Skip to main content
eScholarship
Open Access Publications from the University of California

Scholarly Works (9 results)

  • Article
  • Peer Reviewed
ICTS Publications (2017)

Permanent injury to the cranial nerves can often result in a substantial reduction in quality of life. Novel and innovative interventions can help restore form and function in nerve paralysis, with bioelectric interfaces among the more promising of these approaches. The foreign body response is an important consideration for any bioelectric device as it influences the function and effectiveness of the implant. The purpose of this review is to describe tissue and functional effects of chronic neural implantation among the different categories of neural implants and highlight advances in peripheral and cranial nerve stimulation.Data Sources: PubMed, IEEE, and Web of Science literature search.Review Methods: A review of the current literature was conducted to examine functional and histologic effects of bioelectric interfaces for neural implants.

Bioelectric devices can be characterized as intraneural, epineural, perineural, intranuclear, or cortical depending on their placement relative to nerves and neuronal cell bodies. Such devices include nerve-specific stimulators, neuroprosthetics, brainstem implants, and deep brain stimulators. Regardless of electrode location and interface type, acute and chronic histological, macroscopic and functional changes can occur as a result of both passive and active tissue responses to the bioelectric implant.

A variety of chronically implantable electrodes have been developed to treat disorders of the peripheral and cranial nerves, to varying degrees of efficacy. Consideration and mitigation of detrimental effects at the neural interface with further optimization of functional nerve stimulation will facilitate the development of these technologies and translation to the clinic.

3.

    Cover page: Functional and Histological Effects of Chronic Neural Electrode Implantation.Creative Commons 'BY' version 4.0 license
    • Article
    • Peer Reviewed
    UC Irvine Previously Published Works (2017)
    Traumatic Brain Injury (TBI) is a devastating and widely prevalent cause of death and disability in the United States. Educational interventions integrated into neurosurgical neurotrauma clinics can facilitate patient education and optimize the clinical encounter. Interactive educational modalities may enhance knowledge acquisition and patient satisfaction, however, no description of implementing such a program has been presented in the literature. The implementation of an interactive iBook-based educational intervention in an outpatient neurotrauma clinic is discussed. Concussion and TBI iBooks and surveys were created. Then, a retrospective chart review and data analysis of 202 consecutive patients and family members presenting to the neurotrauma clinic was conducted. The participants completed a presurvey, reviewed an interactive iBook, and then completed a post-survey to test interim knowledge improvement. We discuss the process and problems encountered when creating the iBooks and implementing them in a clinical setting. Between August 1, 2015 and August 1, 2016, 93 patients (46%) and 109 (54%) family members participated in the study, for a total of 202 participants. 104 subjects reviewed a concussion iBook, and 98 subjects reviewed a TBI iBook, depending on their medical condition. Significant improvements in self-reported knowledge measures were demonstrated. Participants ranged in age from 10 to 90 years, with a mean of 45 years. The male to female ratio was 1.104:1. Interactive iBooks were readily implemented into a neurotrauma clinic. Improvements in self-reported knowledge measures and strong preference for the interactive iBook were attributed to the efficacy of the educational intervention. Examples of how interactive iBooks may be a useful adjunct in the education of head injury patients and their families in the neurotrauma setting are presented.
      Cover page: Implementation of an Interactive Tablet-based Educational Intervention in the Neurotrauma Clinic: A 1-year Retrospective Analysis.
      • Article
      • Peer Reviewed
      UC Irvine Previously Published Works (2017)

      Objective

      To review the complex pathogenesis of the subdural membrane and the link between head trauma, dementia, and dural lymphatics.

      Methods

      A thorough literature search of published English-language articles was performed using PubMed, Ovid, and Cochrane databases.

      Results

      Chronic subdural hematoma (cSDH) is a common intracranial pathology and a leading cause of reversible dementia. cSDH is projected to affect at least 60,000 new individuals in the United States annually by 2030. This condition can result from mild to moderate head trauma that leads to hemorrhaging in the dura-arachnoid interface. The short-term and long-term effects of cSDH and the subdural membrane on the pathogenesis of dementia and the newly discovered dural lymphatics is a topic of increasing importance.

      Conclusions

      Further research into the possible link between traumatic brain injury and cSDH in particular and dural lymphatics and intracranial fluid dynamics is warranted.
        Cover page: Chronic Subdural Hematoma: A Perspective on Subdural Membranes and Dementia
        • Article
        • Peer Reviewed
        UC Irvine Previously Published Works (2017)

        Background

        Neurological surgeons oftentimes educate patients and their families on complex medical conditions and treatment options. Time constraints and varied linguistic and cultural backgrounds limit the amount of information that can be disbursed. In this study, we assessed the linguistic validity of interactive educational interventions in non-English-speaking patients with traumatic brain injury (TBI) and concussion and their families.

