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ELECTRICAL
INJURIES: SPEECH,
COMMUNICATION
DISORDERS & AAC --
WHAT'S THE NEXT
STEP?
ICD DIAGNOSTIC CODES FOR ELECTRICAL INJURY’S SEQUELA
W86.8XXS: Exposure to other
electric current-sequela
Y84.3- Complication (delayed)
of electroshock therapy
2
3
4
WHAT AM I UP TO
NOW?
International Advocacy work to
Audit ECT use & rehabilitation for
life after ECT
UK ECT Improving Standards
Campaign Group
PAIMI
Contributor for the Life After ECT
website
Researching assessments and
rehabilitative interventions for
people with a history of Electrical
Injury
This Photo by Unknown Author is licensed under CC BY-SA
This Photo by Unknown Author is licensed under CC BY-SA-NC
This Photo by Unknown Author is licensed under CC BY-SA
5
MY AAC
TECHNOLOGY
6
wired
PRESENTATION OUTLINE
1. What is repetitive electrical trauma?
2. How does electrical injury cause a repetitive mild to moderate traumatic brain
injury?
3. How chronic non-ionizing radiation exposure compounds repetitive traumatic
brain injury
4. What are speech and communication disorders associated with electrical injury.
5. How can AAC improve quality of life?
6. Assessing AAC needs
7
WHO CAN USE THIS
PRESENTATION?
8
NOTHING
PRESENTED IN THIS
PRESENTATION IS
MEDICAL ADVICE,
IT IS PRESENTED
FOR
INFORMATIONAL
PURPOSES ONLY
9
This Photo by Unknown
Author is licensed under
10
11
“IF THESE SOLDIERS WERE
DYING IN THE FIELD RATHER
THAN QUIETLY AT HOME AS A
CONSEQUENCE OF THEIR
SERVICE, WE WOULD LEAVE NO
STONE UNTURNED. WE WOULD
USE THE BEST EXISTING
RESOURCES AND PROGRAMS TO
MAKE SURE THEY HAD
WHATEVER THEY NEEDED TO
SURVIVE”
-GENERAL THOMAS MIKOLAJCIK
(DECEASED)
12
WHO SHOULD
WE STUDY TO
UNDERSTAND
NON-IONIZING
RADIATION?
13
14
WHO CAN THIS
INFORMATION HELP?
Electricians
Welders
Modern combat veterans
TMS recipients
ECT recipients
This Photo by Unknown Author is licensed under CC BY
This Photo by Unknown Author is licensed under CC BY
This Photo by Unknown Author is licensed under CC BY-ND
15
This Photo by Aaron D. Franklin, SpiritualPhysicsofLight.com
16
17
18
19
20
WHO GETS ECT?
This Photo by Unknown Author is licensed under CC BY-SA
21
22
23
ECT’S UNREGULATED DOSING VARIABLES:
Current
Pulse width/Pulse type
(Sine, brief, or ultra-brief)
Frequency (10 to 140 Hertz)
Charge
Voltage
Percentage of device output
power or Joules
Medications in patient’s
system when they had ECT PAGE 24
This Photo by Unknown Author is licensed under CC BY-NC-ND
MORE UNREGULATED DOSING VARIABLES:
Electrode placement
PAGE 25
This Photo by Unknown Author is licensed under CC BY-NC-ND
This Photo by Unknown Author is licensed under CC BY
MORE UNREGULATED DOSING VARIABLES:
How high above seizure
threshold?
2.5-6x
Or
10-20x
PAGE 26
This Photo by Unknown Author is licensed under CC BY-NC-ND
MORE UNREGULATED DOSING VARIABLES:
Number of treatments
Length of time between
treatments
PAGE 27
This Photo by Unknown Author is licensed under CC BY-NC-ND
MORE UNREGULATED DOSING VARIABLES:
How long the stimulus
lasted?
Seizure’s Length of Time
Absence of brain activity
after seizure
PAGE 28
This Photo by Unknown Author is licensed under CC BY-NC-ND
HOW MANY SHOCKS?
This Photo by Unknown Author is licensed under CC BY
29
30
This Photo by Unknown Author is licensed under CC BY-SA-NC
31
MORE UNREGULATED DOSING VARIABLES:
What is the person’s head
and neck size?
PAGE 32
This Photo by Unknown Author is licensed under CC BY-NC-ND
PAGE 33
WHAT CAUSES
NONIONIZING
RADIATION INJURY?
This Photo by Unknown Author is licensed under CC BY-NC-ND
34
35
SPEECH AND
COMMUNICATION
DISORDER SUPPORT?
