Mobile Hardware-Information System for Neuro-Electrostimulation

The article describes organizational principles of the mobile hardware-informational system based on the multifactorial neuro-electrostimulation device. The system is implemented with two blocks: the first block forms the spatially distributed field of low-frequency monopolar current pulses between two multielement electrodes in the neck region. Functions of the second block, specialized control interface, are performed by a smartphone. Information is exchanged between two blocks through a telemetric channel. The mobile hardware-informational system allows to remotely change the structure of the current pulses field, to control its biotropic characteristics and to change the targets of the stimulation. Moreover, it provides patient data collection and processing, as well as access to the specialized databases. The basic circuit solutions for the neuro-electrostimulation device, implemented by means of microcontroller and elements of high-level hardware integration, are described. The prospects of artificial intelligence and machine learning application for treatment process management are discussed. © 2018 Vladimir S. Kublanov et al.)is study was supported by the Act 211 of the Government of the Russian Federation (contract no. 02.A03.21.0006) and was funded by RFBR (project no, 18-29-02052)

Application of multichannel electrical stimulation of the neck nervous structures in patients with depressive disorders: An fMRI case study

The article presents the pilot functional neuroimaging study results of the treatment process by means neuro-electrostimulator SYMPATHOCOR-01 in patients with depressive disorder. The study involved three patients. The changes in the brain's default mode network (DMN) as a result of neuro-electrostimulation course are demonstrated. Along with clinical improvement (HDRS-21 and BDI-II scales), changes in DMN's performance from neuroimaging data are shown. An increase in the medial prefrontal cortex and cingulate gyrus functional connection activity with various parts of the brain was noted. These changes indicate the activation of neuroplasticity processes and restoring the work of DMN in patients with depression. © 2019 by SCITEPRESS - Science and Technology Publications, Lda. All rights reserved.Russian Foundation for Basic Research, RFBR: 18-29-02052Government Council on Grants, Russian FederationThis data acquisition within the study (Chapter 3) was supported by the Act 211 of the Government of the Russian Federation (contract no. 02.A03.21.0006). Data processing (Chapter 4) was funded by RFBR (project no, 18-29-02052)

On some possibilities of organizing a mobile hardware-information system for polyfactorial neuro-electrostimulation

In paper the organizational principles of the mobile hardware-information system for polyfactorial neuroelectrostimulation were considered. It was shown that the system can be implemented by three functionally separate blocks, one of which ensures the formation of a spatially distributed field of current pulses, the second is the specialized interface for the patient, and the third is the specialized interface for the doctor. The exchange of information between the blocks is provided by a telemetric communication channel or via the global network using mobile wearable computers (which can include a personal computer, tablet or smartphone). A personalized patient information system can be implemented on the basis of the neuroelectrostimulation system. In this case patient data can be placed on the server of the medical institution. The prospects for using artificial intelligence and machine learning to control the treatment process were discussed. © 2019 by SCITEPRESS - Science and Technology Publications, Lda. All rights reserved

Clinical Pathways in Stroke Rehabilitation

This open access book focuses on practical clinical problems that are frequently encountered in stroke rehabilitation. Consequences of diseases, e.g. impairments and activity limitations, are addressed in rehabilitation with the overall goal to reduce disability and promote participation. Based on the available best external evidence, clinical pathways are described for stroke rehabilitation bridging the gap between clinical evidence and clinical decision-making. The clinical pathways answer the questions which rehabilitation treatment options are beneficial to overcome specific impairment constellations and activity limitations and are well acceptable to stroke survivors, as well as when and in which settings to provide rehabilitation over the course of recovery post stroke. Each chapter starts with a description of the clinical problem encountered. This is followed by a systematic, but concise review of the evidence (RCTs, systematic reviews and meta-analyses) that is relevant for clinical decision-making, and comments on assessment, therapy (training, technology, medication), and the use of technical aids as appropriate. Based on these summaries, clinical algorithms / pathways are provided and the main clinical-decision situations are portrayed. The book is invaluable for all neurorehabilitation team members, clinicians, nurses, and therapists in neurology, physical medicine and rehabilitation, and related fields. It is a World Federation for NeuroRehabilitation (WFNR) educational initiative, bridging the gap between the rapidly expanding clinical research in stroke rehabilitation and clinical practice across societies and continents. It can be used for both clinical decision-making for individuals and as well as clinical background knowledge for stroke rehabilitation service development initiatives. ; Provides evidence-based clinical practice guidelines for stroke rehabilitation Discusses clinical problems and evidence, comments on assessment, therapy and technical aids Written by experienced experts with a background in clinical practic

Clinical Pathways in Stroke Rehabilitation

This open access book focuses on practical clinical problems that are frequently encountered in stroke rehabilitation. Consequences of diseases, e.g. impairments and activity limitations, are addressed in rehabilitation with the overall goal to reduce disability and promote participation. Based on the available best external evidence, clinical pathways are described for stroke rehabilitation bridging the gap between clinical evidence and clinical decision-making. The clinical pathways answer the questions which rehabilitation treatment options are beneficial to overcome specific impairment constellations and activity limitations and are well acceptable to stroke survivors, as well as when and in which settings to provide rehabilitation over the course of recovery post stroke. Each chapter starts with a description of the clinical problem encountered. This is followed by a systematic, but concise review of the evidence (RCTs, systematic reviews and meta-analyses) that is relevant for clinical decision-making, and comments on assessment, therapy (training, technology, medication), and the use of technical aids as appropriate. Based on these summaries, clinical algorithms / pathways are provided and the main clinical-decision situations are portrayed. The book is invaluable for all neurorehabilitation team members, clinicians, nurses, and therapists in neurology, physical medicine and rehabilitation, and related fields. It is a World Federation for NeuroRehabilitation (WFNR) educational initiative, bridging the gap between the rapidly expanding clinical research in stroke rehabilitation and clinical practice across societies and continents. It can be used for both clinical decision-making for individuals and as well as clinical background knowledge for stroke rehabilitation service development initiatives. ; Provides evidence-based clinical practice guidelines for stroke rehabilitation Discusses clinical problems and evidence, comments on assessment, therapy and technical aids Written by experienced experts with a background in clinical practic

