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Hodgkiss DD, Williams AMM, Shackleton CS, Samejima S, Balthazaar SJT, Lam T, Krassioukov AV, Nightingale TE. Ergogenic effects of spinal cord stimulation on exercise performance following spinal cord injury. Front Neurosci 2024; 18:1435716. [PMID: 39268039 PMCID: PMC11390595 DOI: 10.3389/fnins.2024.1435716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Accepted: 08/05/2024] [Indexed: 09/15/2024] Open
Abstract
Cervical or upper-thoracic spinal cord injury (SCI, ≥T6) often leads to low resting blood pressure (BP) and impaired cardiovascular responses to acute exercise due to disrupted supraspinal sympathetic drive. Epidural spinal cord stimulation (invasive, ESCS) and transcutaneous spinal cord stimulation (non-invasive, TSCS) have previously been used to target dormant sympathetic circuits and modulate cardiovascular responses. This case series compared the effects of cardiovascular-optimised ESCS and TSCS versus sham ESCS and TSCS on modulating cardiovascular responses and improving submaximal upper-body exercise performance in individuals with SCI. Seven males with a chronic, motor-complete SCI between C6 and T4 underwent a mapping session to identify cardiovascular responses to spinal cord stimulation. Subsequently, four participants (two ESCS and two TSCS) completed submaximal exercise testing. Stimulation parameters (waveform, frequency, intensity, epidural electrode array configuration, and transcutaneous electrode locations in the lumbosacral region) were optimised to elevate cardiovascular responses (CV-SCS). A sham condition (SHAM-SCS) served as a comparison. Participants performed arm-crank exercise to exhaustion at a fixed workload corresponding to above ventilatory threshold, on separate days, with CV-SCS or SHAM-SCS. At rest, CV-SCS increased BP and predicted left ventricular cardiac contractility and total peripheral resistance. During exercise, CV-SCS increased time to exhaustion and peak oxygen pulse (a surrogate for stroke volume), relative to SHAM-SCS. Ratings of perceived exertion also tended to be lower with CV-SCS than SHAM-SCS. Comparable improvements in time to exhaustion with ESCS and TSCS suggest that both approaches could be promising ergogenic aids to support exercise performance or rehabilitation, along with reducing fatigue during activities of daily living in individuals with SCI.
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Affiliation(s)
- Daniel D Hodgkiss
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Alison M M Williams
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
| | - Claire S Shackleton
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Soshi Samejima
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Shane J T Balthazaar
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
- Division of Cardiology, Department of Echocardiography, Vancouver General and St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Tania Lam
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
| | - Andrei V Krassioukov
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, BC, Canada
| | - Tom E Nightingale
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
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2
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Gorman BT, Gill C, Etzelmueller M, O'Keeffe C, Reilly RB, Fleming N. The Influence of Body Position on the Resting Motor Threshold of Posterior Root-Muscle Reflexes Evoked via Transcutaneous Spinal Cord Stimulation. J Clin Med 2024; 13:5008. [PMID: 39274221 DOI: 10.3390/jcm13175008] [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: 06/17/2024] [Revised: 08/11/2024] [Accepted: 08/14/2024] [Indexed: 09/16/2024] Open
Abstract
Background: Thoracolumbar transcutaneous spinal cord stimulation (tSCS) non-invasively evokes posterior root-muscle reflexes (PRMR) with the aim of neuromodulating sensorimotor function following spinal cord injury. Research is still in its infancy regarding the effect of body position on the nature of these spinally evoked responses. Therefore, the aim of this study was to investigate the influence of body position on the nature of PRMR responses during tSCS. Methods: A total of 11 (6M, 5F) participants completed a full PRMR recruitment curve from 10 ma up to 120 ma (10 ma increments) at the T11/12 intervertebral space using a singular 3.2 cm diameter cathode. At each intensity, three paired pulses (50 ms inter-pulse interval), followed by three singular pulses with a six-second delay were applied in each body position (supine, supine 90-90, sitting and standing) in a randomised order. The PRMR responses in lower limb muscles were recorded using wireless electromyographic sensors placed on the Soleus, Tibialis Anterior, Rectus Femoris and Bicep Femoris long head. A two-way (body position × muscle) repeated measures analysis of variance was used to investigate the effect of body position on PRMR-evoked responses. Results: There was a significant main effect of body position on PRMR resting motor threshold (RMT) (p < 0.001), first response peak-to-peak amplitude (p = 0.003) and percentage post-activation depression (%PAD) (p = 0.012). Sitting had significantly higher RMT and significantly lower first response peak-to-peak amplitudes compared to all other positions, but significant differences in %PAD were only detectible between supine and standing. Conclusions: Body position influences the nature of PRMR-evoked responses during tSCS.
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Affiliation(s)
- Barry T Gorman
- Discipline of Anatomy, School of Medicine, Trinity College Dublin, D02 R590 Dublin, Ireland
| | - Conor Gill
- School of Engineering, Trinity College Dublin, D02 R590 Dublin, Ireland
| | - Mark Etzelmueller
- School of Engineering, Trinity College Dublin, D02 R590 Dublin, Ireland
- Discipline of Gerontology, School of Medicine, Trinity College Dublin, D02 R590 Dublin, Ireland
| | - Clodagh O'Keeffe
- School of Engineering, Trinity College Dublin, D02 R590 Dublin, Ireland
- Discipline of Gerontology, School of Medicine, Trinity College Dublin, D02 R590 Dublin, Ireland
| | - Richard B Reilly
- School of Engineering, Trinity College Dublin, D02 R590 Dublin, Ireland
- Discipline of Gerontology, School of Medicine, Trinity College Dublin, D02 R590 Dublin, Ireland
- Trinity Centre for Biomedical Engineering, Trinity College Dublin, D02 R590 Dublin, Ireland
| | - Neil Fleming
- Discipline of Anatomy, School of Medicine, Trinity College Dublin, D02 R590 Dublin, Ireland
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3
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Cheng S, Li X, Zhang Y, Liu C, Rao Y, Zhang Y, Wu J, Sun J, Laakso EL. Rehabilitation report of 2 cases of spinal cord ischemic injury after intra-aortic repair. Medicine (Baltimore) 2024; 103:e38852. [PMID: 39058844 PMCID: PMC11272330 DOI: 10.1097/md.0000000000038852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 06/17/2024] [Indexed: 07/28/2024] Open
Abstract
RATIONALE Spinal cord ischemia injury is a serious complication after intra-aortic surgery, with a low incidence but high disability rate. However, patients often do not receive comprehensive treatment in the early stages of the disease. Therefore, active neurological intervention is needed to protect and prevent spinal cord ischemia during and after surgery. In this paper, rehabilitation program and imaging data of 2 cases with spinal cord ischemic injury are presented and discussed regarding causes, prevention and acute treatment with this disease, which could be referred by clinicians. PATIENT CONCERNS Case report 1: A 69-year-old male patient underwent aortic arch aneurysm and thoracic endovascular aortic repair (coated stent) was performed under general anesthesia. Complete paralysis of both lower limbs, constipation, and urinary retention occurred after surgery and was subsequently referred to our rehabilitation department. Case report 2: A man aged 41 years experienced sudden chest pain with no dizziness or headache. Weakness of both lower limbs gradually appeared over 30 minutes with subsequent loss of consciousness. He was diagnosed with aortic dissection and underwent aortic stent implantation. Inpatient rehabilitation began systematically 3 months after discharge. DIAGNOSES The 2 patients were diagnosed with paraplegia and spinal cord ischemic injury. INTERVENTIONS The patients received strength and transfer training, sensory input, health mission, and activities of daily living. OUTCOMES Patient 1 returned home without assistive devices and patient 2 returned home with wheelchair. LESSONS Perioperative spinal cord protection is directly related to postoperative quality of life. Once the symptoms of spinal cord ischemic injury occur, cerebrospinal fluid drainage should be performed as soon as possible to increase mean arterial pressure. At the same time, methylprednisolone, ganglioside, anticoagulation, vasodilator drugs, and symptomatic supportive treatments are required. Intercostal artery and subclavian artery are reconstructed if necessary. Symptom stability flags referral to commence rehabilitation. Repetitive functional training is necessary to help patients return to the family and society as soon as possible.
