Development and Validation of an IoT Neurostimulator for the Treatment of Neurogenic Bladder.

Neurogenic bladder is a dysfunction in the lower urinary tract due to damage to the nervous system. One of the treatments that has shown important results is transcutaneous neuromodulation. The neuromodulation equipment available on the market does not allow remote activation or offer many resources for adjusting the parameters of the generated stimulus, as most devices operate with pre-established parameters in closed packages. For this reason, customizing therapy for each individual can be difficult. Therefore, the objective was to develop and validate a neuromodulation device capable of being remotely programmed and properly monitored. Materials and methods for validating devices were used according to the Brazilian Regulatory Standard (NBR), which deals with general requirements for the basic safety and essential performance of electromedical devices. After verifying the reliability of the device, which was capable of generating a biphasic and symmetrical wave, measured by an oscilloscope, considered safe by the technical requirements, it was tested in a real application. Users reported feeling a comfortable stimulus, similar to other previously used devices, and considered the device easy to use. In this way, it was possible to demonstrate the reliability and validity of the developed device.

Neuromodulação não invasiva em crianças com Bexiga Neurogênica: uma revisão integrativa / Non-invasive neuromodulation in children with Neurogenic Bladder: an integrative review

INTRODUÇÃO: O tratamento da Bexiga Neurogênica (BN) pode ser feito através do manejo farmacológico e/ou não farmacológico. Dentro do tratamento não farmacológico temos a neuromodulação não invasiva (NMNI) realizada com aplicação de eletrodos transcutâneos que sugere uma modulação nos componentes excitatórios e inibitórios do controle da bexiga. OBJETIVO: Reunir evidencias que avaliem o efeito da NMNI na BN de crianças com disfunções neurológicas. MÉTODOS: Trata-se de um artigo de revisão integrativa que foi elaborada seguindo sete etapas. A busca foi feita nas bases de dados PubMed, Biblioteca Virtual de Saúde (BVS) e ScienceDirect. A escolha dos artigos foi realizada inicialmente por dois avaliadores independentes, obedecendo os critérios de elegibilidade: realizar tratamento para BN utilizando estimulação elétrica não invasiva com objetivo de neuromodulação da via urinária; população amostral composta por crianças com alteração miccional em decorrência de alguma disfunção neurológica e possuir os textos disponíveis na íntegra nas plataformas online de busca, no período de Agosto a Novembro de 2018. Foram incluídos artigos que utilizaram NMNI como tratamento da BN em crianças. RESULTADOS: Foram encontrados 440 artigos e apenas 5 atenderam aos critérios de inclusão. Ao todo, participaram dos estudos 141 crianças com acometimentos neurológicos. Os principais elementos utilizados nas avaliações foram diário miccional, o estudo urodinâmico, a coleta da história clínica e o exame físico. Os parâmetros de estimulação e posicionamento de eletrodos foram variados. CONCLUSÃO: A NMNI apresentou bons resultados no tratamento de crianças com BN e, foi observado também, efeitos positivos no intestino neurogênico, porém, são necessários mais estudos que sugiram protocolos bem delineados para a reprodução na prática clínica.

INTRODUCTION: The treatment of Neurogenic Bladder (NB) may be performed through pharmacological and/or nonpharmacological techniques. In relation to the non-pharmacological treatment, non-invasive neuromodulation (NINM) is widely used applying transcutaneous electrodes, which suggest a modulation on the excitatory components and bladder control inhibitors. OBJECTIVE: To gather evidence in order to assess the effect of NINM on the NB of children with neurological dysfunctions. METHODS: It is an integrative review article elaborated following seven steps. The research was done in the databases PubMed, Virtual Health Library (VHL) and ScienceDirect. Assortment of articles was initially made by two independent evaluators, obeying the eligibility criteria: perform NB treatment using noninvasive electrical stimulation aiming urinary tract neuromodulation; population sample composed by children with voiding alteration due to a neurological dysfunction and which have full texts available, from August to November 2018. Were included articles which used NINM as a treatment of NB in children. RESULTS: 440 articles were found, however only five met the inclusion criteria. Overall, 141 children with neurological afflictions were part of the study. The main evaluators elements were the voiding diary, the urodynamic study, collection of clinical history and physical exam. Parameters of stimulation and position of the electrodes varied between the studies. CONCLUSION: NINM showed agreable results in the treatment of children with NB, In addition, positive effects were observed in relation to the neurogenic intestine, despite the needing of further studies which suggest well-designed protocols for reproduction in clinical practice.