Percutaneous nerve stimulation in chronic neuropathic pain patients due to spinal cord injury: a pilot study.

BACKGROUND: The long-term prognosis for neuropathic pain resolution following spinal cord injury (SCI) is often poor. In many SCI patients, neuropathic pain continues or even worsens over time. Thus, new treatment approaches are needed. We conducted a pilot study to evaluate the feasibility and effect of percutaneous (electrical) nerve stimulation (P(E)NS) in SCI patients with chronic neuropathic pain. METHODS: In 18 weeks, 12 P(E)NS treatments were scheduled. Assessment with questionnaires was performed at baseline (T0), after 8 weeks (T8), 18 weeks (T18), and 12 weeks post-treatment (T30). RESULTS: From 26 screened patients, 17 were included. In total, 91.2% questionnaires were returned, 2 patients dropped out, and 4.2% of the patients reported minor side effects. Pain scores on the week pain diary measured with the numerical rating scale improved significantly at T8, from 6.5 at baseline to 5.4, and were still significantly improved at T18. Pain reduction of ≥ 30% directly after a session was reported in 64.6% sessions. In total, 6 patients experienced reduction in size of the pain areas at T18 and T30, with a mean reduction of 45.8% at T18 and 45.3% at T30. CONCLUSION: P(E)NS is feasible as an intervention in SCI patients and might have a positive effect on pain reduction in a part of this patient group.

Impact of Surgical Timing on Motor Level Lowering in Motor Complete Traumatic Spinal Cord Injury Patients.

Patients with complete traumatic spinal cord injury (tSCI) have a low potential to recover ambulation. Motor level recovery, adjacent to the level of injury, could influence functional independency. This study addresses whether surgical timing influences motor level recovery in patients with motor complete (American Spinal Injury Association [ASIA] Impairment Scale A [AIS A]) and motor incomplete (AIS B) tSCI. A retrospective cohort study was performed in the Netherlands in patients with AIS A/B tSCI (C2-L2), who consecutively underwent surgery between January 2010 and April 2020. Neurological examination was performed directly at presentation to the emergency room and at discharge from the rehabilitation facility. Motor level lowering, AIS grade, and upper and lower extremity motor score recovery were calculated for patients who underwent early (< 24 h) and late (24 h+) surgery. A total of 96 patients met the inclusion criteria. In the multi-variate analysis, late surgical decompression (24 h+) was negatively associated with ≥1 motor level lowering and ≥2 AIS grade improvement [odds ratio (OR) 0.11 [95% confidence interval (CI): 0.01, 0.67], p = 0.046, and OR 0.06 [95% CI: 0.00, 047], p = 0.030. respectively). The presence of sacral sparing (AIS B) at initial examination, and cervical level of the tSCI were associated with ≥1 motor level lowering. In addition, AO Spine C-type injuries were negatively associated with any type of neurological recovery, except motor level lowering. Although sensorimotor complete injuries as well as thoracolumbar injuries negatively influence neurological recovery, early surgical decompression (< 24 h) appears independently associated with enhanced neurological recovery in patients with traumatic spinal cord injury despite level and severity of injury.

A novel spelling system for locked-in syndrome patients using only eye contact.

PURPOSE: We developed and evaluated a novel spelling system for patients with locked-in syndrome: patients with tetraplegia, not able to talk, and only able to blink their eyes. METHOD: A new communication grid was compared with existing non-technical communication methods for practical daily use. The means of the number of decision steps to reach a full sentence were compared testing 10 sentences relevant in daily care. These 10 sentences together encompass all letters of the alphabet. RESULTS: The new communication grid is organised alphabetically in 4 columns and 2 main rows, with each row subdivided in three rows. The first column contains vowels while the other columns contain consonants. Letters in each column are alphabetically ordered. When spelling a sentence the conversation partner counts the columns, until the patient indicates by an upward eye movement that the column contains the intended letter. Hereafter, the patient indicates by looking straight ahead or by looking down, whether the intended letter is in the upper or in the lower main row, respectively. The conversation partner will then read out the letters until the patient indicates the intended letter. Compared to other spelling systems, this system requires only vertical eye movement, is easier to memorise, and faster in use. The comparison of means of decision steps to reach the 10 full sentences for different communication grids shows that using the new communication grid is approximately one-third to three times faster than the existing spelling systems (p = 0.005). CONCLUSION: This new grid is a valuable communication tool, especially in situations, such as bathing, getting dressed or out of house activities where no devices are available. Implications for Rehabilitation Communication with patients with locked-in syndrome is a complicated and strenuous task. Communication methods, such as the alphabet board and brain-computer interfaces, are time consuming or too sophisticated to use in daily life tasks. This communication grid is fast, easy to use and memorise and requires only vertical eye movement.