyography Technology in Evaluating Paraspinal Muscle Function

Chronic pain is primarily treated with pharmaceuticals, but the effects remain unsatisfactory. A promising alternative therapy is peripheral nerve stimulation (PNS), but it has been associated with suboptimal efficacy because its modulation mechanisms are not clear and the current therapies are primarily open loop (ie, manually adjusting the stimulation parameters). In this study, we developed a proof-of-concept computational modeling as the first step toward implementing closed-loop PNS in future biological studies. When developing new pain therapies, a useful pain biomarker is the wide-dynamic-range (WDR) neuron activity in the dorsal horn. In healthy animals, the WDR neuron activity occurs in a stereotyped manner; however, this response profile can vary widely after nerve injury to create a chronic pain condition. We hypothesized that if injury-induced changes of neuronal response can be normalized to resemble those of a healthy condition, the pathological aspects of pain may be treated while maintaining protective physiological nociception.Using an in vivo electrophysiology data set of WDR neuron recordings obtained in nerve-injured rats and naïve rats, we constructed sets of linear phenomenologic models of WDR firing rate during windup stimulation for both conditions. Then, we applied robust control systems techniques to identify a closed-loop PNS controller, which can drive the dynamics of WDR neuron response in neuropathic pain model into ranges associated with normal physiological pain.The sets of identified linear models can accurately predict, in silico, nonlinear neural responses to electrical stimulation of the peripheral nerve. In addition, we showed that continuous closed-loop control of PNS can be used to normalize WDR neuron firing responses in three injured cases.In this proof-of-concept study, we show how tractable, linear mathematical models of pain-related neurotransmission can be used to inform the development of closed-loop PNS. This new application of robust control to neurotechnology may also be expanded and applied across other neuromodulation applications. 

Steering Toward Normative Wide-Dynamic-Range Neuron Activity in Nerve-Injured Rats With Closed-Loop Peripheral Nerve Stimulation.

Spinal cord injury (SCI) is a significant cause of disability, affecting both children and adults worldwide. These injuries can arise from various conditions, including traumatic, vascular, tumor-related, infection-related, inflammatory (such as multiple sclerosis), or neurodegenerative (like motor neuron disease) origins. Among these, traumatic spinal cord injuries caused by reasons like falls and traffic accidents stand out, particularly in developed countries. Epidural electrical stimulation (EES) was initially used to inhibit chronic pain. Subsequent studies have shown its effectiveness in individuals with SCI. In research spanning from the past to the present, EES applications have been utilized for activities such as motor function improvement, sensory enhancement, bowel functions, increased sexual functionality, and regulating heart rhythms in people with SCI. However, the exact impact of EES remains inconclusive at present and is still a subject of debate.

Spinal Kord Yaralanması Olan Bireylerde Epidural Elektriksel Stimülasyon Uygulamasının Etkisi

Epidural spinal cord stimulation (eSCS) has shown promise for restoring some volitional motor control after spinal cord injury (SCI). Maximizing therapeutic response requires effective spatial stimulation generated through careful configuration of anodes and cathodes on the eSCS lead. By exploring the way the spatial distribution of low frequency stimulation affects muscle activation patterns, we investigated the spatial specificity of stimulation-evoked responses for targeted muscle groups for restoration after chronic SCI (cSCI) in participants in the Epidural Stimulation After Neurologic Damage (E-STAND) trial.Fifteen participants with Abbreviated Injury Scale A cSCI from the E-STAND study were evaluated with a wide range of bipolar spatial patterns. Surface electromyography captured stimulation-evoked responses from the rectus abdominis (RA), intercostal, paraspinal, iliopsoas, rectus femoris (RF), tibialis anterior (TA), extensor hallucis longus (EHL), and gastrocnemius muscle groups bilaterally. Peak-to-peak amplitudes were analyzed for each pulse across muscles. Stimulation patterns with dipoles parallel (vertical configurations), perpendicular (horizontal configurations), and oblique (diagonal configurations) relative to the rostral-caudal axis were evaluated.Cathodic stimulation in the transverse plane indicated ipsilaterally biased activation in RA, intercostal, paraspinal, iliopsoas, RF, TA, EHL, and gastrocnemius muscles (p < 0.05). We found that caudal cathodic stimulation was significantly more activating only in the RF and EHL muscle groups than in the rostral (p < 0.037 and p < 0.006, respectively). Oblique stimulation was found to be more activating in the RA, intercostal, paraspinal, iliopsoas, and TA muscle groups than in the transverse (p < 0.05).Cathodic stimulation provides uniform specificity for targeting laterality. Few muscle groups responded specifically to variation in rostral/caudal stimulation, and oblique stimulation improved stimulation responses when compared with horizontal configurations. These relations may enable tailored targeting of muscle groups, but the surprising amount of variation observed suggests that monitoring these evoked muscle responses will play a key role in this tailoring process.The Clinicaltrials.gov registration number for the study is NCT03026816. 

Mapping Spinal Cord Stimulation-Evoked Muscle Responses in Patients With Chronic Spinal Cord Injury.

A multicenter, prospective, single-arm study of 60-day peripheral nerve stimulation of the occipital nerves for the treatment of headache.

Chronic shoulder pain commonly results in disability and reduced quality of life, with frequent causes including post-surgical pain, inoperable musculoskeletal injury or joint degeneration, and stroke. Temporary percutaneous peripheral nerve stimulation (PNS) has demonstrated significant and sustained relief of chronic shoulder pain in previous clinical trials. This study presents the first real-world, retrospective review of patient outcomes through up to 6 months following the start of a 60-day PNS treatment for chronic shoulder pain. 

ID: 207021 Significant and Sustained Relief of Shoulder Pain Following 60-day PNS Treatment: A Real-World Retrospective Review

Axial neck pain is a prevalent and often debilitating pain condition with conventional treatment options that commonly lack efficacy or are neurodestructive (e.g., radiofrequency ablation). Sixty-day percutaneous peripheral nerve stimulation (PNS) has emerged as a potential non-destructive treatment for axial neck pain that targets efferent fibers in the cervical medial branch nerves to secondarily produce comfortable, cycling tension in core cervical musculature (e.g., multifidus). The present work is a retrospective review of outcomes from patients receiving 60-day PNS treatment targeting the cervical medial branch nerves in routine clinical practice. 

ID: 206983 Retrospective Review of Real-World Outcomes Following 60-Day PNS of the Cervical Medial Branch Nerves

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