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Context: The evaluation of quadriceps muscle inhibition with the interpolated twitch technique is usually performed by stimulating the femoral nerve (FN). However, there are some problems related to the use of this stimulation site, which may be partially overcome by delivering the stimulation over the motor point (MP). This study sought to compare MP to FN stimulation at different joint angles for the evaluation of quadriceps muscle inhibition, resting peak torque, and discomfort in healthy women. Design: Cross-sectional study. Methods: Sixteen healthy women (age: 28 [4] y; body mass: 60 [5] kg; height: 162 [5] cm) participated in this study. Supramaximal paired stimuli were delivered to the FN and to the rectus femoris MP before and during maximal voluntary contractions at different knee angles (15°, 30°, 45°, 60°, and 90° of knee flexion) to assess muscle inhibition and resting peak torque. Discomfort was also recorded for each stimulation site and knee angle. Results: Muscle inhibition was similar between the 2 stimulation sites (P >.05) and was higher at 45° than at 90° (P =.03). MP stimulation evoked lower resting peak torque at 30° (P =.004), 60° (P =.006), and 90° (P =.006) and higher discomfort at 30° (P =.008) and 90° (P =.027) compared to FN stimulation. Conclusions: Despite lower resting peak torque and higher discomfort at some angles, MP stimulation provided similar muscle inhibition to FN stimulation at all knee angles and is therefore a valid method to evaluate quadriceps muscle inhibition in healthy women. MP stimulation can be used as an alternative to FN stimulation for the evaluation of quadriceps muscle inhibition with no added discomfort at the angles where muscle inhibition is the highest. [ABSTRACT FROM AUTHOR]

As an innovative neural modulation technique, the transcranial magneto-acousto-electric (MAE) stimulation (TMAES) realizes the synergistic regulation of neuronal discharge through the ultrasonic mechanical and inductive electric effects, offering significant prospects in biomedical applications. However, the stimulation accuracy is still limited by the unidirectional distribution of MAE field intensity. A method of constructing center-converging MAE field by coupling the helical wave fronts of focused acoustic-vortex (FAV) beams with a coaxial magnetic field is proposed. By describing FAVs with Laguerre–Gaussian functions, the theory of MAE field construction is derived in explicit formulae and the spatiotemporal characteristics of MAE fields in the focal region are analyzed. It is theoretically and experimentally demonstrated that the MAE field generated by the FAV of lth order is determined by those of (l − 1)th and (l + 1)th orders. The center-converging phase-rotating MAE field can only be generated by the FAV of first order, maintaining a constant peak intensity at the vortex center. Experimental distributions of MAE fields for FAVs of different orders show good agreements with numerical simulations. With the peak pressure of 0.86 MPa and the magnetic intensity of 0.3 T, the peak intensity of 62.1 mV/m reaching the electric stimulation threshold is achieved. The center-converging MAE field constructed by FAV may develop a new synergistic neural modulation scheme for TMAES with enhanced precision and flexibility while ensuring safety and efficacy, thereby exhibiting significant scientific and practical implications. [ABSTRACT FROM AUTHOR]

Context: Lateral epicondylopathy (LE) is a common overuse injury affecting elbow, wrist, and hand function. It is characterized by weakness and pain in the muscles and tendons of the forearm responsible for the extension of your wrist and fingers. Trigger point dry needling is a technique reported to be beneficial in managing pain and dysfunction after LE diagnosis. LE is also commonly treated with conservative treatment, such as joint and soft tissue mobilization, self-care home programs, and anti-inflammatory use. We explored a different dry needling approach consisting of in situ dry needling with electric stimulation combined with targeted therapeutic exercise to treat LE in 3 cases. Case Presentation: Three patients were referred for dry needling once a week for 6 weeks and home-based exercise therapy for LE. They were clinically evaluated using grip strength, a visual analog scale to assess pain, and Patient-Rated Tennis Elbow Evaluation Test scores. These were measured at 4 time points (weeks 0, 2, 4, and 6). Management and Outcomes: The dry needling intervention incorporated 8 locations in the upper-extremity with 2 electric stimulation channels. The patients had reduced pain as measured by a visual analog scale, increased function as measured by the Patient-Rated Tennis Elbow Evaluation Test, and increased grip strength over 6 weeks. Conclusions: This case series illustrates the use of dry needling and a home exercise program to provide a favorable outcome in a patient with LE. Patients had an 80% to 100% reduction in pain and similar improvements in function that were significantly beyond the minimum clinically important difference. This dry needling approach is a safe and effective treatment of LE in the short term. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether transcranial direct-current stimulation (tDCS) optimizes the performance of a wheelchair basketball player on precision tasks. Methods: A right-handed wheelchair basketball player (1.5 points functional class) with myelomeningocele (low lumbar level) participated in this case study. The tDCS neuromodulation protocol was applied throughout 10 interventions of 20 minutes with a current intensity of 2 mA, simultaneously with sport-specific training, 3 times a week for 4 weeks. Anodic stimulation was performed on the right cerebellar hemisphere (CB2) and cathodic stimulation in the left dorsolateral prefrontal cortex. A control participant was submitted to a sham-tDCS stimulation protocol for the same period. Functional performance was assessed before the intervention and after the 5th and 10th interventions using "pass accuracy," "free-throw shooting," and "spot shot" tests. Outcome measures were compared using percentage differences between preintervention, intermediate intervention, and postintervention values. Results: There was a gradual increase in the athlete's total and average scores in all tests performed, with an overall improvement of 78% between the baseline and final assessments, while the control participant had an overall improvement of 6.5%. Conclusion: The tDCS protocol was effective in improving performance in precision activities in a wheelchair basketball player. [ABSTRACT FROM AUTHOR]

Stimulation of sympathetic nerves in the vas deferens yields biphasic contractions consisting of a rapid transient component resulting from activation of P2X1 receptors by ATP and a secondary sustained component mediated by activation of α1-adrenoceptors by noradrenaline. Noradrenaline can also potentiate the ATP-dependent contractions of the vas deferens, but the mechanisms underlying this effect are unclear. The purpose of the present study was to investigate the mechanisms underlying potentiation of transient contractions of the vas deferens induced by activation of α1-adrenoceptors. Contractions of the mouse vas deferens were induced by electric field stimulation (EFS). Delivery of brief (1s duration) pulses (4 Hz) yielded transient contractions that were inhibited tetrodotoxin (100 nM) and guanethidine (10 µM). α,β-meATP (10 µM), a P2X1R desensitising agent, reduced the amplitude of these responses by 65% and prazosin (100 nM), an α1-adrenoceptor antagonist, decreased mean contraction amplitude by 69%. Stimulation of α1-adrenoceptors with phenylephrine (3 µM) enhanced EFS and ATP-induced contractions and these effects were mimicked by the phorbol ester PDBu (1 µM), which activates PKC. The PKC inhibitor GF109203X (1 µM) prevented the stimulatory effects of PDBu on ATP-induced contractions of the vas deferens but only reduced the stimulatory effects of phenylephrine by 40%. PDBu increased the amplitude of ATP-induced currents recorded from freshly isolated vas deferens myocytes and HEK-293 cells expressing human P2X1Rs by 93%. This study indicates that: (1) potentiation of ATP-evoked contractions of the mouse vas deferens by α1-adrenoceptor activation were not fully blocked by the PKC inhibitor GF109203X and (2) that the stimulatory effect of PKC on ATP-induced contractions of the vas deferens is associated with enhanced P2X1R currents in vas deferens myocytes.

Neuropeptides are ubiquitous in the nervous system. Research into neuropeptides has been limited by a lack of experimental tools that allow for the precise dissection of their complex and diverse dynamics in a circuit-specific manner. Opioid peptides modulate pain, reward and aversion and as such have high clinical relevance. To illuminate the spatiotemporal dynamics of endogenous opioid signaling in the brain, we developed a class of genetically encoded fluorescence sensors based on kappa, delta and mu opioid receptors: κLight, δLight and µLight, respectively. We characterized the pharmacological profiles of these sensors in mammalian cells and in dissociated neurons. We used κLight to identify electrical stimulation parameters that trigger endogenous opioid release and the spatiotemporal scale of dynorphin volume transmission in brain slices. Using in vivo fiber photometry in mice, we demonstrated the utility of these sensors in detecting optogenetically driven opioid release and observed differential opioid release dynamics in response to fearful and rewarding conditions.

