The technical expert/clinical user/patient panel (TECUPP): centering patient and family perspectives in patient-reported measure development.

Patient and caregiver perspectives are increasingly incorporated into health care research and policymaking, but their inclusion in the quality measure development process often is not robust. We describe a stakeholder panel model for incorporating patient/caregiver voices in the development of patient-reported measures, the Technical Expert/Clinical User/Patient Panel (TECUPP) model. This model is characterized by significant or equal representation of people with lived experience of the disease or condition (as patients or caregivers) to the clinicians and others with technical expertise who typically comprise technical expert panels.

Process Evaluation of the Los Angeles County Rapid Diversion Program: A Pretrial Mental Health Diversion Program.

The Los Angeles County Rapid Diversion Program (RDP) is a pretrial mental health diversion program operating in seven courthouses in Los Angeles County, California. Established in 2019 as a faster approach to pretrial mental health diversion compared with the traditional approach, RDP allows for the diversion of individuals who have a mental health diagnosis or substance use disorder and certain qualifying misdemeanor or felony charges. Individuals who complete the program have their case dismissed.

Arthroscopic discectomy and interbody fusion of the thoracic spine: A report of ipsilateral 2-portal approach.

Background: The standard approach to the thoracic disc is through thoracotomy. The video-assisted thoracoscopic approach has been used as an alternative to the open approach for nearly 20 years, and more recently, extracavitary, posterolateral approaches have been introduced. Both the transthoracic procedures involve deflating the lung for access to the spine, and postoperative thoracic drainage is necessary; postoperative morbidity can be significant.

Recovery of coordinated gait: randomized controlled stroke trial of functional electrical stimulation (FES) versus no FES, with weight-supported treadmill and over-ground training.

Background: No single intervention restores the coordinated components of gait after stroke.

Objective: The authors tested the multimodal Gait Training Protocol, with or without functional electrical stimulation (FES), to improve volitional walking (without FES) in patients with persistent (>6 months) dyscoordinated gait.

Methods: A total of 53 subjects were stratified and randomly allocated to either FES with intramuscular (IM) electrodes (FES-IM) or No-FES.

Feasibility of combining gait robot and multichannel functional electrical stimulation with intramuscular electrodes.

After stroke rehabilitation, many survivors of stroke exhibit persistent gait deficits. In previous work, we demonstrated significant gains in gait kinematics for survivors of chronic stroke using multichannel functional electrical stimulation with intramuscular electrodes (FES-IM). For this study, we tested the feasibility of combining FES-IM and gait robot technologies for treating persistent gait deficits after stroke.

Use of a postoperative lumbar corset after lumbar spinal arthrodesis for degenerative conditions of the spine. A prospective randomized trial.

Background: Lumbosacral corsets and braces have been used to treat a variety of spinal disorders. Although their use after lumbar arthrodesis for degenerative conditions has been reported, there is a lack of evidence on which to base guidelines on their use. The purpose of this study was to evaluate the effect of a postoperative corset on the outcome of lumbar arthrodesis.

A randomized controlled trial of functional neuromuscular stimulation in chronic stroke subjects.

Background And Purpose: Conventional therapies fail to restore normal gait to many patients after stroke. The study purpose was to test response to coordination exercise, overground gait training, and weight-supported treadmill training, both with and without functional neuromuscular stimulation (FNS) using intramuscular (IM) electrodes (FNS-IM).

Methods: In a randomized controlled trial, 32 subjects (>1 year after stroke) were assigned to 1 of 2 groups: FNS-IM or No-FNS.

Response of sagittal plane gait kinematics to weight-supported treadmill training and functional neuromuscular stimulation following stroke.

After stroke, persistent gait deficits cause debilitating falls and poor functional mobility. Gait restoration can preclude these outcomes. Sixteen subjects (>12 months poststroke) were randomized to two gait training groups.

Development of a hybrid gait orthosis: a case report.

Objective: The purpose of this case study was to improve stability, posture, and speed of gait in an individual with paraplegia through the application of a hybrid system including trunk-hip-knee-ankle-foot orthosis (THKAFO) with lockable joints and multichannel functional electrical stimulation (FES) with implanted electrodes.

Methods: Two hybrid orthoses were implemented and evaluated on a person with complete absence of motor function and sensation below the T-9 level spinal cord injury. The first hybrid was a modified isocentric reciprocal gait orthosis (IRGO) with the knees controlled by FES, the ankles fixed at neutral, and the hips coupled with a reciprocator.

Large-array surface electromyography in low back pain: a pilot study.

Study Design: A large-array surface electromyography device was used to collect data from healthy pain-free persons and from those with acute or chronic low back pain. Images of regional muscle electromyographic activity were assessed visually, and maximum root mean square values were compared statistically.

Objective: To determine whether data differs by patient type.

Functional electrical stimulation for walking in paraplegia: 17-year follow-up of 2 cases.

Objective: To assess the safety and effectiveness of long-term use of functional electrical stimulation (FES) for exercise, standing, and walking in individuals with paraplegia, using percutaneous intramuscular wire electrodes.

Design: Case study with more than 17 years of follow-up.

Setting: Institutional rehabilitation practice.

Performance of an intramuscular electrode during functional neuromuscular stimulation for gait training post stroke.

The goal of rehabilitation for stroke patients in this research was to improve the volitional coordination of the swing phase and stance phases of gait. Functional neuromuscular stimulation (FNS) is a promising rehabilitation tool for restoring motor control. For our gait training protocols, FNS systems with surface electrodes were impractical.

Percutaneous implantation of iliopsoas for functional neuromuscular stimulation.

