Breathing-controlled Electrical Stimulation (BreEStim) for Management of Neuropathic Pain and Spasticity

The overall goal of the following experiment is to improve therapeutic efficacy of electrical stimulation when it is triggered by voluntary breathing. This is achieved by monitoring breathing signals to detect voluntary breathing as a second step, the value of detected breathing signals is compared to the preset threshold, which determines whether a trigger needs to be sent. Next, a trigger is sent to the electrical stimulator in order to deliver an electrical pulse to the target areas that is synchronized with voluntary breathing.

Results are obtained that show increased efficacy in pain relief and spasticity reduction based on breathing controlled electrical stimulation. The main advantage of this technique over existing methods like transcutaneous electrical nerve stimulation or tense, is that voluntary breathing controlled electrical stimulation or breathe stem integrates the intrinsic physiological coupling activated during voluntary breathing to improve therapeutic efficacy of electrical stimulation. To begin setup for stimulation, first, have the subject sit comfortably with arms and hands comfortably on the treatment table.

Then identify and localize the area of interest for surface electrode placement. To perform BRI stim for pain management, first, locate the acupuncture points of Negan and waan on the forearm ipsilateral to the side of interest. Negan is located about three finger widths above the wrist crease on the voler side, and in the middle between medial and lateral boards of the forearm.

Waan is the counterpart of Negan located in the dorsal aspect of the forearm. Trim each self-adhesive electrode to a two by two centimeter square to provide focal and isolated electrical stimulation and place the cathode electrode on nagu and the anode electrode on wagu to perform brief stim for spasticity management. Place the cathode over the finger, extensor muscle belly, and attach the anode to a site, one to two centimeters distal to the cathode.

Then optimize the sites for the anode and cathode to the locations. Eliciting the largest isolated finger extension response with a minimal wrist response shown. Here is a photograph of a patient being treated with BRI stim for both treatment methods.

Next, connect the surface electrodes to the electrical stimulator. Then place and secure the face mask. Select the size of the face mask carefully to fit the individual's face to prevent air leakage, and to provide comfort of wearing the mask, connect the face mask to a pneumatac system.

Now again, for both treatment methods, provide the subject with instructions for voluntary breathing. Voluntary inhalation plays a critical role in this intervention and is defined as effortful. Deep and fast inhalation instruct the subject to take a single isolated deep breath, similar to routine deep breaths, but faster and stronger.

There is no need to perform voluntary exhalation proceeding forced inhalation in a breathing cycle, allow the subject to have eight to 10 practice trials to understand and become comfortable with the instructions. Set a single electrical stimulus as a single square wave pulse with a 0.1 millisecond duration. There is no need to set a frequency parameter.

The intensity of electrical stimulation is different for the different applications for pain management. Use zero as the starting intensity. Then allow the subject to determine incremental changes of the stimulation intensity.

Determine the highest level, whether it is the maximal output of the stimulator or the level the subject can tolerate. Explicitly instruct the subject that discomfort or painfulness, even aversiveness to electrical stimulation is part of treatment. Therefore, encourage the subject to select the highest level that he or she can tolerate.

For spasticity management. Determine the intensity of electrical stimulation at which isolated finger extension responses are elicited with minimal involvement of wrist joint responses. Also determine the highest intensity the subject can tolerate.

Note that the absolute magnitude of stimulation intensity can differ between subjects. Again, encourage the highest intensity that the subject can tolerate to achieve the best outcome for both breathing controlled electrical stimulation and electrical stimulation. Write a customized lab view program to control delivery of stimulation.

Here, the stimulation is demonstrated for pain management. Using BRI stim. Determine the peak airflow rate during voluntary inhalation IE during the deepest and fastest inhalation.

Next, determine the threshold, which is 40%peak airflow rate. Set the threshold higher than the airflow rate during normal breathing to encourage deeper and faster voluntary breathing. Next, set the trigger function.

When the instantaneous airflow rate of an isolated voluntary inhalation reaches or surpasses the threshold, the lab view program will trigger and deliver a single electrical stimulus with preset duration and intensity. Allow the subject to rest upon request to perform randomly triggered electrical stimulation. With e-stim, allow the subject to breathe normally without specific instructions.

The lab view program will randomly deliver a single electrical stimulus with a preset duration and intensity every four to seven seconds. Similarly, allow the subject to rest upon request. Note that it is recommended that each session of treatment contains 100 to 120 brief stim stimuli and should last approximately 30 to 40 minutes to ensure accurate recording and monitoring during stimulation.

Ensure that there is no air leakage from the face mask since voluntary inhalation plays an important role in this protocol. Closely monitor for signs of hypoxemia and hyperventilation while the subject wears the face mask. Be sure to allow rest at the subject's request for this purpose.

Record any side effects, tolerance of voluntary breathing via the face mask and any psychosocial effects that may occur for pain management. Also, record any reduction of pain such as visual analog scores and duration of the effect. Also, record the average intensity for each session since the intensity of electrical stimulation varies during each session of treatment, use the modified visual analog scores to further quantify the effect of pain reduction, such as how much pain is reduced and the duration of reduction.

This patient was a 40-year-old male who suffered a spinal cord injury 4.5 years ago in a motor vehicle accident resulting in a T eight Asia, a spinal cord injury. The patient complained of neuropathic pain at the injury level. While he had no other active medical issues, he had been stable on a pain regime for two weeks prior to the treatment he received E-stim first waited one week as a washout and then received breeze stim with the same dose.

Each treatment session consisted of 120 stimuli surface electrodes were placed on acupoints of the right forearm. Modified visual analog scale was used to compare the effect of each intervention as seen. Here, BRI Stim had a greater pain reduction effect than E-stim except on day two when the patient had a urinary tract infection, which was successfully treated with antibiotics.

The intensity of electrical stimulation was similar between E-stim and bti. The subject tolerated both interventions. Well, even during the UTI, the subject maintained the same dose and schedule of pain medications during the four week experimental period.

Both STI and E-stim treatment sessions were performed at the same time of the day, such that changes in the pain rating could be attributed to stimulation effects and not diurnal variation. Here we see photographic evidence of results for spasticity management. For this patient, the finger flexor spasticity was greatly reduced.

After BRI stim treatment, finger flexor spasticity has been reduced from MAs one plus to a minimum score of MAS equals zero. I'm 69 years of age, and in June 22nd I'll be 70. On May 5th, 2006, I suffered a major stroke and that left my whole entire right side paralyzed.

My hand was just like this on my chest and I couldn't open it for a long time. And then with the little exercise I got so I could use my hand a little, then I met Dr.Shang Lee and he talked about some electronic intervention. So we went to his lab and he attached electrodes to my arm here that would stimulate the muscles of my right hand and with and be controlled by my breeding.

And after 30 minutes of that, I found that I could open and close my hand with regularity with no problems whatsoever. And this has lasted for eight weeks and I feel that if anyone that has had a stroke can partake of the same type of intervention, that it will be of great benefit to them. After watching this video, you should have a good understanding of how to properly use voluntary breathing to trigger electrical stimulation and to improve its therapeutic efficacy.