Context: Plantar intrinsic foot muscle strength training is difficult to master to a degree sufficient to elicit muscle hypertrophy in most individuals. It is possible that combining neuromuscular electrostimulation (NMES) and blood flow restriction (BFR) can elicit plantar intrinsic foot muscle hypertrophy regardless of the individual's technique. This study aimed to determine the effects of NMES training with BFR on acute muscle swelling in the abductor hallucis. Design: Randomized, controlled, single-blind trial design. Methods: Forty-eight participants were randomly allocated to the NMES + BFR, NMES, or Sham NMES + BFR groups. All participants received abductor hallucis NMES for 15 minutes. Participants in the NMES + BFR and Sham NMES + BFR groups received NMES with BFR. The intensity of NMES was the sensory threshold in the Sham NMES + BFR group. The cross-sectional area of the abductor hallucis was measured pretraining and posttraining using ultrasonography by a single investigator blinded to the participants' allocations. Results: After 15 minutes of training, the cross-sectional area of the abductor hallucis was significantly increased in the NMES + BFR (P<.001) and the Sham NMES + BFR (P = .004) groups. Moreover, the rate of increase was significantly higher in the NMES + BFR group than in the NMES or the Sham NMES + BFR groups (P<.001 and P = . 001, respectively). Conclusions: Since it is possible that the amount of muscle swelling immediately after training correlates with muscle hypertrophy when training is continued, the results of this study suggest that NMES training with BFR is a training method that can be expected to produce plantar intrinsic foot muscle hypertrophy. Further studies are needed to confirm the long-term effects of NMES training with BFR. [ABSTRACT FROM AUTHOR]

Retinal prosthetics are one of the leading therapeutic strategies to restore lost vision in patients with retinitis pigmentosa and age-related macular degeneration. Much work has described patterns of spiking in retinal ganglion cells (RGCs) in response to electrical stimulation, but less work has examined the underlying retinal circuitry that is activated by electrical stimulation to drive these responses. Surprisingly, little is known about the role of inhibition in generating electrical responses or how inhibition might be altered during degeneration. Using whole-cell voltage-clamp recordings during subretinal electrical stimulation in the rd10 and wild-type (wt) retina, we found electrically evoked synaptic inputs differed between ON and OFF RGC populations, with ON cells receiving mostly excitation and OFF cells receiving mostly inhibition and very little excitation. We found that the inhibition of OFF bipolar cells limits excitation in OFF RGCs, and a majority of both pre- and postsynaptic inhibition in the OFF pathway arises from glycinergic amacrine cells, and the stimulation of the ON pathway contributes to inhibitory inputs to the RGC. We also show that this presynaptic inhibition in the OFF pathway is greater in the rd10 retina, compared with that in the wt retina.

Muscle fiber conduction velocity (MFCV) can be affected by muscle fiber geometry at different joint angles and during joint movements. This study aimed to investigate MFCV during electrically evoked contraction at different joint angles, during joint movements, and during voluntary contractions. Sixteen healthy young men participated. A stimulation electrode was attached on the innervation zone of the vastus lateralis, and a linear electrode array was attached on the vastus lateralis. Under a static condition, electrically evoked electromyography signals were recorded at knee joint angles set every 15° between 0° and 105°. Under a passive movement condition, signals were recorded during knee extension and flexion passively. Under a voluntary contraction condition, signals were recorded while performing 30% or 60% of maximum voluntary contraction. MFCV was calculated using cross-correlation coefficients. Under the static condition, there were no differences in MFCV among various joint angles. Under the passive movement condition, MFCV was significantly greater during high velocity or shortening. Under the voluntary contraction condition, MFCV was significantly greater during high-intensity voluntary contraction and with a shortened muscle length. Joint angles do not influence MFCV markedly during relaxation, but it is possible to overestimate MFCV during movement or voluntary contraction. [ABSTRACT FROM AUTHOR]

There has been considerable controversy about pre- versus postsynaptic expression of memory-related long-term potentiation (LTP), with corresponding disputes about underlying mechanisms. We report here an instance in male mice, in which both types of potentiation are expressed but in separate branches of the same hippocampal afferent. Induction of LTP in the dentate gyrus (DG) branch of the lateral perforant path (LPP) reduces paired-pulse facilitation, is blocked by antagonism of cannabinoid receptor type 1, and is not affected by suppression of postsynaptic actin polymerization. These observations are consistent with presynaptic expression. The opposite pattern of results was obtained in the LPP branch that innervates the distal dendrites of CA3: LTP did not reduce paired-pulse facilitation, was unaffected by the cannabinoid receptor blocker, and required postsynaptic actin filament assembly. Differences in the two LPP termination sites were also noted for frequency facilitation of synaptic responses, an effect that was reproduced in a two-step simulation by small adjustments to vesicle release dynamics. These results indicate that different types of glutamatergic neurons impose different forms of filtering and synaptic plasticity on their afferents. They also suggest that inputs are routed to, and encoded by, different sites within the hippocampus depending upon the pattern of activity arriving over the parent axon.

Electrically evoked frequency-following responses (eFFRs) provide insight in the phase-locking ability of brainstem of cochlear-implant (CI) users. eFFRs can potentially be used to gain insight in the individual differences in the biological limitation on temporal encoding of the electrically stimulated auditory pathway, which can be inherent to the electrical stimulation itself and/or the degenerative processes associated with hearing loss. One of the major challenge of measuring eFFRs in CI users is the process of isolating the stimulation artifact from the neural response, as both the response and the artifact overlap in time and have similar frequency characteristics. Here we introduce a new artifact removal method based on template subtraction that successfully removes the stimulation artifacts from the recordings when CI users are stimulated with pulse trains from 128 to 300 pulses per second in a monopolar configuration. Our results show that, although artifact removal was successful in all CI users, the phase-locking ability of the brainstem to the different pulse rates, as assessed with the eFFR differed substantially across participants. These results show that the eFFR can be measured, free from artifacts, in CI users and that they can be used to gain insight in individual differences in temporal processing of the electrically stimulated auditory pathway.

A dual-responsive hydrogel drug reservoir responding to body temperature and electrical stimulation achieves high drug release efficiency at 37 °C and efficient transdermal delivery. The Zn battery-driven iontophoresis results in an effective treatment of atopic dermatitis with the release of dexamethasone. This work provides a non-invasive treatment modality for chronic epidermal diseases that require precise drug delivery. [Display omitted] • Polyelectrolyte hydrogel shows thermal-electrochemical dual-responsive drug release. • Wearable Zn battery-powered iontophoresis for transdermal delivery with enhanced efficacy. • Effective treatment of atopic dermatitis in mice is achieved. Atopic dermatitis is a chronic, inflammation skin disease that remains a major public health challenge. The current drug-loading hydrogel dressings offer numerous benefits with enhanced loading capacity and a moist-rich environment. However, their development is still limited by the accessibility of a suitable driven source outside the clinical environment for precise control over transdermal delivery kinetics. Here, we prepare a sulfonated poly(3,4-ethylenedioxythiophene) (PEDOT) polyelectrolyte hydrogel drug reservoir that responds to different stimuli-both endogenous cue (body temperature) and exogenous cue (electrical stimulation), for wearable on-demand transdermal delivery with enhanced efficacy. Functioned as both the drug reservoir and cathode in a Zn battery-powered iontophoresis patch, this dual-responsive hydrogel achieves high drug release efficiency (68.4 %) at 37 °C. Evaluation in hairless mouse skin demonstrates the efficacy of this technology by facilitating transdermal transport of 12.2 μg cm−2 dexamethasone phosphate when discharged with a 103 Ω external resistor for 3 h. The Zn battery-driven iontophoresis results in an effective treatment of atopic dermatitis, displaying reductions in epidermal thickness, mast cell infiltration inhibition, and a decrease in IgE levels. This work provides a new treatment modality for chronic epidermal diseases that require precise drug delivery in a non-invasive way. [ABSTRACT FROM AUTHOR]

• The EOP exposure altered the kinetics of AMPA/GluK receptors in layer V of the ACC. • The EOP exposed mice inhibited evoked excitatory synaptic transmission in the ACC. • The EOP exposure produced short-term depression on thalamo-ACC projections. There are various forms of stress including; physical, psychological and social stress. Exposure to physical stress can lead to physical sensations (e.g. hyperalgesia) and negative emotions including anxiety and depression in animals and humans. Recently, our studies in mice have shown that acute physical stress induced by the elevated open platform (EOP) can provoke long-lasting mechanical hypersensitivity. This effect appears to be related to activity in the anterior cingulate cortex (ACC) at the synaptic level. Indeed, EOP exposure induces synaptic plasticity in layer II/III pyramidal neurons from the ACC. However, it is still unclear whether or not EOP exposure alters intrinsic properties and synaptic transmission in layer V pyramidal neurons. This is essential because these neurons are known to be a primary output to subcortical structures which may ultimately impact the behavioral stress response. Here, we studied both intrinsic properties and excitatory/inhibitory synaptic transmission by using whole-cell patch-clamp method in brain slice preparations. The EOP exposure did not change intrinsic properties including resting membrane potentials and action potentials. In contrast, EOP exposure suppressed the frequency of miniature and spontaneous excitatory synaptic transmission with an alteration of kinetics of AMPA/GluK receptors. EOP exposure also reduced evoked synaptic transmission induced by electrical stimulation. Furthermore, we investigated projection-selective responses of the mediodorsal thalamus to the layer V ACC neurons. EOP exposure produced short-term depression in excitatory synaptic transmission on thalamo-ACC projections. These results suggest that the EOP stress provokes abnormal excitatory synaptic transmission in layer V pyramidal neurons of the ACC. [ABSTRACT FROM AUTHOR]