Women and Men with a history
of ECT and electrical injury have
difficulties obtaining access to
referrals speech
communication disorders and
AAC.
36
WHERE TO GET HELP FOR ELECTRICAL INJURY?
37
38
NEURONS COMMUNICATE BY PASSING APPROXIMATELY
2-4 MILLIAMPERES ELECTRIC CURRENT BACK AND FORTH
39
WHAT CAUSES
ELECTRICAL INJURY?
EITHER
A FLASH (MILLISECOND)
OF A HIGH FIELD OF
ELECTRIC STRENGTH
OR
PROLONGED EXPOSURE
TO A MEDIUM FIELD OF
ELECTRIC STRENGTH
By Biswarup Ganguly, CC BY 3.0, https://commons.wikimedia.org/w/index.php?curid=57159456
40
ELECTRICAL
INJURY ALTERS
HOW CELLS USE
ELECTROLYTES
41
WHAT ARE “ACQUIRED
CHANNELOPATHIES?”14
PAGE 42
PAGE 43
https://twitter.com/Jaco_H_Nel/header_photo
WHAT CAUSES ELECTROLYTE AND OTHER ION SHIFTS?
HYDRATION FOODS LIQUIDS HORMONES ENVIRONMENT
44
•SHIFTS IN
ELECTROLYTES
ALTER NERVE
IMPULSES,
IMPACTING:
MUSCLE TONE,
STRENGTH
COORDINATION
45
PAGE 46
What is electroporation?15, 17
HOW ARE
ELECTRICAL
INJURIES
CLASSIFIED AS
BRAIN
INJURIES?
This Photo by Unknown Author is licensed under CC BY-NC-ND
47
Course
Outline
ECT’s repetitive mild to moderate
traumatic brain injury (rmTBI)
PAGE 48
•Repetitive = number of high electrical field
strength exposures.
•External force caused brain activity “Silence”
and coma.8
•Mild vs moderate acquired brain injury from
cerebral hypoxia and anoxic effects.10, 12, 21
Photo credit 25
PAGE 49
This Photo by Unknown Author is licensed under CC BY
50
CASE STUDY
Female
8 ECT treatments
age 21
Age 46:
Functional MRI
(FNCI) for
lingering ECT
effects
51
52
HOW CAN
ELECTRICAL INJURY
IMPACT SPEECH
AND
COMMUNICATION:
IMMEDIATE VS
LONG-TERM
This Photo by Unknown Author is licensed under CC BY
53
ECT DIRECTLY OVER-STIMULATES
TRIGEMINAL, VAGUS AND OTHER CRANIAL NERVES
NERVES
54
Espinoza RT. An Overview of Electroconvulsive Therapy. https://slideplayer.com/slide/14273442/
55
Kibret B, Premaratne M, Sullivan C, Thomson RH, Fitzgerald PB. Electroco nvulsive therapy (ECT) during pregnancy: quantifying and assessing the electri c field strength inside the foetal brain. Sci Rep. 2018;8(1):4128. doi :10.1038/s41598-018-
22528-x
DO ALL PEOPLE
WITH ELECTRICAL
INJURY DEVELOP
COMMUNICATION
DISORDERS?
This Photo by Unknown Author is licensed under CC BY-NC
56
57
Kibret B, Premaratne M, Sullivan C, Thomson RH, Fitzgerald PB. Electroco nvulsive therapy (ECT) during pregnancy: quantifying and assessing the electri c field strength inside the foetal brain. Sci Rep. 2018;8(1):4128. doi :10.1038/s41598-018-
22528-x
SPEECH AND
COMMUNICATION
CONSIDERATIONS
What is the immediate
need?
How will these needs
evolve over time?
How many hours in a
month with profound
dysarthria and verbal
apraxia does it take to
qualify for considering AAC?
