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3 episodes with transcutaneous
2 episodes with transcutaneous
2 episodes with transcutaneous
In this episode of the PFC Podcast, Dennis and Doug delve into the complexities of bradyarrhythmias, discussing their recognition, causes, and treatment options. They explore the importance of vital signs, differential diagnosis, and the various pharmacological and electrical interventions available for managing bradycardia. The conversation also touches on the implications of overdoses and the long-term management of patients with bradyarrhythmias, emphasizing the need for a comprehensive approach in emergency medicine.TakeawaysRecognizing bradycardia involves checking vital signs and symptoms.Not all bradycardias are the same; context matters.Altered mental status can indicate shock in bradycardia cases.Lyme disease is a significant cause of bradycardia in younger populations.Narcotic overdose can lead to bradycardia and requires immediate attention.Atropine is a quick and handy treatment for bradycardia.Transcutaneous pacing is a common emergency intervention.Dopamine is preferred for its targeting of heart rate in bradycardia.Glucagon is an expensive but necessary treatment for beta-blocker overdose.Treating hypoxia is crucial before addressing bradycardia.Chapters00:00 Introduction to Bradyarrhythmias03:01 Recognizing Bradycardia and Its Symptoms06:14 Causes of Bradycardia09:02 Differential Diagnosis in Bradycardia11:57 Stabilization and Treatment Approaches14:46 Pharmacological Interventions for Bradycardia17:59 Electrical Interventions: Pacing Techniques20:55 Managing Overdoses and Bradycardia23:48 Long-term Management and Follow-up26:54 Conclusion and Key TakeawaysLink to full podcast:https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-228-DImE-e32aek2Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.comFor more content, go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Podcast Show Notes: Peripheral Vascular Disease in PainManagement Episode Highlights: - Host: Dr. David Rosenblum - Podcast: Pain Exam Podcast - Focus: Peripheral Arterial Disease (PAD) in Pain Management Download the App Key Topics Covered: 1. Peripheral Arterial Disease (PAD) Overview - Definition: Arterial sclerosis condition developing over long term - WHO Definition: Exercise-related pain or ankle-brachial index (ABI) < 0.9 - Prevalence: * 3-4% in 60-65 year olds * Increases to 15-20% in 85-90 year olds * Up to 50% of patients may progress to symptomatic stages 2. Diagnostic Considerations Diagnostic Tests: - Ankle Brachial Index (ABI) - Ultrasound - CT Angiography - Physical examination - Pulse volume recordings - Transcutaneous oximetry ABI Interpretation: - 1.0-1.4: Normal - 0.9-1.0: Acceptable - 0.8-0.9: Some arterial disease - 0.5-0.8: Moderate arterial disease - < 0.5: Severe arterial disease 3. Pain Characteristics Types of Pain: - Intermittent claudication - Chronic limb ischemia - Nociceptive pain - Neuropathic pain - Mixed pain syndrome 4. Pain Management Strategies Pharmacological Approaches: - Mild Pain: Paracetamol, NSAIDs - Neuropathic Pain: Lidocaine patches, gabapentin, duloxetine - Severe Pain: Morphine, fentanyl, ketamine Non-Pharmacological Interventions: - Music therapy - Aromatherapy - Psychotherapy - Massage - Acupuncture - TENS - Intermittent pneumatic compression Upcoming Conferences Mentioned: - ASPN - ASIPP - Pain Week - Latin American Pain Society Additional Resources: - Pain Exam newsletter: painexam.com - Virtual pain fellowship at nrappain.org Disclaimer: Always consult with a healthcare professional for personalized medical advice. Reference Garba Rimamskep Shamaki, Favour Markson, Demilade Soji-Ayoade, Chibuike Charles Agwuegbo, Michael Olaseni Bamgbose, Bob-Manuel Tamunoinemi, Peripheral Artery Disease: A Comprehensive Updated Review, Current Problems in Cardiology, Volume 47, Issue 11, 2022,101082, Maier, J.A.; Andrés, V.; Castiglioni, S.; Giudici, A.; Lau, E.S.; Nemcsik, J.; Seta, F.; Zaninotto, P.; Catalano, M.; Hamburg, N.M. Aging and Vascular Disease: A Multidisciplinary Overview. J. Clin. Med. 2023, 12, 5512. https://doi.org/10.3390/jcm12175512 Maier, J.A.; Andrés, V.; Castiglioni, S.; Giudici, A.; Lau, E.S.; Nemcsik, J.; Seta, F.; Zaninotto, P.; Catalano, M.; Hamburg, N.M. Aging and Vascular Disease: A Multidisciplinary Overview. J. Clin. Med. 2023, 12, 5512. https://doi.org/10.3390/jcm12175512
Podcast Show Notes: Peripheral Vascular Disease in PainManagement Episode Highlights: - Host: Dr. David Rosenblum - Podcast: Pain Exam Podcast - Focus: Peripheral Arterial Disease (PAD) in Pain Management Download the App Key Topics Covered: 1. Peripheral Arterial Disease (PAD) Overview - Definition: Arterial sclerosis condition developing over long term - WHO Definition: Exercise-related pain or ankle-brachial index (ABI) < 0.9 - Prevalence: * 3-4% in 60-65 year olds * Increases to 15-20% in 85-90 year olds * Up to 50% of patients may progress to symptomatic stages 2. Diagnostic Considerations Diagnostic Tests: - Ankle Brachial Index (ABI) - Ultrasound - CT Angiography - Physical examination - Pulse volume recordings - Transcutaneous oximetry ABI Interpretation: - 1.0-1.4: Normal - 0.9-1.0: Acceptable - 0.8-0.9: Some arterial disease - 0.5-0.8: Moderate arterial disease - < 0.5: Severe arterial disease 3. Pain Characteristics Types of Pain: - Intermittent claudication - Chronic limb ischemia - Nociceptive pain - Neuropathic pain - Mixed pain syndrome 4. Pain Management Strategies Pharmacological Approaches: - Mild Pain: Paracetamol, NSAIDs - Neuropathic Pain: Lidocaine patches, gabapentin, duloxetine - Severe Pain: Morphine, fentanyl, ketamine Non-Pharmacological Interventions: - Music therapy - Aromatherapy - Psychotherapy - Massage - Acupuncture - TENS - Intermittent pneumatic compression Upcoming Conferences Mentioned: - ASPN - ASIPP - Pain Week - Latin American Pain Society Additional Resources: - Pain Exam newsletter: painexam.com - Virtual pain fellowship at nrappain.org Disclaimer: Always consult with a healthcare professional for personalized medical advice. Reference Garba Rimamskep Shamaki, Favour Markson, Demilade Soji-Ayoade, Chibuike Charles Agwuegbo, Michael Olaseni Bamgbose, Bob-Manuel Tamunoinemi, Peripheral Artery Disease: A Comprehensive Updated Review, Current Problems in Cardiology, Volume 47, Issue 11, 2022,101082, Maier, J.A.; Andrés, V.; Castiglioni, S.; Giudici, A.; Lau, E.S.; Nemcsik, J.; Seta, F.; Zaninotto, P.; Catalano, M.; Hamburg, N.M. Aging and Vascular Disease: A Multidisciplinary Overview. J. Clin. Med. 2023, 12, 5512. https://doi.org/10.3390/jcm12175512 Maier, J.A.; Andrés, V.; Castiglioni, S.; Giudici, A.; Lau, E.S.; Nemcsik, J.; Seta, F.; Zaninotto, P.; Catalano, M.; Hamburg, N.M. Aging and Vascular Disease: A Multidisciplinary Overview. J. Clin. Med. 2023, 12, 5512. https://doi.org/10.3390/jcm12175512
Podcast Show Notes: Peripheral Vascular Disease in PainManagement Episode Highlights: - Host: Dr. David Rosenblum - Podcast: Pain Exam Podcast - Focus: Peripheral Arterial Disease (PAD) in Pain Management Download the App Key Topics Covered: 1. Peripheral Arterial Disease (PAD) Overview - Definition: Arterial sclerosis condition developing over long term - WHO Definition: Exercise-related pain or ankle-brachial index (ABI) < 0.9 - Prevalence: * 3-4% in 60-65 year olds * Increases to 15-20% in 85-90 year olds * Up to 50% of patients may progress to symptomatic stages 2. Diagnostic Considerations Diagnostic Tests: - Ankle Brachial Index (ABI) - Ultrasound - CT Angiography - Physical examination - Pulse volume recordings - Transcutaneous oximetry ABI Interpretation: - 1.0-1.4: Normal - 0.9-1.0: Acceptable - 0.8-0.9: Some arterial disease - 0.5-0.8: Moderate arterial disease - < 0.5: Severe arterial disease 3. Pain Characteristics Types of Pain: - Intermittent claudication - Chronic limb ischemia - Nociceptive pain - Neuropathic pain - Mixed pain syndrome 4. Pain Management Strategies Pharmacological Approaches: - Mild Pain: Paracetamol, NSAIDs - Neuropathic Pain: Lidocaine patches, gabapentin, duloxetine - Severe Pain: Morphine, fentanyl, ketamine Non-Pharmacological Interventions: - Music therapy - Aromatherapy - Psychotherapy - Massage - Acupuncture - TENS - Intermittent pneumatic compression Upcoming Conferences Mentioned: - ASPN - ASIPP - Pain Week - Latin American Pain Society Additional Resources: - Pain Exam newsletter: painexam.com - Virtual pain fellowship at nrappain.org Disclaimer: Always consult with a healthcare professional for personalized medical advice. Reference Garba Rimamskep Shamaki, Favour Markson, Demilade Soji-Ayoade, Chibuike Charles Agwuegbo, Michael Olaseni Bamgbose, Bob-Manuel Tamunoinemi, Peripheral Artery Disease: A Comprehensive Updated Review, Current Problems in Cardiology, Volume 47, Issue 11, 2022,101082, Maier, J.A.; Andrés, V.; Castiglioni, S.; Giudici, A.; Lau, E.S.; Nemcsik, J.; Seta, F.; Zaninotto, P.; Catalano, M.; Hamburg, N.M. Aging and Vascular Disease: A Multidisciplinary Overview. J. Clin. Med. 2023, 12, 5512. https://doi.org/10.3390/jcm12175512 Maier, J.A.; Andrés, V.; Castiglioni, S.; Giudici, A.; Lau, E.S.; Nemcsik, J.; Seta, F.; Zaninotto, P.; Catalano, M.; Hamburg, N.M. Aging and Vascular Disease: A Multidisciplinary Overview. J. Clin. Med. 2023, 12, 5512. https://doi.org/10.3390/jcm12175512
