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News Article | April 28, 2017

Autism, paralysis, and persistent, medication-resistant pain are among the challenges that emerging companies and organizations hope to alleviate through neuromodulation therapy. Neuromodulation therapy, sometimes referred to as bioelectric medicine or electroceuticals, is one of medicine's fastest-growing fields, driven by rising neurological disease in an aging population, and the need for non-pharmacological approaches to manage symptoms. The first use of spinal cord stimulation (SCS) to treat chronic pain of neuropathic origin was reported in 1967 by C. Norman Shealy, M.D., Ph.D. Neuromodulation devices, such as SCS and deep brain stimulation systems, leverage technology developed for cardiac pacemakers and cochlear implants to re-balance neural activity. Neuromodulation therapies help relieve chronic pain or restore function. Existing and emerging devices operate through targeted application of electrical, magnetic, chemical, or optical stimulation. Current or emerging neuromodulation therapies address deficits in vision, hearing, breathing, mobility, grasp or gait, motor function, mood, memory, and digestion. Three panels of innovators will present emerging therapies in a daylong preconference before the International Neuromodulation Society 13th World Congress in Edinburgh, Scotland. The Innovations Day preconference on May 28, 2017 also includes discussion by commercialization experts and financiers about capturing data to support reimbursement. BioInduction Ltd. CEO Ivor Gillbe and neurosurgeon Nik Patel, M.D. will present Picostim, a compact neurostimulator with a volume of 7 cc, designed for implantation in the skull in a single procedure. The device is awaiting clinical trial. The company plans for this neurostimulator to initially be used in patients with advanced Parkinson's disease. The device is being designed to offer stimulation steering, local field potential recording and wireless charging. The privately held company is funded by its founders, angel investors and U.K. government grants. Winifred Wu, chief officer for translational research at the Clearly Present Foundation, will present its aim to accelerate discovery of non-invasive brain stimulation, such as repetitive transcranial magnetic stimulation (rTMS), to treat autism spectrum disorder (ASD). The founder, Kim Hollingsworth Taylor, formed the foundation in 2014 after her son, who she said has high-functioning ASD, participated in a 10-week clinical study of intermittent rTMS. She said he "exhibited remarkable improvements in ASD impairments such as work completion speeds, vastly reduced repetitive behaviors, and increased empathy and flexibility." However, the effect waned over a year. That experience, and the foundation, appear in a chapter of the book Switched On: A Memoir of Brain Change and Emotional Awakening by autism advocate John Elder Robison. Sjaak Deckers, CEO of G-Therapeutics, will present the Go-2 implantable spinal cord stimulation system that is being developed to improve functional recovery of people with spinal cord injury. The initial aim is to provide gait support for people with an incomplete paraplegic injury. Eight patients are being recruited for a feasibility study in Switzerland, under study co-chairs Grégoire Courtine, Ph.D., director of the Center for Neuroprosthetics and Brain Mind Institute at the Swiss Federal Institute of Technology, and Prof. Armin Curt, M.D., who is chairman of the Spinal Cord Injury Center at the University of Zurich and medical director of the Paraplegic Center at the Balgrist University Hospital. The clinical trial, called STIMO: Epidural Electrical Simulation (EES) With Robot-assisted Rehabilitation in Patients With Spinal Cord Injury, will combine stimulation with movement rehabilitation. Chi-Heng (Rex) Chang, GiMer Medical general manager, will present NeuroBlock, a wirelessly charged device that was spun out of the biomedical engineering labs at National Taiwan University. NeuroBlock is an ultra-high-frequency spinal cord stimulation (SCS) device entering its first-in-human pilot study. The initial application will be to address chronic pain through intermittent stimulation of the dorsal root ganglion. The small implantable pulse generator (11 cc in volume) operates without creating tingling sensations of paresthesia like conventional SCS. The development received two National Innovation Awards in Taiwan (in 2016 for best start-up, and in 2014, for outstanding academic research spinout). GiMer derives its name from a fictional Star Wars wooden cane that provided the aging character Yoda supplemental nutrition and pain relief. The company has received private seed funding from two publicly traded companies and a venture fund. Jonathan Sackier, chief medical officer at Helius, will discuss a double-blind, randomized, sham-controlled study of the safety and effectiveness of the Portable Neuromodulation Stimulator (PoNS) 4.0 device for cranial nerve noninvasive neuromodulation (CN-NINM) training in subjects with a chronic balance deficit due to mild-to-moderate traumatic brain injury. A clinical trial of CN-NINM began at 4 US and Canadian sites in 2015 to investigate if the PoNS therapy, Helius' investigational medical device and physical therapy regimen for relief of neurological symptoms of disease or trauma