![]() ![]() Here's what my testing workflow looked like: (And I opted not to test any brand new apps that are still in beta, since there are so many established options out there.) (Of course, if you opt for one of those, you can still easily get AI-generated images from a separate tool and copy them into your presentation app of choice.)īeyond that, I also looked for presentation apps that brought something unique to the table-features above and beyond what you can get for free from a legacy solution like PowerPoint or Google Slides. For that reason, I opted not to make AI features a strict requirement (for now!), and I've still included apps that don't offer AI. ![]() While many apps now offer AI features in one way or another, I found many of these features to be lacking still-they're often slow, struggle to pull in relevant imagery, and yield wildly inconsistent designs. For our purposes here, I only tested software that uses slides, with the familiar deck-based editor you expect from a "presentation" tool (versus, for example, a video creation app). There's no reason to use multiple tools when one can do it all, so I didn't test any apps that require and work on top of another presentation app like PowerPoint or Google Slides.įamiliar, deck-based UI. With capable free tools on the market, affordability is a top consideration. ![]() Creating compelling presentations is important, but you shouldn't have to bust your budget to make it happen. Templates are great, but top presentation apps should enable you to customize just about everything-giving you the flexibility to build exactly what you need.Īffordability. Whether you plan to share your webinar slides later, or you just want to collaborate with a coworker on a presentation, it should be easy to share files and collaborate in real-time.įlexibility and customization options. The best presentation tools should have attractive, professional-looking templates to build presentations in a hurry. With that in mind, here's what I was looking for: After all, slideshows are used for just about everything, from pitch decks and product launches to class lectures and church sermons. When looking for the best presentation apps, I wanted utility players. For more details on our process, read the full rundown of how we select apps to feature on the Zapier blog. ![]() We're never paid for placement in our articles from any app or for links to any site-we value the trust readers put in us to offer authentic evaluations of the categories and apps we review. Unless explicitly stated, we spend dozens of hours researching and testing apps, using each app as it's intended to be used and evaluating it against the criteria we set for the category. We include some sample media files from our new ProContent Library so that you have media to help you get started.Our best apps roundups are written by humans who've spent much of their careers using, testing, and writing about software. So what's in the sample content? We're glad you asked! A new sample library will be installed that contains several presentations showing off some of the different functionality and designs that you can use in ProPresenter 7 as well as a playlist of those files. Click Continue a few times until you reach the Continue Learning screen again. If you went past this screen a little too fast during the initial setup and missed this option, you can always click on the Window menu at the top of the screen and click on Welcome to ProPresenter in the menu. When you click on this option it will start downloading our sample content for you so that you have a few things to get started with when you first open the program. This window will guide you through accepting the EULA, setting up some initial defaults for screens, and showing you this final set of options for common tasks.Īt the top of this list is Get Sample Content. When you first install and open ProPresenter you will see the "Welcome To ProPresenter" window. You can also come back to install this later. Welcome to ProPresenter 7! Are you ready to start taking a look around and getting familiar with the program? We've got some sample content (including some free media just for trying the program!) available that you can install during the initial setup. ![]()
