Dataset Information

Use of shoulder pacemaker for treatment of functional shoulder instability: Proof of concept.

ABSTRACT:

Background

Functional shoulder instability (polar type III) is caused by underactivity of rotator cuff and periscapular muscles, which leads to subluxation or dislocation during shoulder movement. While surgical treatment has shown no benefits, aggravates pain, and frequently diminishes function even further, conservative treatment is often ineffective as well.

Objectives

The aim was to investigate the effectiveness of a "shoulder pacemaker" device that stimulates underactive muscles in patients with functional instability during shoulder movement in order to re-establish glenohumeral stability.

Patients and methods

Three patients with unsuccessfully treated functional shoulder instability causing pain, emotional stress, as well as limitations during daily activities and sports participation were enrolled in this pilot project. The device was used to stimulate the external rotators of the shoulder and retractors of the scapula. Pain level, subjective shoulder instability, range of motion, visible aberrant muscle activation, and signs of dislocation were compared when the device was switched on and off.

Results

No changes were observed when the device was attached but switched off. When the device was switched on, all patients were able to move their arms freely without pain, discomfort, or subjective or objective signs of instability. All patients rated this as an excellent experience and volunteered to train further with the device. No complications were observed.

Conclusion

The electric stimulation of hypoactive rotator cuff and periscapular muscles by means of the shoulder pacemaker successfully re-establishes stability in patients with functional shoulder instability during the time of application.

video online

The online version of this article (doi: 10.1007/s11678-017-0399-z) contains the video: "The Shoulder-Pacemaker: treatment of functional shoulder instability with pathological muscle activation pattern". Video by courtesy of P. Moroder, M. Minkus, E. Böhm, V. Danzinger, C. Gerhardt and M. Scheibel, Charité Universitätsmedizin Berlin 2017, all rights reserved.

SUBMITTER: Moroder P

PROVIDER: S-EPMC5578354 | biostudies-literature | 2017

REPOSITORIES: biostudies-literature

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Publications

Use of shoulder pacemaker for treatment of functional shoulder instability: Proof of concept.

Moroder Philipp P Minkus Marvin M Böhm Elisabeth E Danzinger Victor V Gerhardt Christian C Scheibel Markus M

Obere extremitat 20170404 2

<h4>Background</h4>Functional shoulder instability (polar type III) is caused by underactivity of rotator cuff and periscapular muscles, which leads to subluxation or dislocation during shoulder movement. While surgical treatment has shown no benefits, aggravates pain, and frequently diminishes function even further, conservative treatment is often ineffective as well.<h4>Objectives</h4>The aim was to investigate the effectiveness of a "shoulder pacemaker" device that stimulates underactive musc ...[more]

PMID: 28868087

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Project description:BackgroundPathological muscle activation patterns of the external rotators and periscapular muscles can result in posterior positional functional shoulder instability (PP-FSI). In several patients, physical therapy and surgical treatment are not successful.PurposeThe shoulder-pacemaker treatment concept was evaluated prospectively in patients with PP-FSI and previously failed conventional therapy attempt.Study designCase series; Level of evidence, 4.MethodsA negative selection of 24 consecutive cases of noncontrollable PP-FSI in 16 patients with previously failed conventional therapy were included in this prospective study. The shoulder-pacemaker treatment consisted of an electrical muscle stimulation-based therapy protocol with 9 to 18 one-hour treatment sessions. Two patients were excluded because of nonadherence to the training schedule, leaving a final study cohort of 21 cases in 14 patients. Follow-up included assessment of clinical function, impairment during daily activities and sports, satisfaction, Western Ontario Shoulder Instability Index (WOSI), Rowe score, and Subjective Shoulder Value at 0 weeks, 2 weeks, 4 weeks, 3 months, 6 months, 12 months, and 24 months after intervention.ResultsWOSI, Subjective Shoulder Value, and Rowe score showed a highly significant improvement at all time points of follow-up (P < .001). Young age (P = .005), low weight (P = .019), shoulder activity level (P = .003), unilateral affliction (P = .046), and higher baseline WOSI score (P = .04) were associated with a better treatment effect. Cases with increased glenoid retroversion, posterior scapulohumeral decentering, and dysplastic bony glenoid shape showed a trend toward shorter treatment effect duration. No complications during the intervention or follow-up period were observed.ConclusionThe shoulder-pacemaker therapy concept is an effective treatment with rapid improvement and sustained outcome over the course of 2 years in patients with noncontrollable PP-FSI with previously failed conventional treatment. Young and more athletic patients with lower weight and unilateral pathology respond best to the treatment.

Project description:BackgroundClinical tests for detecting central and peripheral shoulder fatigue are limited. The discrimination of these two types of fatigue is necessary to better adapt recovery intervention. The Kinematic Theory of Rapid Human Movements describes the neuromotor impulse response using lognormal functions and has many applications in pathology detection. The ideal motor control is modeled and a change in the neuromuscular system is reflected in parameters extracted according to this theory.ObjectiveThe objective of this study was to assess whether a shoulder neuromuscular fatigue could be detected through parameters describing the theory, if there is the possibility to discriminate central from peripheral fatigue, and which handwriting test gives the most relevant information on fatigue.MethodsTwenty healthy participants performed two sessions of fast stroke handwriting on a tablet, before and after a shoulder fatigue. The fatigue was in internal rotation for one session and in external rotation during the other session. The drawings consisted of simple strokes, triangles, horizontal, and vertical oscillations. Parameters of these strokes were extracted according to the Sigma-Lognormal model of the Kinematic Theory. The evolution of each participant was analyzed through a U-Mann-Whitney test for individual comparisons. A Hotelling's T 2-test and a U-Mann-Whitney test were also performed on all participants to assess the group evolution after fatigue. Moreover, a correlation among parameters was calculated through Spearman coefficients to assess intrinsic parameters properties of each handwriting test.ResultsCentral and peripheral parameters were statistically different before and after fatigue with a possibility to discriminate them. Participants had various responses to fatigue. However, when considering the group, parameters related to the motor program execution showed significant increase in the handwriting tests after shoulder fatigue. The test of simple strokes permits to know more specifically where the fatigue comes from, whereas the oscillations tests were the most sensitive to fatigue.ConclusionThe results of this study suggest that the Sigma-Lognormal model of the Kinematic Theory is an innovative approach for fatigue detection with discrimination between the central and peripheral systems. Overall, there is a possibility to implement the setting for clinics and sports personalized follow-up.