is effective. Data collection for the primary outcome measure is anticipated to be complete by July 2017. Helius is publicly traded on the Toronto Stock Exchange. Mainstay Medical president and CEO Peter Crosby will present the company's ReActiv8 implantable restorative neurostimulation system as a treatment for patients with chronic low back pain (CLBP) of primarily nociceptive origin. ReActiv8 is designed to electrically stimulate the nerves of the muscles that dynamically stabilize the lumbar spine, to help restore muscle control and allow the body to recover from CLBP. ReActiv8 received CE mark in May 2016 and sales have begun in Germany. The current ReActiv8-B Trial is an international multi-center prospective randomized sham-controlled triple-blinded clinical trial designed to gather safety and efficacy data. Complete enrollment is anticipated in late 2017, with results available in 2018. Up to 27 centers will enroll 128 subjects who suffer from long-term disabling CLBP, are not candidates for and have not previously had spine surgery, are not candidates for SCS, and have failed conventional medical management such as drugs and physical therapy. Frank McEachern, MicroTransponder CEO, will present the company's Vivistim system that provides vagus nerve stimulation (VNS). The system is nearing the end of a U.S. clinical study in 17 patients who are undergoing rehabilitation for upper limb mobility after stroke. Previously, a safety-and-feasibility clinical trial of 20 stroke patients in Glasgow and Newcastle in the U.K. indicated rehabilitation was more successful with VNS than without. Pairing VNS with a specific movement strengthens motor circuits, which may help the patient regain upper limb function. Jens Schouenborg, Ph.D., a professor at Lund University, will present a new generation of matrix-embedded 3-dimensional, flexible neural interfaces. They are designed to be precisely implanted and spread out locally in target brain nuclei for deep brain stimulation (DBS). Preclinical studies indicate that by selecting appropriate biocompatible materials as the embedding matrix material, local injury including loss of neurons and immunological reactions can be minimized. The "3D Cluster Electrode" is intended to significantly improve stimulation specificity in DBS and widen its scope. Clinical studies are to commence during 2019. Daniel McDonnall, Ph.D., the president of Ripple, will present an implantable prosthetic device to restore eyelid motion to patients with unilateral facial paralysis. The wirelessly powered device is intended to prevent painful dry-eye complications and re-animate facial expression. After suffering paralysis due to tumor surgery, trauma, or disease, these patients do not currently have options for dynamic restoration of eyelid motion. The device would pair a detecting electrode on the healthy eyelid to detect the onset of a blink with a stimulating electrode on the paralyzed side to evoke a simultaneous blink. Proof-of-concept studies have been conducted, and component technologies have been developed. Preclinical testing is nearing completion. Sources of funding include the National Eye Institute's Small Business Innovation Research Phase I and II grant awards, as well as a grant from the U.S. Congressionally Directed Medical Research Program. WISE CEO Luca Ravagnan, Ph.D. will present the company's foldable, polymer-based electrode platform that can be applied to neuromonitoring and neuromodulation devices. The company is concluding the CE certification phase for its first product for acute use: cortical electrodes for intraoperative monitoring. The company is developing foldable paddles for SCS to combine the strengths of paddle leads with the ease of percutaneous leads to overcome trade-off between leads' performance and invasiveness of the surgery. Prior to becoming founding director of the Wyss Center in 2015, he coordinated the multidisciplinary team behind the groundbreaking prototype neural interface known as BrainGate while he was the founding chairman of the Department of Neuroscience at Brown University in Rhode Island. The Wyss Center tackles remaining challenges in brain-computer interfaces, such as development of a miniaturized wireless version of the existing BrainGate brain computer interface technology. The system should be suitable for long-term implantation and able to decode and transmit brain signals that signify intended movement. The Wyss Center works alongside collaborators of the next-generation BrainGate2 in a clinical trial to develop assisted communication and restore movement to people with neurologic disease, injury, or limb loss. In March, Donoghue and BrainGate collaborators reported that a paralyzed man in Cleveland used a BrainGate interface, connected to a functional electronic stimulation system, to move his hand and arm to feed himself, drink from a mug, and scratch his nose. The Wyss Center was established with funding from the Swiss entrepreneur and philanthropist Hansjörg Wyss. Guri Oron, CEO of BlueWind Medical, will present the company's miniature wireless and battery-less microstimulator, RENOVA iStim, which delivers targeted peripheral stimulation for a variety of clinical indications. BlueWind Medical, founded in 2010 by Rainbow Medical Group, has successfully completed several clinical studies and is focused on bringing its RENOVA platform to market.