Intracranial electrical kilohertz stimulation has recently been shown to achieve similar therapeutic benefit as conventional frequencies around 140 Hz. However, it is unknown how kilohertz stimulation influences neural activity in the mammalian brain. Using cellular calcium imaging in awake mice, we demonstrate that intracranial stimulation at 1 kHz evokes robust responses in many individual neurons, comparable to those induced by conventional 40 and 140 Hz stimulation in both the hippocampus and sensorimotor cortex. The evoked responses at the single-cell level are shaped by prominent network inhibition and critically depend on brain region. At the network level, all frequencies lead to pronounced population suppression except 1 kHz in the cortex, which evokes balanced excitatory and inhibitory population effects. Thus, kilohertz stimulation robustly modulates neural activity at both the single-neuron and population network levels through mechanisms distinct from conventional frequency stimulation, highlighting the clinical potential of intracranial kilohertz neuromodulation. Mechanistic study using calcium imaging reveals prominent and distinct neuronal responses evoked by kilohertz electrical stimulation compared to conventional clinical neuromodulation frequencies. [ABSTRACT FROM AUTHOR]

ABSTRACT Nanosecond pulse electric field (nsPEF) therapy has attracted attention in recent years as a noninvasive cancer treatment with minimal side effects. However, the relationship between the electrical stress induced in cells by the external electric field and the biological response has not been fully investigated quantitatively. We investigated the effects of nsPEF therapy on cancer cells using microgap electrodes under low‐voltage conditions. We developed an equivalent circuit model using intracellular components to determine the amount of stimulation of cellular components and performed frequency analysis of nsPEF. nsPEF applied to Jurkat cells activated caspase‐3 and induced apoptosis at shorter pulse widths. nsPEF induced biological responses and apoptosis in cancer cells. The relationship between the biological response induced by nsPEF and the amount of electrical stimulation was investigated by comparing the experimental results with frequency analysis. Using quantitative values for each cellular element, the relationship between the biological response and the amount of electrical stimulation can be integrated. [ABSTRACT FROM AUTHOR]

Spinal cord injury (SCI) causes severe motor and sensory deficits, and there are currently no approved treatments for recovery. Nearly 70% of patients with SCI experience pathological muscle cocontraction and spasticity, accompanied by clinical signs such as patellar hyperreflexia and ankle clonus. The integration of epidural electrical stimulation (EES) of the spinal cord with rehabilitation has substantial potential to improve recovery of motor functions; however, abnormal muscle cocontraction and spasticity may limit the benefit of these interventions and hinder the effectiveness of EES in promoting functional movements. High-frequency excitation block introduced in peripheral nerve stimulation could reduce abnormal activity and lead to more physiological activation patterns. Here, we evaluated the application of high-frequency EES (HF-EES) in alleviating undesired muscular cocontraction and spasticity in two patients with motor incomplete SCI implanted with a commercial 32-channel EES paddle commonly used for pain therapy. To design custom HF-EES protocols, we first mapped the muscles targeted by different EES configurations. Our results showed that HF-EES substantially reduced patellar reflex in one participant and eliminated both patellar reflex and ankle clonus in the other participant. By combining HF-EES and low-frequency EES (LF-EES) to enhance functional movements with intensive rehabilitation, we observed notable improvements in lower limb kinematics, muscle strength, and clinical lower limb motor assessments over the trial period. This study suggests that HF-EES could be an important supplementary tool in SCI treatment, emphasizing the importance of personalized rehabilitation approaches and advanced tools to optimize EES treatments and offering hope for individuals with SCI-related motor deficits. Editor's summary: Spinal cord injury (SCI) leads to severe motor impairments that can greatly limit a patient's quality of life. Residual neural signals to impaired limbs can cause undesirable movements such as simultaneous contraction of opposing muscles or spasticity, which can hinder functional movement and rehabilitation. Here, Romeni et al. tested the use of high-frequency epidural electrical stimulation (HF-EES) of the injured spinal cord as part of a broader physical rehabilitation program to attempt to mitigate these pathological movements. In two patients with motor incomplete SCI, the authors show that HF-EES reduced spasticity and pathologic muscle cocontraction. HF-EES was paired with low-frequency (LF)–EES, which enhances activation of the desired muscles for walking and other tasks. Both patients demonstrated improvements in motor ability over the course of rehabilitation, supporting the rationale for further examination of HF-EES as an adjuvant electrical stimulation protocol for patients recovering from SCI. —Molly Ogle [ABSTRACT FROM AUTHOR]

The article delves into the concept of human-computer integration, drawing inspiration from the relationship between bike riders and their bikes. Through research on bike systems, design themes like Lumahelm, Ava, Ari, and Ena are proposed to enhance integration experiences. The study by Andres et al. (7) involved 20 participants aged 24-58, exploring how EEG functionality can enable bikes to respond to brain waves before conscious action, improving subconscious abilities. The authors stress the significance of designing for both conscious and subconscious selves to create engaging interactions between humans and computational machines, suggesting further research in this area. [Extracted from the article]

Human–machine interface (HMI) electrodes enable interactions between humans and bioelectronic devices by facilitating electrical stimulation and recording neural activity. However, reconciling the soft, hydrated nature of living human tissues with the rigid, dry properties of synthetic electronic systems is inherently challenging. Overcoming these significant differences, which is critical for developing compatible, effective, and stable interfaces, has become a key research area in materials science and technology. Recently, hydrogels have gained prominence for use in HMI electrodes because these soft, hydrated materials are similar in nature to human tissues and can be tuned through the incorporation of nanofillers. This review examines the functional requirements of HMI electrodes and highlights recent progress in the development of polyphenol‐mediated multifunctional hydrogel‐based HMI electrodes for bioelectronics. Furthermore, aspects such as mussel‐inspired and polyphenol‐mediated adhesion, underlying mechanisms, tissue‐matching mechanical properties, electrochemical performance, biocompatibility, biofouling resistance, stability under physiological conditions, anti‐inflammatory, and antioxidant properties are discussed. Finally, applications in bioelectronics and further perspectives are outlined. Advances in HMI hydrogel electrodes are expected to facilitate the unprecedented integration of biological systems and electronic devices, potentially revolutionizing various biomedical fields and enhancing the capabilities and performance of bioelectronic devices. [ABSTRACT FROM AUTHOR]

The document presents abstracts from the IFESS 2024 conference, focusing on the effectiveness of neuromuscular electrical stimulation (NMES) in improving muscle endurance, strength, and functional ability in older adults and individuals with spinal cord injuries. The study on older adults showed positive outcomes in muscle endurance, strength, and functional ability after a six-week NMES intervention. Another study highlighted the efficacy of NMES in patients with spinal cord injuries, demonstrating improvements in neurological and motor functions. Additionally, a review of the STIMuSTEP device for dropped foot stimulation showed both successful implantations and instances of device failure, highlighting the device's effectiveness and associated risks. [Extracted from the article]

Objective: To examine the effects of high voltage electrical stimulation (HVES) on pain intensity, maximum mouth opening (MMO), cervical mobility, head position, pressure pain thresholds (PPTs), bite force, joint sounds, and jaw muscle strength in individuals with temporomandibular disorders (TMDs). Methods: Thirty-four individuals with TMDs were randomly divided into the exercise group (EG) (n = 17) and the HVES group (HG) (n = 17). For 4 weeks, EG received exercise therapy alone, while HG received HVES (12 sessions in total, 3 days a week to anterior temporalis and masseter) in conjunction with exercise. Results: After the treatment, in both groups, pain intensity significantly decreased (p <.001); MMO (7.27 mm in HG and 3.61 mm in EG), cervical mobility, head position, PPTs, bite force, and jaw muscle strength significantly increased (p =.043 to <.001). Joint sounds significantly decreased in the HG (p =.008). Left bite force (p =.040) and left medial pterygoid PPT (p =.013) increased more in EG. The change in left bite force in EG over time was significant (p =.040; ηp2 =.126). The effect sizes of treatments were medium to large (from.527 to 1.602) for the evaluated parameters. Conclusion: Although exercise alone was effective in many parameters evaluated, additional application of HVES provided further improvement for pain, MMO, cervical mobility, PPTs, jaw muscle strength and joint sounds. HVES can be routinely used in clinics for individuals with TMDs. [ABSTRACT FROM AUTHOR]