Host Polly Swingle is joined by Dr. TJ Hosa PT, DPT, and Mark Pedziwiatr MS, OTR/L, ATP, to discuss the ARC-EX by Onward Medical, the first system approved for non-invasive spinal cord stimulation for people with spinal cord injury (SCI). It is intended to deliver programmed, transcutaneous electrical spinal cord stimulation in conjunction with functional task practice in the clinic to improve hand sensation and strength in individuals between 18 and 75 years old that present with a chronic, non-progressive neurological deficit resulting from an incomplete spinal cord injury (C2-C8 inclusive). In 2024, the ARC-EX System was granted FDA clearance to market in the United States. You can learn more about this system for use in the clinical setting at www.onwd.com.Dr. TJ Hosa PT, DPT, earned his Bachelors Degree in Exercise Science from Ohio State University (2011) and Doctorate in Physical Therapy from Ohio University (2015). TJ has been a Physical Therapist at The Recovery Project for 10 years. He is the lead of the spinal cord injury and vestibular programs and has additional training in functional electrical stimulation (FES). TJ also specializes in the implementation of high intensity therapy for patients with neuro diagnoses. He is also certified in dry needling and has used it to treat spasticity and a multitude of pain syndromes.Mark Pedziwiatr MS, OTR/L, ATP, earned his Master's degree in Occupational Therapy from Midwestern University, where he conducted research on rehabilitation technology. As an occupational therapist, he brings experience across the continuum of care, including outpatient, inpatient, and acute-care settings. In his current role as a Therapy Consultant with Onward Medical, Mark leverages his clinical experience to support the integration and training of therapists in the use of ARC-EX within spinal cord injury (SCI) rehabilitation clinics across the Midwest.Learn more about The Recovery Project! View our website at www.therecoveryproject.net Call us 855-877-1944 to become a patient Follow us on Instagram Like us on Facebook Thanks for listening!
What if your skin could do more than protect you? In this thought-provoking episode of The Technology of Beauty, Dr. Grant Stevens sits down with Ryan Beal, the CEO of Dyve Biosciences, to explore how transcutaneous drug delivery is poised to reshape both the aesthetics industry and the field of oncology. With Dyve's pioneering platform, molecules once limited to injections or oral delivery are now being driven through the skin — offering a powerful new frontier in treatment possibilities.Ryan walks us through Dyve's surprising evolution from skincare applications and elite athletic performance enhancement to its most ambitious moonshots: noninvasive fat reduction and improving chemotherapy effectiveness through targeted pH modulation.This episode also takes a personal turn, as Ryan opens up about his recent battle with cancer—a diagnosis that came just months after speaking about oncology research on a previous episode. Now a survivor, Ryan shares how his company's technology played a direct role in his treatment, potentially boosting the efficacy of his own chemotherapy regimen. It's a powerful testament to the impact of innovation when professional purpose and personal experience collide.From fat-melting topicals to transdermal neurotoxins and tumor microenvironment alkalinization, Ryan Beal offers an inspiring look at how Dyve Biosciences is transforming medicine one molecule—and one patient—at a time. Don't miss this candid, cutting-edge conversation about the future of drug delivery and the deeply human stories behind biotech breakthroughs on the latest episode of The Technology of Beauty.» Apple Podcasts | https://podcasts.apple.com/us/podcast/technology-of-beauty/id1510898426» Spotify | https://open.spotify.com/show/0hEIiwccpZUUHuMhlyCOAm» Recent episodes | https://www.influxmarketing.com/technology-of-beauty/» Instagram | https://www.instagram.com/thetechnologyofbeauty/» LinkedIn | https://www.linkedin.com/company/the-technology-of-beauty/The Technology of Beauty is produced by Influx Marketing, The Digital Agency for Aesthetic Practices. https://www.influxmarketing.com/Want more aesthetic insights? Subscribe to Next Level Practices, the show where we discuss the ever-changing world of digital marketing and patient acquisition and bring you the latest ideas, strategies, and tactics to help you take your practice to the next level. https://www.influxmarketing.com/next-level-practices/
On today's episode, we're lucky to have a couple of special guests to discuss prehospital transcutaneous pacing. Medics turned medical students and EMS researchers, Josh Kimbrell and Judah Kreinbrook recently published a case series decsribing EMS pacing capture. Like many of our favorite topics this came from a paramedic asking a clinical question with loads of dogma and little evidence. What they found should motivate us all to be skeptical when it comes to determining if TCP is actually working. REFERENCES 1. https://www.mchd-tx.org/wp-content/uploads/2025/03/TCP-Podcast-Figures.pdf 2. Kimbrell, J., Kreinbrook, J., Poke, D., Kalosza, B., Geldner, J., Shekhar, A. C., Miele, A., Bouthillet, T., & Vega, J. (2024). False Electrical Capture in Prehospital Transcutaneous Pacing by Paramedics: A Case Series. Prehospital emergency care, 28(7), 928–936. 3. https://www.ems12lead.com/post/tcp-in-transit-part-i 4. https://www.ems12lead.com/post/transcutaneous-pacing-part-2 5. https://www.ems12lead.com/post/transcutaneous-pacing-part-3
Transcutaneous vagal nerve stimulators are often advertised as insomnia therapies, "helping you fall asleep faster" or "helping you sleep through the night. Do they work? In this Insomnia Monday episode of the podcast, we will:Introduce vagal nerve stimulatorsDescribe the path and role of the vagus nerveUnderstand the role of the parasympathetic nervous systemExamine the limited research on vagal nerve stimulators and sleepUnderstand the scale of the placebo effect in sleep/insomnia researchDifferentiate a statistically meaningful change in sleep/polysomnographic parameters from a "real world" meaningful change in someone struggling with insomniaList the strengths and criticisms of vagal nerve stimulators including study size and study designLear who is the right candidate for vagal nerve stimulatorsProduced by: Maeve WinterMore Twitter: @drchriswinter IG: @drchriwinter Threads: @drchriswinter Bluesky: @drchriswinter The Sleep Solution and The Rested Child Thanks for listening and sleep well!
Join us this episode for a conversation with Dr. James D. Guest, MD, PhD, of The Miami Project to Cure Paralysis, for a conversation about the paper titled "Non-invasive spinal cord electrical stimulation for arm and hand function in chronic tetraplegia: a safety and efficacy trial" published in the journal Nature Medicine. This paper is the culmination of commercialization efforts to bring to market a transcutaneous ("noninvasive") electrical spinal cord simulator for the purpose of recover of upper extremity motor strength. We trust you will enjoy our conversation with Dr. Guest, who was a site-Principal Investigator (PI) for the Up-LIFT trial sponsored by Onward Medical Inc., in the timely wake of the exciting FDA approval of the now-titled ARC-EX® device that was studied in this pivotal clinical trial.
Dr. Anna Latorre is interviewed by Dr. Sara Schaefer about her study exploring the role of transcutaneous spinal cord simulation for suppression of postural tremor in essential tremor, including the potential pathophysiological mechanisms and implications for therapeutic use. Journal CME is available until October 21, 2025 Read the article.