PubMed | Oncology Center Hirslanden Zurich, Balgrist University Hospital, University of Zürich, University of Fribourg and 3 more.
Type: | Journal: Swiss medical weekly | Year: 2015

Rehabilitation for cancer patients aims to reduce physical disability and mental distress resulting from the disease and its treatment. However, little is known about the use of cancer inpatient rehabilitation in Switzerland in relation to sociodemographic and medical characteristics. The main purpose of this study was to evaluate whether there are differences in sociodemographic and medical characteristics between patients who underwent inpatient rehabilitation (users) and those who did not (nonusers).A total of 238 cancer patients from the University Hospital Zurich were included. The sociodemographic and medical characteristics of inpatient rehabilitation users were assessed and compared with those of nonusers. We analysed the differences between inpatient rehabilitation users and nonusers.Of the patients included, 101 (42.4%) used inpatient rehabilitation. They were less likely to be employed (p = 0.029), stayed longer in hospital (p <0.001), and were more likely to have semiprivate or private supplementary health insurance (p = 0.030) than nonusers. There were differences in cancer site (p = 0.001). Patients with tumours of the digestive organs or of the thoracic organs were more likely to use rehabilitation, whereas breast cancer patients were less likely to use it. Stratified analyses showed that male patients with semiprivate or private supplementary health insurance (p = 0.037), lower education (p = 0.039), and lower likelihood of employment (p = 0.051) were more likely to use rehabilitation. Women with an advanced tumour stage used inpatient rehabilitation more often (p = 0.012).Findings show the influence of duration of hospitalisation, insurance type, cancer site, employment status, and gender on the use of inpatient cancer rehabilitation. The results indicate the need of structured standardised procedures for medical referral to be implemented based on screening.

News Article | October 26, 2016

A year ago, the University of Zurich conducted its first parabolic flight for test purposes from Swiss soil. Now a second aircraft is ready for lift-off to research zero gravity: Saturday, an Airbus A310 ZERO-G is set to take off from the air force base in Dübendorf equipped with scientific experiments from the Universities of Zurich, Basel, Lucerne and ETH Zurich. The aircraft will perform special maneuvers to generate weightlessness in particular zones over the Mediterranean. On these trajectories - alternating between steep climbs and descents - the earth's gravitational pull will be overcome for periods of 22 seconds at a time. Diverse experiments can be conducted on board during these brief phases. Parabolic flights are vital for research under changed gravity: They can yield fundamental insights into the role of gravity in biological or physical processes. For instance, UZH is studying how human tissue reacts to the lack of oxygen in zero gravity - a key question for space walks; Lucerne University of Applied Sciences and Arts is using electrophysical tests to research the mechanisms involved in the perception of gravity by cells; a team of chiropractors from Balgrist University Hospital is testing functional connections in the development of back disorders, which can be identified more effectively in zero gravity; and another experiment conducted by ETH Zurich is devoted to the role of gravity in phytoplankton behavior, which should help improve our understanding of one of the most important oceanic microorganisms on earth. Besides these "terrestrial" experiments, however, one is also aimed into space: The University of Basel is testing sedimentation behavior in Mars' gravity, thereby obtaining crucial data for the calibration of mathematical models with a view to reconstructing the planet's environmental history. The research flight is also attractive for the space industry: An experiment conducted by the Swiss start-up SpacePharma is testing scientific hardware designed for use on small satellites. "Thanks to these research missions, Swiss Parabolic Flights, which were initiated by UZH, have taken root in Switzerland," says Professor Oliver Ullrich from the University of Zurich. He runs the Platform for Scientific Research in Zero Gravity, which is also backed by the Swiss Space Office of the State Secretariat for Education, Research and Innovation. The flexible combination of research from universities, industrial experiments and private individuals enables the costs of the flight to be minimized for science. These research flights into zero gravity are made possible by the close collaboration between Novespace, a subsidiary of the French space agency CNES, the Swiss Air Force, the Air Force Center in Dübendorf, Swissport and the Swiss SkyLab Foundation.