Background: In hallux valgus, morphological changes and functional weakness of intrinsic foot muscles occur, especially in the abductor hallucis muscle. Objectives: This study aimed to investigate how a conservative treatment with the addition of neuromuscular electrical stimulation affects the volume and strength of the muscle, the correction of deformity, passive range of motion, pain, and disability. Methods: Twenty-eight female participants (48 feet) were randomly assigned to two groups. The interventions included orthoses and exercise (Ortho) in both groups. One group received additional neuromuscular electrical stimulation of abductor hallucis muscle to activate it. Each group received the treatments for one month and was assessed two times, at baseline before starting and after one month of treatment. Mixed within-between ANOVA, analysis of covariance, and nonparametric tests were used for data analysis. Results: The muscle volume, abduction strength, goniometric angle, and passive hallux dorsi/plantar flexion showed significant changes in both groups (p <.001). Subscales of the foot and ankle ability questionnaire, significantly changed (p ≤.05). Pain decreased significantly in the two groups (p <.001 and p =.02). Intermetatarsal angle did not significantly differ between the two groups (p =.86, partial eta effect size = 0.001). But, the hallux valgus angle mean (on MRI) in the Ortho group was less than that of the orthoNMES group (p =.007, partial eta effect size = 0.15). Conclusion: Both groups showed nearly identical treatment effects in the primary volume and hallux valgus correction outcome measures. In this study, adding neuromuscular electrical stimulation did not have an additional effect compared to conservative in the treatment of hallux valgus. Trial registration number: The RCT Code is IRCT20200915048725N1. [ABSTRACT FROM AUTHOR]

• Electrical stimulation in white matter induces delays in the evoked response due to slow conduction velocity. • The waveforms from white matter and cortical stimulation remain generally identical. • Responses to white matter and cortical stimulation differ on response times. • The relaxation of the N1 component is longer during cortical stimulations. • There is probable activation of intra-cortical axons during cortical stimulation. Direct cortical responses (DCR) and axono-cortical evoked potentials (ACEP) are generated by electrically stimulating the cortex either directly or indirectly through white matter pathways, potentially leading to different electrogenic processes. For ACEP, the slow conduction velocity of axons (median ≈ 4 m.s−1) is anticipated to induce a delay. For DCR, direct electrical stimulation (DES) of the cortex is expected to elicit additional cortical activity involving smaller and slower non-myelinated axons. We tried to validate these hypotheses. DES was administered either directly on the cortex or to white matter fascicles within the resection cavity, while recording DCR or ACEP at the cortical level in nine patients. Short but significant delays (≈ 2 ms) were measurable for ACEP immediately following the initial component (≈ 7 ms). Subsequent activities (≈ 40 ms) exhibited notable differences between DCR and ACEP, suggesting the presence of additional cortical activities for DCR. Distinctions between ACEPs and DCRs can be made based on a delay at the onset of early components and the dissimilarity in the shape of the later components (>40 ms after the DES artifact). The comparison of different types of evoked potentials allows to better understand the effects of DES. [ABSTRACT FROM AUTHOR]

Mitochondria are essential in supplying energy to skeletal muscle. Near-infrared spectroscopy (NIRS) was developed to noninvasively assess mitochondrial capacity (mV̇O2max) as a rate constant of metabolic recovery after exercise. Purpose: This study measured the time course mV̇O2max following both maximal and submaximal exercise. Methods: Healthy male and female participants were tested (n = 12 maximal and n = 8 submaximal exercise). A NIRS device was placed on the left medial gastrocnemius. Participants performed either 1 min of maximal, rapid (~2 Hz), or submaximal (~0.37 Hz) plantar flexion exercise on a custom pneumatic ergometer. mV̇O2max was measured before and immediately after exercise. mV̇O2max measurements consisted of four incomplete recovery curves of muscle metabolism taken after 30 s of electrical muscle stimulation except in the first post-exercise to be consistent with the use of pre-exercise trial. The four recovery curves were collected 50-, 156-, 260-, and 366-s postexercise, each producing an mV̇O2max rate constant. Results: After maximal exercise, muscle acceleration decreased to 52 ± 18% (P = 0.001) of prevalues. mV̇O2max was reduced from the pre-exercise mean at the first post-trial (2.16 ± 0.44 to 1.21 ± 0.52 min−1, P < 0.001). The fourth trial showed recovery from the first (2.2 ± 0.46 min−1 vs 1.21 ± 0.52 min−1, P < 0.001) and was not significantly different from pre-exercise values (2.2 ± 0.46 vs 2.16 ± 0.44 min−1, P = 0.41). No change in acceleration or mV̇O2max was seen after submaximal exercise (P > 0.05). Conclusions: The 56.7% reduction in mV̇O2max supports the hypothesis that in young, healthy individuals, a minute of maximal exercise transiently impairs mV̇O2max, which then recovers within 6 min. The NIRS method shows promise in tracking time course changes in mV̇O2max and warrants further investigation of the transient effects of exercise on mV̇O2max. [ABSTRACT FROM AUTHOR]

Conventional retinal implants involve complex surgical procedures and require invasive implantation. Temporal Interference Stimulation (TIS) has achieved noninvasive and focused stimulation of deep brain regions by delivering high-frequency currents with small frequency differences on multiple electrodes. In this study, we conducted in silico investigations to evaluate extraocular TIS's potential as a novel visual restoration approach. Different from the previously published retinal TIS model, the new model of extraocular TIS incorporated a biophysically detailed retinal ganglion cell (RGC) population, enabling a more accurate simulation of retinal outputs under electrical stimulation. Using this improved model, we made the following major discoveries: (1) the maximum value of TIS envelope electric potential ( EP max) showed a strong correlation with TIS-induced RGC activation; (2) the preferred stimulating/return electrode (SE/RE) locations to achieve focalized TIS were predicted; (3) the performance of extraocular TIS was better than same-frequency sinusoidal stimulation (SSS) in terms of lower RGC threshold and more focused RGC activation; (4) the optimal stimulation parameters to achieve lower threshold and focused activation were identified; and (5) spatial selectivity of TIS could be improved by integrating current steering strategy and reducing electrode size. This study provides insights into the feasibility and effectiveness of a low-invasive stimulation approach in enhancing vision restoration. [ABSTRACT FROM AUTHOR]

Background: The effect of core stabilization exercises (CSE) alone, or in combination with neuromuscular electrical stimulation (NMES) and Kinesio taping (KT) on lung function, respiratory muscle strength, and thickness in patients with stroke is not fully known. Objective: To compare the efficacy of NMES and KT applied with CSE on lung functions, respiratory muscle strength, and thickness in patients with stroke. Methods: A total of 45 stroke patients were randomly assigned to the core stabilization exercises (CSE) group, CSE+KT group or CSE+NMES group, respectively. All groups received the training protocol for 30–45 minutes, 3 days a week, for 6 weeks. Lung functions were measured using portable spirometry. Respiratory muscle strength was assessed using an analog manometer to measure maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP). Peak cough flow (PCF) was measured with a peak flow meter. Respiratory muscles thickness were determined using ultrasonography. Results: Except for FVC (%pred) (F=4.432, p=0.018, np2=0.174), FEV1(%pred) (F=3.725, p=0.032, np2=0.151), and MEP (F=3.861, p=0.029, np2=0.155), the overall group by time interaction for rmANOVA showed that there was no statistically significant difference between groups (p>0.05). After post hoc analysis, it was determined that there was no statistically significant difference between the groups in terms of FVC (%pred), FEV1(%pred) and MEP (p>0.025). Conclusions: The addition of NMES or KT to core stabilization exercises did not appear to provide additional benefit in improving lung function, respiratory muscle strength, and thickness in stroke patients. [ABSTRACT FROM AUTHOR]

Is electrical stimulation (ES) combined with strength training and usual care more effective than usual care alone in increasing the strength of very weak muscles in people with recent spinal cord injury (SCI)? A randomised controlled trial with concealed allocation, intention-to-treat analysis and blinded outcome assessors. Sixty participants with recent SCI were recruited from three SCI units in Australia and Bangladesh. Participants were randomised to either a treatment or control group. A major muscle group of the upper or lower limb with Grade 1 or Grade 2 strength on a standard 6-point manual muscle test was selected. Participants in the experimental group received strength training combined with ES and usual care for the target muscle group over 8 weeks. Participants in the control group received only usual care. Assessments were undertaken by a blinded assessor at baseline and 8 weeks. The primary outcome was voluntary muscle strength on a modified 13-point manual muscle test. The three secondary outcomes were participants' perceptions of strength, function and ability to perform self-selected goals. The mean between-group difference for voluntary strength at 8 weeks was 0.7 out of 13 points (95% CI –0.7 to 2.1), where the clinically worthwhile treatment effect was deemed a priori as 1 point. None of the secondary outcomes demonstrated a clinically important effect. Strength training combined with ES over 8 weeks has a negligible effect on the strength of very weak muscles in people with SCI. ACTRN12621000197831. [ABSTRACT FROM AUTHOR]