Project description:There are no effective treatments for cocaine use disorder (CUD), a chronic, relapsing brain disease characterized by dysregulated circuits related to cue reactivity, reward processing, response inhibition, and executive control. Transcranial magnetic stimulation (TMS) has the potential to modulate circuits and networks implicated in neuropsychiatric disorders, including addiction. Although acute applications of TMS have reduced craving in urine-negative cocaine users, the tolerability and safety of administering accelerated TMS to cocaine-positive individuals is unknown. As such, we performed a proof-of-concept study employing an intermittent theta-burst stimulation (iTBS) protocol in an actively cocaine-using sample. Although our main goal was to assess the tolerability and safety of administering three iTBS sessions daily, we also hypothesized that iTBS would reduce cocaine use in this non-treatment seeking cohort. We recruited 19 individuals with CUD to receive three open-label iTBS sessions per day, with approximately a 60-min interval between sessions, for 10 days over a 2-week period (30 total iTBS sessions). iTBS was delivered to left dorsolateral prefrontal cortex (dlPFC) with neuronavigation guidance. Compliance and safety were assessed throughout the trial. Cocaine use behavior was assessed before, during, and after the intervention and at 1- and 4-week follow-up visits. Of the 335 iTBS sessions applied, 73% were performed on participants with cocaine-positive urine tests. Nine of the 14 participants who initiated treatment received at least 26 of 30 iTBS sessions and returned for the 4-week follow-up visit. These individuals reduced their weekly cocaine consumption by 78% in amount of dollars spent and 70% in days of use relative to pre-iTBS cocaine use patterns. Similarly, individuals reduced their weekly consumption of nicotine, alcohol, and THC, suggesting iTBS modulated a common circuit across drugs of abuse. iTBS was well-tolerated, despite the expected occasional headaches. A single participant developed a transient neurological event of uncertain etiology on iTBS day 9 and cocaine-induced psychosis 2 weeks after discontinuation. It thus appears that accelerated iTBS to left dlPFC administered in active, chronic cocaine users is both feasible and tolerable in actively using cocaine participants with preliminary indications of efficacy in reducing both the amount and frequency of cocaine (and other off target drug) use. The neural underpinnings of these behavioral changes could help in the future development of effective treatment of CUD.

Project description:BackgroundEndocannabinoid dysfunction in animal models of autism spectrum disorder (ASD) and accumulating, albeit anecdotal, evidence for efficacy in humans motivated this placebo-controlled double-blind comparison of two oral cannabinoid solutions in 150 participants (age 5-21 years) with ASD.MethodsWe tested (1) BOL-DP-O-01-W, a whole-plant cannabis extract containing cannabidiol and ?9-tetrahydrocannabinol at a 20:1 ratio and (2) BOL-DP-O-01, purified cannabidiol and ?9-tetrahydrocannabinol at the same ratio. Participants (N?=?150) received either placebo or cannabinoids for 12-weeks (testing efficacy) followed by a 4-week washout and predetermined cross-over for another 12 weeks to further assess tolerability. Registered primary efficacy outcome measures were improvement in behavioral problems (differences between whole-plant extract and placebo) on the Home Situation Questionnaire-ASD (HSQ-ASD) and the Clinical Global Impression-Improvement scale with disruptive behavior anchor points (CGI-I). Secondary measures were Social Responsiveness Scale (SRS-2) and Autism Parenting Stress Index (APSI).ResultsChanges in Total Scores of HSQ-ASD (primary-outcome) and APSI (secondary-outcome) did not differ among groups. Disruptive behavior on the CGI-I (co-primary outcome) was either much or very much improved in 49% on whole-plant extract (n?=?45) versus 21% on placebo (n?=?47; p?=?0.005). Median SRS Total Score (secondary-outcome) improved by 14.9 on whole-plant extract (n?=?34) versus 3.6 points after placebo (n?=?36); p?=?0.009). There were no treatment-related serious adverse events. Common adverse events included somnolence and decreased appetite, reported for 28% and 25% on whole-plant extract, respectively (n?=?95); 23% and 21% on pure-cannabinoids (n?=?93), and 8% and 15% on placebo (n?=?94). Limitations Lack of pharmacokinetic data and a wide range of ages and functional levels among participants warrant caution when interpreting the results.ConclusionsThis interventional study provides evidence that BOL-DP-O-01-W and BOL-DP-O-01, administrated for 3 months, are well tolerated. Evidence for efficacy of these interventions are mixed and insufficient. Further testing of cannabinoids in ASD is recommended. Trial registration ClinicalTrials.gov: NCT02956226. Registered 06 November 2016, https://clinicaltrials.gov/ct2/show/NCT02956226.

Dataset Information

Use of shoulder pacemaker for treatment of functional shoulder instability: Proof of concept.

Background

Objectives

Patients and methods

Results

Conclusion

video online

Publications

Use of shoulder pacemaker for treatment of functional shoulder instability: Proof of concept.

Similar Datasets

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