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Affiliation(s)
- Shu Cheng
- Department of Rehabilitation Medicine, Wuhan University of Science and Technology Affiliated Wuhan Resources & Wisco General Hospital, Wuhan, China
| | - Xuan Li
- Department of Rehabilitation Medicine, Wuhan University of Science and Technology Affiliated Wuhan Resources & Wisco General Hospital, Wuhan, China
| | - Yufei Zhang
- Medical School, Wuhan University of Science and Technology, Wuhan, China
| | - Chenxi Liu
- Medical School, Wuhan University of Science and Technology, Wuhan, China
| | - Yi Rao
- Department of Pain Medicine, Wuhan University of Science and Technology Affiliated Wuhan Resources & Wisco General Hospital, Wuhan, China
| | - Yang Zhang
- Department of Rehabilitation Medicine, Wuhan University of Science and Technology Affiliated Wuhan Resources & Wisco General Hospital, Wuhan, China
| | - Jinlun Wu
- Department of Rehabilitation Medicine, Wuhan University of Science and Technology Affiliated Wuhan Resources & Wisco General Hospital, Wuhan, China
| | - Jinwen Sun
- Department of Rehabilitation Medicine, Wuhan University of Science and Technology Affiliated Wuhan Resources & Wisco General Hospital, Wuhan, China
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4
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Xi P, Yao Q, Liu Y, He J, Tang R, Lang Y. Biomimetic Peripheral Nerve Stimulation Promotes the Rat Hindlimb Motion Modulation in Stepping: An Experimental Analysis. CYBORG AND BIONIC SYSTEMS 2024; 5:0131. [PMID: 38966124 PMCID: PMC11223769 DOI: 10.34133/cbsystems.0131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/23/2024] [Indexed: 07/06/2024] Open
Abstract
Peripheral nerve stimulation is an effective neuromodulation method in patients with lower extremity movement disorders caused by stroke, spinal cord injury, or other diseases. However, most current studies on rehabilitation using sciatic nerve stimulation focus solely on ankle motor regulation through stimulation of common peroneal and tibial nerves. Using the electrical nerve stimulation method, we here achieved muscle control via different sciatic nerve branches to facilitate the regulation of lower limb movements during stepping and standing. A map of relationships between muscles and nerve segments was established to artificially activate specific nerve fibers with the biomimetic stimulation waveform. Then, characteristic curves depicting the relationship between neural electrical stimulation intensity and joint control were established. Finally, by testing the selected stimulation parameters in anesthetized rats, we confirmed that single-cathode extraneural electrical stimulation could activate combined movements to promote lower limb movements. Thus, this method is effective and reliable for use in treatment for improving and rehabilitating lower limb motor dysfunction.
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Affiliation(s)
- Pengcheng Xi
- School of Mechatronical Engineering,
Beijing Institute of Technology, Beijing, People’s Republic of China
| | - Qingyu Yao
- National Engineering Research Center of Neuromodulation,
Tsinghua University, Beijing, People’s Republic of China
| | - Yafei Liu
- School of Mechatronical Engineering,
Beijing Institute of Technology, Beijing, People’s Republic of China
| | - Jiping He
- School of Mechatronical Engineering,
Beijing Institute of Technology, Beijing, People’s Republic of China
- Beijing Innovation Center for Intelligent Robots and Systems,
Beijing Institute of Technology, Beijing, People’s Republic of China
| | - Rongyu Tang
- Institute of Semiconductors,
Chinese Academy of Science, Beijing, People’s Republic of China
| | - Yiran Lang
- School of Life Science,
Beijing Institute of Technology, Beijing, People’s Republic of China
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5
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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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6
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Tharu NS, Wong AYL, Zheng YP. Transcutaneous Electrical Spinal Cord Stimulation Increased Target-Specific Muscle Strength and Locomotion in Chronic Spinal Cord Injury. Brain Sci 2024; 14:640. [PMID: 39061380 PMCID: PMC11274661 DOI: 10.3390/brainsci14070640] [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: 06/10/2024] [Revised: 06/20/2024] [Accepted: 06/24/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND The recovery of locomotion is greatly prioritized, and neuromodulation has been emerging as a promising approach in recent times. STUDY DESIGN Single-subject research design. SETTINGS A laboratory at The Hong Kong Polytechnic University. OBJECTIVES To investigate the effects of augmenting activity-based therapy (ABT) to transcutaneous electrical spinal cord stimulation (TSCS) on enhancing specific lower limb muscle strength and improving locomotor ability in an individual with chronic incomplete spinal cord injury (iSCI). METHODS An individual with iSCI underwent two phases of treatment, ABT alone followed by combined ABT+TSCS, each for a period of 10 weeks. The TSCS stimulated T10-T11 and T12-L1 segments with a frequency of 30 Hz at an intensity between 105 mA and 130 mA. Manual muscle testing, 6 min walk test (6MWT), and surface electromyography (EMG) responses of specific lower limb muscles were measured. Additionally, spasticity and sensorimotor examinations were conducted every two weeks, while pain tolerance was recorded after each treatment session. RESULTS After the ABT+TSCS treatment, there was an increase in overall muscle strength grading (from 1.8 ± 0.3 to 2.2 ± 0.6 out of 5.0). The 6MWT showed a greater increase in walking distance (3.5 m to 10 m) after combined treatment than ABT alone. In addition, the EMG response of the anterior rectus femoris, biceps femoris, medial gastrocnemius, and tibialis anterior after ABT+TSCS increased more than after ABT alone. The spasticity grade was reduced (from 0.8 ± 0.7 to 0.5 ± 0.6) whereas the average lower limb motor score increased from 17 to 23 points. No adverse effects were reported. CONCLUSIONS ABT+TSCS increased the target-specific lower limb muscle strength and walking ability more than ABT alone in an individual with chronic iSCI.
