Perception threshold and electrode position for spinal cord stimulation

The perception threshold for epidural spinal cord stimulation in chronic pain management was analyzed on 3923 testing data obtained from 136 implanted patients. The initial areas of paresthesiae due to stimulation were recorded and reported as the stimulation map according to the location of electrodes. Measurement of dorsal thickness of the cerebrospinal fluid (CSF) layer was obtained from 26 subjects using magnetic resonance imaging (MRI). The results indicate that the perception threshold is a function of the spinal level of the implanted electrodes, of the mediolateral position in the spinal canal and the contact separation of electrode. Differences in perception threshold at various vertebral levels are mainly due to varying depths of the dorsal CSF layer. The medially placed electrodes caudal to the mid-cervical levels have a higher perception threshold than more laterally placed ones. The electrodes at high and mid-cervical levels, however, have a smaller perception threshold if placed medially. The information obtained from this investigation has important implications for the design of a new-generation stimulation system and clinical application to maximize the longevity of the power source

Adaptive Control of a Wearable Exoskeleton for Upper-Extremity Neurorehabilitation

The paper describes the implementation and testing of two adaptive controllers developed for a wearable, underactuated upper extremity therapy robot – RUPERT (Robotic Upper Extremity Repetitive Trainer). The controllers developed in this study were used to implement two adaptive robotic therapy modes – the adaptive co-operative mode and the adaptive active-assist mode – that are based on two different approaches for providing robotic assistance for task practice. The adaptive active-assist mode completes therapy tasks when a subject is unable to do so voluntarily. This robotic therapy mode is a novel implementation of the idea of an active-assist therapy mode; it utilizes the measure of a subject’s motor ability, along with their real-time movement kinematics to initiate robotic assistance at the appropriate time during a movement trial. The adaptive co-operative mode, on the other hand, is based on the idea of enabling task completion instead of completing the task for the subject. Both these therapy modes were designed to adapt to a stroke subject's motor ability, and thus encourage voluntary participation from the stroke subject. The two controllers were tested on three stroke subjects practicing robot-assisted reaching movements. The results from this testing demonstrate that an underactuated wearable exoskeleton, such as RUPERT, can be used for administering robot-assisted therapy, in a manner that encourages voluntary participation from the subject undergoing therapy

Recent developments in biofeedback for neuromotor rehabilitation

The original use of biofeedback to train single muscle activity in static positions or movement unrelated to function did not correlate well to motor function improvements in patients with central nervous system injuries. The concept of task-oriented repetitive training suggests that biofeedback therapy should be delivered during functionally related dynamic movement to optimize motor function improvement. Current, advanced technologies facilitate the design of novel biofeedback systems that possess diverse parameters, advanced cue display, and sophisticated control systems for use in task-oriented biofeedback. In light of these advancements, this article: (1) reviews early biofeedback studies and their conclusions; (2) presents recent developments in biofeedback technologies and their applications to task-oriented biofeedback interventions; and (3) discusses considerations regarding the therapeutic system design and the clinical application of task-oriented biofeedback therapy. This review should provide a framework to further broaden the application of task-oriented biofeedback therapy in neuromotor rehabilitation

Paresthesia thresholds in spinal cord stimulation: a comparison of theoretical results with clinical data

The potential distributions produced in the spinal cord and surrounding tissues by dorsal epidural stimulation at the midcervical, midthoracic, and low thoracic levels were calculated with the use of a volume conductor model. Stimulus thresholds of myelinated dorsal column fibers and dorsal root fibers were calculated at each level in models in which the thickness of the dorsal cerebrospinal fluid (CSF) layer was varied. Calculated stimulus thresholds were compared with paresthesia thresholds obtained from measurements at the corresponding spinal levels in patients. The influences of the CSF layer thickness, the contact separation in bipolar stimulation and the laterality of the electrodes on the calculated thresholds were in general agreement with the clinical dat

Increased phosphatidylcholine (16:0/16:0) in the folliculus lymphaticus of Warthin tumor

Warthin tumor (War-T), the second most common benign salivary gland tumor, consists mainly of neoplastic epithelium and lymphoid stroma. Some proteins and genes thought to be involved in War-T were evaluated by molecular biology and immunology. However, lipids as an important component of many tumor cells have not been well studied in War-T. To elucidate the molecular biology and pathogenesis of War-T, we investigated the visualized distribution of phosphatidylcholines (PCs) by imaging mass spectrometry (IMS). In our IMS analysis of a typical case, 10 signals were significantly different in intensity (p < 0.01) between the War-T and non-tumor (Non-T) regions. Five specific PCs were frequently found in the War-T regions of all of the samples: [PC (16:0/16:0) + K](+) (m/z 772.5), [PC (16:0/20:4) + K](+) (m/z 820.5), [PC (16:0/20:3) + K](+) (m/z 822.5), [PC (18:2/20:4) + K](+) (m/z 844.5), and [PC (18:0/20:5) + K](+) (m/z 846.5). PC (16:0/16:0) was increased specifically in the folliculus lymphaticus of War-T lymphoid stroma, suggesting a different metabolism. Localization of PC (16:0/16:0) might reflect inflammation activity participating in the pathogenesis of War-T. Thus, our IMS analysis revealed the profile of PCs specific to the War-T region. The molecules identified in our study provide important information for further studies of War-T pathogenesis

Ensemble Fractional Sensitivity: A Quantitative Approach to Neuron Selection for Decoding Motor Tasks

A robust method to help identify the population of neurons used for decoding motor tasks is developed. We use sensitivity analysis to develop a new metric for quantifying the relative contribution of a neuron towards the decoded output, called “fractional sensitivity.” Previous model-based approaches for neuron ranking have been shown to largely depend on the collection of training data. We suggest the use of an ensemble of models that are trained on random subsets of trials to rank neurons. For this work, we tested a decoding algorithm on neuronal data recorded from two male rhesus monkeys while they performed a reach to grasp a bar at three orientations (45°, 90°, or 135°). An ensemble approach led to a statistically significant increase of 5% in decoding accuracy and 25% increase in identification accuracy of simulated noisy neurons, when compared to a single model. Furthermore, ranking neurons based on the ensemble fractional sensitivities resulted in decoding accuracies 10%–20% greater than when randomly selecting neurons or ranking based on firing rates alone. By systematically reducing the size of the input space, we determine the optimal number of neurons needed for decoding the motor output. This selection approach has practical benefits for other BMI applications where limited number of electrodes and training datasets are available, but high decoding accuracies are desirable