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Sayed Ahmad AM, Skiadopoulos A, Knikou M. Interactions between arm and leg neuronal circuits following paired cervical and lumbosacral transspinal stimulation in healthy humans. Exp Brain Res 2024; 242:2229-2239. [PMID: 39034329 DOI: 10.1007/s00221-024-06891-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 07/06/2024] [Indexed: 07/23/2024]
Abstract
Transspinal (or transcutaneous spinal cord) stimulation is a promising noninvasive method that may strengthen the intrinsic spinal neural connectivity in neurological disorders. In this study we assessed the effects of cervical transspinal stimulation on the amplitude of leg transspinal evoked potentials (TEPs), and the effects of lumbosacral transspinal stimulation on the amplitude of arm TEPs. Control TEPs were recorded following transspinal stimulation with one cathode electrode placed either on Cervical 3 (21.3 ± 1.7 mA) or Thoracic 10 (23.6 ± 16.5 mA) vertebrae levels. Associated anodes were placed bilaterally on clavicles or iliac crests. Cervical transspinal conditioning stimulation produced short latency inhibition of TEPs recorded from left soleus (ranging from - 6.11 to -3.87% of control TEP at C-T intervals of -50, -25, -20, -15, -10, 15 ms), right semitendinosus (ranging from - 11.1 to -4.55% of control TEP at C-T intervals of -20, -15, 15 ms), and right vastus lateralis (ranging from - 13.3 to -8.44% of control TEP at C-T intervals of -20 and - 15 ms) (p < 0.05). Lumbosacral transspinal conditioning stimulation produced no significant effects on arm TEPs. We conclude that in the resting state, cervical transspinal stimulation affects the net motor output of leg motoneurons under the experimental conditions used in this study. Further investigations are warranted to determine whether this protocol may reactivate local spinal circuitry after stroke or spinal cord injury and may have a significant effect in synchronization of upper and lower limb muscle synergies during rhythmic activities like locomotion or cycling.
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Affiliation(s)
- Abdullah M Sayed Ahmad
- Klab4Recovery Research Program (aka Knikou Lab), The City University of New York, New York, NY, USA
- Department of Physical Therapy, College of Staten Island, The City University of New York, 2800 Victory Blvd, 5N-207, Staten Island, NY, 10314, USA
| | - Andreas Skiadopoulos
- Klab4Recovery Research Program (aka Knikou Lab), The City University of New York, New York, NY, USA
- Department of Physical Therapy, College of Staten Island, The City University of New York, 2800 Victory Blvd, 5N-207, Staten Island, NY, 10314, USA
| | - Maria Knikou
- Klab4Recovery Research Program (aka Knikou Lab), The City University of New York, New York, NY, USA.
- Department of Physical Therapy, College of Staten Island, The City University of New York, 2800 Victory Blvd, 5N-207, Staten Island, NY, 10314, USA.
- Biology PhD Program, CUNY Graduate Center, 365 5th Ave, New York, NY, 10016, USA.
- Collaborative Neuroscience Program, College of Staten Island, 2800 Victory Blvd, 5N-207, Staten Island, NY, 10314, USA.