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Affiliation(s)
- Niraj Singh Tharu
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China;
| | - Arnold Yu Lok Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China;
- Research Institute for Smart Ageing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Yong-Ping Zheng
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China;
- Research Institute for Smart Ageing, The Hong Kong Polytechnic University, Hong Kong SAR, China
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7
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Malloy DC, Côté MP. Multi-session transcutaneous spinal cord stimulation prevents chloride homeostasis imbalance and the development of hyperreflexia after spinal cord injury in rat. Exp Neurol 2024; 376:114754. [PMID: 38493983 DOI: 10.1016/j.expneurol.2024.114754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/28/2024] [Accepted: 03/11/2024] [Indexed: 03/19/2024]
Abstract
Spasticity is a complex and multidimensional disorder that impacts nearly 75% of individuals with spinal cord injury (SCI) and currently lacks adequate treatment options. This sensorimotor condition is burdensome as hyperexcitability of reflex pathways result in exacerbated reflex responses, co-contractions of antagonistic muscles, and involuntary movements. Transcutaneous spinal cord stimulation (tSCS) has become a popular tool in the human SCI research field. The likeliness for this intervention to be successful as a noninvasive anti-spastic therapy after SCI is suggested by a mild and transitory improvement in spastic symptoms following a single stimulation session, but it remains to be determined if repeated tSCS over the course of weeks can produce more profound effects. Despite its popularity, the neuroplasticity induced by tSCS also remains widely unexplored, particularly due to the lack of suitable animal models to investigate this intervention. Thus, the basis of this work was to use tSCS over multiple sessions (multi-session tSCS) in a rat model to target spasticity after SCI and identify the long-term physiological improvements and anatomical neuroplasticity occurring in the spinal cord. Here, we show that multi-session tSCS in rats with an incomplete (severe T9 contusion) SCI (1) decreases hyperreflexia, (2) increases the low frequency-dependent modulation of the H-reflex, (3) prevents potassium-chloride cotransporter isoform 2 (KCC2) membrane downregulation in lumbar motoneurons, and (4) generally augments motor output, i.e., EMG amplitude in response to single pulses of tSCS, particularly in extensor muscles. Together, this work displays that multi-session tSCS can target and diminish spasticity after SCI as an alternative to pharmacological interventions and begins to highlight the underlying neuroplasticity contributing to its success in improving functional recovery.
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Affiliation(s)
- Dillon C Malloy
- Marion Murray Spinal Cord Research Center, Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA 19129, United States of America.
| | - Marie-Pascale Côté
- Marion Murray Spinal Cord Research Center, Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA 19129, United States of America.
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8
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Novikov A, Maldova M, Shamantseva N, Shalmiev I, Shoshina E, Epoyan N, Krutikova N, Moshonkina T. Non-Invasive Spinal Cord Stimulation for Motor Rehabilitation of Patients with Spinal Muscular Atrophy Treated with Orphan Drugs. Biomedicines 2024; 12:1162. [PMID: 38927369 PMCID: PMC11200420 DOI: 10.3390/biomedicines12061162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/17/2024] [Accepted: 05/20/2024] [Indexed: 06/28/2024] Open
Abstract
Spinal muscular atrophy (SMA) is an orphan disease characterized by the progressive degeneration of spinal alpha motor neurons. In recent years, nusinersen and several other drugs have been approved for the treatment of this disease. Transcutaneous spinal cord stimulation (tSCS) modulates spinal neuronal networks, resulting in changes in locomotion and posture in patients with severe spinal cord injury and stroke. We hypothesize that tSCS can activate motor neurons that are intact and restored by medication, slow the decline in motor activity, and contribute to the development of motor skills in SMA patients. Thirty-seven children and adults with SMA types 2 and 3 participated in this study. The median duration of drug treatment was over 20 months. The application of tSCS was performed during physical therapy for 20-40 min per day for ~12 days. Outcome measures were specific SMA motor scales, goniometry of contractured joints, and forced vital capacity. Significant increases in motor function, improved respiratory function, and decreased contracture were observed in both type 2 and 3 SMA participants. The magnitude of functional changes was not associated with participant age. Further studies are needed to elucidate the reasons for the beneficial effects of spinal cord electrical stimulation on SMA.
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Affiliation(s)
- Anton Novikov
- EirMED, 10 Vsevolod Vishnevsky St., 197136 St. Petersburg, Russia
| | - Maria Maldova
- EirMED, 10 Vsevolod Vishnevsky St., 197136 St. Petersburg, Russia
| | - Natalia Shamantseva
- Pavlov Institute of Physiology, Russian Academy of Sciences, 6 Makarova Enb., 199034 St. Petersburg, Russia
| | - Ivan Shalmiev
- EirMED, 10 Vsevolod Vishnevsky St., 197136 St. Petersburg, Russia
| | - Elena Shoshina
- EirMED, 10 Vsevolod Vishnevsky St., 197136 St. Petersburg, Russia
| | - Natalia Epoyan
- EirMED, 10 Vsevolod Vishnevsky St., 197136 St. Petersburg, Russia
| | | | - Tatiana Moshonkina
- Pavlov Institute of Physiology, Russian Academy of Sciences, 6 Makarova Enb., 199034 St. Petersburg, Russia
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9
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Fernández-Pérez JJ, Cinbaz G, Gómez-Soriano J. Toward a better understanding and terminology of transcutaneous spinal cord stimulation techniques. Spinal Cord 2024; 62:195-196. [PMID: 38486052 DOI: 10.1038/s41393-024-00975-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/29/2024] [Accepted: 03/05/2024] [Indexed: 04/11/2024]
Affiliation(s)
- Juan José Fernández-Pérez
- Toledo Physiotherapy Research Group (GIFTO), Faculty of Physiotherapy and Nursing of Toledo, Universidad de Castilla-La Mancha, Toledo, Spain
| | - Gülser Cinbaz
- Faculty of Health Sciences, Istanbul Medeniyet University, Istanbul, Turkey.