This Photo by Unknown Author is licensed under CC BY-NC-ND
58
ELECTRICAL INJURY’S IMMEDIATE IMPACT ON SPEECH &
COMMUNICATION
Aphasia (conductive aphasia most frequently reported by peers,
Lisp or slurred speech (only when tired or overstimulated)
Language and communication regression in people with communication disorders
prior to shock
Worsening Dysarthria (in people with a history)
Mutism
Echolalia
59
DELAYED ELECTRICAL INJURY’S IMPACT ON SPEECH AND
COMMUNICATION
Progressive episodic paroxysmal neuromuscular problems
Slurred speech when tired or overstimulated
Dysarthria
Laryngospasms
Motor Dysfunction
Hoarseness
Apraxia
Fasciculations in tongue, mouth, or neck/throat
Complete loss of functional voice
60
TRIGGERS
Sensory flooding
Rapid weather/ temperature
changes
Foods with high thiol content
neuro cognitive fatigue
Multiple chemical sensitivities
Hyperelectrosensitivity
Alcohol
Caffeine, Green tea, coffee
Stress
Amino Amines and other
medications which block or reduce
ion channel function
61
62
63
64
65
66
67
AAC
CONSIDERATIONS
Visual processing disorder
Colors used on the device
working memory impact
changes in neuromuscular tone
affect accessibility
Non-ionizing radiation emitted
by the device
Corded keyboards and switches
over infrared eye-tracking
68
CALL TO ACTION!
•Automatic referrals for comprehensive speech
assessment
•Routine life-time follow-up to identify delayed
symptom onset of lengthy exposures to chronic,
nonionizing radiation.
•Listen to your clients. Presume Competence
•Fund studies of speech & communication in
people with nonionizing radiation injuries.
•Create resources for Adults living with acquired
speech disorders and their family
members/caregivers.
•Early access to AAC
•Remove barriers to voice banking
69
For more information
www.LifeAfterECT.com
WWW.Change.org/PatientSaf
etyECT
70
This Photo by Unknown Author is licensed under CC BY-SA-NC
71
REFERENCES
72
1. Berg JS, Morse MS. A Shocking Neurological Rarity. Pract Neurol. 2004;4:222-227.
https://pn.bmj.com/content/practneurol/4/4/222.full.pdf
2. Low YS. Delayed neurological manifestations secondary to electrical injury--A case report. Singapore Med J.
1976;17(1):58-60. http://smj.sma.org.sg/1701/1701smj13.pdf
3. Farrell DF, Starr A. Delayed neurological sequelae of electrical injuries. Neurology. 1968;18(6):601-606.
doi:10.1212/WNL.18.6.601
4. Pliskin NH, Fink J, Malina A, et al. The Neuropsychological Effects of Electrical Injury: New Insights. Ann N Y Acad
Sci. 2006;888(1):140-149. doi:10.1111/j.1749-6632.1999.tb07952.x
5. Grube BJ, Heimbach DM. Acute and delayed neurological sequelae of electrical injury. In: Lee RC, Cravalho EG,
Burke JF, eds. Electrical Trauma. ; 2010:133-152. doi:10.1017/cbo9780511663291.008
6. World Health Organization. International Statistical Classification of Diseases and Related Health Problems. 10th
ed. World Health Organization; 1990.
7. National Radiological Protection Board. ELF Electromagnetic Fields and Neurodegenerative Disease: Report of
an Advidory Group on Non-Ionizing Radiation. Vol 12.; 2001. doi:10.1088/0952-4746/22/1/611
8. Hoehl H. Zur Kasuistik des elektrischen Traumas. Muenchener Medizinische Wochenscrift. 1906;53:1275-1276.
https://ia600905.us.archive.org/28/items/MuenchenerMedizinischeWochenschrift5319061.Halbjahr11288/Mu
enchener medizinische Wochenschrift 53 %281906%29%2C 1. Halbjahr - 1-1288.pdf
9. Gallagher JP, Talbert OR. Motor neuron syndrome after electric shock. Acta Neurol Scand. 1991;83(2):79-82.
doi:10.1111/j.1600-0404.1991.tb04653.x
73
10. Committee on Veterans’ Affairs- Subcommittee on Health, Congress) UH of R (110th. Gulf War Exposures.
Presented at the: 2007. https://www.govinfo.gov/content/pkg/CHRG-110hhrg37476/html/CHRG-
110hhrg37476.htm
11. Franklin AD. The Spiritual Physics of Light: How We See, Feel and Know Truth. Accessed January 7, 2022.
https://www.spiritualphysicsoflight.com/color-figures.html
12. US Food and Drug Administration. Neurological Devices; Reclassification of Electroconvulsive Therapy Devices;
Effective Date of Requirement for Premarket Approval for Electroconvulsive Therapy Devices for Certain Specified
Intended Uses. US Department of Health and Human Services: Food and Drug Administration; 2019:66103-
66124.