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![]() Here’s a look at different Valorant pro players’ crosshair codes that you can copy and use in your next match. With so many different settings to experiment with, it can be daunting to figure out what works for you, which is why the crosshair settings used by top players can be a good starting point. KovaaK’s: Which is the best FPS aim trainer?įull list of Valorant Harbor guides: How to play, best maps, agent design explained Phantom or Vandal: nAts explains which Valorant rifle is best for youĮxclusive: How to be an effective Valorant in-game leader, a guide by FNSĪim Lab vs. How to play Viper on Pearl: The best wall and smoke spots However, crosshair choice is still largely a matter of personal preference. ![]() The right crosshair can positively impact your aim and elevate your gameplay. ![]() These best Valorant crosshair codes can be copied and pasted between accounts for quicker import and export of settings, which means you can now easily replicate the crosshair settings used by pro players. Riot Games has made it a lot easier to switch between different crosshairs with the introduction of dedicated crosshair codes in Valorant patch 4.05. ![]() ![]() Notes: Instant Pot Mac and Cheese, Mix Wet Ingredients: While the macaroni is pressure cooking, mix the wet ingredients in a medium mixing bowl.My favorite so far has been the H-E-B Three Cheese Cheddar Blend which has mild and sharp cheddar and fontina. You can keep food in the fridge for up to three days. Salt and pepper can be added to taste.If the pasta stays in the pot, it can cook too long and get lumpy and curdled. Once the cheese has melted, take the pot out of the pressure cooker and pour the macaroni and cheese into a serving dish right away.Repeat, adding 1/3 of the cheese at a time, until all of the cheese has been added. The macaroni should be stirred until the cheese melts. If there is still water, drain the pasta. ![]() Mix the pasta so that there are no clumps.Stir it for about two minutes, or until it gets thick. If it's not already on "keep warm," turn it on.After one minute, use a quick pressure release to open the machine. Let the pasta sit for one minute after the cooking cycle is done.While the pasta is cooking, mix evaporated milk, egg, mustard, and hot pepper sauce together in a small bowl with a whisk.Set the high pressure timer for 4 minutes. In the pot of an electric pressure cooker, mix water and salt.Seal lid, and set to 'Pressure Cook' (or … In your Instant Pot insert, add the dried macaroni noodles, butter, and 1 1/4 cup water. Notes: Instant Pot Kraft Mac and Cheese Recipe, Instructions. Mix well and let sit for 1-2 minutes on the "keep warm" setting, until the mixture thickens.Mix in the milk and the cheese packet's contents.After three minutes of natural release, the gun goes off quickly.After three minutes of letting go naturally, quick.Pressure four minutes of manual high pressure cooking.Do not stir the macaroni in, but leave the cheese packet out.The Instant Pot needs water and butter.Unsaturated Fat: 12 grams unsaturated fat.Let the pressure drop on its own for 1 minute and 30 seconds, then let out the rest of the steam. ![]() Close the lid and steam valve on your pressure cooker. Stir your elbow macaroni and water into your pot. Then you'll need 3 cups of liquid, which can be water or chicken broth. How to cook elbow macaroni in pressure cooker? Stir in 1/4 cup of milk and the contents of the Kraft cheese packet. Do not be surprised if it seems to have too much liquid, like in the picture above. Pressure Cook on manual high pressure for 4 minutes, let the pressure come down on its own for 3 minutes, and then quick release the pressure. How do you cook Kraft Cheese in a pressure cooker? Unless you do a quick release, your pasta will stick together. Add the lid, make sure it's in the sealing position, and set the manual high pressure timer for 4 minutes. How to make boxed Mac and cheese in an Instant Pot Put the macaroni, water, milk, and butter in the bowl of the Instant Pot. How to cook boxed Mac n Cheese in Instant Pot? Sliced hot dogs can be added now if you want to. Add the noodles from your box of boxed macaroni and cheese and stir well so the water gets a little cloudy, which washes off the powder that was on the noodles. If you are cooking hot dogs, add 1 3/4 cups of water. How to Cook Mac and cheese in a pressure cooker?Īdd 1 1/2 cups of water to your pressure cooker. Pour the pasta into the pot in an even layer. Notes: Instant Pot Kraft Macaroni and Cheese (Easy No Drain, Open the Kraft Macaroni and Cheese box and set aside the cheese packet. ![]() If you want it thinner, slowly add milk until you get the right consistency.
![]() ![]() Until they produce a plan, we’re left to rely on a wide array of Republican budgets, statements, and proposals-past and present-which provide clear and consistent evidence that many critical programs the American people count on will be on the chopping block. As the President has made clear, they owe the American people a detailed accounting of exactly what they plan to cut in order to cover the costs of their proposals, while also achieving the kinds of fiscal targets that they claim to support. While they have consistently said that reducing the deficit is a top priority, Congressional Republicans have already proposed policies that would add an additional $3 trillion to the debt over the next decade-all while raising costs for working families and handing out tax giveaways to the wealthy and big corporations. No one earning less than $400,000 per year will pay a penny in new taxes.