Piezoelectric, conductive, and injectable hydrogel (SPG hydrogel) is constructed to rapidly close wounds, efficiently harvest biomechanical energy from animal motion, and generate electrical stimulation for electrotherapy of wound healing. 3-amino-4-methoxybenzoic acid (AMB) monomer was polymerized and grafted onto the gelatin, which was further crosslinked using EDC/NHS and embedded with strontium titanate nanoparticles (80.5 wt%), forming SPG hydrogel. This SPG hydrogel had high tissue adhesion ability, and could generate the output voltage (maximum output voltage 1 V) and current (maximum output current 0.5 nA) upon mechanical bending, promoting NIH-3T3 cell migration and proliferation. Upon application to the mice wound model, the SPG hydrogel rapidly closed the skin wound, smoothed the wound's appearance, reduced the remaining wound size, and increased epidermal thickness, demonstrating remarkable wound healing capabilities. This study suggests that the body motion-promoted electrotherapy offers a promising strategy for wound healing. Piezoelectric nanomaterials are often incorporated into hydrogels to create piezoelectric hydrogels for wound healing. However, piezoelectric nanomaterials tend to agglomerate within the hydrogel matrix, and the hydrogel's low conductivity hinders efficient electron transfer. Together, both factors significantly reduce the piezoelectric effect. In this study, we developed an SPG hydrogel to improve the homogeneity and conductivity of the piezoelectric hydrogel. We first designed a conductive PG hydrogel and then immoblized piezoelectric STO nanoparticles within its matrix through coordination chemistry. Upon mechanical deformation, the uniformly distributed STO nanoparticles can generate electricity, which can efficiently transfer through the conductive matrix to the hydrogel's surface. This design shows great potential for wound healing applications. [Display omitted] [ABSTRACT FROM AUTHOR]

Neuromuscular Electrical Stimulation (NMES) uses electrical impulses to induce muscle contractions, providing benefits in rehabilitation, muscle activation, and as an adjunct to exercise, particularly for individuals experiencing immobilization or physical disability. NMES technology has significantly progressed, with advancements in device development and a deeper understanding of treatment parameters, such as frequency, intensity, and pulse duration. These improvements have expanded NMES applications beyond rehabilitation to include enhanced post-exercise recovery, improved blood glucose uptake, and increased lower limb venous return, potentially reducing thrombotic risks. Despite its benefits, NMES faces challenges in user compliance, often due to improper electrode placement and discomfort during treatment. Research highlights the importance of optimizing stimulation parameters, including electrode positioning, to improve both comfort and treatment efficacy. Recent innovations, such as automated processes for locating optimal stimulation points and adaptable electrode sizes, aim to address these issues. When combined with wearable technologies, these innovations could improve NMES treatment adherence and deliver more consistent, long-term therapeutic outcomes for patients with various physical limitations. Together, these developments indicate a promising future for NMES, presenting a valuable tool to enhance the benefits of physical activity across diverse populations, from rehabilitative care to broader health and wellness applications. [ABSTRACT FROM AUTHOR]

Introduction: Galvanic vestibular stimulation (GVS) is a simple, safe, and noninvasive method of neurostimulation that can be used to improve body balance. Several central nervous system diseases cause alterations in body balance, including HTLV-1-associated myelopathy (HAM). Objective: To test GVS as a balance rehabilitation strategy for HAM. Methods: This study is a quasi-experimental clinical trial in which postural balance was compared before and after a GVS rehabilitation protocol applied to 20 patients with HAM, 12 women and 8 men, average age of 78 and 79 years, respectively. They were followed for nine months after the end of the GVS protocol, which consisted of one GVS session per week for 12 consecutive weeks. The GVS current intensity was progressively increased from 1.0 milliamperes (mA) to 3.5 mA until the third session and maintained at 3.5 mA until the 12th session. The electrical stimulation time progressively increased from 9 min in the first session to 18 min in the second session and maintained at 30 min from the third session onwards. Postural balance was assessed by Time up and go test (TUG), Berg balance scale (BBS) and posturography that were performed before the beginning of the intervention, during the intervention (6th week), at the end of the intervention (12th week) and after 9 months of follow-up without electrical stimulation. Results: In a blind comparison, in the 12th week of stimulation, improvement was observed in all the tests. In TUG, time in seconds changed from 28 before to 18 after GVS (p < 0,001). In BBS, the score changed from 29.00 before to 41.00 points after GVS. In posturography, the stability limit improved after the intervention (p < 0.05). However, after nine months without stimulation, the gain was lost for TUG, for BBS and for stability limit. Conclusion: GVS was an effective method to improve postural instability of patients with HAM in the short term, but the gain in postural stability was not maintained in the long term. A device for home use may be an option for long-term use. [ABSTRACT FROM AUTHOR]

Microelectrode arrays (MEAs) have been widely used in studies on the electrophysiological features of neuronal networks. In classic MEA experiments, spike or burst rates and spike waveforms are the primary characteristics used to evaluate the neuronal network excitability. Here, we introduced a new method to assess the excitability using the voltage threshold of electrical stimulation. We tested the stability of the voltage threshold during the experiment and demonstrated the reliability of our method by examining the effect of Ni2+ on neocortical neuronal networks of acute brain slices from rats. Moreover, we compared our new method with the spontaneous activity analysis, which is one of the most commonly used methods in protocols for large-scale drug screening with MEA; our new method performed better in the experiments investigating the neocortical neuronal network excitability after the application of Ni2+. Based on the results from our study, our new method has great potential for use in large-scale screening of drugs. [ABSTRACT FROM AUTHOR]

[Display omitted] Transcranial electrical stimulation (tES) is a non-invasive technique widely used in modulating brain activity and behavior, but its effects differ across individuals and are influenced by head anatomy. In this study, we investigated how the electric field (EF) generated by high-definition tES varies across the lifespan among different demographic groups and its relationship with neural responses measured by functional magnetic resonance imaging (fMRI). We employed an MRI-guided finite element method to simulate the EF for the two most common tES montages (i.e., targeting the dorsolateral prefrontal cortex and motor cortex, respectively) in two large cohorts of white and Asian participants aged 12 to 100 years. We found that the EF intensity decreased with age, particularly in individuals under 25 years of age, and was influenced by gender and ethnicity. We identified skull thickness, scalp thickness, and epidural cerebrospinal fluid thickness, as the primary anatomical factors accounting for the inter-individual EF variability. Using a concurrent tES-fMRI approach, we observed a spatial consistency between the simulated EF and the brain activity changes induced by tES in the target region. Finally, we developed an open-source toolbox incorporating age-stratified head models to facilitate efficient EF calculations. These findings characterize and quantify the individual differences in tES-induced EF, offering a reference for implementing personalized neuromodulation strategies. [ABSTRACT FROM AUTHOR]

AbstractIntroductionMethodsResultsConclusions\nImplications for rehabilitationElectrical stimulation (E-stim) can reduce the impact of complications, like spasticity, bladder dysfunction in people with spinal cord injuries (SCIs), enhancing quality of life and health outcomes. With SCI prevalence high in regional Australia and a shift towards home-based community integrated care, the perspectives of people with SCI and healthcare professionals on current and future use of E-stim home-devices are needed.A mixed-methods concurrent triangulation approach was used. A cross-sectional survey collected demographics and perspectives on E-stim technology from 84 individuals with SCI and healthcare professionals. Focus groups with 36 participants explored the experiences, facilitators, and barriers of using E-stim home-devices.Healthcare professionals prioritised the use of E-stim for muscle strength and functional improvements, whereas people with SCI prioritised alleviating secondary complications. Healthcare professionals emphasised personal responsibility; however, people with SCI saw the clinical relationship as an important facilitator. Both groups agreed on the cost, accessibility, and funding as major barriers.Different expectations between healthcare professionals and people with SCI highlight the need for improved communication when establishing goals and expected outcomes. Successful E-stim home-device implementation relies on device availability and tailoring education to suit people with SCI and healthcare professionals.Having an easy access to an electrical stimulation (E-stim) home-device can be a useful tool to improve muscle strength and reduce secondary complications, such as spasticity, bladder, and bowel dysfunction in people with spinal cord injury (SCI).Communication between healthcare professionals and people with SCI with clear goals and expected outcomes should be improved for successful implementation of E-stim home-devices.Tailoring education for healthcare professionals, people with SCI and people involved in decision-making for implementation of E-stim home-devices is essential to meet the needs and priorities of people with SCI.Having an easy access to an electrical stimulation (E-stim) home-device can be a useful tool to improve muscle strength and reduce secondary complications, such as spasticity, bladder, and bowel dysfunction in people with spinal cord injury (SCI).Communication between healthcare professionals and people with SCI with clear goals and expected outcomes should be improved for successful implementation of E-stim home-devices.Tailoring education for healthcare professionals, people with SCI and people involved in decision-making for implementation of E-stim home-devices is essential to meet the needs and priorities of people with SCI. [ABSTRACT FROM AUTHOR]