In this "Ask the Expert" episode, Dr. GG deFiebre of SRNA was joined by Dr. Rebecca Martin, who detailed the mechanism and benefits of transcutaneous spinal cord stimulation (TSS). Dr. Martin explained how TSS, a non-invasive method, aims to amplify spinal cord excitability and improve neurological functions like movement and sensation [00:01:25]. She contrasted TSS with implanted spinal stimulators, noting their respective applications and advantages [00:02:34]. Dr. Martin shared the promising outcomes of TSS in clinical trials, emphasizing its potential for widespread clinical use, and she urged patients to inquire about it at their clinics [00:05:42]. You can read her group's recent paper here: "Transcutaneous Spinal Cord Stimulation Enables Recovery of Walking in Children with Acute Flaccid Myelitis" https://www.mdpi.com/2227-9067/11/9/1116 Rebecca Martin, OTR/L, OTD, CPAM received her Bachelor of Science in Occupational Therapy from Boston University in 2001 and her Occupational Therapy Doctorate from Rocky Mountain University of Allied Health Professions in 2008. Prior to joining the Kennedy Krieger Institute, Dr. Martin worked in brain injury rehabilitation in Boston, Massachusetts. Dr. Martin joined Kennedy Krieger in 2005 as a Senior Occupational Therapist in the International Center for Spinal Cord Injury. Since 2010, Dr. Martin has been the Manager of Clinical Education and Training at ICSCI and is responsible for program development, staff training, and oversight of the clinical research program. Dr. Martin speaks nationally on topics related to Activity-Based Rehabilitation; she has taught many continuing education courses for rehabilitation professionals in the areas of neurological pathology, rehabilitation, and research. She has been the principal investigator and co-investigator for grants from the Paralyzed Veterans of America Education Foundation and Department of Defense to develop, promote, and disseminate an activity-based restorative therapy training program and curriculum. In 2011, Dr. Martin was awarded the Leader in Spinal Cord Injury Care by the International Center for Spinal Cord Injury at Kennedy Krieger. From 2011-2016, Dr. Martin served as a Committee Chair for the annual Contemporary Trends in Spinal Cord Injury Management Symposium at Kennedy Krieger. As a consultant for SwissStim, she has helped create clinical use guidelines for training and documentation. In 2015, Dr. Martin was invited to serve on the NIH and NINDS Committee to establish Pediatric Spinal Cord Injury Common Data Elements.
The conversation is about a paper on false electrical capture and pre-hospital transcutaneous pacing by paramedics. The guests, Tom Boutilet, Josh Kimbrell, and Judah Kreinbrook, discuss their research findings and the implications for paramedics. They conducted a retrospective study and found that paramedics often mistakenly believe they have electrical capture when they do not. They emphasize the importance of confirming electrical capture before assuming mechanical capture. They also discuss the challenges of pulse palpation and the need for more rigorous research in EMS and ED settings. The conversation discusses the challenges and considerations in transcutaneous pacing, specifically focusing on the verification of mechanical capture. The speakers explore the use of various methods to confirm mechanical capture, such as feeling for a pulse, using pulse oximetry, and utilizing ultrasound. They also discuss the difficulty of accurately assessing mechanical capture and the potential for false electrical capture. The conversation concludes with a discussion on the transfer of pacing from one device to another and the importance of verifying capture during the process.
Have you tried TENs? DocJen and Dr. Dom dive into Transcutaneous electrical nerve stimulation. They dive into how it affects the body to reduce pain in the short-term, potential contraindications, and critically analyze the research that has been done on TENs. Finally, they discuss its use during labour and how it can facilitate pain management temporarily. Let's dive into all things TENs! VivoBarefoot Discount: Something that can surprisingly affect the health of our hamstrings is what we wear on our feet. It challenges the whole back-side chain to work through its full range of motion. Your feet have the components they need to support themselves! That's why we love VivoBarefoot because the shoes themselves help us gain mobility and strength in our feet. Live that barefoot life in style, choose VivoBarefoot and use code TOB at checkout to get 15% off! Your foot and body will thank you (affiliate link)! **Vivo offers a 100-day trial period. If you are not completely satisfied, you can send the shoes back and get a refund. What You Will Learn In This PT Pearl: 02:00 - What are TENS and how does it affect our body/work? 5:20 - Contradictions 6:08 - How do TENs affect lower back pain? 8:36 - A 2017 Study 10:35 - A 2022 Study with back exercises 11:11 - A 2010 Review 14:15 - Limitations of the study 16:11 - TENS & Labour? To Watch the PT Pearl on YouTube, click here: https://youtube.com/watch/ --- Send in a voice message: https://podcasters.spotify.com/pod/show/tobpodcast/message
Nerw błędny jest kluczowym elementem autonomicznego układu nerwowego, który unerwia większość narządów, zwłaszcza tych w obrębie przewodu pokarmowego. Nerw błędny jest głównym składnikiem osi neuroendokrynnoimmunologicznej, która zapewnia regulację wrodzonej odpowiedzi odpornościowej przed zakażeniami i stanem zapalnym, pomagając organizmowi przywrócić równowagę. Z tego powodu stymulacja nerwu błędnego jest aktualnie intensywnie badany pod kątem przeciwzapalnego potencjału terapeutycznego w niektórych chorobach. Gość: dr Maciej Duczyński – fizjoterapeuta i student osteopatii. Od lat pasjonuje się układem nerwowym i możliwościami poprawy jego funkcjonowania poprzez terapię manualną. Maciek popularyzuje metodę elektrostymulacji nerwu błędnego w leczeniu pacjentów ze schorzeniami autoimmunologicznymi, zaburzeniami funkcji przewodu pokarmowego i depresją. Misją Maćka jest przede wszystkim edukacja i pokazywanie ludziom, że osiągnięcie zdrowia nie musi być bardzo skomplikowane. Na co dzień pracuje z pacjentami w gabinecie Triada Zdrowia na warszawskich Włochach oraz prowadzi szkolenia dla fizjoterapeutów w firmie Neuroprojekt. Oprócz tego Maćka znajdziecie na instagramie pod nickiem @duczynski.m W odcinku znajdziesz odpowiedzi m. in. na następujące pytania: Na czym polega praca fizjoterapeuty i osteopaty? Czym jest terapia manualna? Dlaczego chorujemy? Jak emocje i stres wpływają nasze ciało? Czym jest zmienność rytmu zatokowego (HRV)? Czym jest nerw błędny i czy ma związek z chorobami? Czym jest teoria poliwagalna? Jak możemy stymulować nerw błędny? Czy elektrostymulacja nerwu błędnego jest metoda leczenia chorób autoimmunologicznych i metabolicznych? Lista publikacji o których wspominamy w podcaście: Bonaz B. i wsp. Anti-inflammatory properties of the vagus nerve: potential therapeutic implications of vagus nerve stimulation. J Physiol. 2016 Oct 15;594(20):5781-5790. Kelly M.J. i wsp. Manipulation of the inflammatory reflex as a therapeutic strategy. Cell Rep Med. 2022 Jul 19;3(7):100696. Kuzior K. i Gorczyca W. Odruch zapalny jako przykład współzależności pomiędzy układem odpornościowym i nerwowym. Chemistry, environment, biotechnology 2010, XIV, 139–151. Bellocchi Ch. i wsp. The Interplay between Autonomic Nervous System and Inflammation across Systemic Autoimmune Diseases. Int J Mol Sci . 2022 Feb 23;23(5):2449. Adlan A.M. i wsp. Autonomic function and rheumatoid arthritis—A systematic review. Semin. Arthritis Rheum. 2014, 44, 283–304. Ghia J.-E. i wsp. Vagus nerve integrity and experimental colitis. Am. J. Physiol. Liver Physiol. 2007, 293,G560–G567. Koopman F.A. i wsp. Vagus nerve stimulation inhibits cytokine production and attenuates disease severity in rheumatoid arthritis. Proc. Natl. Acad. Sci. USA 2016, 113, 8284–8289 Sorski L. i Gidron Y. The Vagal Nerve, Inflammation, and Diabetes-A Holy Triangle. Cells. 2023 Jun 15;12(12):1632. Fang J. i wsp. Transcutaneous Vagus Nerve Stimulation Modulates Default Mode Network in Major Depressive Disorder. Biol Psychiatry . 2016 Feb 15;79(4):266-73. de Moraes T.l. i wsp. Brief periods of transcutaneous auricular vagus nerve stimulation improve autonomic balance and alter circulating monocytes and endothelial cells in patients with metabolic syndrome: a pilot study. Bioelectron Med. 2023 Mar 31;9(1):7. Hilz M.J. Transcutaneous vagus nerve stimulation - A brief introduction and overview. Auton Neurosci. 2022 Dec;243:103038. Inbaraj G. i wsp. Immediate Effects of OM Chanting on Heart Rate Variability Measures Compared Between Experienced and Inexperienced Yoga Practitioners. Int J Yoga. 2022 Jan-Apr;15(1):52-58. Black D.S. i Slavich G.M. Mindfulness meditation and the immune system: a systematic review of randomized controlled trials.Ann N Y Acad Sci. 2016 Jun;1373(1):13-24.
Researchers in Scotland are using Transcutaneous electrical nerve stimulation (TENS) as a method of pain relief for people suffering from peripheral artery disease (P.A.D.), a circulation issue that causes leg pain and leg cramps while walking. Walking is the best medicine for P.A.D. patients because it helps stimulate the body's ability to establish a collateral network of vessels that can re-route blood flow around blockages and severely narrowed areas in the arteries. The problem is each step can be painful for these patients due to the nerve pain caused by restricted blood flow to muscles, tissues and nerves in the lower extremities. Physiotherapist Dr. Chris Seenan and Doctorate student and researcher Daniel Tiboldi have been studying this issue and trying to get a greater understanding on physical, emotional, and behavioral barriers limiting mobility. One research project led by Dr. Seenan involves attaching a TENS unit to strategic areas on these patients where the pain is occurring while they walk. This study found improved walking distance in those patients who wore the TENS unit. Dr. Seenan talk with hosts Kym McNicholas and Dr. John Phillips about the results and next steps in their research.
Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2023.03.30.534835v1?rss=1 Authors: Bryson, N. K., Lombardi, L., Hawthorn, R., Fei, J., Keesey, R., Peiffer, J. D., Seanez, I. Abstract: Objective. Transcutaneous spinal cord stimulation (tSCS) has been gaining momentum as a non-invasive rehabilitation approach to restore movement to paralyzed muscles after spinal cord injury (SCI). However, its low selectivity limits the types of movements that can be enabled and, thus, its potential applications in rehabilitation. Approach. In this cross-over study design, we investigated whether muscle recruitment selectivity of individual muscles could be enhanced by multielectrode configurations of tSCS in 16 neurologically intact individuals. We hypothesized that due to the segmental innervation of lower limb muscles, we could identify muscle-specific optimal stimulation locations that would enable improved recruitment selectivity over conventional tSCS. We elicited leg muscle responses by delivering biphasic pulses of electrical stimulation to the lumbosacral enlargement using conventional and multielectrode tSCS. Results. Analysis of recruitment curve responses confirmed that multielectrode configurations could improve the rostrocaudal and lateral selectivity of tSCS. To investigate whether motor responses elicited by spatially selective tSCS were mediated by posterior root-muscle reflexes, each stimulation event was a paired pulse with a conditioning-test interval of 33.3 ms. Muscle responses to the second stimulation pulse were significantly suppressed, a characteristic of post-activation depression suggesting that spatially selective tSCS recruits proprioceptive fibers that reflexively activate muscle-specific motor neurons in the spinal cord. Moreover, the combination of leg muscle recruitment probability and segmental innervation maps revealed a stereotypical spinal activation map in congruence with each electrode's position. Significance. Improvements in muscle recruitment selectivity could be essential for the effective translation into stimulation protocols that selectively enhance single-joint movements in neurorehabilitation. Copy rights belong to original authors. Visit the link for more info Podcast created by Paper Player, LLC
As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below.Enjoy!_____________________________________________________________________________________Show notes, articles, and CME form can be found on our website: http://www.the-incubator.org/113/
As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below.Enjoy!_____________________________________________________________________________________Show notes, articles, and CME form can be found on our website: http://www.the-incubator.org/113/
Carbon dioxide measurement is a fundamental measurement in the NICU. It is essential to maintain CO2 levels within target levels to ensure positive outcomes. Guest Chelsea Lee, Clinical Education Manager at Sentec, shares the benefits of transcutaneous CO2 monitoring technology not only our fragile patients, but in guiding clinical decisions and prompt interventions.
Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2022.09.06.506783v1?rss=1 Authors: Dalrymple, A. N., Hooper, C. A., Kuriakose, M. G., Capogrosso, M., Weber, D. J. Abstract: Spinal cord neuromodulation has gained much attention for demonstrating improved motor recovery in people with spinal cord injury, motivating the development of clinically applicable technologies. Among them, transcutaneous spinal cord stimulation (tSCS) is attractive because of its non-invasive profile. Many tSCS studies employ a high-frequency (10 kHz) carrier, which has been reported to reduce stimulation discomfort. However, these claims have come under scrutiny in recent years. The purpose of this study was to determine whether high-frequency tSCS is more comfortable at therapeutic amplitudes, which evoke posterior root-muscle (PRM) reflexes. In 16 neurologically intact participants, tSCS was delivered using a 1-ms long monophasic pulse with and without a high-frequency carrier. Stimulation amplitude and pulse duration were varied and PRM reflexes were recorded from the soleus, gastrocnemius, and tibialis anterior muscles. Participants rated their discomfort during stimulation from 0-10 at PRM reflex threshold. At PRM reflex threshold, high-frequency stimulation (0.87 {+/-} 0.2) was equally comfortable as conventional stimulation (1.03 {+/-} 0.18) but required approximately double the charge to evoke the PRM reflex (conventional: 32.4 {+/-} 9.2 C; high-frequency: 62.5 {+/-} 11.1 C). Strength-duration curves for high-frequency stimulation had a rheobase that was 4.8X greater and a chronaxie that was 5.7X narrower than the conventional monophasic pulse, indicating that high-frequency stimulation was less efficient in recruiting neural activity in spinal roots. High-frequency tSCS is equally as comfortable as conventional stimulation at amplitudes required to stimulate spinal dorsal roots. Copy rights belong to original authors. Visit the link for more info Podcast created by PaperPlayer
For our 33rd podcast episode, I review the recommendations for screening and managing hyperbilirubinemia. The American Academy of Pediatrics recommends universal screening of bilirubin levels in newborns, so I review how that can be done, when it should occur, and when it should be repeated. We discuss which infants are more at risk for elevated bilirubin levels and how those risk factors contribute to guidelines for the treatment plan. I discuss the nomograms commonly used and recommended by the American Academy of Pediatrics that guide the care of identifying infants at risk as well as when they should be treated. I review phototherapy, the primary treatment plan for hyperbilirubinemia, including how it effectively lowers bilirubin levels as well as the clinical considerations that should be applied during treatment. Whether you are a neonatal clinician or a parent, this review on how to effectively screen for and manage hyperbilirubinemia will be beneficial. Hyperbilirubinemia is incredibly common in neonates. Clinicians who care for infants whether they are a term newborn in the nursery or an infant in the NICU, will manage infants with elevated bilirubin levels. And parents of either term, healthy infants, or those critically ill in the NICU, it is essential that you understand the risks of hyperbilirubinemia and the screening and management process for it. Tune in now to learn more!Our NICU Roadmap: A Comprehensive NICU Journal: https://empoweringnicuparents.com/nicujournal/NeoTech NeoShades Free Sample: neotechneoshades.comNICU Mama Hats: https://empoweringnicuparents.com/hats/NICU Milestone Cards: https://empoweringnicuparents.com/nicuproducts/Bilirubin Document: https://empoweringnicuparents.com/bili/Empowering NICU Parents Show Notes: https://empoweringnicuparents.com/episode33Empowering NICU Parents Instagram: https://www.instagram.com/empoweringnicuparents/Empowering NICU Parents FB Group: https://www.facebook.com/groups/empoweringnicuparentsPinterest Page: https://pin.it/36MJjmH
Light therapy has surprisingly plausible mechanisms through which it could influence the progression of ALS. Here we describe these, as well as some limited pre-clinical and clinical data, and information about dosing, risks, and costs.
Dr. Mandy Rounds, a Research Fellow at MedStar National Rehabilitation Hospital, interviews Dr. Argy Stampas an Associate Professor in the Department of Physical Medicine and Rehabilitation at McGovern Medical School at UTHealth and the Director of Spinal Cord Injury Medicine Research at TIRR Memorial Hermann about his article, “Safety, Feasibility, and Efficacy of Transcutaneous Tibial Nerve Stimulation in Acute Spinal Cord Injury Neurogenic Bladder: A Randomized Control Pilot Trial”. They discuss this type of tibial nerve stimulation intervention that has been used in other populations and how it is now being used to improve bladder function in those with neurogenic bladder. To access this journal article, click here:https://www.sciencedirect.com/science/article/abs/pii/S1094715921019917?via%3Dihub
Today we'll be discussing the TENS Machine, what it is, and how it might be helpful with labour. TENS stands for Transcutaneous electrical nerve stimulation is a method of pain relief that can be used for lots of different things from back pain to period pain. Today we're specifically going to talk about an obstetric TENS machine, which is used as pain relief during labour. On top of the basics, we'll also talk about who it might be most useful for and who shouldn't use one. Plus, I'll share my top tips on how to get the most out of your TENS machine in labour. If you're pregnant, or just want to know a bit more about TENS, then this episode is for you! EnjoyLINKS:Join FitNest Mama: https://www.fitnestmama.comFree Pregnancy Workshop: 3 Ways to Prepare for Labour: https://members.fitnestmama.com/challengeFree Postnatal Workshop: Returning to Fitness After Birth: https://members.fitnestmama.com/postnatalworkshopFreebies: https://www.fitnestmama.com/quiz
Transcutaneous pacing is an important emergency skill. In this podcast, senior emergency medicine trainee Dr Tim Balfour joins Todd to discuss the indications for pacing, describe the process of applying and adjusting it, and share some tips and tricks for its use. See omnystudio.com/listener for privacy information.