Ĭongressional Republicans have taken a very different approach. ![]() The President’s Budget details a blueprint to build on this progress, deliver on the agenda he laid out in his State of the Union, and finish the job: continuing to grow the economy from the bottom up and middle out by investing in America, lowering costs for families, protecting and strengthening Medicare and Social Security, and reducing the deficit by nearly $3 trillion over the next decade by making the wealthy and big corporations pay their fair share and cutting wasteful spending on Big Pharma, Big Oil, and other special interests. And the reforms he signed into law to take on Big Pharma, lower prescription drug costs, and make the wealthy and large corporations pay their fair share will reduce the deficit by hundreds of billions of dollars more over the coming decade. While the previous Administration passed a nearly $2 trillion unpaid-for tax cut with benefits skewed to the wealthy and big corporations while dramatically increasing the deficit, President Biden cut the deficit by more than $1.7 trillion during his first two years in office-the largest decline in American history. ![]() The President has done all of this while delivering on his commitment to fiscal responsibility. And the President’s plan is rebuilding America’s infrastructure, making the economy more competitive, investing in American innovation and industries that will define the future, and fueling a manufacturing boom that is strengthening parts of the country that have long been left behind while creating good jobs for workers, including those without college degrees. The President has taken action to lower costs and give families more breathing room, including cutting prescription drug costs, health insurance premiums, and energy bills, while driving the uninsured rate to historic lows. The past two years were the best two years for new small business applications on record. The Black and Hispanic unemployment rates are near record lows. The unemployment rate has fallen to 3.4 percent, the lowest in 54 years. Under the President’s leadership, the economy has added more than 12 million jobs-more jobs in two years than any president has created in a four-year term-including 800,000 manufacturing jobs. Over the past two years, in the face of significant challenges, that economic strategy has produced historic progress for the American people. President Biden has long believed that we need to grow the economy from the bottom up and middle out, not the top down. Get Involved Show submenu for “Get Involved””īudget Details Plan to Invest in America, Lower Costs and Cut Taxes for Working Families, and Protect and Strengthen Medicare and Social Security.The White House Show submenu for “The White House””.Office of the United States Trade Representative.Office of Science and Technology Policy. ![]() Executive Offices Show submenu for “Executive Offices””.Administration Show submenu for “Administration””. ![]() ![]() ![]() It was a turn that was ripe for satire, which is just what creator Alan Spencer did with this short-lived series. And, of course, our culture reflected this by the return of Dirty Harry, the Eastwood-inspired TV show Hunter, and three Death Wish sequels. them” mentality fueled by the Cold War was rampant in the ’80s. Vigilante justice and a tough-nosed “us vs. Sledge Hammer! Original Run: 1986-88 Creator: Alan Spencer Stars: David Rasche, Anne-Marie Martin, Harrison Page Network: ABC Fun trivia bit: It also starred Robert Englund, better known as Freddy Krueger, the same year he appeared in the first A Nightmare on Elm Street and became a horror icon.- Jim Vorelħ9. Louis called it “ Dynasty with lizard makeup and laser guns.” It was also plagued by cast issues-Michael Ironside straight-up walked out on the program during its first and only season. Expanded into a full series, however, the show was more like a sci-fi soap opera with lizard people: The Post Dispatch in St. The story of Earth being invaded by friendly-looking “Visitors” who actually turn out to be man-eating reptile people was pure 1950s sci-fi claptrap, simply updated with ’80s fashion, but unfolding over the course of a two-night miniseries, it was cheesy good fun. V Original Run: 1983-85 Creator: Kenneth Johnson Stars: Marc Singer, Faye Grant, Jane Badley, Michael Ironside, Robert Englund Network: NBC V in the 1980s is a great example of a concept that worked well as a miniseries but couldn’t support itself as a full-on TV show. ![]() For those between-decade shows, we judged them based only on what parts aired in the ’80s themselves, so in the case of the best show of the 1990s, The Simpsons, its one ’80s Christmas special did not allow it to make the cut.Ĩ0. To be eligible, a series had to air either part or all of its run between Januand December 31, 1989. ![]() Big hair, loud colors, and very special episodes ruled the day, as TV dared to talk about issues that had always been taboo.