13. American Psychiatric Association. Committee on Electroconvulsive Therapy, Weiner RD. The Practice of
Electroconvulsive Therapy: Recommendations for Treatment, Training, and Privileging: A Task Force Report of the
American Psychiatric Association. 2nd ed. American Psychiatric Association; 2001. Accessed October 14, 2019.
https://psycnet.apa.org/record/2001-06855-000
14. Castleman KR. Expert Report on Electroconvulsive Therapy (Castleman Exibit C).; 2018.
15. Read J, Hancock SP, Cunliffe S, Henry ME. ECT : Dangerous on Either Side of the Pond ECT : An Effective and Safe
Treatment. Psychiatr Times. 2021;38(4):4-6. https://www.psychiatrictimes.com/view/ect-dangerous-either-side-
pond
16. Hancock SP. Whose Finger is Taking the Pulse of America’s Shock Treatment Controversy? Mad In America.
https://www.madinamerica.com/2020/07/finger-pulse-shock-treatment-controversy/. Published July 16, 2020.
74
17. Sackeim HA. Sackeim says 2 Million a year have ECT in 2004 court deposition. Published online 2004.
https://youtu.be/12oScZatwKg
18. Oppenheim M. Thousands of women given ‘dangerous’ electric shocks as mental health treatment in England.
Independent. https://www.independent.co.uk/news/health/electroconvulsive-therapy-brain-mental-health-
b2095155.html. Published 2022. Accessed February 7, 2022.
19. Mckersie AM. Effects of funding on electroconvulsive therapy in California. Published online 2011. http://sdsu-
dspace.calstate.edu/handle/10211.10/1142
20. Wilson D. F. D. A. Is Studying the Risk of Electroshock Devices. The New York Times.
https://www.nytimes.com/2011/01/24/business/24shock.html?fbclid=IwAR3Ei8SYgqva
1uAiELmmVYnRhsZ9Aude9QLolycCkLyOCb0R4K_flV68kWs. Published January 23, 2011.
21. UPDATE 1: Facing ‘Direct Harassment and Meritless Litigation,’ Electroconvulsive Therapy Device Maker MECTA
Corporation Seeks to Reorganize. Reorg.com. Published 2021. Accessed February 7, 2022.
https://reorg.com/mecta-corp-first-day-declaration
22. Somatics LLC. Regulatory Update to Thymatron System IV Instruction Manual. Somatics, LLC; 2018. Accessed
November 22, 2018. http://www.thymatron.com/downloads/System_IV_Regulatory_Update.pdf
23. Somatics LLC. Thymatron ® System IV. Somatics website. Published 2019.
http://www.thymatron.com/catalog_cautions.asp
24. Hancock SP. The Cumulative Effect: ECT’s Microstructural Damages Presentation Outline. In: A Disorder For
Everyone. ; 2021:1-16. doi:10.13140/RG.2.2.20059.85287
75
25. Abbott CC, Quinn D, Miller J, et al. Electroconvulsive Therapy Pulse Amplitude and Clinical Outcomes. Am J
Geriatr Psychiatry. 2021;29(2):166-178. doi:10.1016/j.jagp.2020.06.008
26. Castleman KR. Personal Communication, June 11, 2020.
27. Sartorius A, Kellner CH, Karl S. The Trigeminocardiac Reflex in Electroconvulsive Therapy. J ECT. 2022;Publish
Ah(00):1-2. doi:10.1097/YCT.0000000000000859
28. American Psychiatric Association. Electroconvulsive Therapy: Task Force Report.; 1978.
https://www.psychiatry.org/File Library/Psychiatrists/Directories/Library-and-Archive/task-force-
reports/tfr1978_ECT.pdf
29. Royal College of Psychiatrists. The ECT Handbook (Council Report CR128).; 2004.
30. Sackeim HA. In reply to “Relapse of depression after electroconvulsive therapy.” J Am Med Assoc.
2001;285(24):3088. doi:10.1001/jama.285.24.3087
31. Dominion Hospital. How Do You Know If ECT Treatments Are Working? YouTube; 2018.
https://www.youtube.com/clip/Ugkx-EZ_79VCHmwfY-7S1YOKhuB1Stn644kR
32. Simonson M. Psychiatric Hospitals Can Still Force Patients to Accept Shock Treatment . One Connecticut Patient
Has Been Shocked 500 Times in Five Years . Reason. https://reason.com/2020/02/11/psychiatric-hospitals-can-
still-force-patients-to-accept-shock-treatment-one-connecuticut-patient-has-been-shocked-500-times-in-five-
years/printer/. Published February 11, 2020. Accessed October 26, 2020.
