TENS and FES for sensory impairment and gait dysfunction following removal of spinal cord ependymoma--a case report.

BACKGROUND: Sensory deficits are commonly reported following the resection of spinal cord tumours. The use of transcutaneous electrical nerve stimulation (TENS) as augmented sensory input is described in the research literature but rarely in the clinical literature. Functional electrical stimulation (FES) is used for people with motor impairments rather than sensory impairments. METHOD AND RESULTS: This case report describes the use of TENS and FES for a patient with severe sensory loss and mild weakness in the right leg following the removal of an intramedullary spinal cord tumour. The patient was able to walk more quickly and more confidently when using TENS and FES in combination. She consistently reported greater benefits from TENS alone compared to FES alone and continued to use TENS delivered via a sock electrode at six months after surgery. CONCLUSION: The use of TENS as a sensory stimulus was an invaluable component of this patient's treatment, allowing her to engage in a more challenging balance and gait programme at an earlier stage in her rehabilitation. Combining FES with TENS was also useful and allowed treatment to address motor and sensory impairments concurrently during functional activity.

Acupuncture for back pain, knee pain and insomnia in transverse myelitis - a case report.

This case report describes the use of acupuncture for back pain, knee pain and insomnia in a 49 year old woman with a recent diagnosis of transverse myelitis with paraplegia, sensory disturbance, and bladder and bowel dysfunction. She was receiving intensive in-patient multi-disciplinary rehabilitation but was struggling to participate fully due to pain and poor sleep quality. She received a course of acupuncture in addition to standard care and reported substantial benefits including reduction in pain, improved sleep and mood, and reduction in daytime fatigue. Effective symptom control allowed this patient to participate more fully in her rehabilitation programme. Reduction of knee pain and sleep disturbance was maintained until discharge, 15 weeks after the last acupuncture treatment. This case report suggests that acupuncture may be an option to consider for other patients with pain or sleep disturbance that is interfering with their rehabilitation programme.

Comparison of the effect of two types of acupuncture on quality of life in secondary progressive multiple sclerosis: a preliminary single-blind randomized controlled trial.

OBJECTIVE: To compare the effect of two types of acupuncture on the quality of life of individuals with secondary progressive multiple sclerosis and provide preliminary evidence regarding the safety of this intervention for this population. DESIGN: Preliminary single-blind randomized controlled trial. SETTING: Outpatient attendance at rehabilitation unit. PARTICIPANTS: Fourteen participants with secondary progressive multiple sclerosis. INTERVENTIONS: Chinese medical acupuncture or minimal acupuncture. Participants received 10 treatments over five weeks. MEASURES: Multiple Sclerosis Impact Scale 29, Fatigue Severity Scale and General Health Questionnaire 12 were measured pre and post intervention. Adverse events and other responses during treatment were recorded prospectively. RESULTS: Participants receiving minimal acupuncture demonstrated statistically significant greater improvement in the Multiple Sclerosis Impact Scale 29 psychological subscale compared with those receiving Chinese medical acupuncture in an intention-to-treat analysis (P=0.04), with mean change in Chinese acupuncture group of 6.0 (SD 13.9) and in minimal acupuncture group of 23.0 (SD 21.0). No other statistically significant difference between the groups was found. No major adverse events were noted. Minor adverse events such as lower limb muscle spasms or pain were noted in some participants in both intervention groups. CONCLUSION: Minimal acupuncture resulted in greater improvement of Multiple Sclerosis Impact Scale 29 psychological subscale compared with Chinese medical acupuncture. No other differences between the groups were found. In view of the small sample these results are not conclusive. This study provides preliminary evidence to suggest that acupuncture is safe for people with secondary progressive multiple sclerosis. A large-scale trial is required to provide more definitive evidence.

Acupuncture for central pain affecting the ribcage following traumatic brain injury and rib fractures--a case report.

This case report describes the use of acupuncture in the management of chronic central pain in a 51 year old man following severe traumatic brain injury and multiple injuries including rib fractures. The patient reported rapid and significant improvements in pain and mood during a course of acupuncture treatment. Chronic pain following traumatic brain injury is a significant problem. Chronic pain after rib fractures is also commonly reported. Acupuncture is widely used in the management of pain but its use has been reported rarely in the traumatic brain injury literature. This case report suggests that acupuncture may be a useful option to consider in these patients. Outcome was assessed formally using a 0-10 verbal numerical rating scale for pain, and the Hospital Anxiety and Depression Scale (HADS) for psychological status before and after the course of treatment. These scales are widely used in clinical practice as well as in research involving patients with traumatic brain injury, although they have not been validated in this population. The changes in this patient's outcome scores were not consistent with the benefits he reported. Treatment of this patient highlighted the difficulties of using standardised self rating scales for patients with cognitive impairment. The report also discusses the effects of acupuncture on this patient's mood.