Sarabadani Tafreshi A.,ETH Zurich | Sarabadani Tafreshi A.,University of Zürich | Klamroth-Marganska V.,Balgrist University Hospital | Nussbaumer S.,Hocoma | Riener R.,Balgrist University Hospital
IEEE Transactions on Biomedical Engineering | Year: 2015

Prolonged bed rest has significant negative impacts on the human body, particularly on the cardiovascular system. To overcome adverse effects and enhance functional recovery in bedridden patients, the goal is to mobilize patients as early as possible while controlling and stabilizing their cardiovascular system. In this paper, we used a robotic tilt table that allows early mobilization by modulating body inclination and automated leg movement to control the cardiovascular variables heart rate (HR) or systolic or diastolic blood pressures (sBP, dBP). The design and use of a control system is often done with a simulation model of a plant, but the time-variant and nonlinear nature of the cardiovascular system and subject-specific responses to external stimuli makes the modeling and identification challenging. Instead, we implemented an intelligent self-learning fuzzy controller that does not need any prior knowledge about the plant. The controller modulates the body inclination in order to adjust the cardiovascular parameters, with leg movement considered as a perturbing factor to the controller. The controller performance was evaluated in six healthy subjects. Measured mean values of HR, sBP, and dBP differed from desired reference values by 1.11 beats/min, 5.10 mmHg, and 2.69 mmHg, respectively. With this new control strategy, HR and dBP could be successfully controlled within medically tolerable ranges (deviations < 2.5 beats/min and < 5 mmHg from desired values, respectively). The control of sBP was less accurate; the results suggest that simultaneous control of multiple input stimuli rather than only adaptive automatic change of the tilt table angle might improve the controllability. © 1964-2012 IEEE.

Jaremko J.L.,University of Alberta | Lambert R.G.W.,University of Alberta | Zubler V.,Balgrist University Hospital | Weber U.,Balgrist University Hospital | And 8 more authors.
Journal of Rheumatology | Year: 2014

Objective. As a wider variety of therapeutic options for osteoarthritis (OA) becomes available, there is an increasing need to objectively evaluate disease severity on magnetic resonance imaging (MRI). This is more technically challenging at the hip than at the knee, and as a result, few systematic scoring systems exist. The OMERACT (Outcome Measures in Rheumatology) filter of truth, discrimination, and feasibility can be used to validate image-based scoring systems. Our objective was (1) to review the imaging features relevant to the assessment of severity and progression of hip OA; and (2) to review currently used methods to grade these features in existing hip OA scoring systems. Methods. A systematic literature review was conducted. MEDLINE keyword search was performed for features of arthropathy (such as hip + bone marrow edema or lesion, synovitis, cyst, effusion, cartilage, etc.) and scoring system (hip + OA + MRI + score or grade), with a secondary manual search for additional references in the retrieved publications. Results. Findings relevant to the severity of hip OA include imaging markers associated with inflammation (bone marrow lesion, synovitis, effusion), structural damage (cartilage loss, osteophytes, subchondral cysts, labral tears), and predisposing geometric factors (hip dysplasia, femoral-acetabular impingement). Two approaches to the semiquantitative assessment of hip OA are represented by Hip OA MRI Scoring System (HOAMS), a comprehensive whole organ assessment of nearly all findings, and the Hip Inflammation MRI Scoring System (HIMRISS), which selectively scores only active lesions (bone marrow lesion, synovitis/effusion). Validation is presently confined to limited assessment of reliability. Conclusion. Two methods for semiquantitative assessment of hip OA on MRI have been described and validation according to the OMERACT Filter is limited to evaluation of reliability. (First Release Nov 15 2013; J Rheumatol 2014;41:359-69; doi:10.3899/jrheum.131082). © The Journal of Rheumatology Copyright 2014. All rights reserved.