33. Unal G, Swami JK, Canela C, et al. Adaptive current-flow models of ECT: Explaining individual static impedance,
dynamic impedance, and brain current density. Brain Stimul. 2021;14(5):1154-1168.
doi:10.1016/j.brs.2021.07.012 76
34. Kibret B, Premaratne M, Sullivan C, Thomson RH, Fitzgerald PB. Electroconvulsive therapy (ECT) during
pregnancy: quantifying and assessing the electric field strength inside the foetal brain. Sci Rep. 2018;8(1):4128.
doi:10.1038/s41598-018-22528-x
35. Rosalind Franklin University of Medicine and Science. Massive study reveals few differences between men’s
and women’s brains: Neuroscientists conduct meta-synthesis of three decades of research. ScienceDaily.
Published 2021. Accessed February 7, 2022.
https://www.sciencedaily.com/releases/2021/03/210325115316.htm
36. Mezei G, Lau E, Pace ND, Schenk J, Kheifets L. Receipt of Electroconvulsive Therapy and Subsequent
Development of Amyotrophic Lateral Sclerosis: A Cohort Study. Bioelectromagnetics. 2022;43(2):81-89.
doi:10.1002/bem.22389
37. Understanding Veterans’ Risk for ALS. IamALS. Accessed February 7, 2022. https://iamals.org/get-
help/understanding-veterans-risk-for-als/
38. Kleber J. Where have I been? PSP, Palliative Care, Grief, ECT and BiPolar talk - Solo Episode. Published online
2022. https://www.livedexperiencepodcast.com/where-have-i-been-psp-palliative-care-grief-ect-and-bipolar-
talk-solo-episode/
39. McPherson E. Growing up with mental illness: Joel was suddenly thrust into a foster care home at seven.
9NEWS. https://www.9news.com.au/national/growing-up-with-mental-illness-joel-was-suddenly-thrust-into-a-
foster-care-home-at-seven/39f440b4-8f14-45fb-8463-8c8b23cb17c3. Published May 23, 2022.
40. Electrical Contractors Association of Alberta. Dr. Marc Jeschke Interview on Electrical Injuries - Part 1. YouTube;
2021. https://www.youtube.com/watch?v=NXKzUIahH1I
77
41. LEE RC. Cell Injury by Electric Forces. Ann N Y Acad Sci. 2005;1066(1):85-91. doi:10.1196/annals.1363.007
42. Lee RC, Kolodney MS. Electrical injury mechanisms: dynamics of the thermal response. Plast Reconstr Surg.
1987;80(5):663-671. https://pubmed.ncbi.nlm.nih.gov/3671557/
43. Lee RC, Kolodney MS. Electrical injury mechanisms: Electrical breakdown of cell membranes. Plast Reconstr
Surg. 1987;80(5):680-681. doi:10.1097/00006534-198711000-00003
44. Morse JS, Morse MS. Diffuse electrical injury: Comparison of physical and neuropsychological symptom
presentation in males and females. J Psychosom Res. 2005;58(1):51-54. doi:10.1016/j.jpsychores.2004.06.001
45. Morse MS, Berg JS, TenWolde RL. Diffuse electrical injury: A study of 89 subjects reporting long-term
symptomatology that is remote to the theoretical current pathway. IEEE Trans Biomed Eng. 2004;51(8):1449-
1459. doi:10.1109/TBME.2004.827343
46. Hancock SP. Acquired Channelopathies Secondary to Repetitive High Energy Field “Low-Voltage” Electrical
Injury.; 2020. doi:10.13140/RG.2.2.15825.15207
47. Ptáček LJ. Channelopathies: ion channel disorders of muscle as a paradigm for paroxysmal disorders of the
nervous system. Neuromuscul Disord. 1997;7(4):250-255. doi:10.1016/S0960-8966(97)00046-1
48. Erro R, Bhatia KP, Espay AJ, Striano P. The epileptic and nonepileptic spectrum of paroxysmal dyskinesias:
Channelopathies, synaptopathies, and transportopathies. Mov Disord. 2017;32(3):310-318.
doi:10.1002/mds.26901
49. Lomas M, Rickard V, Milton F, Savage S, Weir A, Zeman A. Electroconvulsive therapy related autobiographical
amnesia: a review and case report. Cogn Neuropsychiatry. 2021;26(2):107-121.