Peripheral neuropathy (PN), the most common complication of diabetes, leads to sensory loss and associated health issues as pain and increased fall risk. However, present treatments do not counteract sensory loss, but only partially manage its consequences. Electrical neural stimulation holds promise to restore sensations, but its efficacy and benefits in PN damaged nerves are yet unknown. We designed a wearable sensory neuroprosthesis (NeuroStep) providing targeted neurostimulation of the undamaged nerve portion and assessed its functionality in 14 PN participants. Our system partially restored lost sensations in all participants through a purposely calibrated neurostimulation, despite PN nerves being less sensitive than healthy nerves (N = 22). Participants improved cadence and functional gait and reported a decrease of neuropathic pain after one day. Restored sensations activated cortical patterns resembling naturally located foot sensations. NeuroStep restores real-time intuitive sensations in PN participants, holding potential to enhance functional and health outcomes while advancing effective non-invasive neuromodulation. Neuropathy leads to sensory loss and increased risk of fall. Here, the authors design a wearable non-invasive neuroprosthesis that restores lost sensations and improves gait. [ABSTRACT FROM AUTHOR]

Dysphagia is a frequent and life-threatening complication of multiple sclerosis (MS). Swallowing disturbances may be present at all stages of MS, although their prevalence increases with age, with disease duration, and in progressive phenotypes. The pathophysiology of dysphagia in MS is likely due to a combination of factors, including the involvement of corticobulbar tracts, the cerebellum, and the brainstem. Accurate diagnosis and early management of swallowing disorders improve quality of life and may delay complications or invasive therapeutic interventions. Here we provide an overview of the pathophysiology, the assessment, and the management of MS dysphagia, also examining the possible role of novel therapeutic strategies. Although studies using imaging and neurophysiological techniques have contributed to better characterize swallowing alterations in MS, the treatment of dysphagia is still challenging. Rehabilitation represents the main therapeutic approach for swallowing disorders. Recently, some innovative neurophysiological approaches, such as pharyngeal electrical stimulation (PES), repetitive transcranial magnetic stimulation (rTMS), and transcranial direct current stimulation (tDCS), have been proposed as a supplement to swallowing therapy in different neurological conditions. However, only few studies have explored the role of neuromodulation for MS dysphagia. [ABSTRACT FROM AUTHOR]

Background Objective Methods Results Conclusion Functional electrical stimulation (FES) and robotic exoskeletons represent emerging technologies with significant potential for restoring critical physical functions such as standing and walking—functions that are most susceptible after spinal cord injury (SCI). However, the further development and successful integration of these technologies into clinical practice and daily life require a deep understanding of consumer perspectives.This review synthesizes consumer perspectives from a diverse range of technology stakeholders, including medical service providers, researchers, and persons affected by SCI—those living with SCI and their caregivers. By capturing this diverse range of perspectives, the review aims to describe the real‐world implications, challenges, and expectations associated with FES and robotic exoskeleton technologies.Relevant literature was primarily identified through a search in EBSCO, SCOPUS, and Web of Science. The authors supplemented the search by reviewing reference lists including appropriate articles identified by the authors. The PICO question guiding this process was defined as P (persons with SCI and caregivers, researchers, clinicians, and developers), I (use of FES or robotic exoskeletons), C (technology users compared to non‐users), and O (stakeholder perspectives and experiences). Each identified article underwent a thorough appraisal, after which findings were summarized to present consumers' viewpoints on FES and robotic exoskeleton technologies.The review focuses on key areas such as perceived benefits, limitations, implementation barriers, and consumer expectations. The benefits identified are multifaceted, extending from physical improvements, such as enhanced mobility and muscle strength, to psychological gains including increased confidence and sense of independence. However, these technologies also face perceived limitations, often related to accessibility, cost, and usability challenges. Beyond technical issues, implementation barriers are related to factors like insurance coverage and the need for specialized training for both users and providers. Consumer expectations include hope for technological advancements, increased accessibility and affordability, and a desire for more personalized and adaptable solutions tailored to the unique needs of individuals with SCI.This comprehensive overview of consumer perspectives offers insights into the needs and preferences of the end‐users, which are essential for creating user‐centric technology and effectively translating research findings into clinical practice. [ABSTRACT FROM AUTHOR]

Objective: Targeted transcutaneous electrical nerve stimulation (tTENS) is a non-invasive neural stimulation technique that involves activating sensory nerve fibers to elicit tactile sensations in a distal, or referred, location. Though tTENS is a promising approach for delivering haptic feedback in virtual reality or for use by those with somatosensory deficits, it was not known how the perception of tTENS might be influenced by changing wrist position during sensorimotor tasks. Approach: We worked with 12 able-bodied individuals and delivered tTENS by placing electrodes on the wrist, thus targeting the ulnar, median, and radial nerves, and eliciting tactile sensations in the hand. We recorded perceptual data across three wrist postures: neutral, 45° extension, and 45° flexion. For each posture, the participants drew where they perceived the elicited percepts on a map of the hand. They verbally reported the quality of the percepts in their own words. We also varied the pulse amplitude and width of the stimulation to generate a strength-duration curve, from which we extracted the rheobase current and chronaxie time. Linear mixed models were run on the slope and intercept of the linear fit between pulse width and pulse amplitude to investigate effects of gender, posture, and electrode placement. Main results: As wrist posture changed, sensation quality was modulated for half of the participants, and percept location changed for 11/12 participants. The rheobase, chronaxie, and percept sizes were influenced by wrist posture, but the direction of these changes varied by participant and therefore the effect was not systematic. The statistical models indicated interactions between posture and electrode placement, as well as an effect of gender. Significance: If using tTENS with electrodes placed on the wrist to convey haptic feedback during sensorimotor tasks, in which wrist posture will likely change, it may be important to characterize perception on an individual basis. [ABSTRACT FROM AUTHOR]

Background: Stroke is the leading cause of acquired motor deficiencies in adults. Restoring prehension abilities is challenging for individuals who have not recovered active hand opening capacities after their rehabilitation. Self-triggered functional electrical stimulation applied to finger extensor muscles to restore grasping abilities in daily life is called grasp neuroprosthesis (GNP) and remains poorly accessible to the post-stroke population. Thus, we developed a GNP prototype with self-triggering control modalities adapted to the characteristics of the post-stroke population and assessed its impact on abilities. Methods: Through two clinical research protocols, 22 stroke participants used the GNP and its control modalities (EMG activity of a pre-defined muscle, IMU motion detection, foot switches and voice commands) for 3 to 5 sessions over a week. The NeuroPrehens software interpreted user commands through input signals from electromyographic, inertial, foot switches or microphone sensors to trigger an external electrical stimulator using two bipolar channels with surface electrodes. Users tested a panel of 9 control modalities, subjectively evaluated in ease-of-use and reliability with scores out of 10 and selected a preferred one before training with the GNP to perform functional unimanual standardized prehension tasks in a seated position. The responsiveness and functional impact of the GNP were assessed through a posteriori analysis of video recordings of these tasks across the two blinded evaluation multi-crossover N-of-1 randomized controlled trials. Results: Non-paretic foot triggering, whether from EMG or IMU, received the highest scores in both ease-of-use (median scores out of 10: EMG 10, IMU 9) and reliability (EMG 9, IMU 9) and were found viable and appreciated by users, like voice control and head lateral inclination modalities. The assessment of the system's general responsiveness combined with the control modalities latencies revealed median (95% confidence interval) durations between user intent and FES triggering of 333 ms (211 to 561), 217 ms (167 to 355) and 467 ms (147 to 728) for the IMU, EMG and voice control types of modalities, respectively. The functional improvement with the use of the GNP was significant in the two prehension tasks evaluated, with a median (95% confidence interval) improvement of 3 (− 1 to 5) points out of 5. Conclusions: The GNP prototype and its control modalities were well suited to the post-stroke population in terms of self-triggering, responsiveness and restoration of functional grasping abilities. A wearable version of this device is being developed to improve prehension abilities at home. Trial Registration: Both studies are registered on clinicaltrials.gov: NCT03946488, registered May 10, 2019 and NCT04804384, registered March 18, 2021. [ABSTRACT FROM AUTHOR]

Key points The frequent poor functional outcomes after delayed surgical repair of injured human peripheral nerves results in progressive downregulation of growth‐associated genes in parallel with reduced neuronal regenerative capacity under each of the experimental conditions of chronic axotomy of neurones that remain without target contact, chronic distal nerve stump denervation, and chronic muscle denervation. Brief (1 h) low‐frequency (20 Hz) electrical stimulation (ES) accelerates the outgrowth of regenerating axons across the surgical site of microsurgical repair of a transected nerve. Exercise programmes also promote nerve regeneration with the combination of ES and exercise being the most effective. An ES conditioning lesion of intact nerve (CES) accelerates both axonal outgrowth and regeneration rate after the surgical repair of a more distal injury to the nerve, in contrast to ES of a repaired injury nerve that accelerates only the axon outgrowth. A CES accelerates both axonal outgrowth and regeneration rate after the surgical repair of a more distal injury to the nerve, in contrast to ES of a repaired injury nerve that accelerates only the axon outgrowth. The loss of contractility of permanently denervated muscles in cauda equinae‐injured patients with accompanying severe loss of muscle mass, disarray of thick and thin contractile filaments, and disorganization of the sarcoplasmic reticulum that controls calcium delivery to the filaments, is alleviated by a 2‐year programme of daily ES of the quadriceps muscle. These findings hold promise for recovery and rehabilitation in patients who suffer injury to the neuromuscular system. Poor functional outcomes after delayed surgical repair of injured human peripheral nerves are replicated by chronic neuronal axotomy, Schwann cell denervation in a nerve autograft, and muscle denervation. Exponential decline in expression of growth‐associated genes accompanies the same decline in regenerative capacity. Brief (1 h) low‐frequency (20 Hz) electrical stimulation (ES) that generates action potential conduction to the neuronal soma accelerates the outgrowth of regenerating axons across the surgical repair site of the transected nerve, even after delayed surgery. The same ES regimen accelerates muscle reinnervation in patients with chronic nerve injury who undergo carpal tunnel syndrome release surgery. A 2‐year programme of daily ES of permanently denervated quadriceps muscles in cauda equinae‐injured patients reinstated their contractility and organization. [ABSTRACT FROM AUTHOR]