As always, feel free to send us questions, comments or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through instagram or twitter, @nicupodcast. Or contact Ben and Daphna directly via their twitter profiles: @drnicu and @doctordaphnamd. Papers discussed in today's episode are listed and timestamped below.enjoy!________________________________________________________________________________________03:20 - Use of Antenatal Corticosteroids at 22 Weeks of Gestation. https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2021/09/use-of-antenatal-corticosteroids-at-22-weeks-of-gestation09:40 - Parent Preferences for Transparency of Their Child's Hospitalization Costs. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/278439819:55 - Monitoring of carbon dioxide in ventilated neonates: a prospective observational study. https://fn.bmj.com/content/early/2021/08/02/archdischild-2021-322138 31:00 - Medication Use in the Neonatal Intensive Care Unit and Changes from 2010-2018. https://www.jpeds.com/article/S0022-3476(21)00860-X/fulltext37:50 - Early-Onset Sepsis Among Very Preterm Infants. https://pediatrics.aappublications.org/content/148/4/e202105245646:15 - Dexmedetomidine versus intermittent morphine for sedation of neonates with encephalopathy undergoing therapeutic hypothermia. https://www.nature.com/articles/s41372-021-00998-853:40 - Survival prediction modelling in extreme prematurity: are days important? https://www.nature.com/articles/s41372-021-01208-158:50 - Association of time of first corticosteroid treatment with bronchopulmonary dysplasia in preterm infants. https://onlinelibrary.wiley.com/doi/10.1002/ppul.2561062:30 - Burnout and Perceptions of Stigma and Help-Seeking Behavior Among Pediatric Fellows. https://pediatrics.aappublications.org/content/148/4/e2021050393
Dr Taylor Krick is a Chiropractor and Functional Medicine Practitioner practicing from the Washington Wellness Centre in Washington, Illinois. He has a special interest in educating people to help take control of their health, and in this episode, he and Nathan discuss the use of transcutaneous vagal nerve stimulation (tVNS) to aid healing. Dr Krick provides a lesson on the vagal nerve as well as the use of tVNS in practice, including who may be suited to this method of therapy and specific information regarding the use of devices. Tune in to learn how to improve your or your patients' vagal tone for optimal health and wellbeing. Highlights About the wanderer nerve (9:00) Accessing the vagal nerve (19:20) Transcutaneous vagal nerve stimulation in practice (30:00) Discussion regarding the research landscape (38:00) Treating chronic illness (43:00) Using a transcutaneous vagal nerve stimulation device in clinic (49:30) Where you can find Dr Taylor Krick (58:00) Useful links and resources Dr Taylor Krick's clinic: Washington Wellness Center - https://www.washwellnesscenter.com/ Wellness Washington Center educational videos - https://www.washwellnesscenter.com/videos
Dr Taylor Krick is a Chiropractor and Functional Medicine Practitioner practicing from the Washington Wellness Centre in Washington, Illinois. He has a special interest in educating people to help take control of their health, and in this episode, he and Nathan discuss the use of transcutaneous vagal nerve stimulation (tVNS) to aid healing. Dr Krick provides a lesson on the vagal nerve as well as the use of tVNS in practice, including who may be suited to this method of therapy and specific information regarding the use of devices. Tune in to learn how to improve your or your patients' vagal tone for optimal health and wellbeing. Highlights About the wanderer nerve (9:00) Accessing the vagal nerve (19:20) Transcutaneous vagal nerve stimulation in practice (30:00) Discussion regarding the research landscape (38:00) Treating chronic illness (43:00) Using a transcutaneous vagal nerve stimulation device in clinic (49:30) Where you can find Dr Taylor Krick (58:00) Useful links and resources Dr Taylor Krick's clinic: Washington Wellness Center - https://www.washwellnesscenter.com/ Wellness Washington Center educational videos - https://www.washwellnesscenter.com/videos
Aging published this high-scoring research paper on July 30, 2019, entitled, “Effects of transcutaneous vagus nerve stimulation in individuals aged 55 years or above: potential benefits of daily stimulation,” by researchers from the United Kingdom's University of Leeds and University of Glasgow. In 2019, the researchers reported on the results of the effects of tVNS among participants 55 years of age and older in three studies. In the first study, they observed the effects of acute, single-session tVNS on cardiovascular autonomic function compared with the effects of sham (ear lobe/placebo) stimulation among 14 healthy participants 55 years of age and older. They collected baseline values and measured heart rate variability (HVR) and baroreflex sensitivity. “Since not all participants responded to tVNS, we examined if it was possible to identify potential tVNS responders from baseline parameters.” In the second study, the researchers explored the effects of acute, single-session tVNS on autonomic function in the same age group by expanding the sample to 51 participants. The third study examined 26 participants in the same age group when administered tVNS once per day, for 15-minutes, over the course of two weeks. The researchers reported the impacts of daily tVNS in measures of autonomic function, health-related quality of life (QoL), mood, and sleep. “Transcutaneous vagal nerve stimulation (tVNS) acutely administered to the tragus in healthy volunteers aged ≥ 55 years was associated with improvements in spontaneous cardiac baroreflex sensitivity and HRV.” To date, this study has generated an Altmetric Attention Score of 350. The Altmetric Attention Score provides an at-a-glance indication of the volume and type of online attention the research has received. Top Aging publications rated by Altmetric Attention Score - https://www.aging-us.com/news_room/altmetric Sign up for free Altmetric alerts about this article - https://oncotarget.altmetric.com/details/email_updates?id=10.18632%2Foncotarget.102074 DOI - https://doi.org/10.18632/aging.102074 Full text - https://www.aging-us.com/article/102074/text Correspondence to: Jim Deuchars email: J.Deuchars@leeds.ac.uk Keywords: vagus nerve stimulation, autonomic nervous system, neuromodulation, quality of life, mood, aging About Aging Launched in 2009, Aging publishes papers of general interest and biological significance in all fields of aging research and age-related diseases, including cancer—and now, with a special focus on COVID-19 vulnerability as an age-dependent syndrome. Topics in Aging go beyond traditional gerontology, including, but not limited to, cellular and molecular biology, human age-related diseases, pathology in model organisms, signal transduction pathways (e.g., p53, sirtuins, and PI-3K/AKT/mTOR, among others), and approaches to modulating these signaling pathways. Please visit our website at http://www.Aging-US.com or connect with us on: Twitter - https://twitter.com/AgingJrnl Facebook - https://www.facebook.com/AgingUS/ SoundCloud - https://soundcloud.com/aging-us YouTube - https://www.youtube.com/agingus LinkedIn - https://www.linkedin.com/company/aging Aging is published by Impact Journals, LLC please visit http://www.ImpactJournals.com or connect with @ImpactJrnls Media Contact 18009220957 MEDIA@IMPACTJOURNALS.COM
En este episodio, entrevisto a Diego Serrano Muñoz, fisioterapeuta perteneciente al GIFTO, Grupo Investigación Fisioterapia de Toledo de la UCLM y profesor en esta misma universidad. Interesado en el campo de la neurorrehabilitación, es Máster en Neurocontrol motor por URJC y Doctorado en Investigación Sociosanitaria y de la Actividad Física. En esta entrevista hablamos sobre lesión medular, estimulación eléctrica epidural y transcutánea, proyectos del GIFTO y sobre la espasticidad y su relación con la electroterapia. Referencias del episodio: (1) Tesis Doctoral Diego Serrano Muñoz: EFECTO DE LA APLICACIÓN TRANSCUTÁNEA DE CORRIENTES ELÉCTRICAS DE BAJA Y MEDIA FRECUENCIA SOBRE EL SISTEMA SENSITIVO-MOTOR DE VOLUNTARIOS SANOS (2018) (https://www.researchgate.net/publication/330212978_Efecto_de_la_aplicacion_transcutanea_de_corrientes_electricas_de_baja_y_media_frecuencia_sobre_el_sistema_sensitivo-motor_de_voluntarios_sanos). (2) Wagner (2018). Targeted neurotechnology restores walking in humans with spinal cord injury (https://www.nature.com/articles/s41586-018-0649-2). (3) Inanici. Transcutaneous Electrical Spinal Stimulation to Restore Upper Extremity Functions in Spinal Cord Injury (http://depts.washington.edu/moritlab/?page_id=677) (https://www.youtube.com/watch?v=FwPYGrQgFnc&ab_channel=CenterforNeurotechnology). (4) Megía (2020). Transcutaneous Spinal Cord Stimulation Enhances Quadriceps Motor Evoked Potential in Healthy Participants: A Double-Blind Randomized Controlled Study (https://pubmed.ncbi.nlm.nih.gov/33066103/). (5) Inanici (2018). Transcutaneous Electrical Spinal Stimulation Promotes Long-Term Recovery of Upper Extremity Function in Chronic Tetraplegia (https://pubmed.ncbi.nlm.nih.gov/29877852/). (6) Hofstoetter (2020). Transcutaneous Spinal Cord Stimulation Induces Temporary Attenuation of Spasticity in Individuals with Spinal Cord Injury (https://pubmed.ncbi.nlm.nih.gov/31333064/). (7) Kumru (2020). Estimulación no invasiva cerebral y medular para la recuperación motora y funcional tras una lesión medular (https://www.neurologia.com/articulo/2019453). (8) Serrano-Muñoz (2017). Intensity matters: Therapist-dependent dose of spinal transcutaneous electrical nerve stimulation (https://pubmed.ncbi.nlm.nih.gov/29244850/). (9) Fernández-Tenorio (2019). Transcutaneous electrical nerve stimulation for spasticity: A systematic review (https://pubmed.ncbi.nlm.nih.gov/27474366/). Twitter Diego Serrano Muñoz: @Diego_SerranoM
Moderator: Cristiano Gomes, MD Sacral is the Target Speaker: Steven W. Siegel, MD Other Targets Speaker: Scott A. MacDiarmid, MD Just think of the number of patients we see each and every day with overactive bladder and who do not reach their treatment goal in spite of us trying a number of medications and behavioral interventions. And to make the problem worse, the penetrance of our thirdline therapies in patients with refractory OAB (ROAB) is less than 5%. Dr. Siegel will highlight the benefits of sacral nerve stimulation for the management of this difficult population of patients. I will shine the light on neuromodulation directed towards ‘other targets’ concentrating on the tibial and saphenous nerve. I will briefly remind us of the excellent efficacy and safety of percutaneous tibial nerve stimulation (PTNS) advancing us one step closer to neuromodulation for the masses. I will introduce a subcutaneously implanted coin-sized tibial nerve stimulator (eCoin), an exciting new office-based implant currently under investigation. Transcutaneous electrical stimulation of the saphenous nerve will also be noted. Our goal is to highlight therapies and to energize the audience in pursuing excellence in the management of the overactive bladder patient. Steve plays tennis, I’m hockey. Not a fair fight but welcome to our program. Cheers.
Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2020.08.25.265876v1?rss=1 Authors: Sharon, O., Fahoum, F., Nir, Y. Abstract: Vagus nerve stimulation (VNS) is widely used to treat drug-resistant epilepsy and depression. While the precise mechanisms mediating its long-term therapeutic effects are not fully resolved, they likely involve Locus Coeruleus (LC) stimulation via the nucleus of the solitary tract (NTS) that receives afferent vagal inputs. In rats, VNS elevates LC firing and forebrain noradrenaline (NE) levels, whereas LC lesions suppress VNS therapeutic efficacy. Non-invasive transcutaneous VNS (tVNS) employs electrical stimulation targeting the auricular branch of the vagus nerve at the Cymba Conchae of the ear, but it remains unclear to what extent tVNS mimics VNS. Here, we investigated the short-term effects of tVNS in healthy human male volunteers (n=24) using high-density EEG and pupillometry during visual fixation at rest, comparing short (3.4s) trials of tVNS to sham electrical stimulation at the earlobe (far from the vagus nerve branch) to control for somatosensory stimulation. Although tVNS and sham stimulation did not differ in subjective intensity ratings, tVNS led to robust pupil dilation (peaking 4-5s after trial onset) that was significantly higher than following sham stimulation. We further quantified how tVNS modulates idle occipital alpha (8-13Hz) activity, identified in each participant using parallel factor analysis. We found that tVNS attenuates alpha oscillations to a greater extent than does sham stimulation. Thus, tVNS reliably induces pupillary and EEG markers of arousal beyond the effects of somatosensory stimulation, supporting the hypothesis that it elevates noradrenaline and acetylcholine signaling and mimics invasive VNS. Copy rights belong to original authors. Visit the link for more info
This podcast discusses the paper External transcutaneous ultrasound technique in the equine cricoarytenoideus dorsalis muscle: Assessment of muscle size and echogenicity with resting endoscopy.
Organic Non-opioid Care for Chronic Pain – Dr. Jason Jones Elizabeth City, NC Chiropractor In case you just started taking opioids prescriptions for controlling chronic pain, then you might want to try out a non-opioid method for caring for chronic pain. This is because over-dependence on opioids can lead to addiction and overdoes which comes with several diverse side effects. But Chiropractic utilizes safe methods to tackle chronic pain. The non-opioid treatment for chronic pain includes the following: Cold and heat Cold can be essential soon after sustaining an injury to relieve pain, reduce inflammation, trigger recovery, and reduce muscle spasms. Heat increases relaxed muscles and raises your pain threshold. Exercise Staying fit physically, irrespective of certain pain, can play an important role for individuals with some of the most typical pain conditions, including arthritis, low back pain, and fibromyalgia. Weight loss Several painful health-related conditions get more critical by excess weight. Thus, it makes more sense, that losing weight could assist in relieving certain kinds of pain. Occupational therapy (OT) and physical therapy (PT) OT and PT assist in improving your capability to carry out activities of daily living, like bathing, dressing, and eating. Transcutaneous electrical nerve stimulation (TENS) This method uses an extremely mild electrical current to prevent pain signals from going to your brain from your body. Ultrasound This type of therapy works by directing sound waves into bodily tissues. It is most times utilized for improving blood circulation, promoting healing, and decreasing inflammation. Cold laser therapy This is an FDA-approved therapy for treating pain conditions. The cold laser releases pure light of a wavelength that is absorbed into an affected or injured area and might minimize inflammation and accelerate tissue repair. Mind-body techniques Mind-body relaxation methods are typically used at healthcare centers and hospital-based pain clinics. They consist of: Meditation Mindfulness Progressive muscle relaxation Breathing exercises Tai chi and Yoga These exercise and mind-body practices use meditation, breath control, and movements to strengthen and stretch muscles. They might assist with chronic pain conditions like low back pain, fibromyalgia, headaches, or arthritis. Biofeedback This machine-assisted method of caring for chronic pain helps people take charge of their body reactions and responses, including acute and chronic pain. Chiropractic is a non-opioid treatment for caring for chronic pain since it helps in improving your body’s function and also helps your body to heal itself. Acupuncture Acupuncture has to do with putting tremendously fine needles into your skin at precise points on your body. This method might relieve pain by discharging endorphins, (the natural painkilling chemicals in the body). It might also help in influencing serotonin levels, the brain transmitter in charge of mood change. If you want non-opioid treatment and care for a chronic pain you are experiencing, then visit Dr. Jason Jones at our Chiropractic Office in Elizabeth City, NC. We help to correct your body’s alignment to relieve and care for your pains.
In this episode of Discussions in Spinal Cord Injury Science (DiSCIS), we interview Candy Tefertiller, PT, DPT, PhD, NCS about Transcutaneous Electrical Spinal Cord Stimulation. For more information, refer to: Taccola G, et al. And yet it moves: recovery of volitional control after spinal cord injury. Prog Neurobiol. 2018;160:64-81. The Spinal Cord Injury Special Interest Group is a part of the Academy of Neurologic Physical Therapy, www.neuropt.org.
About Kimberly Iller ND, EAMP, LaC Dr. Iller is an outstanding Functional Medicine Practitioner/Naturopathic Physician in the Seattle area at Functional Medicine Northwest and also the director of a non-profit clinic called Equity in Health Dr. Iller has extensive training in the management of all fatiguing illnesses including Lyme Disease and it’s co-infections, viral infections, biotoxin exposure and mitochondrial dysfunction. She has clinical training in the management of Lyme Disease through Dr. Ross and Dr. Brooke, and training through the International Lyme and Associated Diseases Society (ILADS), which complements the extensive background she has as a naturopathic physician. In addition, she is also one of the nation’s leading IV nutritional therapists and a practitioner of traditional Chinese Medicine. Dr. Iller is a licensed Naturopathic Doctor (ND) and Acupuncturist (L.Ac) in the state of Washington. She graduated from Bastyr University with a degree in Naturopathic Medicine, Acupuncture, and Oriental Medicine. Dr. Iller completed a fellowship in Oriental Medicine at the Long Hua Hospital, Shanghai and Shanghai University of Traditional Chinese Medicine, China, where she focused on endocrine disorders, cardiology, and neurological imbalances. About CES: What is Cranioelectrical Stimulation: CES is an "electroceutical" technique that involves applying a pulsed, low-amplitude electrical current to the head using electrodes placed on the earlobes. Its FDA approved for the treatment of anxiety, depression, and insomnia. Also being used for fibromyalgia, chronic pain, opiate withdrawal, and headaches. There other terms used to describe this technique including transcranial electrotherapy (TCET) and neuroelectric therapy (NET). The device looks similar to Transcutaneous electrical nerve stimulation (TENS) but is configured differently. In this episode we discuss CES for PTSD, Depression, Anxiety , and Pain from a clinicians and patients perspective. #ptsd, #anxiety, #depression Read more at www.soundintegrative.com --- Support this podcast: https://anchor.fm/adam-rinde/support
In our first official “vodcast”, we discuss pearls and pitfalls of transcutaneous pacing, and how it’s much more difficult than “you either have capture or you don’t”. “Phantom” complexes are rarely reported on or discussed in Paramedic school, but one monitor manufacturer appreciates how they can make verifying true electrical capture very difficult. The folks over at ems12lead.com have put a lot of work into providing education and spreading the word around the problem of false capture.