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Steele AG, Vette AH, Martin C, Masani K, Sayenko DG. Synergistic effects of transcutaneous spinal stimulation and neuromuscular electrical stimulation on lower limb force production: Time to deliver. PLoS One 2024; 19:e0296613. [PMID: 39213293 PMCID: PMC11364223 DOI: 10.1371/journal.pone.0296613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 08/09/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Transcutaneous spinal stimulation (TSS) and neuromuscular electrical stimulation (NMES) can facilitate self-assisted standing in individuals with paralysis. However, individual variability in responses to each modality may limit their effectiveness in generating the necessary leg extension force for full body weight standing. To address this challenge, we proposed combining TSS and NMES to enhance leg extensor muscle activation, with optimizing timing adjustment to maximize the interaction between the two modalities. METHODS To assess the effects of TSS and NMES on knee extension and plantarflexion force, ten neurologically intact participants underwent three conditions: (1) TSS control, (2) NMES control, and (3) TSS + NMES. TSS was delivered between the T10 and L2 vertebrae, while NMES was delivered to the skin over the right knee extensors and plantarflexors. TSS and NMES were administered using a 15 Hz train of three 0.5 ms biphasic pulses. During the TSS + NMES condition, the timing between modalities was adjusted in increments of ¼ the interval within a 15 Hz frequency, i.e., 66, 49.5, 33, 16.5, and 1 ms. RESULTS NMES combined with TSS, produced synergistic effects even on non-targeted muscle groups, thereby promoting leg extension across multiple joints in the kinematic chain. The sequence of NMES or TSS trains relative to each other did not significantly impact motor output. Notably, a delay of 16.5 to 49.5 ms between interleaved TSS and NMES pulses, each delivered at 15 Hz, results in more robust and synergistic responses in knee extensors and plantarflexors. CONCLUSIONS By adjusting the timing between TSS and NMES, we can optimize the combined use of these modalities for functional restoration. Our findings highlight the potential of integrated TSS and NMES protocols to enhance motor function, suggesting promising avenues for therapeutic applications, particularly in the rehabilitation of individuals with SCI.
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Affiliation(s)
- Alexander G. Steele
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, Houston, Texas, United States of America
| | - Albert H. Vette
- Department of Mechanical Engineering, Donadeo Innovation Centre for Engineering, University of Alberta, Edmonton, Alberta, Canada
- Glenrose Rehabilitation Hospital, Alberta Health Services, Edmonton, Alberta, Canada
| | - Catherine Martin
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, Houston, Texas, United States of America
| | - Kei Masani
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- KITE Research Institute–University Health Network, Toronto, ON, Canada
| | - Dimitry G. Sayenko
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, Houston, Texas, United States of America
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McKenzie K, Veit N, Aalla S, Yang C, Giffhorn M, Lynott A, Buchler K, Kishta A, Barry A, Sandhu M, Moon Y, Rymer WZ, Jayaraman A. Combining Neuromodulation Strategies in Spinal Cord Injury Gait Rehabilitation: A Proof Of Concept, Randomized, Crossover Trial. Arch Phys Med Rehabil 2024:S0003-9993(24)01073-6. [PMID: 38969255 DOI: 10.1016/j.apmr.2024.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 06/17/2024] [Accepted: 06/18/2024] [Indexed: 07/07/2024]
Abstract
OBJECTIVES To evaluate if acute intermittent hypoxia (AIH) coupled with transcutaneous spinal cord stimulation (tSCS) enhances task-specific training and leads to superior and more sustained gait improvements as compared with each of these strategies used in isolation in persons with chronic, incomplete spinal cord injury. DESIGN Proof of concept, randomized crossover trial. SETTING Outpatient, rehabilitation hospital. INTERVENTIONS Ten participants completed 3 intervention arms: (1) AIH, tSCS, and gait training (AIH + tSCS); (2) tSCS plus gait training (SHAM AIH + tSCS); and (3) gait training alone (SHAM + SHAM). Each arm consisted of 5 consecutive days of intervention with a minimum of a 4-week washout between arms. The order of arms was randomized. The study took place from December 3, 2020, to January 4, 2023. MAIN OUTCOME MEASURES 10-meter walk test at self-selected velocity (SSV) and fast velocity, 6-minute walk test, timed Up and Go (TUG) and secondary outcome measures included isometric ankle plantarflexion and dorsiflexion torque RESULTS: TUG improvements were 3.44 seconds (95% CI: 1.24-5.65) significantly greater in the AIH + tSCS arm than the SHAM AIH + tSCS arm at post-intervention (POST), and 3.31 seconds (95% CI: 1.03-5.58) greater than the SHAM + SHAM arm at 1-week follow up (1WK). SSV was 0.08 m/s (95% CI: 0.02-0.14) significantly greater following the AIH + tSCS arm than the SHAM AIH + tSCS at POST. Although not significant, the AIH + tSCS arm also demonstrated the greatest average improvements compared with the other 2 arms at POST and 1WK for the 6-minute walk test, fast velocity, and ankle plantarflexion torque. CONCLUSIONS This pilot study is the first to demonstrate that combining these 3 neuromodulation strategies leads to superior improvements in the TUG and SSV for individuals with chronic incomplete spinal cord injury and warrants further investigation.