        Methods

        A total of 273 English-, Spanish-, Korean-, and Vietnamese-speaking neurotrauma patients (n =124) and family members (n =149) completed a presurvey to evaluate their incipient understanding, interacted with an iPad-based iBook (Apple) on concussion or TBI in their native language, completed a postsurvey to gauge changes in understanding, and then consulted with their neurosurgeon.

        Results

        All participants (124 patients and 149 family members) had significantly increased (95% confidence interval [CI], P < 0.01) postsurvey scores (average pre-iBook score, 2.810; average post-iBook score, 4.109), regardless of native language or cultural background. Caucasian participants scored significantly higher than the combination of all ethnicities on both the baseline survey (95% CI, P < 0.01) and the post-iBook survey (95% CI, P < 0.01), and Asian participants scored significantly lower (95% CI, P < 0.05) than the combination regardless of similar baseline scores.

        Conclusions

        Interactive iBook-based interventions on concussion and TBI can increase participants' comprehension, improve their comfort with their medical condition and the follow-up care, and enhance communication with their physicians. These findings are linguistically valid irrespective of the participants' native language or cultural background.
          Cover page: Linguistic Validation of Interactive Educational Interventions in Neurologic Trauma
          • Article
          • Peer Reviewed
          UC Irvine Previously Published Works (2017)

          Objectives

          Traumatic Brain Injury (TBI) is a common and debilitating injury that is particularly prevalent in patients over 60. Given the influence of head injury on dementia (and vice versa), and the increased likelihood of ground-level falls, elderly patients are vulnerable to TBI. Educational interventions can increase knowledge and influence preventative activity to decrease the likelihood of further TBI. We sought to determine the efficacy of interactive tablet-based educational interventions in elderly patients on self-reported knowledge.

          Patients and methods

          Patients and family members, ages 20-90, presenting to a NeuroTrauma clinic completed a pre-survey to assess baseline TBI or concussion knowledge, depending on their diagnosis. Participants then received an interactive electronic book (eBook), or a text-based pamphlet with identical information, and completed a post-survey to test interim knowledge improvement.

          Results

          All participants (n=180), regardless of age, had significantly higher post-survey scores (p<0.01, 95% CI). Elderly participants who received the eBook (n=39) scored lower than their younger counterparts despite higher pre-survey scores (p<0.01, 95% CI). All participants who received the eBook (n=20, 90) significantly improved on the post-survey (p<0.01, 95% CI) when compared to participants who received the paper pamphlets (n=10, 31). All participants significantly preferred the eBook (p<0.01, 95% CI).

          Conclusions

          We demonstrated that interactive educational interventions are effective in the elderly TBI population. Enhanced educational awareness in the elderly population, especially patients at risk or with prior TBI, may prevent further head injury by educating patients on the importance of avoiding further head injury and taking precautionary measures to decrease the likelihood of further injury.
            Cover page: Interactive eBooks in educating patients and their families about head injury regardless of age.
            • Article
            • Peer Reviewed
            UC Irvine Previously Published Works (2019)
            The aim of this study is to discuss the state of the art with regard to established or promising bioelectric therapies meant to alter or control neurologic function. We present recent reports on bioelectric technologies that interface with the nervous system at three potential sites-(1) the end organ, (2) the peripheral nervous system, and (3) the central nervous system-while exploring practical and clinical considerations. A literature search was executed on PubMed, IEEE, and Web of Science databases. A review of the current literature was conducted to examine functional and histomorphological effects of neuroprosthetic interfaces with a focus on end-organ, peripheral, and central nervous system interfaces. Innovations in bioelectric technologies are providing increasing selectivity in stimulating distinct nerve fiber populations in order to activate discrete muscles. Significant advances in electrode array design focus on increasing selectivity, stability, and functionality of implantable neuroprosthetics. The application of neuroprosthetics to paretic nerves or even directly stimulating or recording from the central nervous system holds great potential in advancing the field of nerve and tissue bioelectric engineering and contributing to clinical care. Although current physiotherapeutic and surgical treatments seek to restore function, structure, or comfort, they bear significant limitations in enabling cosmetic or functional recovery. Instead, the introduction of bioelectric technology may play a role in the restoration of function in patients with neurologic deficits.
              Cover page: Interfacing with the nervous system: a review of current bioelectric technologies
              • Article
              • Peer Reviewed
              UC Irvine Previously Published Works (2017)

              Introduction

              Physicians in the ambulatory setting face challenges in adequately educating patients in a brief office encounter.