doi:10.1080/13546805.2021.1871889
78
50. Nicole S, Fontaine B. Skeletal muscle sodium channelopathies. Curr Opin Neurol. 2015;28(5):508-514.
doi:10.1097/WCO.0000000000000238
51. Kim J. Channelopathies. Korean J Pediatr. 2014;57(1):1-18. http://dx.doi.org/10.3345/kjp.2014.57.1.1
52. Cannon SC. Pathomechanisms in Channelopathies of Skeletal Muscle and Brain. Annu Rev Neurosci.
2006;29(1):387-415. doi:10.1146/annurev.neuro.29.051605.112815
53. Ryan DP, Ptáček LJ. Episodic neurological channelopathies. Neuron. 2010;68(2):282-292.
doi:10.1016/j.neuron.2010.10.008
54. Verwijk E, Obbels J, Spaans HP, Sienaert P. Dokter, komt mijn geheugen terug? Elektroconvulsietherapie en
cognitieve bijwerkingen in de praktijk = Doctor, will I get my memory back? Electroconvulsive therapy and
cognitive side-effects in daily practice. Tijdschr Psychiatr. 2017;59(10):632-637.
http://search.ebscohost.com/login.aspx?direct=true&db=psyh&AN=2017-48405-
008&lang=cs%0Ahttp://e.verwijk@parnassia.nl
55. Sato J, Inagaki H, Kusui M, Yokosuka M, Ushida T. Lowering barometric pressure induces neuronal activation in
the superior vestibular nucleus in mice. PLoS One. 2019;14(1). doi:10.1371/JOURNAL.PONE.0211297
56. Zipes DP, Rubart M. Neural modulation of cardiac arrhythmias and sudden cardiac death. Hear Rhythm.
2006;3(1). doi:10.1016/j.hrthm.2005.09.021
57. Hyvönen S, Lohi J, Tuuminen T. Moist and Mold Exposure is Associated With High Prevalence of Neurological
Symptoms and MCS in a Finnish Hospital Workers Cohort. Saf Health Work. 2020;11(2):173-177.
doi:10.1016/j.shaw.2020.01.003
79
58. Roth CC, Tolstykh GP, Payne JA, et al. Nanosecond pulsed electric field thresholds for nanopore formation in
neural cells. J Biomed Opt. 2013;18(3):035005. doi:10.1117/1.jbo.18.3.035005
59. Chen W, Zhongsheng Z, Lee RC. Supramembrane potential-induced electroconformational changes in sodium
channel proteins: A potential mechanism involved in electric injury. Burns. 2006;32(1):52-59.
doi:10.1016/j.burns.2005.08.008
60. Pliquett U, Joshi RP, Sridhara V, Schoenbach KH. High electrical field effects on cell membranes.
Bioelectrochemistry. 2007;70(2):275-282. doi:10.1016/j.bioelechem.2006.10.004
61. Reisner AD. Possible mechanisms for delayed neurological damage in lightning and electrical injury. Brain Inj.
2013;27(5):565-569. doi:10.3109/02699052.2013.766928
62. Chen W, Lee RC. Evidence for Electrical Shock–induced Conformational Damage of Voltage-gated Ionic Channels.
Ann N Y Acad Sci. 1994;720(1):124-135. doi:10.1111/j.1749-6632.1994.tb30440.x
63. Sun T, Dasgupta A, Zhao Z, Nurunnabi M, Mitragotri S. Physical triggering strategies for drug delivery. Adv Drug
Deliv Rev. Published online 2020. doi:10.1016/j.addr.2020.06.010
64. Batista Napotnik T, Polajžer T, Miklavčič D. Cell Death Due To Electroporation – A Review. Bioelectrochemistry.
Published online 2021:107871. doi:10.1016/j.bioelechem.2021.107871
65. Garcia PA, Rossmeisl JH, Neal RE, et al. Intracranial nonthermal irreversible electroporation: In vivo analysis. J
Membr Biol. 2010;236(1):127-136. doi:10.1007/s00232-010-9284-z
66. Assistant Secretary of Defense. Traumatic Brain Injury (TBI): DoD Standard Surveillance Case Definition for TBI
Adapted for AFHSB Use. 2016;(April 2015):1-40.
80
67. American Psychiatric Association. Committee on Electroconvulsive Therapy, Weiner RD. The Practice of
Electroconvulsive Therapy : Recommendations for Treatment, Training, and Privileging : A Task Force Report of
the American Psychiatric Association. 2nd ed. American Psychiatric Association; 2001. Accessed January 5,
2019.