Wittmann F.,ETH Zurich | Lambercy O.,ETH Zurich | Gonzenbach R.R.,University of Zürich | Van Raai M.A.,ETH Zurich | And 6 more authors.
IEEE International Conference on Rehabilitation Robotics | Year: 2015

Virtual reality therapy systems have the potential to increase the intensity and frequency of physical activity of stroke patients at home. This might help to increase the dose of rehabilitation, without the costs associated with clinic visits and therapist supervision. We present a therapy game that continuously estimates the patient's arm reachable three-dimensional (3D) workspace with a voxel-based model and selects targets to be reached accordingly, in order to increase challenge without causing frustration. This exercise is implemented on a novel, inertial measurement unit (IMU) based virtual reality system for the training of upper limb function. We present data from a pilot trial with 5 chronic stroke patients who trained for 6 weeks at home and without therapist supervision. On average, the patients' in-game assessed 3D workspace grew by 10.7% in volume and their score on the Fugl-Meyer Upper Extremity score improved by 5 points. The average self-selected therapy time, over the course of the therapy, was 16.8 h. These results suggest that the proposed assessment-driven target selection is viable for unsupervised home therapy and could form the basis for additional therapy games in the future. © 2015 IEEE.

Maksymowych W.P.,University of Alberta | Cibere J.,Arthritis Research Centre of Canada | Loeuille D.,Nancy University Hospital Center | Weber U.,Balgrist University Hospital | And 6 more authors.
Journal of Rheumatology | Year: 2014

Objective. Development of a validated magnetic resonance image (MRI) scoring system is essential in hip OA because radiographs are insensitive to change. We assessed the feasibility and reliability of 2 previously developed scoring methods: (1) the Hip Inflammation MRI Scoring System (HIMRISS) and (2) the Hip Osteoarthritis MRI Scoring System (HOAMS). Methods. Six readers (3 radiologists, 3 rheumatologists) participated in 2 reading exercises. In Reading Exercise 1, MRI of the hip of 20 subjects were read at a single time point followed by further standardization of methodology. In Reading Exercise 2, MRI of the hip of 18 subjects from a randomized controlled trial, assessed at 2 timepoints, and 27 subjects from a cross-sectional study were read for HIMRISS and HOAMS bone marrow lesions (BML) and synovitis. Reliability was assessed using intraclass correlation coefficient (ICC) and kappa statistics. Results. Both methods were considered feasible. For Reading 1, HIMRISS ICC were 0.52, 0.61, 0.70, and 0.58 for femoral BML, acetabular BML, effusion, and total scores, respectively; and for HOAMS, summed BML and synovitis ICC were 0.52 and 0.46, respectively. For Reading 2, HIMRISS and HOAMS ICC for BML and synovitis-effusion improved substantially. Interobserver reliability for change scores was 0.81 and 0.71 for HIMRISS femoral and HOAMS summed BML, respectively. Responsiveness and discrimination was moderate to high for synovitis-effusion. Significant associations were noted between BML or synovitis scores and Western Ontario and McMaster Universities Osteoarthritis Index pain scores for baseline values (p < 0.001). Conclusion. The BML and synovitis-effusion components of both HIMRISS and HOAMS scoring systems are feasible and reliable, and should be validated further. (First Release Nov 15 2013; J Rheumatol 2014;41:370.8; doi:10.3899/jrheum.131083). © The Journal of Rheumatology Copyright 2014. All rights reserved.