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Affiliation(s)
| | - Nicole Veit
- Shirley Ryan AbilityLab, Chicago; Department of Biomedical Engineering, Northwestern University, Evanston
| | | | - Chen Yang
- Shirley Ryan AbilityLab, Chicago; Feinberg School of Medicine, Northwestern University, Chicago
| | | | | | | | | | | | - Milap Sandhu
- Shirley Ryan AbilityLab, Chicago; Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago
| | - Yaejin Moon
- Shirley Ryan AbilityLab, Chicago; Feinberg School of Medicine, Northwestern University, Chicago
| | - William Zev Rymer
- Shirley Ryan AbilityLab, Chicago; Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago; Department of Neuroscience, Feinberg School of Medicine, Northwestern University, Chicago
| | - Arun Jayaraman
- Shirley Ryan AbilityLab, Chicago; Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago.
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Chu X, Liu S, Zhao X, Liu T, Xing Z, Li Q, Li Q. Case report: Virtual reality-based arm and leg cycling combined with transcutaneous electrical spinal cord stimulation for early treatment of a cervical spinal cord injured patient. Front Neurosci 2024; 18:1380467. [PMID: 38826775 PMCID: PMC11140104 DOI: 10.3389/fnins.2024.1380467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 05/06/2024] [Indexed: 06/04/2024] Open
Abstract
Spinal cord injury is a condition affecting the central nervous system, causing different levels of dysfunction below the point of nerve damage. A 50-year-old woman suffered a neck injury as a result of a car accident. After undergoing posterior cervical C3-C6 internal fixation with titanium plates on one side and C7 lamina decompression, the patient, who had been diagnosed with C3-C7 cervical disk herniation and spinal stenosis causing persistent compression of the spinal cord, was transferred to the rehabilitation department. After implementing the combined therapy of Virtual Reality-based arm and leg cycling along with transcutaneous electrical stimulation of the spinal cord, the patients experienced a notable enhancement in both sensory and motor abilities as per the ASIA scores. The patient's anxiety and depression were reduced as measured by the Hamilton Anxiety and Hamilton Depression Tests. As evaluated by the SCIM-III, the patient's self-reliance and capacity to carry out everyday tasks showed ongoing enhancement, leading to the restoration of their functionality. Hence, the use of Virtual Reality-based arm and leg cycling along with transcutaneous electrical spinal cord stimulation has potential to positively impact function in patients with spinal cord injury. However, as this is a case report, the small number of patients and the fact that the intervention was initiated early after the injury, we were unable to separate the recovery due to the intervention from the natural recovery that is known to occur in the initial weeks and months after SCI. Therefore, further randomized controlled trials with a large sample size is necessary.
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Affiliation(s)
- Xiaolei Chu
- Department of Rehabilitation, Tianjin University Tianjin Hospital, Tianjin, China
| | - Shuaiyi Liu
- Tianjin Key Laboratory of Exercise Physiology and Sports Medicine, Institute of Sport, Exercise and Health, Tianjin University of Sport, Tianjin, China
| | - Xiaoxuan Zhao
- Tianjin Key Laboratory of Exercise Physiology and Sports Medicine, Institute of Sport, Exercise and Health, Tianjin University of Sport, Tianjin, China
| | - Tao Liu
- Tianjin Key Laboratory of Exercise Physiology and Sports Medicine, Institute of Sport, Exercise and Health, Tianjin University of Sport, Tianjin, China
| | - Zheng Xing
- Department of Rehabilitation, Tianjin University Tianjin Hospital, Tianjin, China
| | - Qingwen Li
- Tianjin Key Laboratory of Exercise Physiology and Sports Medicine, Institute of Sport, Exercise and Health, Tianjin University of Sport, Tianjin, China
| | - Qi Li
- Department of Rehabilitation, Tianjin University Tianjin Hospital, Tianjin, China
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Ivanenko Y, Shapkova EY, Petrova DA, Kleeva DF, Lebedev MA. Exoskeleton gait training with spinal cord neuromodulation. Front Hum Neurosci 2023; 17:1194702. [PMID: 37250689 PMCID: PMC10213721 DOI: 10.3389/fnhum.2023.1194702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 04/27/2023] [Indexed: 05/31/2023] Open
Abstract
Neuromodulating the locomotor network through spinal cord electrical stimulation (SCES) is effective for restoring function in individuals with gait deficits. However, SCES alone has limited effectiveness without concurrent locomotor function training that enhances activity-dependent plasticity of spinal neuronal networks by sensory feedback. This mini review discusses recent developments in using combined interventions, such as SCES added to exoskeleton gait training (EGT). To develop personalized therapies, it is crucial to assess the state of spinal circuitry through a physiologically relevant approach that identifies individual characteristics of spinal cord function to develop person-specific SCES and EGT. The existing literature suggests that combining SCES and EGT to activate the locomotor network can have a synergistic rehabilitative effect on restoring walking abilities, somatic sensation, and cardiovascular and bladder function in paralyzed individuals.