īelow, we went through the archives of the airwaves, picking the 80 best TV shows of the 1980s. Nostalgia for bygone eras gave me a connection to the ’50s with Happy Days and the ’60s with Wonder Years, but mostly shows captured the 1980s in all of its neon glory. It was a golden age for sitcoms and for big, silly action-adventures where the good guys always won-plenty to distract us from the last vestiges of the Cold War and a pair of nuclear arsenals that could do a decent imitation of the Death Star. This was the decade of the VCR, but you still didn’t make plans on Thursday nights. To say that I was raised by 1980s TV is unfair to my wonderful parents, but I certainly spent as much time with the Keatons, the Huxtables, the Seavers, the 4077th, and the Cheers gang as I did around my own kitchen table. ![]() ![]() ![]() Just download the resume and edit it according to your liking. Its compatibility with other text document applications and software make it a must-have. You don’t have to be a wizard or a genius to edit a Word template. There are a lot of times that a job seeker doesn’t get hired because the resume does not contain any contact information, and, sadly, that is wasted opportunity that could have been prevented with a proper outline. It is understandable that looking for a job takes up a lot of your brain’s thinking space, so it is helpful to have a blueprint on what a resume should essentially have. You have a thought-out guide so you don’t miss any important details.Make sure you have the right resume format for your Word template (use our resume format guide) and make sure each section of the resume addresses exactly what the employer needs - our handy resume-writing guide will give you all the tips you need.Download Now Why Do You Need Resumes Templates?Īside from saving resources such as time and energy, here are other reasons why you need a resume template: While putting together a resume that looks its best is important, what you put in your resume is just as important. Highlight the URL you want to link to, go to the “Insert” tab on your Word screen, and click on the “Links” icon. If you want to point employers towards a job network profile (e.g., LinkedIn) or a professional portfolio site, be sure to link the text of your Word resume. To see how experts in your field space their resume, visit out resume examples page. Don’t clutter up your Word resume template with too much text use peppy bullet points and phrases, and use margins that are at least 1 inch from the edges of the document. What’s not in your resume can be just as important as what’s in your resume - aim to create a document that has a bit of space and is easy on the eyes. You might be tempted to use special graphic elements in your Word resume template to gussy it up, but employers (and the applicant tracking systems (ATS) they use to scan resumes) will find it easier to read your resume if you use simple lines and bullet points. Make sure your formatting is consistent throughout, and when you’re ready to save the document, click the paragraph icon again to return to normal view. Now you’ll see how tabs, spaces and paragraph returns are used in your document. ![]() Just go to the “home” tab of your Microsoft Word screen and click the paragraph icon. The easy way to check your Word template resume layout is to display all the formatting marks for your resume. You can always go back and edit your document or customize its appearance if needed.ġ. Once you’ve completed your resume, you can save it and download it in Microsoft Word format. ![]() Save your resume and download it in Word.Just adapt them as needed for your own resume. Be sure to include both hard and soft skills.Īs with the other sections of your resume, we’ll give you professionally-written suggestions on what to include in your Word template resume summary. Provide details on your education, and we’ll fill out your education section for you, followed by suggestions on the skills you should feature for your job Word resume template. ![]() Complete your education and skills section.Open our Resume Builder - you’ll be given the option of choosing from dozens of templates, all of which can be saved in Microsoft Word format.Īfter you enter some info about your past and/or current jobs, we’ll provide you with expert suggestions on how to fill out your work history section in your Word resume template. Download a personalized cover letter in minutes with our cover letter builder. ![]() ![]() ![]() Here you will find a list of discussions in the Rocket League Trading forum at the Other Online Games Trading category. ![]() We offer all the features you need for a successful and safe trade. The rules above would be adjusted without further notice, please read carefully before playing. Buy Rocket League accounts at worlds leading marketplace for Rocket League keys, items, skins and leveling/boosting services.Only the first ONE account from some IP allowed to join the giveaway every day, and other accounts from the IP will not be counted into our Rank List!.NOTICE: Multiple accounts from same IP, cheating and robots is forbidden here! To Be Fair, please only register one account with your correct e-mail to play! Please do not open crates continuously for hours, otherwise it will be determined as suspicious by our system.Creating or signing into an existing Epic Games Account is the first step of the process. 