| | - Julio Gómez-Soriano
- Toledo Physiotherapy Research Group (GIFTO), Faculty of Physiotherapy and Nursing of Toledo, Universidad de Castilla-La Mancha, Toledo, Spain
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10
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Cavaggioni L, Scurati R, Tosin M, Vernole R, Bonfanti L, Trecroci A, Formenti D. Are Dryland Strength and Power Measurements Associated with Swimming Performance? Preliminary Results on Elite Paralympic Swimmers. Sports (Basel) 2024; 12:94. [PMID: 38668562 PMCID: PMC11054501 DOI: 10.3390/sports12040094] [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: 02/23/2024] [Revised: 03/18/2024] [Accepted: 03/22/2024] [Indexed: 04/29/2024] Open
Abstract
This study aimed to identify the relationship between dryland tests and swimming performance in elite Paralympic swimmers. Fifteen competitive swimmers (age: 27.4 ± 5.4 years, height: 1.70 ± 6.8 m, body mass: 67.9 ± 9.2 kg; 9 males, 6 females) performed a lat pull-down and a bench press incremental load test to determine maximum power (Pmax), the strength corresponding to maximum power (F@Pmax), and the barbell velocity corresponding to maximum power (V@Pmax) from the force-velocity and power-velocity profiles. These outcomes were also normalized by the athlete's body mass. Swimming performance was carried out from the best result in a 100 m freestyle race registered during an international competition. Lat pull-down F@Pmax was significantly associated with 100 m freestyle chronometric time (ρ = -0.56, p < 0.05), and lat pull-down V@Pmax presented a relationship with mean swimming velocity (ρ = 0.71, p < 0.01). Similarly, bench press F@Pmax and the normalized F@Pmax were significantly related to the mean swimming velocity (ρ = -0.51, ρ = -0.62, p < 0.05). Stepwise multiple regression showed that lat pull-down V@Pmax, bench press normF@Pmax, and V@Pmax accounted for 40.6%, 42.3%, and 65.8% (p < 0.05) of the mean swimming velocity variance. These preliminary results highlighted that simple dryland tests, although with a moderate relationship, are significantly associated with 100 m freestyle swimming performance in elite Paralympic swimmers.
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Affiliation(s)
- Luca Cavaggioni
- Obesity Unit—Laboratory of Nutrition and Obesity Research, Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, 20145 Milan, Italy
- Department of Biotechnology and Life Sciences, University of Insubria, 21100 Varese, Italy; (L.B.); (D.F.)
| | - Raffaele Scurati
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, 20133 Milan, Italy; (R.S.); (A.T.)
| | - Massimiliano Tosin
- Italian Paralympic Swimming Federation, 00144 Rome, Italy; (M.T.); (R.V.)
| | - Riccardo Vernole
- Italian Paralympic Swimming Federation, 00144 Rome, Italy; (M.T.); (R.V.)
| | - Luca Bonfanti
- Department of Biotechnology and Life Sciences, University of Insubria, 21100 Varese, Italy; (L.B.); (D.F.)
| | - Athos Trecroci
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, 20133 Milan, Italy; (R.S.); (A.T.)
| | - Damiano Formenti
- Department of Biotechnology and Life Sciences, University of Insubria, 21100 Varese, Italy; (L.B.); (D.F.)
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11
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Tajali S, Balbinot G, Pakosh M, Sayenko DG, Zariffa J, Masani K. Modulations in neural pathways excitability post transcutaneous spinal cord stimulation among individuals with spinal cord injury: a systematic review. Front Neurosci 2024; 18:1372222. [PMID: 38591069 PMCID: PMC11000807 DOI: 10.3389/fnins.2024.1372222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/06/2024] [Indexed: 04/10/2024] Open
Abstract
Introduction Transcutaneous spinal cord stimulation (TSCS), a non-invasive form of spinal cord stimulation, has been shown to improve motor function in individuals living with spinal cord injury (SCI). However, the effects of different types of TSCS currents including direct current (DC-TSCS), alternating current (AC-TSCS), and spinal paired stimulation on the excitability of neural pathways have not been systematically investigated. The objective of this systematic review was to determine the effects of TSCS on the excitability of neural pathways in adults with non-progressive SCI at any level. Methods The following databases were searched from their inception until June 2022: MEDLINE ALL, Embase, Web of Science, Cochrane Library, and clinical trials. A total of 4,431 abstracts were screened, and 23 articles were included. Results Nineteen studies used TSCS at the thoracolumbar enlargement for lower limb rehabilitation (gait & balance) and four studies used cervical TSCS for upper limb rehabilitation. Sixteen studies measured spinal excitability by reporting different outcomes including Hoffmann reflex (H-reflex), flexion reflex excitability, spinal motor evoked potentials (SMEPs), cervicomedullay evoked potentials (CMEPs), and cutaneous-input-evoked muscle response. Seven studies measured corticospinal excitability using motor evoked potentials (MEPs) induced by transcranial magnetic stimulation (TMS), and one study measured somatosensory evoked potentials (SSEPs) following TSCS. Our findings indicated a decrease in the amplitude of H-reflex and long latency flexion reflex following AC-TSCS, alongside an increase in the amplitudes of SMEPs and CMEPs. Moreover, the application of the TSCS-TMS paired associative technique resulted in spinal reflex inhibition, manifested by reduced amplitudes in both the H-reflex and flexion reflex arc. In terms of corticospinal excitability, findings from 5 studies demonstrated an increase in the amplitude of MEPs linked to lower limb muscles following DC-TSCS, in addition to paired associative stimulation involving repetitive TMS on the brain and DC-TSCS on the spine. There was an observed improvement in the latency of SSEPs in a single study. Notably, the overall quality of evidence, assessed by the modified Downs and Black Quality assessment, was deemed poor. Discussion This review unveils the systematic evidence supporting the potential of TSCS in reshaping both spinal and supraspinal neuronal circuitries post-SCI. Yet, it underscores the critical necessity for more rigorous, high-quality investigations.