Support the Northwest Regional SCI System by donating at http://www.acceleratemed.org/SCI. What was it like to be a study participant in a clinical trial at the University of Washington? Find out in this podcast, where Jeanne Hoffman, PhD, interviews Jon, a person with SCI who volunteered for the study that was highlighted in our first podcast, Transcutaneous Electrical Stimulation with Chet Moritz. This study is designed to restore hand and arm function in SCI using a non-invasive procedure. Jon shared the remarkable impact that this has made on his life. After listening, please give us feedback using this survey: https://is.gd/sciforumpod
Kessler Foundation Disability Rehabilitation Research and Employment
Welcome to Kessler Foundation’s 2019 Evening of Discovery and Discussion. A panel discussion about our transcutaneous and epidural stimulation research. Joining us this evening is panel moderator Steve Adubato, PhD, our distinguished panelist Gail Forrest, PhD (https://kesslerfoundation.org/aboutus/Gail%20Forrest), Director of Kessler Foundation’s Center for Spinal Stimulation, Steven Kirshblum, MD (https://kesslerfoundation.org/about-us/foundation-staff/steven-kirshblum-md), Kessler Foundation’s Chief Medical Officer and Co-Director of the Center for Spinal Stimulation, Guang Yue, PhD (https://kesslerfoundation.org/aboutus/Guang%20Yue), Director of Kessler Foundation’s Center for Mobility and Rehabilitation Engineering Research and research participants Natalie Barrett from New Jersey, Jimmy Brown from New York, and Kelly Thomas from Florida. The Center for Spinal Stimulation at Kessler Foundation will explore two groundbreaking treatments for recovery after spinal cord injury: transcutaneous stimulation and epidural stimulation. Transcutaneous stimulation, a non-invasive treatment, applies an electrical current to the skin overlying the spinal cord. Epidural stimulation applies a continuous electrical current to the spinal cord through a surgically implanted stimulator. In initial studies, these treatments, along with physical therapy, have restored function for people with paralysis. Researching transcutaneous stimulation and epidural stimulation will help Kessler Foundation scientists understand neuroplasticity and the neural mechanisms behind the restoration of neurological function. View the podcast transcript at https://kesslerfoundation.org/sites/default/files/2019-08/2019-Cultivation-Event-Transforming-Care-and-Recovery-for-People-with-SCI-Podcast-final-transcript-with-names.pdf For more information about the Center for Spinal Stimulation, go to https://kesslerfoundation.org/research/center-spinal-stimulation Listen to multiple sclerosis and stroke research and innovations in research and employment for veterans from past Cultivation Events at https://soundcloud.com/kesslerfoundation/sets/cultivation-events Like us on FaceBook, follow us on Instagram, listen to us on Soundcloud, and tweet with us on Twitter!
This episode we talk to Dr. Ordonez about what it’s like to be an academic attending and what it felt like the first year out. Why go into academics, how to best go about obtaining an academic position and other survival tips are all discussed in this podcast! Host: Miguel Reyes, MD Guest: Edgar Ordonez, MD Key Points: Find a niche and go with it, that can be your key to success. Find a mentor and ask for advice, be honest with them and yourself. Stay humble, you won’t always know the answer. Transcutaneous before transvenous pacing!
Support the Northwest Regional SCI System by donating at http://www.acceleratemed.org/SCI. Chet Moritz, PhD, is an associate professor in the University of Washington Departments of Electrical and Computer Engineering, Rehabilitation Medicine, and Physiology and Biophysics, as well as the co-director for the Center for Neurotechnology. He talks with UW rehab psychologist Jeanne Hoffman about his research to restore hand and arm function for people with spinal cord injury using transcutaneous (through the skin) electrical spinal stimulation. After listening, please give us feedback using this survey: https://is.gd/sciforumpod
Recorded on a day when everything melted, the conversation was naturally about how the heat can affect you when you have a Chronic Illness. Coping with extremes of temperature can be trying when you're perfectly well, but when you're low on energy/strength/spoons* it can prove extra difficult. We also discuss pain management options, and delve into the labyrinth that is Pam's medication regime. Here are the links to [Spoon Theory](https://butyoudontlooksick.com/articles/written-by-christine/the-spoon-theory/), [EDS](https://www.ehlers-danlos.com/what-is-eds/), [TENS](https://en.wikipedia.org/wiki/Transcutaneous_electrical_nerve_stimulation) and the [MS Society](https://www.mssociety.org.uk/care-and-support/resources-and-publications/publications-search/hot-and-cold-temperature-and-ms#) info on coping with the heat. Stay cool and #keeptalking ! Simon & Pam
Dr. Ted Filandrianos DMD, FAGD has been practicing dentistry since 1981 and has continually been voted, “America's Top Dentist” by the Consumer Research Council of America since 2003. When it comes to diagnosing patients, this caring dentist doesn't just look in the mouth. Specializing in a wide range of cosmetic procedures, from full mouth reconstruction to cosmetic "white" restorations, Dr. Ted's goal is to not just treat the symptoms but also determine the root cause of the problem. Working with his dental team of 5, he uses Transcutaneous Electrical Nerve Stimulation (TENS) to rebuild the bite and make the patients stop grinding and clenching. www.teethbydrted.com/meet-the-doctors/dr-theodore-filandrianos/ http://www.bostonmagazine.com/sponsor-content/good-dentistry-is-about-more-than-teeth/
Dr. Ted Filandrianos DMD, FAGD has been practicing dentistry since 1981 and has continually been voted, “America’s Top Dentist” by the Consumer Research Council of America since 2003. When it comes to diagnosing patients, this caring dentist doesn’t just look in the mouth. Specializing in a wide range of cosmetic procedures, from full mouth reconstruction to cosmetic "white" restorations, Dr. Ted's goal is to not just treat the symptoms but also determine the root cause of the problem. Working with his dental team of 5, he uses Transcutaneous Electrical Nerve Stimulation (TENS) to rebuild the bite and make the patients stop grinding and clenching. www.teethbydrted.com/meet-the-doctors/dr-theodore-filandrianos/ http://www.bostonmagazine.com/sponsor-content/good-dentistry-is-about-more-than-teeth/
Discussion of the paper: 'Transcutaneous sacral nerve stimulation for intraoperative verification of internal anal sphincter innervation' The contributor in the podcast is: Dr. Daniel Kauff (Department of General, Visceral and Transplant Surgery, University Medicine of the Johannes Gutenberg-University Mainz, Mainz, Germany). Read the paper here: http://onlinelibrary.wiley.com/doi/10.1111/nmo.13140/full
Most newborns will have some jaundice. Most jaundice is benign. So, how can we sort through the various presentations and keep our newborns safe? Pathologic Jaundice When a baby is born with jaundice, it’s always bad. This is pathologic jaundice, and it’s almost always caught before the baby goes home. Think about ABO-incompatbility, G6PD deficiency, Crigler-Najjar, metabolic disturbances, and infections to name a few. Newborns are typically screened and managed. Physiologic Jaundice Physiologic jaundice, on the other hand, is usually fine, until it’s not. All babies have some inclination to develop jaundice. Their livers are immature. They may get a little dehydrated, especially if mother’s milk is late to come in. In today’s practice, we are challenged to catch those at risk for developing complications from rising bilirubin levels. Hyperbilirubinemia is the result of at least one of three processes: you make too much, you don’t process it enough, or you don’t get rid of it fast enough. Increased production Bilirubin mostly comes from the recycling of red blood cells. Heme is broken down in in the liver and spleen to biliverdin then bilirubin. Normal, full term babies without jaundice run a little high -- bilirubin production is two to three times higher than in adults, because they are born with a higher hematocrit. Also, fetal hemoglobin is great at holding on to oxygen, but has a shorter life span, and high turn-over rate, producing more bilirubin. Impaired conjugation Think of bilirubin as your email. Unconjugated bilirubin is your unread email. To process it or get rid of it – you have to open it. Of course, the more unread messages that accumulate, the more unwell you feel. Conjugated bilirubin is your opened and processed email. So much easier to sort out, deal with, and get rid of. Decreased excretion Both unread email and unconjugated bilirubin continue to float around in your inbox. Unconjugated bilirubin keeps getting reabsorbed in the intestinal mucosa through enterohepatic circulation. Processed email and conjugated bilirubin are easier to sort out. Conjugated bilirubin is water soluble, so it goes right into the read folder in your gallbladder, and is excreted off your inbox. Later on down the line in the intestine, conjugated bilirubin can’t be reabsorbed through the intestinal mucosa. Like when you open an email and forget about it – it passes on through, out of your system. Newborns are terrible at answering emails. There is a lot of unread unconjugated bilirubin is floating around. The liver and spleen are just not able to keep up. Also, newborns have a double-whammy administrative load. Normally, bacteria in the gut can further break down conjugated bilirubin to urobilin and get excreted in the urine. The infant’s gut is relatively sterile, so no admin assistance there. Just to add to the workload a poor little newborn has to do – he is being sabotaged by extra beta-glucuronidase which will take his hard-earned conjugated bilirubin and unconjugate it again, then recycle it, just like email you “mark as unread”. How Does this All Go Down? The recommended followup is 48 hours after discharge from the nursery for a routine bilirubin check, often in clinic, and often via the transcutaneous route. More Specifically: Infant Discharged Should Be Seen by Age Before age 24 h 72 h Between 24 and 48 h 96 h Between 48 and 72 h 120 h The neonate will end up in your ED off hours, if there is concern, if his status deteriorates, or simply by chance. We need to know how to manage this presentation, because time is of the essence to avoid complications if hyperbilirubinemia is present. Critical Action #1: Assess risk for developing severe hyperbilirubinemia. This will tell you: check now in ED or defer to clinic (default is to check). Risk Factors for Developing Hyperbilirubinemia Total serum bilirubin/Transcutaneous bilirubin in high-risk zone Jaundice in first 24 hours ABO incompatibility with positive direct Coombs, known hemolytic disease, or elevated ETCO Gestational age 35-36 weeks Prior sibling had phototherapy Cephalohematoma or bruising Exclusive breastfeeding, especially with poor feeding or weight loss East Asian Race Critical Action #2 Check bilirubin and match this with how old the child is -- in hours of life -- at the time of bilirubin measurement. This will tell you: home or admission. Use the Bilitool or Bhutani Nomogram (below). Can I go Home Now? Risk Stratification for Developing Severe Hyperbilirubinemia. Bhutani et al. Pediatrics. 