20 crates opening as a round (Multiple rounds ACCPETED), your round with the highest price (total price of all the items your opened from crates) will be counted to rank on below list. Rocket League’s cross-platform progression is made possible with an Epic Games Account.Join The Givaway Easily: Register and Set your platform, Choose OPEN CRATE to Play our crate simulator.We'll be sad to see you go, but to delete your account you can head to the Security Keep in mind that you need to be logged in for this and there is a 60 days cooldown until you can change your You can change the username on your own by visiting your Account Settings page. IfĪfter this you're still not sure why, you may contact us, but appeals are very rarely Please check our trading rules at /trading/rules. It is very, very rare that our moderation team make mistakes and bans are usually well justified with supportingĮvidence. Rocket League Account Activation page on the Otherwise, please ensure that your Epic Account is configured properly on the If you've won this many but the process says You'll need at least 35 online wins on your Rocket League account. Platform - follow the instructions carefully. Visiting your Account page whilst logged in. ![]() Why can't I make a trade or message usersīefore you're able to send messages or create trades, you have to link at least one of your platform accounts by If you have lost the password to your RLG account, you can request a password reset on the If you already have a Premium plan with auto-reply, you can configure it in your account settings: /account/messages. PLAY ROCKET LEAGUE FOR FREE Download and compete in the high-octane hybrid of arcade-style soccer and vehicular mayhem Unlock items in Rocket Pass, climb the Competitive Ranks, compete in Competitive Tournaments, complete Challenges, enjoy cross-platform progression and more The field is waiting. Read more on our Premium landing page: /premium. The auto-reply feature can be unlocked by purchasing a Professional, Ultimate, or Titanium plan. Head to /contact to contact us, if your issue relates to this website.ĭoes Rocket League Garage have a Discord? Our trading rules can be found at /trading/rules. Rocket League Garage supports PC, Playstation, Xbox, Epic Games and Nintendo Switch. What platforms are supported on Rocket League Garage? Rocket League - Rocket League is a high-powered hybrid of arcade-style soccer and vehicular mayhem with easy-to-understand controls and fluid, physics-driven competition. Please visitĪnd follow directions to properly report a bug or glitch. I have an issue with the game, or found a bug in the game, how can I report it?įor any issues related to the game, please contact Psyonix, not us. Rocket League Championship Series is located at The official website of Rocket League can be found at (other than our Epic Creator Code - #EpicPartner), we are just a fan site for the game. Rocket League Garage is not affiliated with Psyonix or Epic Games General Are you an official website of Rocket League? The following are questions that some members of the site have asked us, or ones that we feel you might find ![]() ![]() ![]() Learn more: Cassie Stephens/Clay Turtles 14. ![]() If you don’t have a kiln, use air-dry clay, or even try this with Play-Doh. Have kids use the sole of their shoe (stomp!) to create textures and patterns. Model textured clay turtlesīreak out the clay! These little turtles are easy to assemble, but it’s the shells that are the really fun part. Show kids that even their scribbles are full of personality and life! Let kids experiment with a variety of media (crayons, markers, pastels, etc.), then turn their scribbles into creatures in a few simple steps. So go ahead and try this Paul Klee–inspired kindergarten art project, even if it is a wee bit messy. You might shudder at the idea of dipping your shape blocks in paint, but let’s face it: those sticky blocks were due for a good cleaning anyway. Learn more: Deep Space Sparkle/Color Wheel Flowers 11. They get good practice with scissor skills too. Kids paste primary flower petals first, then fill in with secondary colors. This might look like just another cute kindergarten art project, but really, the goal is to teach the color-wheel concept. Learn more: Deep Space Sparkle/Watercolor Castle 10. ![]() Students will definitely be amazed to see the way the crayons resist the paint. These castles use a fun technique where students draw designs and shapes with crayons and then paint over it with watercolors. Learn more: Meri Cherry Art Studio/Self-Portrait Shadow Box 9. Attach a transparency to the front and add fun details using Sharpies or chalk markers. Turn old cardboard boxes (cereal boxes are the perfect