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Affiliation(s)
- Shirin Tajali
- KITE Research Institute – University Health Network, Toronto, ON, Canada
| | - Gustavo Balbinot
- KITE Research Institute – University Health Network, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Center for Advancing Neurotechnological Innovation to Application – CRANIA, University Health Network, Toronto, ON, Canada
| | - Maureen Pakosh
- Library & Information Services, University Health Network, Toronto Rehabilitation Institute, ON, Canada
| | - Dimitry G. Sayenko
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, Houston, TX, United States
| | - Jose Zariffa
- KITE Research Institute – University Health Network, Toronto, ON, Canada
- Edward S. Rogers Sr. Department of Electrical and Computer Engineering, University of Toronto, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Kei Masani
- KITE Research Institute – University Health Network, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
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Wang B, Xu L, Zheng P, Zhang Y, Liu W, Wang Y, Zhang Z. Development and validation of a nomogram for predicting the prognosis in children with spinal cord injuries. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024:10.1007/s00586-024-08208-7. [PMID: 38509262 DOI: 10.1007/s00586-024-08208-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 02/04/2024] [Accepted: 02/25/2024] [Indexed: 03/22/2024]
Abstract
AIMS This research aims to construct and verify an accurate nomogram for forecasting the 3-, 5-, and 7-year outcomes in pediatric patients afflicted with spinal cord injury (SCI). METHODS Pediatric patients with SCI from multiple hospitals in China, diagnosed between Jan 2005 and Jan 2020, were incorporated into this research. Half of these patients were arbitrarily chosen for training sets, and the other half were designated for external validation sets. The Cox hazard model was employed to pinpoint potential prognosis determinants related to the American Spinal Injury Association (ASIA) and Functional Independence Assessment (FIM) index. These determinants were then employed to formulate the prognostic nomogram. Subsequently, the bootstrap technique was applied to validate the derived model internally. RESULTS In total, 224 children with SCI were considered for the final evaluation, having a median monitoring duration of 68.0 months. The predictive nomogram showcased superior differentiation capabilities, yielding a refined C-index of 0.924 (95% CI: 0.883-0.965) for the training cohort and a C-index of 0.863 (95% CI: 0.735-0.933) for the external verification group. Additionally, when applying the aforementioned model to prognostic predictions as classified by the FIM, it demonstrated a high predictive value with a C-index of 0.908 (95% CI: 0.863-0.953). Moreover, the calibration diagrams indicated a consistent match between the projected and genuine ASIA outcomes across both sets. CONCLUSION The crafted and verified prognostic nomogram emerges as a dependable instrument to foresee the 3-, 5-, and 7-year ASIA and FIM outcomes for children suffering from SCI.
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Affiliation(s)
- Bo Wang
- Department of Orthopaedic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Liukun Xu
- Department of Orthopaedic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Pengfei Zheng
- Department of Orthopaedic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Yapeng Zhang
- Anhui Province Children's Hospital, Hefei City, 230051, Anhui Province, China
| | - Wangmi Liu
- The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou City, 310009, Zhejiang Province, China
| | - Yuntao Wang
- Zhongda Hospital, Southeast University, Nanjing City, 210000, Jiangsu Province, China
| | - Zhiqun Zhang
- Department of Orthopaedic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China.
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Massey S, Konig D, Upadhyay P, Evcil ZB, Melin R, Fatima M, Hannah R, Duffell L. The effects of transcutaneous spinal cord stimulation delivered with and without high-frequency modulation on spinal and corticospinal excitability. Artif Organs 2024; 48:297-308. [PMID: 37840354 DOI: 10.1111/aor.14660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 09/14/2023] [Accepted: 09/25/2023] [Indexed: 10/17/2023]
Abstract
Transcutaneous spinal cord stimulation (TSCS) has been shown to improve motor recovery in people with spinal cord injury (SCI). Some groups deliver TSCS modulated with a kHz-frequency (TSCS-kHz); the intensity used for TSCS-kHz is usually set based on the motor threshold for TSCS, even though TSCS-kHz threshold is considerably higher than TSCS. As a result, TSCS-kHz interventions tend to be delivered at low intensities with respect to the motor threshold (~40%). In this study, we compared the effects of sub-threshold TSCS and TSCS-kHz, when delivered at similar intensity relative to their own motor threshold. Experiment I compared the after-effects of 20 min of sub-threshold (40% threshold) TSCS and TSCS-kHz on spinal and corticospinal excitability in able-bodied participants. Experiment II assessed the dose-response relationship of delivering short (10-pulse) trains of TSCS and TSCS-kHz at three different current intensities relative to the threshold (40%, 60%, and 80%). Experiment I found that 20 min of TSCS-kHz at a 40% threshold decreased posterior root reflex amplitude (p < 0.05), whereas TSCS did not. In experiment II, motor-evoked potential (MEP) amplitude increased following short trains of TSCS and TSCS-kHz of increasing intensity. MEP amplitude was significantly greater for TSCS-kHz compared with TSCS when delivered at 80% of the threshold (p < 0.05). These results suggest that TSCS and TSCS-kHz have different effects when delivered at similar intensity relative to their own threshold; both for immediate effects on corticospinal excitability and following prolonged stimulation on spinal excitability. These different effects may be utilized for optimal rehabilitation in people with SCI.
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Affiliation(s)
- Sarah Massey
- Department of Medical Physics & Biomedical Engineering, University College London, London, UK
- Aspire Centre for Rehabilitation Engineering and Assistive Technology, UCL Institute of Orthopaedics and Musculoskeletal Sciences, Royal National Orthopaedic Hospital, London, UK
| | - Danielle Konig
- Department of Medical Physics & Biomedical Engineering, University College London, London, UK
| | - Pratham Upadhyay
- Department of Medical Physics & Biomedical Engineering, University College London, London, UK
| | - Zehra Beril Evcil
- Department of Medical Physics & Biomedical Engineering, University College London, London, UK
| | - Rebbekha Melin
- Department of Medical Physics & Biomedical Engineering, University College London, London, UK
| | - Memoona Fatima
- Department of Medical Physics & Biomedical Engineering, University College London, London, UK
| | - Ricci Hannah
- Centre for Human and Applied Physiological Sciences, Kings College London, London, UK
| | - Lynsey Duffell
- Department of Medical Physics & Biomedical Engineering, University College London, London, UK
- Aspire Centre for Rehabilitation Engineering and Assistive Technology, UCL Institute of Orthopaedics and Musculoskeletal Sciences, Royal National Orthopaedic Hospital, London, UK
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Allen JR, Karri SR, Yang C, Stoykov ME. Spinal Cord Stimulation for Poststroke Hemiparesis: A Scoping Review. Am J Occup Ther 2024; 78:7802180220. [PMID: 38477681 PMCID: PMC11017736 DOI: 10.5014/ajot.2024.050533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024] Open
Abstract
IMPORTANCE Spinal cord stimulation (SCS) is a neuromodulation technique that can improve paresis in individuals with spinal cord injury. SCS is emerging as a technique that can address upper and lower limb hemiparesis. Little is understood about its effectiveness with the poststroke population. OBJECTIVE To summarize the evidence for SCS after stroke and any changes in upper extremity and lower extremity motor function. DATA SOURCES PubMed, Web of Science, Embase, and CINAHL. The reviewers used hand searches and reference searches of retrieved articles. There were no limitations regarding publication year. STUDY SELECTION AND DATA COLLECTION This review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. The inclusion and exclusion criteria included a broad range of study characteristics. Studies were excluded if the intervention did not meet the definition of SCS intervention, used only animals or healthy participants, did not address upper or lower limb motor function, or examined neurological conditions other than stroke. FINDINGS Fourteen articles met the criteria for this review. Seven studies found a significant improvement in motor function in groups receiving SCS. CONCLUSIONS AND RELEVANCE Results indicate that SCS may provide an alternative means to improve motor function in the poststroke population. Plain-Language Summary: The results of this study show that spinal cord stimulation may provide an alternative way to improve motor function after stroke. Previous neuromodulation methods have targeted the impaired supraspinal circuitry after stroke. Although downregulated, spinal cord circuitry is largely intact and offers new possibilities for motor recovery.