1999. In general, babies at low-risk and low-intermediate risk can go home (see below). Babies at high-intermediate or high risk are admitted (see below). Critical Action #3: Assess risk for developing subsequent neurotoxicity. This will tell you: a) phototherapy or b) exchange transfusion Phototherapy Now? Exchange Transfusion Now? Threshold for Initiating Exchange Transfusion by Risk Stratum. Bhutani et al. Pediatrics. 1999. Home care The neonate who is safe to go home is well appearing, and not dehydrated. His total bilirubin is in the low to low-intermediate risk for developing severe hyperbilirubinemia, and he is not at high risk for neurotoxicity based on risk factors. Babies need to stay hydrated. Breast feeding mothers need encouragement and need to offer feeds 8-12 times/day – an exhausting regimen. The main message is: stick with it. Make sure to enlist the family's help and support to keep Mom hydrated, eating well, and resting whenever she can. Supplementing with formula or expressed breast milk is not routinely needed. Be explicit that the neonate should not receive water or sugar water – it can cause dangerous hyponatremia. A moment of solid precautionary advice could avert a disaster in the making. The child’s pediatrician will help more with this, and you can remind nursing mothers of the excellent La Leche League – an international group for breastfeeding support. They have local groups everywhere, including a hotline to call. Nursery Care If the baby is at high intermediate or high risk for hyperbilirubinemia, then he should be admitted for hydration, often IV. Most babies with hyperbilirubinemia are dehydrated, which just exacerbates the problem. Bililights or biliblankets, provide the baby with the right blue spectrum of light to isomerize bilirubin to the more soluble form. Traditionally, we have thought them to be more effective or safer than filtered sunlight. A recent randomized control trial by Slusher et al. in the New England Journal of Medicine compared filtered sunlight versus conventional phototherapy for safety and efficacy in a resource-poor environment. These were all term babies with clinically significant jaundice in Nigeria. To standardize the intervention, they used commercial phototherapy canopies that remove most UV rays. None of them became dehydrated or became sunburned. The filtered sunlight resulted in a 93% successful treatment versus 90% for conventional phototherapy. My take away: we now have some evidence basis for using filtered sunlight as an adjunct for babies well enough to go home. Critical Care Although rare, the critically ill neonate with hyperbilirubinemia requires immediate intervention. He will be dehydrated – possibly in shock. He will be irritable. Or, he may just have a dangerously high bilirubin level – at any minute he could develop bilirubin induced neurologic dysfunction, or BIND, especially when bilirubin concentrations reach or surpass 25 mg/dL (428 micromol/L). The bilirubin is so concentrated that it leeches past the blood brain barrier and causes neuronal apoptosis. BIND is a spectrum from acute bilirubin encephalopathy to kernicterus, all involving some disorder in vision, hearing, and later gait, speech, and cognition. Acute bilirubin encephalopathy starts subtly. The neonate may be sleepy but hypotonic or have a high-pitched cry; he maybe irritable or inconsolable, jittery or lethergic. The dehydration and neurologic dysfnction from the hyperbilirubinemia may even cause fever. Check the bilirubin in any neonate you are working up for sepsis. Acute bilirubin encephalopathy may progress to an abnormal neurologic exam, seizures, apnea, or coma. Kernicterus is the final, permanent result of bilirubin encephalpathy. The child may have choreoathetoid cerebral palsy with chorea, tremor, ballismus, and dystonia. He may have sensorineural hearting loss, or cognitive dysfunction. It is for this reason that any child sick enough to be admitted should be considered for exchange transfusion. Most babies need just a little gentle rehydration and bililights, but to be sure, the admitting team will look at a separate nomogram to gage the child’s risk and decide whether to pull the trigger on exchange transfusion. For our purposes, a ballpark estimate is that if the total serum bilirubin is 5 mg/dL above the phototherapy threshold, or if they have any red flag signs or symptoms, then exchange transfusion should be started. Exchange transfusion involves taking small aliquots of blood from the baby and replacing them with donor blood. It’s often a manual procedure, done with careful monitoring. It can be done with any combination of umbilical arteries or veins with peripheral arteries or veins. In general, arteries are the output, veins are for transfusion. The baby may need a double-volume exchange, which ends up replacing about 85% of circulating blood, a single-voume exchange, replacing about 60% of blood, or any fraction of that with apartial volume exchange. It is a very delicate procedure that requires multiple hours and often multiple staff. For our pruposes, just be aware that the jaundiced baby in front of you may need escalation of his care. Summary Find out the hour of life of the baby at the time of bilirubin measurement. Identify risk factors for developing severe hyperbilirubinemia and/or neurotoxicity The child with low to low-intermediate risk may be a good outpatient candidate provided he is well, not dehydrated, and follow-up is assured. The child with high-intermediate to high-risk for developing severe hyperbilirubinemia should be admitted for hydration, bililights, and/or assessment for exchange transfusion. The unwell child with or without current neurologic findings should have immediate exchange transfusion. References Benitz WE. Hospital Stay for Healthy Term Newborn Infants. Pediatrics. 2015; 135(5):948-53. Bhutani V et al. Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation. Pediatrics. 2004; 114(1). Bhutani VK, Wong RJ. Bilirubin Neurotoxicity in Preterm Infants: Risk and Prevention. J Clin Neonatol. 2013 Apr-Jun; 2(2): 61–69. Bosschaart N et al. Limitations and Opportunities of Transcutaneous Bilirubin Measurements. Pediatrics. 2012; 129(4). Colletti JE, Kothari S, Jackson DM, Kilgore KP, Barringer K. An emergency medicine approach to neonatal hyperbilirubinemia. Emerg Med Clin North Am. 2007 Nov;25(4):1117-35, vii. Gamaleldin R et al. Risk Factors for Neurotoxicity in Newborns With Severe Neonatal Hyperbilirubinemia. Pediatrics. 2011; 128(4):825-31. Lauer BJ, Spector ND. Hyperbilirubinemia in the Newborn. Pediatrics in Review. 2011; 32(8):341-9. Maisels J et al. Hyperbilirubinemia in the Newborn Infant ≥35 Weeks’ Gestation: An Update With Clarifications. Pediatrics. 2009; 124(4):1193-6. Smitherman H, Stark AR, Bhutani VK. Early recognition of neonatal hyperbilirubinemia and its emergent management. Semin Fetal Neonatal Med. 2006 Jun;11(3):214-24. Vandborg PK, Hansen BM, Greisen G, Ebbesen F. Dose-response relationship of phototherapy for hyperbilirubinemia. Pediatrics. 2012 Aug;130(2):e352-7. This post and podcast are dedicated to Gita Pensa, MD, for her commitment to #FOAMed and passion for asynchronous learning and education innovation.
Discussion of the paper: 'Transcutaneous cervical vagal nerve stimulation modulates cardiac vagal tone and tumor necrosis factor-alpha.' The contributor in the podcast is: Dr Christina Brock (Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark). Read the paper here: http://onlinelibrary.wiley.com/doi/10.1111/nmo.12984/full
Cardiology Mazwi, M Introduction To Transcutaneous Pacing Podcast 072815 by OPENPediatrics
Background Aim of the study was assessment of efficacy and safety of transcutaneous stimulation of the auricular branch of the vagal nerve (t-VNS) in the treatment of chronic migraine. Methods A monocentric, randomized, controlled, double-blind study was conducted. After one month of baseline, chronic migraine patients were randomized to receive 25 Hz or 1 Hz stimulation of the sensory vagal area at the left ear by a handhold battery driven stimulator for 4 h/day during 3 months. Headache days per 28 days were compared between baseline and the last month of treatment and the number of days with acute medication was recorded The Headache Impact Test (HIT-6) and the Migraine Disability Assessment (MIDAS) questionnaires were used to assess headache-related disability. Results Of 46 randomized patients, 40 finished the study (per protocol). In the per protocol analysis, patients in the 1 Hz group had a significantly larger reduction in headache days per 28 days than patients in the 25 Hz group (−7.0 ± 4.6 vs. −3.3 ± 5.4 days, p = 0.035). 29.4 % of the patients in the 1 Hz group had a ≥50 % reduction in headache days vs. 13.3 % in the 25 Hz group. HIT-6 and MIDAS scores were significantly improved in both groups, without group differences. There were no serious treatment-related adverse events. Conclusion Treatment of chronic migraine by t-VNS at 1 Hz was safe and effective. The mean reduction of headache days after 12 weeks of treatment exceeded that reported for other nerve stimulating procedures.
Pediatric Grand Rounds with Matthew OConnor, MD
Craig Hore uses a case to frame a discussion about emergency pacing with both transcutaneous and transvenous methods covered.
Wed, 1 Jan 1992 12:00:00 +0100 https://epub.ub.uni-muenchen.de/9511/1/9511.pdf Jonas, Udo; Allhoff, E. P.; Djamilian, Mohamad H.; Thon, Walter F.; Stief, Christian Georg
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