Neurotechnologies Covered:   Electrical stimulation over the surface of the arm or hand Electrical stimulation over the surface of the spine Electrical stimulation over the surface of the head Magnetic stimulation over the surface of the head Braces that are powered to amplify movements Brain computer interface with a cap Baclofen pum

Grampurohit, PhD, OTR/L, Namrata

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Thomas Jefferson University Jefferson Digital Commons Department of Occupational Therapy Faculty Papers Department of Occupational Therapy 2-2020 Appendix 10: Neurotechnology Descriptions Namrata Grampurohit, PhD, OTR/L Thomas Jefferson University Follow this and additional works at: https://jdc.jefferson.edu/otfp  Part of the Neurosciences Commons, and the Occupational Therapy Commons Let us know how access to this document benefits you Recommended Citation Grampurohit, PhD, OTR/L, Namrata, "Appendix 10: Neurotechnology Descriptions" (2020). Department of Occupational Therapy Faculty Papers. Paper 71. https://jdc.jefferson.edu/otfp/71 This Article is brought to you for free and open access by the Jefferson Digital Commons. The Jefferson Digital Commons is a service of Thomas Jefferson University's Center for Teaching and Learning (CTL). The Commons is a showcase for Jefferson books and journals, peer-reviewed scholarly publications, unique historical collections from the University archives, and teaching tools. The Jefferson Digital Commons allows researchers and interested readers anywhere in the world to learn about and keep up to date with Jefferson scholarship. This article has been accepted for inclusion in Department of Occupational Therapy Faculty Papers by an authorized administrator of the Jefferson Digital Commons. For more information, please contact: JeffersonDigitalCommons@jefferson.edu.  Appendix 10 1  Neurotechnologies  Neurotechnology Medical term Description Benefits Risks NON-INVASIVE PROCEDURES E1. Electrical stimulation over the surface of the arm or hand    https://www.strokengine.ca/en/patient-info/functional-electrical-stimulation-upper-extremity-info/ Electrical stimulation (E-stim) OR Transcutaneous Electrical Nerve Stimulation (TENS) OR Neuromuscular Electrical Stimulation (NMES) OR Functional Electrical Stimulation (FES) Electrical stimulation uses surface electrodes (adhesive pads or stickers) over the skin which are attached to a machine. The machine sends a small amount of electrical current to weak or paralyzed muscles. Tingling sensation is experienced over the skin in the area of stimulation. -Increase in muscle contraction1 -Increase in blood circulation2 -Reduces spasticity3 -Reduce pain4 -Increase aerobic fitness5  -Skin irritation6 -Burning sensation4 -Muscle tears  -Pain4 -Tingling below application site4 E2. Electrical stimulation over the surface of the spine http://depts.washington.edu/moritlab/?page_id=718  Transcutaneous Spinal Cord Stimulation Electrical stimulation uses surface electrodes (adhesive pads or stickers) over the skin of the lower back and abdomen that are attached to a machine. The machine sends small amount of electrical current that can stimulate nerves in the spinal cord from outside the body.         -Immediate effect while the stimulator is on3 -Controlling locomotion7 -Long-lasting effects (up to a week)3 -Reduced pain4 -Reduced spasticity3 -Skin irritation6 -Burning sensation4 -Pain4 -Tingling below application site4  Appendix 10 2  E3. Electrical stimulation over the surface of the head  https://www-ncbi-nlm-nih-gov.proxy1.lib.tju.edu/pmc/articles/PMC5702643/  Stroke, Depression, anxiety, pain, Parkinson’s disease Transcranial Direct Current Stimulation (TDCS) Electrodes are placed over the scalp directly over the brain area to be stimulated. A small amount of electric current is passed through.  -Temporary improvement in emotion and mental functioning8 -Fatigue9 -Improvement of language in aphasia10  -Tickling or burning sensation over the head11  -Headache11,12 -Skin lesions or burns11 -Nausea11,12 -Difficulty concentrating12 -Fatigue11 -Redness12 -Mood changes11,12  E4. Magnetic stimulation over the surface of the head   https://www.medpagetoday.com/psychiatry/depression/56168       Cost: $200 to $300 per session (20 min) – Needs 5 sessions/wk for 4-6 wks Transcranial Magnetic Stimulation (TMS), Repetitive TMS (rTMS) A magnetic coil is placed over the head, creating changing magnetic fields over the surface of the brain. It is used to create electric current at a specific area in the brain. (FDA approved) -Improves mood13  -Cannot be used with metal objects near the head -Headache14 -Pain over scalp -Loud machine noise -Crying -Seizure14  E5. Braces that are powered to amplify movements    https://myomo.com/what-is-a-myopro-orthosis/ Myoelectric brace The electrical signals from weak muscles are converted into large movement of the brace to allow improved movement.  -Improved movement15, 16, 17 -Allows the patient to perform movement they otherwise are unable to complete15, 16, 17 -Effective in improving motor control15, 16, 17 -Improvement in self-reported function and -Pressure sores -Chafing of the skin -Mechanical irritation                           Appendix 10 3  perception of recovery15, 16, 17 E6. Brain computer interface with a cap https://www.odtmag.com/contents/view_breaking-news/2017-08-30/stroke-patients-motor-function-improved-with-brain-computer-interface/ EEG driven brain computer interface Brain computer interfaces or brain machine interfaces are hardware and software systems that allow brain activity to control a hand brace to move the hand. Some brain computer interfaces are implanted in the brain and others use an external cap. -Communication19 -Movement control19 -Control of external devices19 -Improved motor function19             -BCIs placed outside of the skull have a limited ability to read brain signals20 -Signal connection problems20 -Quality of electroencephalography signals is affected by scalp, skull, and many other layers as well as background noise20 -Skin irritation or hair loss secondary to cap pulling on hair follicles21 INVASIVE PROCEDURES E7. Baclofen pump   http://www.emdocs.net/core-em-intrathecal-baclofen-withdrawal/   Intrathecal Baclofen Therapy (ITB) The medicine Baclofen is placed in a round metal disc under the skin of the abdomen and delivered by a pump and a catheter directly into the spine. Refills are done every 1 to 6 months and battery is changed every 5 to 7 years. (FDA approved) -Reduces spasticity22 -Improved ambulation/wheelchair seating -Reduced spasticity-related pain -Improved sleep -Dosing errors -Weakness23 -Sleepiness23 -Upset stomach23 -Nausea23 -Vomiting -Headache -Dizziness -Confusion -Catheter, Battery or pump malfunction (CSF leakages)23 -Hypotonia23 -Infection -ITB withdrawal syndrome (rare)23   Appendix 10 4  E8. Implanted stimulators for the nerves of the arm and hand https://connect.springerpub.com/content/book/978-0-8261-3775-3/part/part05/chapter/ch48  Peripheral nerve and field stimulators (PNFS) Peripheral nerve and field stimulation involves placing the electrodes directly on nerves or under the skin in the painful region. It is a minimally invasive procedure, requiring a small incision over the targeted area. -Pain reduction for chronic pain24 30 to 40% rate of complications -Hardware complication: movement, breaking or malfunction of the electrode -Infection, pain over electrode  -Rare: headache, neurological damage E9. Implanted stimulators for the spine  https://www.spinalcord.com/blog/what-to-know-epidural-stimulation-spinal-cord-injury  Spinal cord injury – traumatic and non-traumatic: Cost: $15 - 50K without insurance, Covered by some insurance such as Medicare and Blue Cross and Blue Shield Epidural Electrical stimulation (EES) or Epi-stim Stimulators for the spinal cord are surgically placed directly on the cord for continuous electrical current.  -Increases muscle contraction25, 26 -Programming issues for the device -Movement, leakage of current, & failure of electrode -Nerve injury 27,28 -Infection28 -Pain at the site28 -Equipment failure 27,28   Appendix 10 5  E10. Braces powered by implanted sensors in the brain  https://www.extremetech.com/extreme/102927-brain-computer-interfaces-creep-closer-to-bionic-mecha-dream  Brain computer interface (BCI), Neural-control interface (NCI), Direct neural interface (DNI), Brain machine interface (BMI) A small chip is surgically placed in the brain and connects to an external brace that can move the arm or hand. -Increased movement  Communication29 -Increased perception29 -Increased motor activity29 -Increased sensation29 -Infection -Anesthesia risk -Scarring over brain -Pain at location site, headaches E11. Deep Brain Stimulation for Parkinson’s disease https://www.nejm.org/doi/full/10.1056/NEJMct1208070  Deep Brain Stimulation A brain pacemaker is placed surgically on specific areas of the brain. (FDA approved) -Reduces tremor30 and epilepsy  -Reduced dyskinesia31 -Increased control with movements -Infection -Electrode movement, damage or malfunction -Scarring over brain -Worsening of gait, balance, and/or speech31  E12. Nerve transfers https://www.mayoclinic.org/diseases-conditions/brachial-plexus-injury/diagnosis-treatment/drc-20350241 Nerve transfer A nerve transfer is a surgical procedure where a nerve with a less important role is transferred surgically to another more important nerve that is not functioning.   Regain important movement 32, 33, 34 -Anesthesia risk -Infection  Appendix 10 6  E13. Tendon transfers http://blog.handcare.org/blog/2017/04/26/4-reasons-you-may-need-tendon-transfer-surgery/  Tendon transfer A tendon transfer is a surgical procedure where a tendon with a less important role is transferred to serve the function of a weak tendon with a crucial role.  Regain important movement32 -Anesthesia risk -Infection                                                            Appendix 10 7  References    1Ashida Y, Himori K, Tatebayashi D, Yamada R, Ogasawara R, Yamada T. Effects of contraction mode and stimulation frequency on electrical stimulation-induced skeletal muscle hypertrophy. J. Appl. Physiol. 2018;124(2):341-348. doi:10.1152/japplphysiol.00708.2017.  2Yamabata S, Shiraishi H, Munechika M, et al. Effects of electrical stimulation therapy on the blood flow in chronic critical limb ischemia patients following regenerative therapy. SAGE Open Med. 2016;4:2050312116660723. doi:10.1177/2050312116660723.  3Hofstoetter US, Freundl B, Danner SM, et al. Transcutaneous Spinal Cord Stimulation Induces Temporary Attenuation of Spasticity in Individuals with Spinal Cord Injury. J. Neurotrauma 2019. doi:10.1089/neu.2019.6588.  4Cogiamanian F, Vergari M, Pulecchi F, Marceglia S, Priori A. Effect of spinal transcutaneous direct current stimulation on somatosensory evoked potentials in humans. Clin. Neurophysiol. 2008;119(11):2636-2640. doi:10.1016/j.clinph.2008.07.249.  5Wilbanks SR, Rogers R, Pool S, Bickel CS. Effects of functional electrical stimulation assisted rowing on aerobic fitness and shoulder pain in manual wheelchair users with spinal cord injury. J. Spinal Cord Med. 2016;39(6):645-654. doi:10.1179/2045772315Y.0000000052.  6Johnson MI, Ashton CH, Thompson JW. An in-depth study of long-term users of transcutaneous electrical nerve stimulation (TENS). Implications for clinical use of TENS. Pain 1991;44(3):221-229. doi:10.1016/0304-3959(91)90089-g.  7Gerasimenko Y, Gorodnichev R, Moshonkina T, Sayenko D, Gad P, Reggie Edgerton V. Transcutaneous electrical spinal-cord stimulation in humans. Ann. Phys. Rehabil. Med. 2015;58(4):225-231. doi:10.1016/j.rehab.2015.05.003.  8Ferrucci R, Bortolomasi M, Vergari M, et al. Transcranial direct current stimulation improves patients with severe major depression. Brain Stimulat. 