scholarly journals Immediate Effects of Transcutaneous Spinal Cord Stimulation on Motor Function in Chronic, Sensorimotor Incomplete Spinal Cord Injury

2020 ◽  
Vol 9 (11) ◽  
pp. 3541
Author(s):  
Christian Meyer ◽  
Ursula S. Hofstoetter ◽  
Michèle Hubli ◽  
Roushanak H. Hassani ◽  
Carmen Rinaldo ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Cord Stimulation ◽  
Spinal Injury ◽  
Plantar Flexion ◽  
Spinal Reflex ◽  
Incomplete Spinal Cord Injury ◽  
Spinal Circuitry ◽  
Cord Injury ◽  
Spinal Excitability

Deficient ankle control after incomplete spinal cord injury (iSCI) often accentuates walking impairments. Transcutaneous electrical spinal cord stimulation (tSCS) has been shown to augment locomotor activity after iSCI, presumably due to modulation of spinal excitability. However, the effects of possible excitability modulations induced by tSCS on ankle control have not yet been assessed. This study investigated the immediate (i.e., without training) effects during single-sessions of tonic tSCS on ankle control, spinal excitability, and locomotion in ten individuals with chronic, sensorimotor iSCI (American Spinal Injury Association Impairment Scale D). Participants performed rhythmic ankle movements (dorsi- and plantar flexion) at a given rate, and irregular ankle movements following a predetermined trajectory with and without tonic tSCS at 15 Hz, 30 Hz, and 50 Hz. In a subgroup of eight participants, the effects of tSCS on assisted over-ground walking were studied. Furthermore, the activity of a polysynaptic spinal reflex, associated with spinal locomotor networks, was investigated to study the effect of the stimulation on the dedicated spinal circuitry associated with locomotor function. Tonic tSCS at 30 Hz immediately improved maximum dorsiflexion by +4.6° ± 0.9° in the more affected lower limb during the rhythmic ankle movement task, resulting in an increase of +2.9° ± 0.9° in active range of motion. Coordination of ankle movements, assessed by the ability to perform rhythmic ankle movements at a given target rate and to perform irregular movements according to a trajectory, was unchanged during stimulation. tSCS at 30 Hz modulated spinal reflex activity, reflected by a significant suppression of pathological activity specific to SCI in the assessed polysynaptic spinal reflex. During walking, there was no statistical group effect of tSCS. In the subgroup of eight assessed participants, the three with the lowest as well as the one with the highest walking function scores showed positive stimulation effects, including increased maximum walking speed, or more continuous and faster stepping at a self-selected speed. Future studies need to investigate if multiple applications and individual optimization of the stimulation parameters can increase the effects of tSCS, and if the technique can improve the outcome of locomotor rehabilitation after iSCI.

scholarly journals Modification of spasticity by transcutaneous spinal cord stimulation in individuals with incomplete spinal cord injury

2013 ◽  
Vol 37 (2) ◽  
pp. 202-211 ◽  
Author(s):  
Ursula S. Hofstoetter ◽  
William B. McKay ◽  
Keith E. Tansey ◽  
Winfried Mayr ◽  
Helmut Kern ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Cord Stimulation ◽  
Incomplete Spinal Cord Injury ◽  
Cord Injury ◽  
Transcutaneous Spinal Cord Stimulation

scholarly journals Strategies to augment volitional and reflex function may improve locomotor capacity following incomplete spinal cord injury

2018 ◽  
Vol 119 (3) ◽  
pp. 894-903
Author(s):  
Kristan A. Leech ◽  
Hyosub E. Kim ◽  
T. George Hornby
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Muscle Activation ◽  
Afferent Input ◽  
Incomplete Spinal Cord Injury ◽  
Locomotor Function ◽  
Cord Injury ◽  
Neurophysiological Mechanisms ◽  
Locomotor Capacity ◽  
Spinal Excitability