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Affiliation(s)
- Jonathan R Allen
- Jonathan R. Allen, OTD, OTR/L, is Occupational Therapist, Corewell Health, Grand Rapids, MI. At the time of the study, Allen was Doctoral Student, Department of Occupational Therapy, College of Health Sciences, University of Michigan-Flint;
| | - Swathi R Karri
- Swathi R. Karri, is Osteopathic Medical Student II, Chicago College of Osteopathic Medicine, Midwestern University, Downers Grove, IL
| | - Chen Yang
- Chen Yang, PhD, is Postdoctoral Fellow, Max Näder Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, and Postdoctoral Fellow, Physical Medicine & Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Mary Ellen Stoykov
- Mary Ellen Stoykov, PhD, OTR/L, is Research Scientist, Arms + Hands Lab, Shirley Ryan AbilityLab, Chicago, IL, and Research Associate Professor, Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL
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Miller T, Hosseinzadeh A, Thordarson T, Kalimullina T, Samejima S, Shackleton C, Malik R, Calderón-Juárez M, Sachdeva R, Krassioukov A. Web-Based Information on Spinal Cord Stimulation: Qualitative Assessment of Publicly Accessible Online Resources. JMIR Public Health Surveill 2024; 10:e50031. [PMID: 38393781 PMCID: PMC10924266 DOI: 10.2196/50031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 12/26/2023] [Accepted: 01/08/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Despite the growing accessibility of web-based information related to spinal cord stimulation (SCS), the content and quality of commonly encountered websites remain unknown. OBJECTIVE This study aimed to assess the content and quality of web-based information on SCS. METHODS This qualitative study was prospectively registered in Open Science Framework. Google Trends was used to identify the top trending, SCS-related search queries from 2012 to 2022. Top queried terms were then entered into separate search engines. Information found on websites within the first 2 pages of results was extracted and assessed for quality using the DISCERN instrument, the Journal of the American Medical Association benchmark criteria, and the Health on the Net Foundation code of conduct certification. Website readability and SCS-related information were also assessed. RESULTS After exclusions, 42 unique sites were identified (scientific resources: n=6, nonprofit: n=12, for-profit: n=20, news or media: n=2, and personal or blog: n=2). Overall, information quality was moderate (DISCERN). Few sites met all the Journal of the American Medical Association benchmark criteria (n=3, 7%) or had Health on the Net Foundation certification (n=7, 16%). On average, information was difficult to read, requiring a 9th- to 10th-grade level of reading comprehension. Sites described SCS subcategories (n=14, 33%), indications (n=38, 90%), contraindications (n=14, 33%), side effects or risks (n=28, 66%), device considerations (n=25, 59%), follow-up (n=22, 52%), expected outcomes (n=31, 73%), provided authorship details (n=20, 47%), and publication dates (n=19, 45%). The proportion of for-profit sites reporting authorship information was comparatively less than other site types (n=3, 15%). Almost all sites focused on surgically implanted SCS (n=37, 88%). On average, nonprofit sites contained the greatest number of peer-reviewed reference citations (n=6, 50%). For-profit sites showed the highest proportion of physician or clinical referrals among site types (n=17, 85%) indicating implicit bias (ie, auto-referral). CONCLUSIONS Overall, our findings suggest the public may be exposed to incomplete or dated information from unidentifiable sources that could put consumers and patient groups at risk.
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Affiliation(s)
- Tiev Miller
- International Collaboration on Repair Discoveries, The University of British Columbia, Vancouver, BC, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Ali Hosseinzadeh
- International Collaboration on Repair Discoveries, The University of British Columbia, Vancouver, BC, Canada
| | - Thomas Thordarson
- International Collaboration on Repair Discoveries, The University of British Columbia, Vancouver, BC, Canada
| | - Tamila Kalimullina
- International Collaboration on Repair Discoveries, The University of British Columbia, Vancouver, BC, Canada
| | - Soshi Samejima
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Claire Shackleton
- International Collaboration on Repair Discoveries, The University of British Columbia, Vancouver, BC, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Raza Malik
- International Collaboration on Repair Discoveries, The University of British Columbia, Vancouver, BC, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Martín Calderón-Juárez
- International Collaboration on Repair Discoveries, The University of British Columbia, Vancouver, BC, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Rahul Sachdeva
- International Collaboration on Repair Discoveries, The University of British Columbia, Vancouver, BC, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Andrei Krassioukov
- International Collaboration on Repair Discoveries, The University of British Columbia, Vancouver, BC, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
- Spinal Cord Program, GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, BC, Canada
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Omofuma I, Carrera R, King-Ori J, Agrawal SK. The effect of transcutaneous spinal cord stimulation on the balance and neurophysiological characteristics of young healthy adults. WEARABLE TECHNOLOGIES 2024; 5:e3. [PMID: 38486863 PMCID: PMC10936317 DOI: 10.1017/wtc.2023.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 09/01/2023] [Accepted: 10/31/2023] [Indexed: 03/17/2024]
Abstract
Transcutaneous spinal cord stimulation (TSCS) is gaining popularity as a noninvasive alternative to epidural stimulation. However, there is still much to learn about its effects and utility in assisting recovery of motor control. In this study, we applied TSCS to healthy subjects concurrently performing a functional training task to study its effects during a training intervention. We first carried out neurophysiological tests to characterize the H-reflex, H-reflex recovery, and posterior root muscle reflex thresholds, and then conducted balance tests, first without TSCS and then with TSCS. Balance tests included trunk perturbations in forward, backward, left, and right directions, and subjects' balance was characterized by their response to force perturbations. A balance training task involved the subjects playing a catch-and-throw game in virtual reality (VR) while receiving trunk perturbations and TSCS. Balance tests with and without TSCS were conducted after the VR training to measure subjects' post-training balance characteristics and then neurophysiological tests were carried out again. Statistical comparisons using t-tests between the balance and neurophysiological data collected before and after the VR training intervention found that the immediate effect of TSCS was to increase muscle activity during forward perturbations and to reduce balance performance in that direction. Muscle activity decreased after training and even more once TSCS was turned off. We thus observed an interaction of effects where TSCS increased muscle activity while the physical training decreased it.