size) into shadow boxes with a photo of a student inside. Learn more: Cassie Stephens/Kindergarten Alphabet Paintings 8. Then paint alphabet letters over the top. Fold paper into squares and add a different color or pattern to each. Kindergarten is all about the ABCs, so this is a perfect kindergarten art project. Visit the link to learn how to do hand cats, hand giraffes, hand dinos, and more! Trace your handĪnyone can do a hand turkey. Learn more: A Dab of Glue Will Do/Fingerprint Tree 6. Mix it up with fall colors to make this an autumn craft instead of spring. OK, technically this one is finger painting, but it’s a little more sophisticated. These sweet little snails are easy to make, especially when you use the free printable templates available at the link. Pile up paper tubesĭon’t throw away those tubes after you print with them! Instead, pile them up to make unique sculptures. ![]() ![]() There's more to AutoHotkey than we could ever fit into one small article, so check out the AutoHotkey documentation and forums for more advanced instructions and ideas. ahk script to Windows' startup folder, located at %APPDATA%\Microsoft\Windows\Start Menu\Programs\Startup, so it will automatically run every time you turn on your computer.) You can quit the program at any time to set your keys back to their default actions. This will launch AutoHotkey in the system tray, and it will run in the background interpreting your hotkeys for you. Once you've finished adding your hotkeys to the script, save the file and double-click on it. You can even have one hotkey perform multiple actions in a series, giving you robust control over your shortcuts. You can create hotkeys to type certain lines of text, run a program or batch file, or create shortcuts for specific programs. This is where AutoHotkey becomes more powerful. ![]() Where ^ corresponds to Ctrl and + to Shift, as described here. You would create a line in your script like this: You can add a comment above it using a semicolon ( ) to remind you of what that hotkey does or why.Īgain, SharpKeys is a better choice for a simple remapping like this, but let's say you wanted to do something slightly more complicated, like remap Caps Lock to Ctrl+Shift+Esc, so you can see the Windows Task Manager with one keypress. This remaps Caps Lock to the right Windows key. You can create basic hotkeys by adding a line like this: Right-click on the resulting file and open it in Notepad. It's a bit more difficult to use than the software you get with gaming keyboards, but if your keyboard doesn't come with its own remapping program, it's your next best bet.Īfter installing AutoHotkey, you can create your hotkeys by right-clicking anywhere in Windows Explorer and choosing New > AutoHotkey Script. ![]() If neither of the above options suit your needs, you can create extremely powerful hotkeys with AutoHotkey, a free program that comes with its own little scripting language for you to describe the actions you want your hotkeys to take. But if you already have it on your system, it may be able to do exactly what you want without installing any other software, so give it a shot. Your mileage may vary with these, as I've found certain programs to be jankier than others in the past. When in doubt, check the support page for your specific keyboard, and you'll find tutorials on how to get it done. Some will even let you "record" macros, allowing you to create complex shortcuts just by recording your actions and assigning them to a hotkey.Įach of these programs are a bit different, so we can't go into all of them here, but the gist should be the same across manufacturers: download the software, select your keyboard, and look for the option to create new hotkeys, macros, or actions. Not only can you remap keys, but many of these programs let you create multi-key shortcuts, insert blocks of text, or create different profiles for each of your games. If your keyboard comes with advanced software, like Logitech's Gaming Software, Corsair's iCUE, or Razer's Synapse, you may have some key-remapping features already present on your system. You can even delete SharpKeys when you're done the program is merely a user-friendly interface for the Windows registry, so once the changes are made, you don't need it anymore. Close the program, restart your computer, and you should find your keys have taken on their new roles. Repeat this process for any other remappings, then click the Write to Registry button. You can also press the Type Key button and press a key on your keyboard if you have trouble hunting it down in the list. The left column denotes the key you'll press (for example, the Caps Lock key) and the right column denotes the action that key will take (for example, acting as the Windows key). ![]() To remap a key, click the Add button and choose your keys from the two columns. You don't have to rely on some other software as a middleman, and you'll run into the fewest compatibility issues, since Windows itself is interpreting the keystrokes.