Hip flexion is required for walking and stair climbing. Percutaneous electrical stimulation of the iliopsoas muscle is a potentially useful and reliable method of providing hip flexion in individuals who are paralyzed. In this study, groin, lateral abdominal, and paraspinal approaches of percutaneous electrode implantation for electrical stimulation of the iliopsoas muscle are described.

Surgical technique for installing an eight-channel neuroprosthesis for standing.

A standardized surgical procedure to implant an eight-channel functional neuromuscular stimulation system in the lower extremities for standing, exercise, and transfers for individuals with spinal cord injury has been developed. The implanted components include: (1) one eight-channel receiver-stimulator, (2) epimysial electrodes, (3) intramuscular electrodes, and (4) inline connectors. The development process included identifying the target muscle set for electrode placement and the corresponding surgical approaches, determining the stages of the surgical procedure, and assessing the effectiveness and stability of the implanted neuroprosthesis.

Feasibility of gait training for acute stroke patients using FNS with implanted electrodes.

Following stroke, many patients do not regain a normal, safe gait pattern even after receiving conventional physical therapy. One promising technique is functional neuromuscular stimulation (FNS) with intramuscular (IM) electrodes (FNS-IM). Five subjects were admitted into the study at 3 weeks to 3 months following the stroke.

The Case Western Reserve University hybrid gait orthosis.

Six individuals with paraplegia and injury levels from C-1 through T-12 participated in a study to evaluate the functional capabilities of a hybrid gait orthotic system. Subjects learned to use a custom-built reciprocal gait orthosis without stimulation and with electrical stimulation activating between 4 and 16 muscles. Outcomes were scored with standard physical therapy measures including the Tinetti test, a timed get up and go, Borg rating of perceived exertion, and the Functional Index Measure (FIM).

Implanted functional electrical stimulation system for mobility in paraplegia: a follow-up case report.

A 16-channel functional electrical stimulation (FES) system has been implanted in a person with T10 paraplegia for over a year. The system consists of two eight-channel radio frequency controlled receiver-stimulators delivering stimuli through a network of 14 epimysial and two intramuscular electrodes. Using this system and a walker for support, the subject was able to stand up for 8 min and walk regularly for 20 m.

Walking with a hybrid orthosis system.

Objective: The purpose of this case study was to determine the functional effectiveness of the hybrid orthosis system (HOS) for sit-to-stand and walking compared with the reciprocal gait orthosis (RGO) alone in a subject with significant orthopedic abnormalities.

Design: A subject with complete T7 paraplegia and a 13 cm leg length discrepancy was implanted with 14 intramuscular electrodes and fitted with a custom isocentric RGO. The subject was instructed in the use of the HOS and a two wheeled walker in the home and community settings.

Reliability of closed double helix electrode for functional electrical stimulation.

The reliability of a closed double helix electrode in the lower limbs was studied. This electrode is an implanted intramuscular electrode and is used for a totally implantable functional electrical stimulation system. Eighty electrodes were evaluated retrospectively with a mean period of 15 months.

Implantation of a 16-channel functional electrical stimulation walking system.

A 16-channel electrical stimulation system was implanted in a 39-year-old patient with T10 paraplegia to restore sit to stand, walking, and exercise functions. System implantation required two surgical sessions. In the first session, the posterior muscle set consisting of bilateral semimembranosus, adductor magnus, and gluteus maximus muscles were exposed and epimysial electrodes sutured at the point of greatest muscle contraction.

Ankle, knee, and hip moments during standing with and without joint contractures: simulation study for functional electrical stimulation.

Joint contractures have been one of the contraindications for use of functional electrical stimulation for standing in paraplegic patients. A simulation study using a three-segment link mechanical model of the human body was performed to calculate the muscle moments at the ankles, knees, and hips during standing with and without having joint contractures. The knee and hip angles were varied in 5 degrees increments, whereas the ankle angles were varied in 1 degree increments.

Transforaminal and posterior decompressions of the lumbar spine. A comparative study of stability and intervertebral foramen area.

Study Design: Ten fresh, cadaveric, two-vertebrae, functional spinal units were used to study the pathoanatomy, intervertebral foraminal area, and flexibility changes after posterior and transforaminal decompression.

Objectives: To determine the feasibility of an endoscopic transforaminal approach as an alternative to conventional approaches, to establish the adequacy of transforaminal decompression without destabilizing the spine, and to study the structural changes in the spine after decompressions.

Summary Of The Background Data: Posterior decompression entails major dissection and excision of bone and ligaments to access the spinal canal.

Endoscopic transiliac approach to L5-S1 disc and foramen. A cadaver study.

Study Design: The toros of fresh cadavers were used to create endoscopic channels through the iliac wings to gain access to the L5-S1 disc and foramen. The spine and pelvis then were dissected out en bloc, and the anatomic relationships were studied.

Objectives: To determine the feasibility of a transiliac approach to the L5-S1 disc and foramen and to assess the safety of this approach by studying the anatomic relationships of the transiliac track.

Muscle selection and walking performance of multichannel FES systems for ambulation in paraplegia.

A minimal set of muscles (8 to 16) were identified as candidates for implantation in a clinical system to provide walking function to individuals with complete paraplegia using functional electrical stimulation (FES). Three subjects with complete motor and sensory paraplegia had percutaneous intramuscular electrodes implanted in all major muscles controlling the trunk, hips, knees, and ankles. Stimulation patterns for walking with FES were generated for different sets of eight and 16 muscles.

Therapeutic neural effects of electrical stimulation.

The use of a functional neuromuscular stimulation (FNS) device can have therapeutic effects that persist when the device is not in use. Clinicians have reported changes in both voluntary and electrically assisted neuromuscular function and improvements in the condition of soft tissue. Motor recovery has been observed in people with incomplete spinal cord injury, stroke, or traumatic brain injury after the use of motor prostheses.