Purpose: To systematically evaluate evidence from published systematic reviews for the effectiveness of rehabilitation interventions in adults with burn injury. Materials and methods: A comprehensive literature review conducted using medical and health science electronic databases up to 31 July 2022. Two independent reviewers selected studies, extracted data, and assessed methodological study quality using A Measurement Tool to Assess Systematic Reviews (AMSTAR-2), and the certainty of evidence for reported outcomes using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) tool. Results: Twenty-one systematic reviews evaluated five categories of interventions: physical, psychological, technology-aided modalities, educational and occupational programs, complementary and alternative medicine. Outcomes included fitness level, hand function, oedema, pain, pruritus, psychological state, quality of life, range of motion, return to work, strength, scar characteristics, level of impairment and burn knowledge. The methodological quality was rated as "critically low" for all reviews. Quality of evidence for the effectiveness of evaluated interventions ranged from "moderate to very low." Conclusions: Beneficial effects of inhaled aromatherapy and extracorporeal shockwave therapy on pain reduction; inhaled or massage aromatherapy, music therapy on anxiety were reported. Safety of interventions was not evaluated, due to the lack of adverse event reporting in primary studies and the included reviews. IMPLICATIONS FOR REHABILITATION: Burn injury is a leading cause of severe morbidity, and long-term disability, with significant health and economic burden. There is emerging evidence to support the use of complementary and alternative medicine interventions (such as aromatherapy and music therapy) for alleviating anxiety. Extracorporeal shockwave therapy with comprehensive rehabilitation therapy has positive effects on pain reduction. These interventions may be considered as adjunctive tools to enhance burn rehabilitation care and improve patient outcomes. However, further robust studies are required to strengthen the evidence, explore adverse effects and associated cost efficiency. [ABSTRACT FROM AUTHOR]

Objectives: Electroceuticals refers to the constantly growing disciplines of bioelectric and bioelectronic medication. These include a broad variety of devices that have been invented and are now being utilized in medical implants, wearable medical electronics, and bioelectronics. The primary aim of this study is to encompass several facets of electroceuticals, their applications, and recent advancements in the field of medical challenges. Evidence acquisitions: A complete literature study was conducted, which included a comprehensive review of globally recognized scientific research databases. Results: The progressive refinement and diminution of technology, in conjunction with swift advancements in comprehending the role of electrical pathways in the human body, have rendered it progressively viable to manipulate these pathways for therapeutic purposes. Discussion and conclusion: Electrical stimulation impacts and modifies biological functioning and pathological processes in the body. In the contemporary era of medicine, health care practitioners from a variety of fields utilize electricity to cure disease or injury or to assess and diagnose using a variety of electrically driven medical tools. [ABSTRACT FROM AUTHOR]

Introduction: Postoperative cognitive dysfunction (POCD) is a common complication following surgery. Electroacupuncture (EA), manual acupuncture (MA), transcutaneous electrical acupoint stimulation (TEAS), and cognitive training (CT) can effectively maintain or improve the postoperative cognitive function of patients. However, it remains unclear which therapy is the most effective. Therefore, this network meta-analysis aims to compare and rank the efficacy of these non-pharmacological therapies for POCD to identify the optimal therapy. Methods and analysis: A systematic search will be conducted across seven databases (PubMed, Cochrane Library, EMBASE, Web of Science, CINAHL, AMED, and PsycINFO) for articles published between January 2000 and November 2023. Two reviewers will independently conduct study selection and data extraction. The primary outcome will be the changes in the overall cognitive function before and after the intervention. The secondary outcome will be the incidence of POCD. The risk of bias will be assessed using the revised Risk of Bias Assessment Tool. Pairwise and Bayesian network meta-analyses will be performed using RevMan, STATA, and Aggregate Data Drug Information System statistical software. Additionally, the quality of evidence will be assessed using the Grading of Recommendations Assessment, Development, and Evaluation guidelines. Ethics and dissemination: The results will be disseminated to peer-reviewed journals or conferences. Trial registration: PROSPERO registration number: CRD42023454028. [ABSTRACT FROM AUTHOR]

Background: Cardiac contractility modulation (CCM) is non-excitatory electrical stimulation for improving cardiac function. This study aimed to evaluate the effects of CCM on autophagy and apoptosis of cardiac myocytes in a rabbit model of chronic heart failure (CHF) and explore its possible mechanism. Methods: Thirty rabbits were randomised into the Sham, heart failure (HF) and CCM groups, and animals in all three groups were sacrificed after 16 weeks of ascending aortic constriction or sham surgery. The expression of autophagy associated protein LC3 was observed by immunofluorescence staining. With Western-blot measured the expression of Beclin1, P62, LC3B (II/I) and Bcl-2, ALDH2, Bax and Caspase-3 protein in myocardial tissue. The apoptosis rate and the apoptosis of myocardial cells was observed by flow cytometry and TUNEL method. Results: 1) In comparison to the Sham group, the expression of LC3 and Beclin1 was significantly increased, and the expression of p62 protein was decreased in the heart tissues of rabbits in the HF group. Compared with HF group, after CCM intervention, the expression of Beclin1 and LC3B proteins decreased, while the P62 protein increased, and the LC3B(II/I) ratio decreased (P<0.05). 2) The expression of Bcl-2, ALDH2 protein and Bcl-2 mRNA decreased compared with the Sham group (P<0.05), while the expression of Bax, Caspase-3 protein and mRNA was significantly increased (P<0.05). However, the expression of ALDH2 mRNA in the CCM group was not statistically significant. The expression of Bcl-2, ALDH2 protein and mRNA increased after CCM intervention, and the expression of Bax, Caspase-3 protein and mRNA decreased (P<0.05). 3) The apoptosis situation in the Sham group was similar to that of normal myocardium, compared with the Sham group, the number of apoptotic bodies increased, and the apoptosis percentage of cardiomyocytes increased significantly (P<0.05). After CCM intervention, the number of apoptotic bodies and the percentage of apoptosis decreased compared with the HF group (P<0.05). Conclusions: The intervention of CCM has been shown to enhance both myocardial systolic and diastolic function in rabbits with CHF. The mechanism may be related to the inhibition of cardiomyocyte autophagy by regulating the expression levels of Beclin1, P62, and LC3B(II/I) in cardiomyocytes, as well as the reversal of cardiomyocyte apoptosis by regulating the expression levels of Bcl-2, ALDH2, Bax, and Caspase-3 in cardiomyocytes. [ABSTRACT FROM AUTHOR]

The landscape of therapeutic deep brain stimulation (DBS) for locomotor function recovery is rapidly evolving. This review provides an overview of electrical neuromodulation effects on spinal cord injury (SCI), focusing on DBS for motor functional recovery in human and animal models. We highlight research providing insight into underlying cellular and molecular mechanisms. A literature review via Web of Science and PubMed databases from 1990 to May 29, 2024, reveals a growing body of evidence for therapeutic DBS in SCI recovery. Advances in techniques like optogenetics and whole-brain tractogram have helped elucidate DBS mechanisms. Neuronal targets sites for SCI functional recovery include the mesencephalic locomotor region (MLR), cuneiform nucleus (CNF), and nucleus raphe magnus (NRG), with pedunculopontine nucleus (PPN), periaqueductal gray (PAG), and nucleus ventroposterolateral thalami (VPL) for post-injury functional recovery treatment. Radiologically guided DBS optimization and combination therapy with classical rehabilitation have become an effective therapeutic method, though ongoing interventional trials are needed to enhance understanding and validate DBS efficacy in SCI. On the pre-clinical front, standardization of pre-clinical approaches are essential to enhance the quality of evidence on DBS safety and efficacy. Mapping brain targets and optimizing DBS protocols, aided by combined DBS and medical imaging, are critical endeavors. Overall, DBS holds promise for neurological and functional recovery after SCI, akin to other electrical stimulation approaches. [ABSTRACT FROM AUTHOR]