https://books.google.com/books?id=iuuLJtmo_EYC&dq=+avery+Winokur+%22Electroconvulsive+therapy%22&l
r=&source=gbs_navlinks_s
68. Ferraro A, Roizin L. Cerebral Morphologic changes in monkeys subjected to a large number of electrically
induced convulsions (32-100). Am J Psychiatry. 1949;106(October):278-284. doi:10.1176/ajp.106.4.278
69. Omalu B. Chronic Traumatic Encephalopathy. In: Niranjan A, Lunsford LD, eds. Concussion. Vol 28. Karger
Publishers; 2014:38-49. doi:10.1159/000358761
70. Omalu B, Hansen S, Williams E, et al. Traumatic Brain Injury Advisory Board Meeting Minutes.; 2019.
https://www.dor.ca.gov/Content/DorIncludes/documents/TBI/TBI Full Committee Meeting Minutes 8-26-
19.docx
71. Fink M. Electroconvulsive Therapy: A Guide for Professionals and Their Patients.; 2009.
https://epdf.tips/electroconvulsive-therapy-a-guide-for-professionals-and-their-patients.html
72. Kirstein L, Ottosson J-O. Experimental studies of electroencephalographic changes following electroconvulsive
therapy: the role of the electrical stimulation and of the seizure studied by variation of stimulus modification by
lidocaine of seizure discharge. Acta Psychiatr Scand Suppl. 1960;35(145):49-67.
https://pubmed.ncbi.nlm.nih.gov/14409401/
73. Somatics LLC. The Thymatron® System IV: Description and Specifications. ML-TS4, Re. Somatics, LLC 81
74. Somatics L. User Manual Thymatron® System IV (Revision 21). Revision 2.; 2019.
http://thymatron.com/downloads/System_IV_Instruction_Manual_Rev21.pdf
75. Skau S, Bunketorp-Käll L, Kuhn HG, Johansson B. Mental Fatigue and Functional Near-Infrared Spectroscopy
(fNIRS) – Based Assessment of Cognitive Performance After Mild Traumatic Brain Injury. Front Hum Neurosci.
2019;13(May):1-12. doi:10.3389/fnhum.2019.00145
76. Allen M. What is EPIC Concussion Treatment? Cognitive Fx Website. Published 2021. Accessed August 6, 2022.
https://www.cognitivefxusa.com/blog/epic-concussion-treatment
77. Department of Psychiatry: Univeristy of Michigan. ECT: The final (essential) option. Michigan Medicine News
and Publications. Published 2021. Accessed August 6, 2022.
https://medicine.umich.edu/dept/psychiatry/news/archive/202107/ect-final-essential-option
78. Steel J, Ferguson A, Spencer E, Togher L. Language and cognitive communication disorder during post-traumatic
amnesia: Profiles of recovery after TBI from three cases. Brain Inj. 2017;31(13-14):1889-1902.
doi:10.1080/02699052.2017.1373200
79. Yiannopoulou KG, Papagiannis GI, Triantafyllou AI, et al. Neurological and neurourological complications of
electrical injuries. Neurol Neurochir Pol. 2021;55(1):12-23. doi:10.5603/JNNS.a2020.0076
80. Fromm GH, Terrence CF, Maroon JC. Trigeminal Neuralgia Current Concepts Regarding Etiology and
Pathogenesis. Arch Neurol. 1984;41(11). doi:10.1001/archneur.1984.04050220102026
81. Surviving electroshock – International support group for ECT survivors. Facebook. Accessed October 23, 2020.
https://www.facebook.com/groups/ECTsurvivors
82
82. Jeschke M. Electrical Injury. Published online 2021. https://lifeafterect.com/guest-understanding-electrical-
injury-dr-marc-jeschke/
83. Kriss A, L.D. Blumhardt, A.M. Halliday, R.T.C. Pratt. Neurological asymmetries immediately after unilateral ECT. J
Neurol Neurosurg Psychiatry. 1978;41(12):1135-1144. doi:10.1136/jnnp.41.12.1135
84. Stern TA, Fricchione GL, Cassem NH, Jellinek MS, Rosenbaum JF. Massachusetts General Hospital Handbook of
General Hospital Psychiatry. 7th ed. Elsevier; 2018. doi:10.1016/B978-0-323-02767-0.X5001-3
