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Advances in Neuroprosthetics
Published in Chang S. Nam, Anton Nijholt, Fabien Lotte, Brain–Computer Interfaces Handbook, 2018
In a proof-of-principle wireless neuroprosthetics technology study, rhesus monkeys with a spinal lesion were implanted with a wireless brain–spine interface in the leg locus of their motor cortex along with a lumbar spinal cord stimulator. Weight-bearing locomotion of the paralyzed leg was restored in 6 days post-lesion without training, suggesting the viability of applying this type of neuroprosthetic to individuals with spinal cord injuries (Capogrosso et al. 2016).
Medical device usability and user errors
Published in B. S. Dhillon, Systems reliability and usability for engineers, 2019
In the area of health care, many types of medical devices are used, and a good number of these are prone to user/human error. In 1991, the U.S. Food and Drug Administration (FDA) conducted a study of device-related data collected over many years and highlighted the 20 medical devices most prone to user/human error [2,11,17]: Glucose meter (highest error-prone)Balloon catheterOrthodontic bracket alignerAdministration kit for peritonea dialysisPermanent pacemaker electrodeImplantable spinal cord stimulatorIntravascular catheterInfusion pumpUrological catheterElectrosurgical cutting and coagulation deviceNonpowered suction apparatusMechanical/hydraulic impotance deviceImplantable pacemakerPeritoneal dialysate delivery systemCatheter introducerCatheter guide wireTransluminal coronary angioplasty catheterLow-energy defibrillator (external)Continuous ventilator (respirator)Contact lens cleaning and disinfecting solution (lowest error-prone)
Advanced methods of spinal stimulation in the treatment of chronic pain: pulse trains, waveforms, frequencies, targets, and feedback loops
Published in Expert Review of Medical Devices, 2019
Ankit Maheshwari, Jason E. Pope, Timothy R. Deer, Steven Falowski
The outcomes of subthreshold paresthesia free spinal cord stimulation, dorsal root ganglion stimulation and burst DR stimulation appear to be better than previously reported outcomes for traditional, open circuit spinal cord stimulation. Mechanistically, it appears that all stimulation strategies have a common theme: a beta fiber activation seems to play a critical role. As compared to previously reported outcomes with spinal cord stimulation, most recent data has shown a higher proportion of responders with at least 50% pain relief. Innovative leads and placement techniques have also decreased the risk of migration and surgical complications. Most of the data reported apply to failed back surgery syndrome including back pain as well as leg pain. The other common indication is complex regional pain syndrome (CRPS) affecting the extremities. There still appears to be a lack of data specifically in the context of neck pain and upper extremity neuropathic pain as well as other chronic neuropathic pain syndromes. Some of the key studies cited have been industry sponsored which remains a limitation of the data; however, several studies included in this review had excellent methodology. Future studies should include studies with peer reviewed funding as well as larger pragmatic trials to reflect real-world experience. The ultimate goal in the field of neuromodulation will be to eliminate focal neuropathic pain by the process of lead optimization, waveform delivery and decrease the risk of surgical complications, while offering sustainable therapy. As the role of systemic opioid therapy is declining, it appears that medical devices may play a more prominent role in chronic pain treatment. This will also introduce the need for indication expansion, looking specifically at chronic chest pain, chronic abdominal pain, post-surgical syndromes. Upcoming space broadening and innovative strategies are focused on sustainability and efficacy. Retrospective reviews have suggested areas of improvement, with more prospective studies upcoming [46–48]. Keeping patients in therapy longer may also mean keeping patients in optimal therapy continuously or introduction of new waveforms in legacy devices, along with adapters or universal headers and leads to mix and match therapies across different manufacturers.