Brain disorders, in particular mental disorders, might be effectively treated by direct electrical brain stimulation, but clinical progress requires understanding of therapeutic mechanisms. Animal models have not helped, because there are no direct animal models of mental illness. Here, we propose a potential path past this roadblock, by leveraging a common ingredient of most mental disorders: impaired cognitive control. We previously showed that deep brain stimulation (DBS) improves cognitive control in humans. We now reverse translate that result using a set-shifting task in rats. DBS-like stimulation of the midstriatum improved reaction times without affecting accuracy, mirroring our human findings. Impulsivity, motivation, locomotor, and learning effects were ruled out through companion tasks and model-based analyses. To identify the specific cognitive processes affected, we applied reinforcement learning drift-diffusion modeling. This approach revealed that DBS-like stimulation enhanced evidence accumulation rates and lowered decision thresholds, improving domain-general cognitive control. Reanalysis of prior human data showed that the same mechanism applies in humans. This reverse/forward translational model could have near-term implications for clinical DBS practice and future trial design. Editor's summary: Because of the complexity of cognitive processes involved in mental disorders, it has proven difficult to test therapeutic strategies in animal models. Here, Reimer et al. used a reverse translational approach to understand how deep brain stimulation (DBS) improves cognitive control, a process impaired in many mental disorders. A combination of learning tasks and computational models showed that striatal stimulation improved information processing needed for decision making in rats. Complementary computational models applied to previously collected clinical data indicate that similar mechanisms were at play in humans. These results suggest that cognitive control could be used as a readout for the preclinical testing of DBS interventions. —Daniela Neuhofer [ABSTRACT FROM AUTHOR]

Neonatal brachial plexus palsy (NBPP) is a flaccid paralysis of the upper limbs that occurs in about 0.4 percent of live births. This condition can produce permanent disabilities; to date, there is no consensus on protocols to be applied for the rehabilitation of children with this condition. The aim of this article is to provide a concise overview of conservative treatment beyond traditional physical therapy for the management of the child with NBPP and to offer a number of useful options for creating the most comprehensive and functional rehabilitation treatment possible. We conducted a narrative review after analyzing articles from the past 50 years on PubMed, Cochrane Library, Scopus, and Web of Science with the following search string [("neonatal brachial plexus palsy" OR "obstetric brachial plexus palsy" OR "birth brachial plexus palsy") AND ("rehabilitation" OR "physiotherapy" OR "conservative treatment")]. We identified a potential of 1275 articles, but only 11 were exclusively about conservative approaches. The most represented rehabilitation approaches in the literature were botulinum toxin, constraint-induced movement therapy (CIMT), virtual reality, neuromuscular electrical stimulation, and kinesiotaping. In conclusion, the various rehabilitation approaches for NBPP are promising, but none can be considered the best option when used alone. In light of the current evidence, a multimodal approach is needed. [ABSTRACT FROM AUTHOR]

Introduction: Neuropsychiatric symptoms such as depression and anxiety are a significant burden on patients with multiple sclerosis (MS). Their pathophysiology is complex and yet to be fully understood. There is an urgent need for non-invasive treatments that directly target the brain and help patients with MS. One such possible treatment is transcranial direct current stimulation (tDCS), a popular and effective non-invasive brain stimulation technique. Methods: This mechanistic review explores the efficacy of tDCS in treating depression and anxiety in MS while focusing on the underlying mechanisms of action. Understanding these mechanisms is crucial, as neuropsychiatric symptoms in MS arise from complex neuroinflammatory and neurodegenerative processes. This review offers insights that may direct more focused and efficient therapeutic approaches by investigating the ways in which tDCS affects inflammation, brain plasticity, and neural connections. Searches were conducted using the PubMed/Medline, ResearchGate, Cochrane, and Google Scholar databases. Results: The literature search yielded 11 studies to be included in this review, with a total of 175 patients participating in the included studies. In most studies, tDCS did not significantly reduce depression or anxiety scores as the studied patients did not have elevated scores indicating depression and anxiety. In the few studies where the patients had scores indicating mild/moderate dysfunction, tDCS was more effective. The risk of bias in the included studies was assessed as moderate. Despite the null or near-null results, tDCS may still prove to be an effective treatment option for depression and anxiety in MS, because tDCS produces a neurobiological effect on the brain and nervous system. To facilitate further work, several possible mechanisms of action of tDCS have been reported, such as the modulation of the frontal–midline theta, reductions in neuroinflammation, the modulation of the HPA axis, and cerebral blood flow regulation. Conclusions: Although tDCS did not overall demonstrate positive effects in reducing depression and anxiety in the studied MS patients, the role of tDCS in this area should not be underestimated. Evidence from other studies indicates the effectiveness of tDCS in reducing depression and anxiety, but the studies included in this review did not include patients with sufficient depression or anxiety. Future studies are needed to confirm the effectiveness of tDCS in neuropsychiatric dysfunctions in MS. [ABSTRACT FROM AUTHOR]

Background/Objectives: Before a cochlear implant is considered, patients undergo various audiological tests to assess their suitability. One key test measures the auditory brainstem response (ABR) to acoustic stimuli. However, in some cases, even with maximum sound stimulation, no response is detected. Methods: The promontory test involves electrical stimulation near the auditory nerve, allowing patients to associate the sensation. Ideally, the electrode is placed in the middle ear after opening the eardrum. This method, along with trans-tympanic electrically evoked ABR in local anesthesia (LA-TT-EABR) and the cortical equivalent (LA-TT-EALR), helps assess the auditory nerve's existence and excitability. The TympEALR test, utilizing a "tympanic LA-TT-EALR", provides an alternative measurement. Previous research has shown the possibility of deriving brainstem and cortical potentials through trans-tympanic electrical stimulation, allowing for objective assessment of the auditory nerve's integrity and potentially objectifying patient sensations. Results: Sixteen patients have been tested using TympEALR. In seven of these, we found a positive response. The morphology was similar to other electrically evoked cortical auditory responses (EALR), e.g., using cochlear implants or trans-tympanic stimulation electrodes. We observed a higher influence of electrical artifacts than in other EALRs. Conclusions: TympEALR showed positive results in nearly half of the study participants, potentially avoiding invasive procedures. TympEALR can be a valuable alternative to trans-tympanic methods. More research is needed to determine if a negative result suggests against cochlear implantation. [ABSTRACT FROM AUTHOR]

Background/Objectives: Preclinical studies have evidenced a peripheral nerve blockade with kilohertz high-frequency alternating current (KHFAC) stimulation. It could have a potential effect on aberrant nerve hyperactivity, such as tremor in people with Parkinson's disease (PwPD). The objective was to investigate the effects of transcutaneous KHFAC at 10 kHz compared with sham intervention on tremor modulation, upper limb motor function, and adverse events in PwPD. Methods: This randomized, double-blind, crossover trial included PwPD, who received transcutaneous KHFAC and sham interventions, within a 48 h washout period. Measurements were taken pre-intervention, during, immediately after, and 10 min post-intervention. The main outcomes were rest, postural, and kinetic tremor acceleration. Secondary outcomes were handgrip strength, nine-hole peg test (NHPT), movement onset time, and adverse events. Results: Sixteen PwPD were analyzed. Kinetic tremor diminished only in active treatment from baseline at post-intervention (−32.3% (SD 63.3); p = 0.03) and 10 min after intervention (−38.9% (SD 60.3); p = 0.03). Active treatment showed a greater reduction in kinetic tremor at post-treatment compared to sham (−58.7% SD 123; p = 0.055) close to reaching statistical significance. Only active intervention diminished movement onset time at post-intervention (−26.9% (SD 28.3); p = 0.04). Active intervention diminished handgrip strength compared to sham intervention during the stimulation (−6.6% (SD 10.0); p = 0.02). No relevant adverse effects were reported. Conclusions: KHFAC stimulation at 10 kHz appeared safe and showed potential benefits for reducing kinetic tremor in PwPD. The transient reduction in grip strength suggested an effect on alpha-motoneurons. However, further studies with larger sample sizes are necessary to confirm these findings. [ABSTRACT FROM AUTHOR]

Contraction of heart muscle requires activation of both the actin and myosin filaments. The mechanism of myosin filament activation is unknown, but the leading candidate hypothesis is direct mechano‐sensing by the filaments. Here, we tested this hypothesis by activating intact trabeculae from rat heart by electrical stimulation under different loads and measuring myosin filament activation by X‐ray diffraction. Unexpectedly, we found that the distinct structural changes in the myosin filament associated with activation had different dependences on the load. In early activation, all the structural changes indicated faster activation at higher load, as expected from the mechano‐sensing hypothesis, but, at later times, the helical order of the myosin motors characteristic of the inactivated state was lost even at very low load. We conclude that mechano‐sensing does operate in heart muscle, but it is supplemented by a previously undescribed mechanism that links myosin filament activation to actin filament activation. Key points: Myosin filament activation controls the strength and speed of contraction in heart muscle.Early activation of the myosin filament is determined by the filament load.At later times, myosin filament activation is controlled by a load independent pathway.This load independent pathway provides new targets and assays for drug development. [ABSTRACT FROM AUTHOR]