Many studies highlight the remarkable plasticity demonstrated by spinal circuits following an incomplete spinal cord injury (SCI). Such plasticity can contribute to improvements in volitional motor recovery, such as walking function, although similar mechanisms underlying this recovery may also contribute to the manifestation of exaggerated responses to afferent input, or spastic behaviors. Rehabilitation interventions directed toward augmenting spinal excitability have shown some initial success in improving locomotor function. However, the potential effects of these strategies on involuntary motor behaviors may be of concern. In this article, we provide a brief review of the mechanisms underlying recovery of volitional function and exaggerated reflexes, and the potential overlap between these changes. We then highlight findings from studies that explore changes in spinal excitability during volitional movement in controlled conditions, as well as altered kinematic and behavioral performance during functional tasks. The initial focus will be directed toward recovery of reflex and volitional behaviors following incomplete SCI, followed by recent work elucidating neurophysiological mechanisms underlying patterns of static and dynamic muscle activation following chronic incomplete SCI during primarily single-joint movements. We will then transition to studies of locomotor function and the role of altered spinal integration following incomplete SCI, including enhanced excitability of specific spinal circuits with physical and pharmacological interventions that can modulate locomotor output. The effects of previous and newly developed strategies will need to focus on changes in both volitional function and involuntary spastic reflexes for the successful translation of effective therapies to the clinical setting.

scholarly journals Locomotor Training Progression and Outcomes After Incomplete Spinal Cord Injury

2005 ◽  
Vol 85 (12) ◽  
pp. 1356-1371 ◽  
Author(s):  
Andrea L Behrman ◽  
Anna R Lawless-Dixon ◽  
Sandra B Davis ◽  
Mark G Bowden ◽  
Preeti Nair ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Injury ◽  
Walking Ability ◽  
Locomotor Training ◽  
Full Time ◽  
Incomplete Spinal Cord Injury ◽  
Weight Support ◽  
Walking Activity ◽  
Cord Injury

Abstract Background and Purpose. The use of locomotor training with a body-weight–support systemand treadmill (BWST) and manual assistance has increased in rehabilitation. The purpose of this case report isto describe the process for retraining walking in a person with an incomplete spinal cord injury (SCI) using the BWST and transferring skills from the BWST to overground assessment and community ambulation. Case Description. Following discharge from rehabilitation, a man with an incomplete SCI at C5–6 and an American Spinal Injury Association (ASIA) Impairment Scale classification of D participated in 45sessions of locomotor training. Outcomes. Walking speed and independence improved from 0.19 m/s as a home ambulator using a rolling walker and a right ankle-foot orthosis to 1.01 m/s as a full-time ambulator using a cane only for communitymobility. Walking activity (X̄±SD) per 24 hours increased from 1,054±543 steps to 3,924±1,629 steps. Discussion. In a person with an incomplete SCI, walking ability improved after locomotor trainingthat used a decision-making algorithm and progression across training environments.

scholarly journals Feasibility and utility of transcutaneous spinal cord stimulation combined with walking-based therapy for people with motor incomplete spinal cord injury

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Liza V. McHugh ◽  
Ashley A. Miller ◽  
Kristan A. Leech ◽  
Cynthia Salorio ◽  
Rebecca H. Martin
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Adverse Events ◽  
Spinal Cord Stimulation ◽  
Walking Speed ◽  
Minimal Detectable Change ◽  
Walk Test ◽  
Incomplete Spinal Cord Injury ◽  
Cord Injury ◽  
Transcutaneous Spinal Cord Stimulation

Abstract Study design Prospective case series. Objectives To evaluate the feasibility and preliminary efficacy of combining transcutaneous spinal cord stimulation (TSCS) with walking-based physical therapy. Setting Hospital-based outpatient center in Maryland, United States. Methods Ten individuals with chronic (>1 year) motor incomplete spinal cord injury (iSCI) completed 23 sessions of 2-h therapy over 8 weeks. TSCS was delivered for the first 30 min of each session using a clinically available device with adjustable current. To assess feasibility of the intervention, we tracked pain, adverse events, and participant retention. Preliminary efficacy was assessed by evaluating changes in walking speed, endurance, and quality following the intervention with select functional outcome measures (10-m walk test (10MWT), 6-min walk test (6MWT), timed up and go, and walking index for spinal cord injury II). Results We found that the combined intervention was feasible in an outpatient clinical setting. Participants tolerated the TSCS well, with no reports of significant adverse events or other issues (e.g., skin irritation or pain that disrupted training). None of the participants elected to discontinue the study. Participants also showed significant improvements in each measure of walking function following the intervention. Changes in walking speed, as measured by the 10MWT (0.56 ± 0.29 m/s to 0.72 ± 0.36 m/s), exceeded the minimal clinically important difference for individuals with iSCI. Changes in walking quality and endurance, as measured by the 6MWT (149.88 ± 99.87 m to 194.53 ± 106.56 m), exceeded the minimal detectable change for individuals with iSCI. Conclusions These results indicate that TSCS is clinically feasible and may be useful as an adjunct to walking-based therapy for adults with iSCI.

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