              Objective

              To evaluate the efficacy of an iPad-based interactive educational module (iBook) in various otologic pathologies.

              Methods

              Patients presenting with symptoms of tinnitus, dizziness, hearing loss, or cochlear implant evaluation were included. In total, 44 patients received the iBook and 22 patients served as controls. Prior to viewing the iBook, patients completed a pre-survey to assess baseline knowledge. After viewing the iBook, patients completed a post-survey to assess changes in perception and knowledge of their disease. Results were compared to that of the control group who did not receive iBook supplementation prior to being seen by the physician.

              Results

              Paired t-test analysis showed significant improvements (p<0.01) in both self-reported perception and concrete understanding in various concepts when compared to pre-iBook results. This was further compared to the control group, which showed a significant gain in factual knowledge (p=0.02).

              Conclusion

              Patients who viewed the iBook, personalized to their diagnosis, displayed significantly improved understanding of their condition. Increased use of interactive educational modalities, such as the iBook, can be of benefit to an otologic practice in improving patient education and satisfaction.
                Cover page: Use of interactive iBooks for patient education in otology
                • Article
                • Peer Reviewed
                UC Irvine Previously Published Works (2018)
                Past and recent attempts at devising objective biomarkers for traumatic brain injury (TBI) in both blood and cerebrospinal fluid have focused on abundance measures of time-dependent proteins. Similar independent determinants would be most welcome in diagnosing the most common form of TBI, mild TBI (mTBI), which remains difficult to define and confirm based solely on clinical criteria. There are currently no consensus diagnostic measures that objectively define individuals as having sustained an acute mTBI. Plasma metabolomic analyses have recently evolved to offer an alternative to proteomic analyses, offering an orthogonal diagnostic measure to what is currently available. The purpose of this study was to determine whether a developed set of metabolomic biomarkers is able to objectively classify college athletes sustaining mTBI from non-injured teammates, within 6 hours of trauma and whether such a biomarker panel could be effectively applied to an independent cohort of TBI and control subjects. A 6-metabolite panel was developed from biomarkers that had their identities confirmed using tandem mass spectrometry (MS/MS) in our Athlete cohort. These biomarkers were defined at ≤6 hours following mTBI and objectively classified mTBI athletes from teammate controls, and provided similar classification of these groups at the 2, 3, and 7 days post-mTBI. The same 6-metabolite panel, when applied to a separate, independent cohort provided statistically similar results despite major differences between the two cohorts. Our confirmed plasma biomarker panel objectively classifies acute mTBI cases from controls within 6 hours of injury in our two independent cohorts. While encouraged by our initial results, we expect future studies to expand on these initial observations.
                  Cover page: Plasma metabolomic biomarkers accurately classify acute mild traumatic brain injury from controls
                  • Article
                  • Peer Reviewed
                  UC San Francisco Previously Published Works (2018)
                  The present study was designed to characterize transduction of non-human primate brain and spinal cord with a modified adeno-associated virus serotype 2, incapable of binding to the heparan sulfate proteoglycan receptor, referred to as AAV2-HBKO. AAV2-HBKO was infused into the thalamus, intracerebroventricularly or via a combination of both intracerebroventricular and thalamic delivery. Thalamic injection of this modified vector encoding GFP resulted in widespread CNS transduction that included neurons in deep cortical layers, deep cerebellar nuclei, several subcortical regions, and motor neuron transduction in the spinal cord indicative of robust bidirectional axonal transport. Intracerebroventricular delivery similarly resulted in widespread cortical transduction, with one striking distinction that oligodendrocytes within superficial layers of the cortex were the primary cell type transduced. Robust motor neuron transduction was also observed in all levels of the spinal cord. The combination of thalamic and intracerebroventricular delivery resulted in transduction of oligodendrocytes in superficial cortical layers and neurons in deeper cortical layers. Several subcortical regions were also transduced. Our data demonstrate that AAV2-HBKO is a powerful vector for the potential treatment of a wide number of neurological disorders, and highlight that delivery route can significantly impact cellular tropism and pattern of CNS transduction.
                    Cover page: Extensive Transduction and Enhanced Spread of a Modified AAV2 Capsid in the Non-human Primate CNS
                    Top