program control is not necessary for doctors. Simple self-programming can be achieved through the simple version of patient program control device, and patients or family members can be accompanied by simple self-programming. However, this applies to patients or family members who have sufficient understanding of their own condition, and are proficient in the operation methods of the patient program control device. When it is not convenient to return to the hospital, you can fine-tune the parameters at home and observe the changes in the efficacy. If you have any questions during operation, you should contact the doctor or the engineer of the pacemaker manufacturer in time.
Commonly adjustable contents for patient program control devices include: ① Adjust the stimulation intensity; ② Replace the stimulation program group; ③ Turn on and off. After each program control, the doctor will give certain patient program control authority to adjust the program control device according to the specific situation of the patient.
Adjust the stimulation intensity
Open the control authority for a certain range of voltages according to the specific situation (usually ±0.4-0.5v) (if it is a constant current mode, it is current), while the stimulation frequency and pulse width usually do not open the patient's control authority because the stimulation intensity caused by its adjustment changes greatly, and the possible effects are more complicated.
Adjust the voltage stimulation intensity main purpose: ① insufficient efficacy needs to increase : The symptoms of one limb are not satisfactory. If Parkinson's disease patients still have tremor, sluggish or stiffness, the stimulation parameters of the corresponding limb can be increased; ② stimulation side effects need to reduce : One limb may have stimulation-related side effects such as numbness and spasm , you can try to reduce the stimulation parameters of the limb. After the reduction, if these discomforts gradually disappear, it can be clearly defined as stimulation-related side effects; ③ Parkinson's disease patients need to reduce dysfunction: Abnormal movement is often manifested as involuntary dance-like activities of the trunk or limbs (note that limb tremor is not abnormal movement). If there is abnormal movement on a certain limb, the stimulation parameters of the corresponding limb can be adjusted down and then observed whether the abnormal movement is reduced. It is generally applicable to the stimulation parameters of a certain limb, which can slightly reduce the stimulation parameters. If it is obvious abnormal movement, the doctor should contact the doctor to adjust the drug or further program control at the same time.
How many precautions are there for : ① Be sure to distinguish the left and right limbs of , and do not reverse them! If you are not sure, contact the doctor or engineer in time to confirm. If the limb side is disconnected, it may cause abnormal movements/side effects to cause limb parameters on the side that should have been reduced but increased, while the parameters on the limb side that is insufficient in efficacy should have been increased but decreased, which in turn magnifies the original problem and reduces the efficacy. For patients using imported brands, a simple way to remember left and right of the patient program control device is "the left side of the program control device on the left side of the patient's limb, and the right side of the screen corresponds to the right side of the patient's limb ". ② For insufficient efficacy and need to increase the stimulation parameters, it is not recommended to adjust the parameter range at a time or to adjust the parameters frequently (such as multiple times in a day). For voltage, it is advisable to adjust 0.05v-0.10v each time. After adjustment, you can observe for 2-3 days. If you are not satisfied, then gradually adjust it.
Replacement stimulation program group
0 The settings of multiple stimulation program groups are mainly suitable for patients with symptoms with complex . If the symptoms worsen, there are symptoms such as frozen gait, dysarthria, etc.; for patients who have just turned on the computer or have not complicated symptoms, multiple stimulation groups are not required. When setting up a stimulation group, the doctor will tell you under what circumstances to change the stimulation group.
The purpose of setting up multiple program groups is that, first, due to the limited observation time of doctors during program control, multiple program groups can be set up to standby, and patients can determine the best group by adjusting at home for a long time to observe the difference in efficacy between different groups; second, for individual complex symptoms, the same set of parameters may not be able to take into account different symptoms, and multiple program groups can also be set up to switch the program groups when necessary (for example, program groups with strong parameters may be convenient to move, but their speech worsens; while program groups with slightly lower parameters may improve speech, but their actions are slightly poor).The difference between the
stimulation group is mainly the difference in the settings of stimulation contacts (different positions), modes (commonly used single-negative stimulation, bipolar stimulation, double-negative stimulation, cross-electric pulse, variable frequency stimulation, etc.), and the settings of stimulation frequency or pulse width. For poor efficacy, if the stimulation voltage amplitude is adjusted through the patient program control device, for example, the voltage adjustment has reached the permission range set by the doctor, then consider changing the stimulation group. Just like when adjusting the current parameters, it is not recommended to change the group frequently. Each time the group is changed, it can be observed for several days to 2 weeks. Unless there is obvious stimulation side reactions causing discomfort or abnormal movement after the replacement, adjust it back to the original stimulation group in time. If there are multiple stimulation groups, after changing the stimulation group, it is recommended that the patient record the symptoms of each program group when using it, such as the improvement of different symptoms in the program group, or whether there are related side effects. This information is of guidance for the next doctor's program control.
power switch
power switch is the most basic function of a patient program control device, but it is only necessary to use it in special circumstances.
① requires shutdown before partial inspection or treatment: Currently, most pacemakers can only shut down for 1.5T magnetic resonance. After magnetic resonance check , they must confirm shutdown multiple times before performing magnetic resonance check , and then turn on the computer after completing the scan; ECG is performed to avoid interference with ECG monitoring; in addition, when planning any invasive treatment (such as surgery) , you should contact the engineer or doctor in advance to confirm whether it will cause interference to the pacemaker, and shut down if necessary.
② Severe abnormal movements can be temporarily turned off : If the patient has obvious abnormal movements during the drug opening period after adjusting the parameters by program control or after adjusting the dosage of the drug, if the abnormal movement amplitude is large, it may cause a dangerous situation. The power can be temporarily turned off. Generally, it can effectively alleviate abnormal movements. After the effect of the drug has passed, then restart the computer. At the same time, confirm with the doctor about the adjustment of the next medication or the adjustment of the stimulation parameters.
③ rule out the aggravation of symptoms caused by accidental shutdown : Sudden symptoms worsen, first use the patient program control device to check whether the pacemaker is too low or accidentally touches the power off, and charge or turn on in time. Whether it is a patient, family member or accompanying staff, they need to master the method of turning on and off the machine. When operating the program control device, do not accidentally touch and turn off the machine. For some patients with severe symptoms, touching and turning off the machine by mistake may cause danger if the family member does not provide timely assistance.
summary
Although the patient program control device provides convenience for home self-programming, does not recommend frequent adjustments in both stimulation intensity or program group. It is advisable to maintain stable stimulation parameters as much as possible. Because the fluctuations in the symptoms of the disease may be affected by a variety of factors, it is recommended to maintain the parameters for several days or longer after each use of the patient program control device to observe the adjustment effect of the stimulation parameters. If the problem is not solved by adjusting the patient program control device, the program control should be returned to the hospital if necessary.
( Department of Neurosurgery, First Affiliated Hospital of Sun Yat-sen University, Wu Bin, Liu Jinlong)
