ABSTRACT
We report on a patient who underwent magnetic resonance guided focused ultrasound (MRgFUS) thalamotomy to treat tremor 3 years after a stereotactic radiosurgery (SRS) thalamotomy. The SRS produced only limited and transient improvements and was associated with a persistent hyperintensity on T2-FLAIR MR images. The MRgFUS thalamotomy was successful, with tremor improvement at 3 months, no adverse effects, and radiological appearance of the MRgFUS lesion similar to other patients undergoing this therapy. We also observed that the SRS-related T2-FLAIR hyperintensity had increased signal intensity 1 day post-MRgFUS, but appeared completely resolved 3 months post-MRgFUS. In conclusion, the case demonstrates that MRgFUS thalamotomy may effectively control tremor in patients with a history of SRS thalamotomy. We also speculate on the potential mechanisms of the apparent resolution of radiation-related change, and discuss possible applications of MRgFUS to reduce persistent SRS-related inflammation.
ABSTRACT
Objective: The primary goal of this study was to investigate the feasibility of utilizing intermittent electrical stimulation (IES) in an intensive care environment as a potential method for preventing pressure ulcers. Furthermore, we wished to evaluate the practicality of the innovation and end-user acceptability. Approach: Twenty immobile subjects, age ranging from 19 to 86 years old with a Braden Scale score ranging from 9 to 16 (very high to moderate risk of developing pressure ulcers), were enrolled. Intermittent 35 Hz electrical stimulation was administered through surface electrodes to the gluteal muscles causing them to contract for 10 s every 10 min. Subjects utilized IES on a program that increased from 4 to 24 h per day over 8 days and lasted up to a maximum of 4 weeks. Results: Bedside nurses reported that IES was simple to use, took an average of 6 min to apply, and 2 min to remove. Furthermore, IES could be easily incorporated into routine patient care. No pressure ulcers occurred in any subject during the study. No untoward reactions or adverse events had occurred directly as a result of IES. Innovation: IES represents a potential method of preventing bedsores. This study represents a necessary pilot study, investigating safety and feasibility before proceeding with a larger randomized controlled trial to determine efficacy. Conclusion: Our results suggest that IES is both safe and feasible to implement in intensive care units.
ABSTRACT
Objective: To investigate the safety, feasibility, and acceptability of a novel treatment, intermittent electrical stimulation (IES), for preventing deep tissue injury (DTI) in different healthcare settings. Approach: Testing was conducted in an acute rehabilitation unit of a general hospital, a tertiary rehabilitation hospital, a long-term care facility, and homecare (HC). IES was delivered through surface electrodes placed either directly on the gluteal muscles or through mesh panels inside a specialized garment. Study participants at risk for DTI used the system for an average of 4 weeks. Outcome measures included skin reaction to long-term stimulation, demands on the caregiver, stability of induced muscle contraction, and acceptability as part of the users' daily routine. Results: A total of 48 study participants used the IES system. The system proved to be safe and feasible in all four clinical settings. No pressure ulcers were observed in any of the participants. There was no difference between the clinical settings in patient positioning, ease of finding optimal stimulation site, and patient acceptance. Although donning and doffing time was longer in the long-term care and HC settings than the acute rehabilitation unit and tertiary rehabilitation facility, time required to apply the IES system was <18 min (including data collection). The patients and caregivers did not find the application disruptive and indicated that the stimulation was acceptable as part of their daily routine in over 97% of the time. Innovation and Conclusion: We demonstrated the safety, feasibility, and acceptability of a novel method of IES to prevent DTI in a continuum of healthcare settings.
