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Algorithms for Automated Calibration of Transcutaneous Spinal Cord Stimulation to Facilitate Clinical Applications

Transcutaneous spinal cord stimulation (tSCS) is a promising intervention that can benefit spasticity control and augment voluntary movement in spinal cord injury (SCI) and multiple sclerosis. Current applications require expert knowledge and rely on the thorough visual analysis of electromyographic...

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Autores principales: Salchow-Hömmen, Christina, Schauer, Thomas, Müller, Philipp, Kühn, Andrea A., Hofstoetter, Ursula S., Wenger, Nikolaus
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8623351/
https://www.ncbi.nlm.nih.gov/pubmed/34830746
http://dx.doi.org/10.3390/jcm10225464
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author Salchow-Hömmen, Christina
Schauer, Thomas
Müller, Philipp
Kühn, Andrea A.
Hofstoetter, Ursula S.
Wenger, Nikolaus
author_facet Salchow-Hömmen, Christina
Schauer, Thomas
Müller, Philipp
Kühn, Andrea A.
Hofstoetter, Ursula S.
Wenger, Nikolaus
author_sort Salchow-Hömmen, Christina
collection PubMed
description Transcutaneous spinal cord stimulation (tSCS) is a promising intervention that can benefit spasticity control and augment voluntary movement in spinal cord injury (SCI) and multiple sclerosis. Current applications require expert knowledge and rely on the thorough visual analysis of electromyographic (EMG) responses from lower-limb muscles to optimize attainable treatment effects. Here, we devised an automated tSCS setup by combining an electrode array placed over low-thoracic to mid-lumbar vertebrae, synchronized EMG recordings, and a self-operating stimulation protocol to systematically test various stimulation sites and amplitudes. A built-in calibration procedure classifies the evoked responses as reflexes or direct motor responses and identifies stimulation thresholds as recommendations for tSCS therapy. We tested our setup in 15 individuals (five neurologically intact, five SCI, and five Parkinson’s disease) and validated the results against blinded ratings from two clinical experts. Congruent results were obtained in 13 cases for electrode positions and in eight for tSCS amplitudes, with deviations of a maximum of one position and 5 to 10 mA in amplitude in the remaining cases. Despite these minor deviations, the calibration found clinically suitable tSCS settings in 13 individuals. In the remaining two cases, the automatic setup and both experts agreed that no reflex responses could be detected. The presented technological developments may facilitate the dissemination of tSCS into non-academic environments and broaden its use for diagnostic and therapeutic purposes.
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spelling pubmed-86233512021-11-27 Algorithms for Automated Calibration of Transcutaneous Spinal Cord Stimulation to Facilitate Clinical Applications Salchow-Hömmen, Christina Schauer, Thomas Müller, Philipp Kühn, Andrea A. Hofstoetter, Ursula S. Wenger, Nikolaus J Clin Med Article Transcutaneous spinal cord stimulation (tSCS) is a promising intervention that can benefit spasticity control and augment voluntary movement in spinal cord injury (SCI) and multiple sclerosis. Current applications require expert knowledge and rely on the thorough visual analysis of electromyographic (EMG) responses from lower-limb muscles to optimize attainable treatment effects. Here, we devised an automated tSCS setup by combining an electrode array placed over low-thoracic to mid-lumbar vertebrae, synchronized EMG recordings, and a self-operating stimulation protocol to systematically test various stimulation sites and amplitudes. A built-in calibration procedure classifies the evoked responses as reflexes or direct motor responses and identifies stimulation thresholds as recommendations for tSCS therapy. We tested our setup in 15 individuals (five neurologically intact, five SCI, and five Parkinson’s disease) and validated the results against blinded ratings from two clinical experts. Congruent results were obtained in 13 cases for electrode positions and in eight for tSCS amplitudes, with deviations of a maximum of one position and 5 to 10 mA in amplitude in the remaining cases. Despite these minor deviations, the calibration found clinically suitable tSCS settings in 13 individuals. In the remaining two cases, the automatic setup and both experts agreed that no reflex responses could be detected. The presented technological developments may facilitate the dissemination of tSCS into non-academic environments and broaden its use for diagnostic and therapeutic purposes. MDPI 2021-11-22 /pmc/articles/PMC8623351/ /pubmed/34830746 http://dx.doi.org/10.3390/jcm10225464 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Salchow-Hömmen, Christina
Schauer, Thomas
Müller, Philipp
Kühn, Andrea A.
Hofstoetter, Ursula S.
Wenger, Nikolaus
Algorithms for Automated Calibration of Transcutaneous Spinal Cord Stimulation to Facilitate Clinical Applications
title Algorithms for Automated Calibration of Transcutaneous Spinal Cord Stimulation to Facilitate Clinical Applications
title_full Algorithms for Automated Calibration of Transcutaneous Spinal Cord Stimulation to Facilitate Clinical Applications
title_fullStr Algorithms for Automated Calibration of Transcutaneous Spinal Cord Stimulation to Facilitate Clinical Applications
title_full_unstemmed Algorithms for Automated Calibration of Transcutaneous Spinal Cord Stimulation to Facilitate Clinical Applications
title_short Algorithms for Automated Calibration of Transcutaneous Spinal Cord Stimulation to Facilitate Clinical Applications
title_sort algorithms for automated calibration of transcutaneous spinal cord stimulation to facilitate clinical applications
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8623351/
https://www.ncbi.nlm.nih.gov/pubmed/34830746
http://dx.doi.org/10.3390/jcm10225464
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