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Affiliation(s)
- Isirame Omofuma
- Mechanical Engineering Department, Columbia University, New York, NY, USA
| | - Robert Carrera
- Mechanical Engineering Department, Columbia University, New York, NY, USA
| | | | - Sunil K Agrawal
- Mechanical Engineering Department, Columbia University, New York, NY, USA
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Hassan AB, Salihu AT, Masta MA, Gunn H, Marsden J, Abdullahi A, Ahmad RY, Danazumi MS. Effect of transcutaneous spinal direct current stimulation on spasticity in upper motor neuron conditions: a systematic review and meta-analysis. Spinal Cord 2023; 61:587-599. [PMID: 37640926 DOI: 10.1038/s41393-023-00928-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 08/02/2023] [Accepted: 08/16/2023] [Indexed: 08/31/2023]
Abstract
STUDY DESIGN A systematic review and meta-analysis of clinical trials. OBJECTIVES To determine the effect of non-invasive transcutaneous spinal direct current stimulation (tsDCS) on spasticity, activity limitations and participation restrictions in various upper motor neuron diseases. METHODS Six databases including CINAHL plus, Cochrane CENTRAL, Embase, MEDLINE, SCOPUS and Web of Science were searched for the relevant records from January 2008 to December 2022. Two reviewers independently selected and extracted data on spasticity, activity limitations and participation restrictions. The risk of bias was evaluated using the PEDro scale while the GRADE approach established the certainty of the evidence. RESULTS Eleven studies were identified of which 5 (45.5%) were rated as having a low risk of bias and 8 (72.7%) were meta-analyzed. The meta-analyses did not show any significant differences between cathodal (SMD = -0.67, 95% CI = -1.50 to 0.15, P = 0.11, I2 = 75%, 6 RCTs) or anodal (SMD = 0.11, 95% CI = -0.43 to -0.64, p = 0.69, I2 = 0%, 2 RCTs) and sham tsDCS for spasticity. There was also no significant difference between active and sham tsDCS for activity limitations (SMD = -0.42, 95% CI = -0.04 to 0.21, p = 0.2, I2 = 0%, 2 RCTs) and participation restrictions (MD = -8.10, 95% CI = -18.02 to 1.82, p = 0.11, 1 RCT). CONCLUSIONS The meta-analysis of the available evidence provides an uncertain estimate of the effect of cathodal tsDCS on spasticity, activity limitation and participation restriction. It might be very helpful, or it may make no difference at all. However, considering the level of the evidence and the limitation in the quality of the majority of the included studies, further well-designed research may likely change the estimate of effect. TRIAL REGISTRATION PROSPERO CRD42021245601.
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Affiliation(s)
- Auwal B Hassan
- Department of Medical Rehabilitation (Physiotherapy), Faculty of Allied Health Sciences, College of Medical Sciences, University of Maiduguri, Maiduguri, Borno State, Nigeria
| | - Abubakar T Salihu
- Department of Physiotherapy, Monash University, Melbourne, VIC, Australia
| | - Mamman A Masta
- Department of Medical Rehabilitation (Physiotherapy), Faculty of Allied Health Sciences, College of Medical Sciences, University of Maiduguri, Maiduguri, Borno State, Nigeria
| | - Hilary Gunn
- Peninsula Allied Health Centre, University of Plymouth, Plymouth, UK
| | - Jonathan Marsden
- Peninsula Allied Health Centre, University of Plymouth, Plymouth, UK
| | - Auwal Abdullahi
- Department of Physiotherapy, Bayero University Kano, Kano, Nigeria
| | - Rufa'i Y Ahmad
- Department of Physiotherapy, Bayero University Kano, Kano, Nigeria
| | - Musa S Danazumi
- Discipline of Physiotherapy, School of Allied Health, Human Services and Sport, College of Sciences, Health and Engineering, La Trobe University, Bundoora, VIC, 3085, Australia.
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Malloy DC, Côté MP. Multi-session transcutaneous spinal cord stimulation prevents chloridehomeostasis imbalance and the development of spasticity after spinal cordinjury in rat. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.10.24.563419. [PMID: 37961233 PMCID: PMC10634766 DOI: 10.1101/2023.10.24.563419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Spasticity is a complex and multidimensional disorder that impacts nearly 75% of individuals with spinal cord injury (SCI) and currently lacks adequate treatment options. This sensorimotor condition is burdensome as hyperexcitability of reflex pathways result in exacerbated reflex responses, co-contractions of antagonistic muscles, and involuntary movements. Transcutaneous spinal cord stimulation (tSCS) has become a popular tool in the human SCI research field. The likeliness for this intervention to be successful as a noninvasive anti-spastic therapy after SCI is suggested by a mild and transitory improvement in spastic symptoms following a single stimulation session, but it remains to be determined if repeated tSCS over the course of weeks can produce more profound effects. Despite its popularity, the neuroplasticity induced by tSCS also remains widely unexplored, particularly due to the lack of suitable animal models to investigate this intervention. Thus, the basis of this work was to use tSCS over multiple sessions (multi-session tSCS) in a rat model to target spasticity after SCI and identify the long-term physiological improvements and anatomical neuroplasticity occurring in the spinal cord. Here, we show that multi-session tSCS in rats with an incomplete (severe T9 contusion) SCI (1) decreases hyperreflexia, (2) increases the low frequency-dependent modulation of the H-reflex, (3) prevents potassium-chloride cotransporter isoform 2 (KCC2) membrane downregulation in lumbar motoneurons, and (4) generally augments motor output, i.e., EMG amplitude in response to single pulses of tSCS, particularly in extensor muscles. Together, this work displays that multi-session tSCS can target and diminish spasticity after SCI as an alternative to pharmacological interventions and begins to highlight the underlying neuroplasticity contributing to its success in improving functional recovery.