Fecal Incontinence

Fecal incontinence is a common and disabling condition that unfortunately remains an “orphan” in terms of medical research and effective therapies. This book provides a brief review of the pathophysiology of fecal incontinence with specific focus on women and children. Authorship is drawn internationally, with a strong surgical input. Contributions from the authors provide critical reviews of the evaluation of function, with illustrations of a range of surgical interventions which might be applied should medical therapies fail

Non-invasive and minimally invasive techniques for urodynamic stress incontinence of urine in women

1. Extra-corporeal magnetic energy stimulation of pelvic floor muscles for urodynamic stress incontinence;Objective: To assess the efficacy and practicalities of extra-corporeal magnetic energy stimulation of pelvic floor muscles as a non-invasive technique for urodynamic stress incontinence of urine in women.Design: Prospective non-controlled study.Setting: 2 district general hospitals.Population: Female patients with urodynamic stress incontinence of urine.Main outcome measures: Pad test, continence diary, quality of life assessment using the King's health and EuroQol questionnaires as well as side effects and drop out.Method; 18, twice weekly sessions. Assessment was made on recruitment, at the end of treatment and at 3 months follow up.Results: 48 patients were recruited, 31 completed treatment sessions and 27 attended for follow up at 3 months. There was no significant change in outcome measures at the end of treatment as well as at 3 months follow up. Side effects were encountered by 52.1 % of patients and the drop out rate was 35.4%. Relevant side effects were significantly more common in those who dropped out.Conclusions; Extra-corporeal magnetic energy stimulation of pelvic floor muscles seems unlikely to improve urodynamic stress incontinence of urine. This appears to be due to the passive nature of the contractions evoked. Side effects are prominent and appear to contribute to the drop out rate.2. Transvaginal radiofreguency remodelling of the endopelvic fascia for urodynamic stress incontinence due to urethral hypermobility:Objective: To assess the efficacy and safety of transvaginal radiofrequency remodelling of the endopelvic fascia as a minimally invasive technique for urodynamic stress incontinence of urine due to urethral hypermobility in women.Design: Prospective non-controlled study.Setting: 3 district general hospitals and 1 university hospital.Population: Female patients with urodynamic stress incontinence of urine due to urethral hypermobility.Main outcome measures: Pad test, urodynamic assessment, continence diary, pain scores and operative as well as post-operative complications.Method: Transvaginal radiofrequency of the endopelvic fascia. Assessment was made on recruitment, during hospital admission and at 3,6 and 12 months follow up.Results: 24 patients were available for analysis. A rising failure rate was noted as early as 3 months, leading to a cumulative cure rate of 36% at 12 months follow up. No major complications were encountered and pain scores were mild.Conclusions: The effectiveness of transvaginal radiofrequency remodelling of the endopelvic fascia for urodynamic stress incontinence of urine due to urethral hypermobility appears to be low. Inherent weakness of the endopelvic fascia appears to be the main reason. The technique has a low complication and pain profile.3. Comparison between the tension·free vaginal tape (TVT), pelvicol as well as short autologous slings for urodynamic stress incontinence:Objective: To compare the efficacy and morbidity of the tension·free vaginal tape (TVT), pelvicol as well as short autologous slings, as minimally invasive technique for urodynamic stress incontinence of urine in women.Design: Muticentre randomised controlled single blind study.Setting: 4 district general hospitals and 2 teaching university hospitals.Population: Female patients with urodynamic stress incontinence of urine.Main outcome measures: Quality of life and symptom assessment using Bristol Female Lower Urinary Tract Symptoms as well as EuroQol questionnaires, pad test, continence diary, operating time, stay in hospital, operative as well as post-operative complications.Method: Tension-free vaginal tape (TVT) , pelvicol or short autologous sling insertion. Assessment was made on recruitment, during hospital stay and at 6 weeks as well as 6 and 12 months follow up.Results: A total of 181 patients were recruited. An interim analysis of re-operation rate showed a significantly higher rate with pelvicol, necessitating closure of this arm. All pelvicol failures appeared after 6 months, raising the possibility of a delayed reaction. No significant difference was observed between the tension-free vaginal tape (TVT) and short autologous slings in terms of operative as well as post-operative complications, pad test and continence diary. Operating time and post-operative stay in hospital were significantly shorter following the tension-free vaginal tape (TVT) sling than after the short autologous one. This reduces the higher capital cost of the tension free vaginal tape (TVT) sling. There was also a short term advantage in quality of life assessment.Conclusions: Pelvicol slings are associated with a delayed failure, and should not therefore be used for continence surgery. Although both the tension-free vaginal tape (TVT) and short autologous slings are equally effective and have a comparable complications profile, the tension-free vaginal tape (TVT) sling is quicker to insert and is followed by a shorter stay in hospital; 2 features that reduce its higher cost. It is also associated with a better quality of life change in the short term