Spinal Cord Pacemaker Therapy (SPINAL CORD STIMULATION)
Advanced spinal cord paralysis is the local disruption of neuronal transmission circuits within the spinal cord white matter and the development of paralysis or paralysis below the injury site. In patients whose motor functions have been completely eliminated clinically, the effectiveness of standard physical therapy and rehabilitation applications is extremely limited, and it is not possible to walk independently or control voluntary movements with these methods. The general approach is to prevent and treat secondary complications that develop in these patients. The vast majority of these patients cannot regain their motor functions and live their lives with the hope that they will one day be able to perform voluntary movements again. Today, treatment is focused on restarting transmission or reorganization in the damaged area through spinal anatomical structures that remain intact after the injury.
Within the gray matter, most of the motor neurons and the interneuronal transmission network survived intact. Following damage to neurons and transmission circuits beneath the lesion site, a series of physiological, biochemical and cellular changes develop. Synaptic reorganization A rapid regeneration process develops in transmembrane receptors and genes Neuronal transmission network formed by spinal cord elements; Propriospinal neural signal transmission capacity after trauma, Processing of sensory signals Motor movement redevelopment Activity-dependent re-tension ability is alive Spinal cord pacemakers have been used successfully in the treatment of chronic pain and movement disorders for over 40 years. In cases of spinal cord damage, pacemakers can restart voluntary motor movements by using the intact neuronal transmission network beneath the lesion site.
Spinal Cord Battery (SPINAL CORD STIMULATOR) Mechanism of Action
Stimulation of the posterior part of the spinal cord activates medium and large diameter sensory nerve fibers located in the posterior roots. These stimuli fire reflex and interneuronal circuits via trans synaptic pathway, regulate the stimuli, and initiate motor neuronal stimulation, thus, contraction and relaxation movements occur with the organization of neuronal circuits in multiple muscle groups. With tonic stimuli applied at appropriate frequency intervals with spinal cord pacemakers, voluntary neural circuits are activated, and spinal reflexes stimulated at multiple levels can be coordinated. At correctly adjusted frequency intervals, pacemakers create rhythmic movement responses in the legs. It has been shown that voluntary movements can be initiated in fully paralyzed volunteer patients in the supine position even in the absence of position stimuli and brain stimuli. It has been shown with EMG (electromyography) that these stimuli initiate rhythmic flexion/extension movements at appropriate stimulation frequencies. It has been shown that when pacemaker therapy is applied together with robotic rehabilitation in patients, patients can walk actively with the robot, but it takes a long time for them to walk independently. During robotic rehabilitation, increasing body weight gradually allows patients to walk with minimal support, while it has been shown that robotic rehabilitation alone without a battery cannot initiate voluntary movements in the patient. As a result; the human spinal cord can initiate rhythmic flexion/extension movements in response to spinal cord stimulation, and in fully paralyzed patients with full body weight load in appropriate stimulation programs, strong extension movements can be achieved and the patient can stand. The spinal cord stimulator alone cannot initiate walking movements without support with tonic stimulation. Sensory feedback signals from the legs regulate the coordination and activation of the spinal motor neuron pool through reflex circuits during walking. Therefore, robotic rehabilitation is extremely important for ensuring the continuation of proprioceptive signals in patients undergoing spinal cord stimulation. Spinal cord stimulators should be reprogrammed in accordance with the neurological feedback provided by the patient. The spinal cord stimulator is placed and programmed uniquely for each patient. The number of electrodes to be used during the application and the type of stimulator should be selected according to the patient. Placing and operating it is not sufficient for treatment. The patient should be monitored at appropriate intervals, uninterrupted rehabilitation treatment should be continued, and necessary program additions should be made. Spinal cord stimulation is not a treatment method with guaranteed results. In parallel with the increase in the number of applications, the success rate is increasing with experience, knowledge and technological advances. The success rates due to its use in complete transection patients are extremely low.
SPINAL CORD STIMULATOR APPLICATION PURPOSES:
- Elimination of circulatory disorders due to increased sympathetic activity, maximizing blood circulation in the spinal cord and body areas depending on the level of damage
- Initiating the nerve damage repair process by increasing spinal cord blood circulation
- Regulation of involuntary movements due to uncontrolled electrical stimulation
- Treating pressure sores and preventing muscle atrophy by maximizing circulation in affected body areas
- Preventing involuntary urine leakage
- Preventing involuntary fecal leakage
- Treating neuropathic pain caused by nerve damage
- Providing appropriate electrical support to intact spinal cord nerve structures during the regeneration process of spinal cord injury
- Reintroduction and strengthening of voluntary movements
ATTENTION!!!
SPINAL CORD STIMULATION TREATMENT IS NOT A TREATMENT METHOD WITH A GUARANTEED RESULT.
NO PATIENT SETS A POSITIVE OR NEGATIVE EXAMPLE FOR ANOTHER PATIENT.
EACH PATIENT’S TREATMENT PROCESS AND RESULTS ARE SPECIFIC TO THAT PATIENT.
THE LEVEL OF PROTECTION OF THE REMAINING SPINAL CORD IS DETERMINANT IN THE SUCCESS OF TREATMENT, NOT THE TIME THAT HAS PASSED SINCE THE DAMAGE.
PHYSICAL THERAPY AND REHABILITATION MUST BE CONTINUED UNINTERRUPTED.
STIMULATOR PROGRAMS MUST BE RENEWED IN ACCORDANCE WITH THE IMPROVEMENT ACHIEVEMENT.
THERE IS NO STANDARD TREATMENT PROGRAM FOR EVERY PATIENT.