Brunner F.,Balgrist University Hospital | Gymesi A.,University of Zürich | Kissling R.,Balgrist University Hospital | Bachmann L.M.,University of Zürich
Journal of Rehabilitation Medicine | Year: 2010

Objective: The aim of this study was to investigate patients' knowledge of the most salient features of complex regional pain syndrome and to identify patient characteristics associated with the patients' level of knowledge. Methods: Questionnaire interview of 101 patients with complex regional pain syndrome in Switzerland (mean age 54 years, 77% female). A questionnaire about patients' diseaserelated knowledge was developed and piloted. The level of knowledge was defined by a consensus process among clinical experts and a patient. The questions were based on expert consensus about the minimum knowledge a person affected with complex regional pain syndrome should have. Results: Only 6 patients (6%) reached the minimum medical knowledge. The mean score for all participants was 7.6 points out of a total score of 11 points (range 3-11, SD 2.1). The scores were slightly higher among patients with higher education (apprenticeship, vocational school +0.38 (95% confidence interval (CI); -0.59 to 1.34: p=0.44), university entrance diploma +1.12 (95% CI-0.16 to 2.49: p=0.08), university diploma, advanced technical college +2.36 (95% CI 1.11-3.61 : p<0.001)) compared with mandatory school, and among those with professional medical backgrounds +1.13 (95% CI 0.06-2.20: p=0.04). Most patients received information from their caregivers and wanted to know more about therapy or general aspects of the condition. Conclusion: Many patients with complex regional pain syndrome do not have the minimum knowledge of their disease as defined by clinical experts. Physicians should be aware that patients expect to receive disease-related information primarily from their caregivers. In particular, patients wanted more information about therapy and general aspects of the illness. © 2010 Foundation of Rehabilitation Information.

Berndt K.,Balgrist University Hospital
Journal of the American Association for Laboratory Animal Science : JAALAS | Year: 2012

Intraarterial chemotherapy (IAC) is considered effective for the treatment of solid tumors with high local doses of systemically toxic chemotherapeutics. Osteosarcoma, which is often located in the extremities, is a potential target for IAC. However, the efficacy of this treatment modality has varied, and standardized protocols are difficult to establish due to tumor heterogeneity and the limited numbers of patients available for clinical trials. Reproducible experimental models are needed to further investigate IAC in osteosarcoma. Here, we describe a new microsurgical technique for repeated infusion of drugs into the mouse femoral artery for local treatment of experimental intratibial metastasizing osteosarcoma. We successfully achieved 5 catheterizations at 3-d intervals in 70% of the mice tested. Laser speckle imaging indicated a maximal 50% reduction in blood flow around the ankle region of catheterized legs infused with 0.5 mg/kg cisplatin. However, blood flow in the front feet was affected only minimally. Histologic examination of catheterized arteries of saline control or cisplatin-treated mice showed circular fibrinoid media necrosis and partial thrombosis, but total occlusion of the arteries was not observed. The method we describe for repeated transient catheterization of the mouse femoral artery likely will be useful in future studies comparing the efficacies of intraarterial and systemic cisplatin treatment of intratibial metastasizing osteosarcoma in mice under standardized conditions.

Heitz C.,University of Zürich | Bachmann L.M.,University of Zürich | Leibfried A.,Balgrist University Hospital | Kissling R.,Balgrist University Hospital | And 6 more authors.
BMC Musculoskeletal Disorders | Year: 2010

Background. The Dutch Walking Stairs, Walking Ability and Rising and Sitting Questionnaires are three validated instruments to measure physical activity and limitations in daily living in patients with lower extremity disorders living at home of which no German equivalents are available. Our scope was to translate the Walking Stairs, Walking Ability and Rising and Sitting Questionnaires into German and to verify its concurrent validity in the two domains pain and activities in daily living by comparing them with the corresponding measures on the Visual Analogue Scale. Methods. We translated the Walking Stairs, Walking Ability and Rising and Sitting Questionnaires according to published guidelines. Demographic data and validity were assessed in 52 consecutive patients with Complex Regional Pain Syndrome 1 of the lower extremity. Information on age, duration of symptoms, type of Complex Regional Pain Syndrome 1 and type of initiating event were obtained. We assessed the concurrent validity in the two domains pain and activities in daily living by comparing them with the corresponding measures on the Visual Analogue Scale. Results. We found that variability in the German Walking Stairs, Walking Ability and Rising and Sitting Questionnaires was largely explained by measures of pain and activities in daily living on the Visual Analogue Scale. Conclusion. Our study shows that the domains pain and activities in daily living are properly represented in the German versions of the Walking Stairs, Walking Ability and Raising and Sitting Questionnaires. We would like to propagate their use in clinical practice and research alike. © 2010 Heitz et al; licensee BioMed Central Ltd.

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