ĭownload the program (I recommend the portable zip version, which doesn't require installation) and start it up. Since SharpKeys writes this information directly to the Windows registry, it's the best option for these kinds of one-to-one key remappings. As an example, I use SharpKeys to make my Alt key act as the Ctrl key, and my Caps Lock act as the Windows key. If you merely want to remap one key to another, SharpKeys is a simple, open-source program that uses the Windows registry. ![]() ![]() ![]() Once the leads are placed, they are connected to an external battery and covered by a large bandage. A physician will use a small needle to place two temporary leads for the spinal cord stimulator along the area of the spine that correlates with your pain. When you are brought into the procedure room, nurses will clean your skin at the injection sites and apply a local anesthetic to numb your skin. After being admitted, you will receive sedation through an IV prior to the procedure. The SCS trial procedure is performed by a physician at an outpatient surgery center. The spinal cord stimulation procedure is broken up into two parts, a trial period and the permanent implant. Spinal cord stimulation has proven to be a very effective treatment for relieving pain from a variety of conditions, including failed back surgery, sciatica, spinal stenosis, epidural fibrosis, and diabetic peripheral neuropathy (DPN). This innovative technique is capable of providing at least as much relief as opioid medications, without the negative side-effects. Pain is reduced because the electrical pulses modify and mask pain signals before they reach the brain. The leads apply the electricity to the nerves, “stimulating” them. The battery emits mild electric pulses which are carried to the nerves by the leads. The leads are then connected to the battery, which is implanted into a small pocket in the lower abdomen. The leads are placed along the spine, next to the nerves causing pain. A stimulator consists of two parts, a battery and a pair of thin leads with electrodes on the tips. The device that performs stimulation therapy is called a spinal cord stimulator. Any significant local pain should be reported to the doctor.Spinal cord stimulation is primarily prescribed for patients who have tried conservative therapies and experienced inadequate pain relief, would not benefit from additional surgery, or do not want to pursue surgery due to risks or long recovery. The site on the back where the leads and electrodes were inserted is usually uncomfortable for a few days. If the pain is not relieved, the doctor should be contacted right away so the device can be reprogrammed. The doctor may ask the patient to track which stimulation settings are used at different times and how well the pain was relieved.With some models, adjustments are needed for significant body movements, such as getting up or lying down. The controller offers a range of adjustments in the intensity and duration of stimulation. The patient is given the controller and can turn it on to send pulses of current to the electrodes as needed.A hand-held controller to adjust the amount of stimulation is programmed by the doctor based on the earlier feedback from the patient during adjustment of the electrical contacts.The patient is given time to recover from the procedure before going home.See Rechargeable Spinal Cord Stimulators for Chronic Pain The wire connecting to the external neurostimulator is taped to the person’s back during the trial to hold it in place. The leads are connected to an exterior pulse transmitter that the patient wears on a belt.Once the patient has reported on the pain-relief coverage, the patient is again sedated. Devices using newer technology generally avoid the tingling sensation and a wake-up test may not be needed.) Each electrode affects pain in a different area, so doctor-patient communication is crucial in making sure the doctor has adjusted the location of the electrical contacts to cover all the areas in pain. (If a low-frequency system is used, the goal will be to cover all painful areas with a slight tingling sensation known as paresthesia. The patient is awakened to provide feedback on the specific areas where pain is relieved by the stimulation, and where pain relief is still required. ![]() See Introduction to Diagnostic Studies for Back and Neck Pain In some cases, a small incision may be needed to insert the needle. The needle contains thin, insulated wires, called leads, with electrical contacts attached. Guided by fluoroscopy (a type of X-ray), the doctor inserts a hollow needle into the area around the spinal canal called the epidural space.Local anesthesia is applied to the injection site and sedation may be provided.Procedures vary somewhat with the stimulation device used, but these are the typical steps. The trial period procedure is usually performed in a doctor’s office or a surgical center. ![]() |
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