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Affiliation(s)
| | - Elena Y. Shapkova
- Saint-Petersburg State Research Institute of Phthisiopulmonology, Saint Petersburg, Russia
- Institute of Translational Biomedicine, St. Petersburg State University, Saint Petersburg, Russia
| | - Daria A. Petrova
- Vladimir Zelman Center for Neurobiology and Brain Rehabilitation, Skolkovo Institute of Science and Technology, Moscow, Russia
| | - Daria F. Kleeva
- Vladimir Zelman Center for Neurobiology and Brain Rehabilitation, Skolkovo Institute of Science and Technology, Moscow, Russia
| | - Mikhail A. Lebedev
- Faculty of Mechanics and Mathematics, Lomonosov Moscow State University, Moscow, Russia
- Sechenov Institute of Evolutionary Physiology and Biochemistry of the Russian Academy of Sciences, Saint Petersburg, Russia
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Oh J, Steele AG, Varghese B, Martin CA, Scheffler MS, Markley RL, Lo YK, Sayenko DG. Cervical transcutaneous spinal stimulation for spinal motor mapping. iScience 2022; 25:105037. [PMID: 36147963 PMCID: PMC9485062 DOI: 10.1016/j.isci.2022.105037] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 07/29/2022] [Accepted: 08/25/2022] [Indexed: 12/02/2022] Open
Abstract
Transcutaneous spinal stimulation (TSS) is a promising approach to restore upper-limb (UL) functions after spinal cord injury (SCI) in humans. We sought to demonstrate the selectivity of recruitment of individual UL motor pools during cervical TSS using different electrode placements. We demonstrated that TSS delivered over the rostrocaudal and mediolateral axes of the cervical spine resulted in a preferential activation of proximal, distal, and ipsilateral UL muscles. This was revealed by changes in motor threshold intensity, maximum amplitude, and the amount of post-activation depression of the evoked responses. We propose that an arrangement of electrodes targeting specific UL motor pools may result in superior efficacy, restoring more diverse motor activities after neurological injuries and disorders, including severe SCI.
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Affiliation(s)
- Jeonghoon Oh
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, 6550 Fannin Street, Houston, TX 77030, USA
| | - Alexander G. Steele
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, 6550 Fannin Street, Houston, TX 77030, USA
- Department of Electrical and Computer Engineering, University of Houston, N308 Engineering Bldg 1, 4726 Calhoun Rd., Houston, TX 77204, USA
| | - Blesson Varghese
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, 6550 Fannin Street, Houston, TX 77030, USA
| | - Catherine A. Martin
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, 6550 Fannin Street, Houston, TX 77030, USA
| | - Michelle S. Scheffler
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, 6550 Fannin Street, Houston, TX 77030, USA
| | - Rachel L. Markley
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, 6550 Fannin Street, Houston, TX 77030, USA
| | | | - Dimitry G. Sayenko
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, 6550 Fannin Street, Houston, TX 77030, USA
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