85. Felkel WC, Wagner G, Kimball J, et al. Tardive seizure with postictal aphasia: a case report. J ECT.
2012;28(3):180-182. doi:10.1097/YCT.0b013e318255a8d4
86. Pinkhasov A, Furer T, Augusto S. Transient Expressive Aphasia After Bitemporal Electroconvulsive Therapy. J
ECT. 2015;31(1):e20-e21. doi:10.1097/YCT.0000000000000207
87. Buday J, Albrecht J, Mares T, Raboch J, Anders M. Transient aphasia after right-unilateral ultrabrief
electroconvulsive therapy: A case report. Brain Stimul. 2018;11(5):1203-1204. doi:10.1016/j.brs.2018.06.007
88. Trimble MR. Psychopathology of frontal lobe syndromes. Semin Neurol. 1990;10(3):287-294. doi:10.1055/s-
2008-1041280
89. Fridriksson J, Ouden D-B Den, Hillis AE, et al. Anatomy of aphasia revisited. doi:10.1093/brain/awx363
90. Pratt RT, Warrington EK, Halliday AM. Unilateral ECT as a test for cerebral dominance, with a strategy for
treating left-handers. Br J Psychiatry. 1971;119(548):79-83. doi:10.1192/bjp.119.548.79
91. Mashayekhi A, Ghayoumi A. Catatonia Development in a Patient with Bipolar Disorder Following
Electroconvulsive Therapy: A Case Report. Iran J Psychiatry. 2019;14(1):109-112.
http://www.ncbi.nlm.nih.gov/pubmed/31114623
83
92. Friedberg J. Neuropathologic Effects of ECT. Am J Psychiatry. 1981;138(8):1129.
93. Kolshus E, Ryan KM, Blackshields G, Smyth P, Sheils O, McLoughlin DM. Peripheral blood microRNA and VEGFA
mRNA changes following electroconvulsive therapy: implications for psychotic depression. Acta Psychiatr
Scand. 2017;136(6):594-606. doi:10.1111/acps.12821
94. Yarnell PR. Neurorehabilitation of cerebral disorders following lightning and electrical trauma.
NeuroRehabilitation. 2005;20(1):15-18. https://content.iospress.com/articles/neurorehabilitation/nre00259
95. Matthews E, Balestrini S, Sisodiya SM, Hanna MG. Muscle and brain sodium channelopathies: genetic causes,
clinical phenotypes, and management approaches. Lancet Child Adolesc Heal. 2020;4642(19):1-12.
doi:10.1016/S2352-4642(19)30425-0
96. Bocchino J V, Tucker HM. Recurrent laryngeal nerve pathology in spasmodic dysphonia. Laryngoscope.
1978;88(8 Pt 1):1274-1278. doi:10.1288/00005537-197808000-00008
97. Yogakanthi S, Wools C, Mathers S. Unilateral vocal cord adductor weakness: an atypical manifestation of motor
neurone disease State-Wide Progressive. BMJ Neurol Open. 2021;3:205. doi:10.1136/bmjno-2021-000205
98. Hancock SP. Communication Strategy for Electrical Injury Sequelea (ASL for Episodic Verbal Apraxia and
Dystonia). YouTube; 2021. https://youtu.be/AvpzIufrBZ4
99. Hancock SP. Electrical Injury: Thiols, Reactive Oxygen Species, Nerve/Vascular Function--Case Study. YouTube;
2021. https://youtu.be/SgWS9z0BQ0U
100. Zhou Y. An oxidative stress response mechanism by the vibrio cholerae arcab two-component system.
Published online 2020. https://repository.upenn.edu/edissertations/3941/
84
101. Koliwad SK, Brzezinska AK, Elliott SJ. Redox Regulation of Ion Channels. In: Sen CK, Sies H, Baeuerle PA, eds.
Antioxidant and Redox Regulation of Genes. Elsevier Inc.; 2000:81-104. doi:10.1016/B978-012636670-9/50006-
4
102. Baba SP, Bhatnagar A. Role of thiols in oxidative stress. Curr Opin Toxicol. 2018;7:133-139.
doi:10.1016/j.cotox.2018.03.005
103. Puglia MP, Holman AE, Elliott AB, Gruffi CA. Anesthesia in Pediatric Otolaryngology. In: Cummings Pediatric
Otolaryngology. Elsevier; 2021:15-45. doi:10.1016/B978-0-323-69618-0.00002-0
104. General Motor Dysfunction of the Tongue 18 Months after Electroconvulsive Therapy (ECT). YouTube; 2022.
https://youtube.com/shorts/dHnavS9jia8
105. Jaw Fasciculations a Decade after Electroconvulsive Therapy. YouTube; 2021.
https://www.youtube.com/shorts/Jh2X7xe0jAg
106.Keszler A, Lindemer B, Broeckel G, Weihrauch D, Gao Y, Lohr NL. In Vivo Characterization of a Red Light-
Activated Vasodilation: A Photobiomodulation Study. Front Physiol. 2022;13(May):1-10.
doi:10.3389/fphys.2022.880158
107. Cough Drop. Every voice should be heard. https://www.mycoughdrop.com/?ref=gb2
85