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Virtual Reality in Robotic Neurorehabilitation
Published in Christopher M. Hayre, Dave J. Muller, Marcia J. Scherer, Virtual Reality in Health and Rehabilitation, 2020
Nicolas Wenk, Karin A. Buetler, Laura Marchal-Crespo
Besides neurorehabilitation, VR therapy has been evidenced to be a valid tool for non-pharmacological pain and anxiety reduction by providing distraction from chronic and acute pain (e.g., Martini, 2016; Pourmand et al., 2018) associated with rheumatism (e.g., Tack, 2019), phantom limb pain after amputation (Matamala-Gomez et al., 2020; Murray et al., 2006; Osumi et al., 2020; Perry et al., 2018), and regional pain from (past) injuries (Feyzioğlu et al., 2020; Hoffman et al., 2011). Further, VR interventions have been applied in the field of psychotherapy, especially in the treatment of anxiety-related (e.g., specific phobias, Boeldt et al., 2019; Freeman et al., 2017) and post-traumatic stress disorders (Gonçalves et al., 2012; Oing and Prescott, 2018). For these patients, immersion in various safe, confidential, and controllable computer-generated interactive scenarios is a promising alternative to standard therapy sessions in public space. Finally, enriched VEs have become a unique opportunity to transport patients to both, stimulating and calming places, e.g., during intensive care after critical illness (Gerber et al., 2019, 2017; Hirota, 2020), or at different stages of neurodegenerative diseases (Dockx et al., 2016; Ferguson et al., 2020; Gates et al., 2019; Kim et al., 2019; Moreno et al., 2019; Sokolov et al., 2020).
Digital public space for the evolved mind
Published in Naomi Jacobs, Rachel Cooper, Living in Digital Worlds, 2018
However, these feelings are not always just related to habit, or just metaphorical. Brain imaging studies have shown that the mental mapping of yourself, or ‘body schema’ can be ‘extended’ onto a tool; for example, extending the reach of the arm (Maravita & Iriki, 2004, Sposito et al, 2012). This integration can lead to remarkable phenomena such as the ‘rubber hand illusion’ (Botvinick & Cohen, 1998; Ehrsson et al, 2004; Tsakiris & Haggard, 2005) in which participants are shown a prosthetic rubber hand being stroked simultaneously with their own (hidden) hand, and experience the prosthetic as part of their body, feeling shock if it is struck. Such phenomena have been used to treat phantom limb pain, allowing amputees to ‘feel’ an artificial arm as their own, ‘unclench’ the painful phantom fist and relieve the pain. Although a level of identification as a ‘real’ limb is needed for this to work (for example it does not work with a wooden stick: Tsakiris et al 2008, de Preester & Tsakiris 2009), enough personal connection and expression can lead to, for example, musicians who feel their instruments are ‘part of themselves’.
Anticipating and preventing complications in spinal cord stimulator implantation
Published in Expert Review of Medical Devices, 2023
Steven M. Falowski, Hao Tan, Joseph Parks, Alaa Abd-Elsayed, Ahmed Raslan, Jason Pope
Ensuring successful SCS trial and implantation, and optimal patient outcomes begins prior to surgery. It begins with appropriate patient selection before proceeding with the procedure. NACC has provided selection criteria for candidates seeking pain control with implantation of neuromodulation devices, which the authors endorse as an appropriate starting point in clinical practice [3,4,22]. As with all surgical procedures, there are known modifiable risk factors that can be optimized prior to elective surgery and reduce risk of the above mentioned complications. Optimization of nutritional status, smoking cessation, glycemic control in diabetic patients, pre-operative cardiac clearance in patients with known or at risk for cardiovascular disease, screening for active signs or symptoms of ongoing infection and ensuring the patient has adequately completed treatment prior to surgery, addressing psychological preparedness of the patient, and appropriately holding therapeutic anti-coagulation for an appropriate length of time based on medication half-life after discussion with the managing clinician are a few appropriate clinical measures to mitigate risk of SCS procedure-related complications [8,11]. Patient selection leads to appropriate choice of system. taking into account that certain systems may affect supra-spinal and cortical changes addressing different patient factors [47]. In addition, diagnosis may dictate use of system such as the use of dorsal root ganglion stimulation in phantom limb pain secondary to poor topographic selectivity with SCS in this patient group [22].
Methods and strategies of tDCS for the treatment of pain: current status and future directions
Published in Expert Review of Medical Devices, 2020
Kevin Pacheco-Barrios, Alejandra Cardenas-Rojas, Aurore Thibaut, Beatriz Costa, Isadora Ferreira, Wolnei Caumo, Felipe Fregni
Moreover, Bocci et al. 2019 [165], performed a double-blind sham-controlled crossover trial in 14 patients with phantom limb pain (upper and lower limb amputees, mixed etiologies), showed that anodal c-tDCS improves both paroxysmal pain and non-painful phantom limb sensations in subjects with upper limb amputations, but no changes in phantom limb pain and stump pain intensity. The main limitations in these studies are the small sample size and the variability of the reference electrode (buccinator area versus right shoulder), which can modify the electrical current direction and the final stimulation target. Also, it is necessary to explore the combination of c-tDCS with more studied behavioral interventions (e.g., mirror therapy, motor imagery) ([166], since it has been reported synergic effects of tDCS and behavioral interventions to reduce pain (79).
Developing an optimized strategy with transcranial direct current stimulation to enhance the endogenous pain control system in fibromyalgia
Published in Expert Review of Medical Devices, 2018
Dante Duarte, Luis Eduardo Coutinho Castelo-Branco, Elif Uygur Kucukseymen, Felipe Fregni
Mendonça et al. [22] obtained positive and larger effects on pain relief, quality of life, depression, and anxiety by combining tDCS with aerobic exercise for the treatment of fibromyalgia. In addition, preliminary data regarding non-invasive brain stimulation for fibromyalgia and aerobic exercise have shown that these techniques yield significant results when compared to control interventions and baseline symptoms [16,21,65,66]. Pinto et al. is using mirror therapy with tDCS to treat phantom limb pain, exemplifying a combined therapy with tDCS as a strategy to enhance sensory afference [67]. Moreover, it was demonstrated that the combination between tDCS and visual illusion provides long term effects in pain relief of spinal cord injury patients [68] and leads to significant alterations in contact heat-evoked potential (CHEPS) and pain thresholds [69]. In this context, some studies have shown the activation of sensorimotor cortex after mirror therapy, mirror illusion and visual feedback when combined with M1 tDCS, therefore inferring the potential benefits of this strategy [70,71]. In addition, for chronic low back pain, the combination of tDCS and peripheral electrical stimulation seems to improve pain and sensitization, in a greater magnitude than when compared with control or when performed alone [72,73]. It is important to point out that the main characteristic to consider for selecting an optimized combination therapy is to ensure that both interventions target neural networks synergistically, driving the neurophysiological mechanisms of each treatment alone toward similar directions or pathways.