2008;1(3):259. doi:10.1016/j.brs.2008.06.042.  9Ferrucci R, Vergari M, Cogiamanian F, et al. Transcranial direct current stimulation (tDCS) for fatigue in multiple sclerosis. NeuroRehabilitation 2014;34(1):121-127. doi:10.3233/NRE-131019.  10Monti A, Ferrucci R, Fumagalli M, et al. Transcranial direct current stimulation (tDCS) and language. J. Neurol. Neurosurg. Psychiatr. 2013;84(8):832-842. doi:10.1136/jnnp-2012-302825.  11Matsumoto H, Ugawa Y. Adverse events of tDCS and tACS: A review. Clin. Neurophysiol. Pract. 2017;2:19-25. doi:10.1016/j.cnp.2016.12.003.  12Thair H, Holloway AL, Newport R, Smith AD. Transcranial direct current stimulation (tdcs): A beginner’s guide for design and implementation. Front. Neurosci. 2017;11:641. doi:10.3389/fnins.2017.00641.  13Berlim MT, Van den Eynde F, Daskalakis ZJ. A systematic review and meta-analysis on the efficacy and acceptability of bilateral repetitive transcranial magnetic stimulation (rTMS) for treating major depression. Psychol. Med. 2013;43(11):2245-2254. doi:10.1017/S0033291712002802.   Appendix 10 8  14Bae EH, Schrader LM, Machii K, et al. Safety and tolerability of repetitive transcranial magnetic stimulation in patients with epilepsy: a review of the literature. Epilepsy Behav. 2007;10(4):521-528. doi:10.1016/j.yebeh.2007.03.004.  15Dunaway S, Dezsi DB, Perkins J, Tran D, Naft J. Case Report on the Use of a Custom Myoelectric Elbow-Wrist-Hand Orthosis for the Remediation of Upper Extremity Paresis and Loss of Function in Chronic Stroke. Mil. Med. 2017;182(7):e1963-e1968. doi:10.7205/MILMED-D-16-00399.  16Peters HT, Page SJ, Persch A. Giving Them a Hand: Wearing a Myoelectric Elbow-Wrist-Hand Orthosis Reduces Upper Extremity Impairment in Chronic Stroke. Arch. Phys. Med. 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Neurophysiol. 2001;112(3):536-544. doi:10.1016/S1388-2457(00)00533-2.  22Pucks-Faes E, Hitzenberger G, Matzak H, et al. Eleven years’ experience with Intrathecal Baclofen - Complications, risk factors. Brain Behav. 2018;8(5):e00965. doi:10.1002/brb3.965.  23Mohammed I, Hussain A. Intrathecal baclofen withdrawal syndrome- a life-threatening complication of baclofen pump: a case report. BMC Clin. Pharmacol. 2004;4:6. doi:10.1186/1472-6904-4-6.  24Mitchell B, Vivian D, Verrills P, Sinclair C. Peripheral nerve field stimulation: A novel treatment for chronic low back pain. Medicine & Science in Sports & Exercise 2008;40(Supplement):S4-S5. doi:10.1249/01.mss.0000321464.52452.9a.  25Mayr W, Krenn M, Dimitrijevic MR. Epidural and transcutaneous spinal electrical stimulation for restoration of movement after incomplete and complete spinal cord injury. Curr. Opin. Neurol. 2016;29(6):721-726. doi:10.1097/WCO.0000000000000382.  26Hofstoetter US, Freundl B, Binder H, Minassian K. 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Deep brain stimulation for movement disorders: update on recent discoveries and outlook on future developments. J. Neurol. 2015;262(11):2583-2595. doi:10.1007/s00415-015-7790-8.  31Okun MS. Deep-brain stimulation for Parkinson’s disease. N. Engl. J. Med. 2012;367(16):1529-1538. doi:10.1056/NEJMct1208070.  32Compton J, Owens J, Day M, Caldwell L. Systematic review of tendon transfer versus nerve transfer for the restoration of wrist extension in isolated traumatic radial nerve palsy. J. Am. Acad. Orthop. Surg. Glob. Res. Rev. 2018;2(4):e001. doi:10.5435/JAAOSGlobal-D-18-00001.  33Siqueira M, Martins R, Faglioni Junior W, Foroni L, Heise C. Restoration of Elbow Flexion in Traumatic Upper Brachial Plexus Palsy in Adults: Outcome with Intraplexus Distal Nerve Transfers in 78 Patients. Arq. Bras. Neurocir. 2018;37(04):285-290. doi:10.1055/s-0038-1676533.  34Sturma A, Hruby LA, Farina D, Aszmann OC. Structured motor rehabilitation after selective nerve transfers. J. Vis. Exp. 2019;(150). doi:10.3791/59840.                   

Appendix 10: Neurotechnology Descriptions

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