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Affiliation(s)
- Dillon C. Malloy
- Marion Murray Spinal Cord Research Center, Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA 19129
| | - Marie-Pascale Côté
- Marion Murray Spinal Cord Research Center, Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA 19129
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Mondello SE, Young L, Dang V, Fischedick AE, Tolley NM, Wang T, Bravo MA, Lee D, Tucker B, Knoernschild M, Pedigo BD, Horner PJ, Moritz CT. Optogenetic spinal stimulation promotes new axonal growth and skilled forelimb recovery in rats with sub-chronic cervical spinal cord injury. J Neural Eng 2023; 20:056005. [PMID: 37524080 PMCID: PMC10496592 DOI: 10.1088/1741-2552/acec13] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 07/17/2023] [Accepted: 07/31/2023] [Indexed: 08/02/2023]
Abstract
Objective.Spinal cord injury (SCI) leads to debilitating sensorimotor deficits that greatly limit quality of life. This work aims to develop a mechanistic understanding of how to best promote functional recovery following SCI. Electrical spinal stimulation is one promising approach that is effective in both animal models and humans with SCI. Optogenetic stimulation is an alternative method of stimulating the spinal cord that allows for cell-type-specific stimulation. The present work investigates the effects of preferentially stimulating neurons within the spinal cord and not glial cells, termed 'neuron-specific' optogenetic spinal stimulation. We examined forelimb recovery, axonal growth, and vasculature after optogenetic or sham stimulation in rats with cervical SCI.Approach.Adult female rats received a moderate cervical hemicontusion followed by the injection of a neuron-specific optogenetic viral vector ipsilateral and caudal to the lesion site. Animals then began rehabilitation on the skilled forelimb reaching task. At four weeks post-injury, rats received a micro-light emitting diode (µLED) implant to optogenetically stimulate the caudal spinal cord. Stimulation began at six weeks post-injury and occurred in conjunction with activities to promote use of the forelimbs. Following six weeks of stimulation, rats were perfused, and tissue stained for GAP-43, laminin, Nissl bodies and myelin. Location of viral transduction and transduced cell types were also assessed.Main Results.Our results demonstrate that neuron-specific optogenetic spinal stimulation significantly enhances recovery of skilled forelimb reaching. We also found significantly more GAP-43 and laminin labeling in the optogenetically stimulated groups indicating stimulation promotes axonal growth and angiogenesis.Significance.These findings indicate that optogenetic stimulation is a robust neuromodulator that could enable future therapies and investigations into the role of specific cell types, pathways, and neuronal populations in supporting recovery after SCI.
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Affiliation(s)
- Sarah E Mondello
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, United States of America
- Center for Neurotechnology, Seattle, WA 98195, United States of America
| | - Lisa Young
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, United States of America
| | - Viet Dang
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, United States of America
| | - Amanda E Fischedick
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, United States of America
| | - Nicholas M Tolley
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, United States of America
- Center for Neurotechnology, Seattle, WA 98195, United States of America
| | - Tian Wang
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, United States of America
| | - Madison A Bravo
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, United States of America
- Center for Neurotechnology, Seattle, WA 98195, United States of America
| | - Dalton Lee
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, United States of America
| | - Belinda Tucker
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, United States of America
| | - Megan Knoernschild
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, United States of America
| | - Benjamin D Pedigo
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, United States of America
- Center for Neurotechnology, Seattle, WA 98195, United States of America
| | - Philip J Horner
- Center for Neuroregeneration, Department of Neurological Surgery, Houston Methodist Research Institute, Houston, TX 77030, United States of America
| | - Chet T Moritz
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, United States of America
- Center for Neurotechnology, Seattle, WA 98195, United States of America
- Department of Electrical and Computer Engineering, University of Washington, Seattle, WA 98195, United States of America
- Department of Physiology and Biophysics, University of Washington, Seattle, WA 98195, United States of America
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20
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Mundra A, Varma Kalidindi K, Chhabra HS, Manghwani J. Spinal cord stimulation for spinal cord injury - Where do we stand? A narrative review. J Clin Orthop Trauma 2023; 43:102210. [PMID: 37663171 PMCID: PMC10470322 DOI: 10.1016/j.jcot.2023.102210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/14/2023] [Accepted: 06/29/2023] [Indexed: 09/05/2023] Open
Abstract
Recovery of function following a complete spinal cord injury (SCI) or an incomplete SCI where recovery has plateaued still eludes us despite extensive research. Epidural spinal cord stimulation (SCS) was initially used for managing neuropathic pain. It has subsequently demonstrated improvement in motor function in otherwise non-recovering chronic spinal cord injury in animal and human trials. The mechanisms of how it is precisely effective in doing so will need further research, which would help refine the technology for broader application. Transcutaneous spinal cord stimulation (TSCS) is also emerging as a modality to improve the functional outcome in SCI individuals, especially when coupled with appropriate rehabilitation. Apart from motor recovery, ESCS and TSCS have also shown improvement in autonomic, metabolic, genitourinary, and pulmonary function. Since the literature on this is still in its infancy, with no large-scale randomised trials and different studies using different protocols in a wide range of patients, a review of the present literature is imperative to better understand the latest developments in this field. This article examines the existing literature on the use of SCS for SCI individuals with the purpose of enabling functional recovery. It also examines the voids in the present research, thus providing future directions.
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Affiliation(s)
- Anuj Mundra
- Department of Spine and Rehabilitation, Sri Balaji Action Medical Institute, New Delhi, 110063, India
| | | | - Harvinder Singh Chhabra
- Department of Spine and Rehabilitation, Sri Balaji Action Medical Institute, New Delhi, 110063, India
| | - Jitesh Manghwani
- Indian Spinal Injuries Centre, Vasant Kunj, New Delhi, 110070, India
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21
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Yang D, Wang H, Xue Y, Bai S, Zhou Y, Duan Y, Zhao Y, Sha K, Yu C, Wang H, Peng Y, Wang Y, Qie S. Effects of Rehabilitation Therapy at Different Intervention Times on Daily Living Activity and Motor Function in Patients with Traumatic Spinal Cord Injury. Am J Health Behav 2023; 47:471-478. [PMID: 37596748 DOI: 10.5993/ajhb.47.3.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2023]
Abstract
Objectives: We investigated the impact of traumatic spinal cord injury (TSCI) on daily living activities and motor function of TSCI patients. Methods: A total of 88 TSCI patients were randomly divided into Group A (N=44) and Group B (N=44). Group A received rehabilitation treatment 7 days after the stabilization of vital signs, and Group B received rehabilitation treatment 30 days after hospitalization. Results: The compliance rate of Group A (93.18%) was higher than that of Group B (72.73%) (χ 2 =6.510, p<.05); The scores of American Spinal Injury Association (ASIA) and Activities of Daily Living (ADL) in Group A were higher than those in Group B. The self-rating score of anxiety and depression was lower than that of Group B (p<.05). Conclusion: For the rehabilitation treatment of TSCI patients, it is better to choose the intervention after the vital signs are stable to improve patients' ability for daily living activities and motor function.
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Affiliation(s)
- Deng Yang
- Department of Urology and Metabolic Rehabilitation Center, Beijing Rehabilitation Hospital Affiliated to Capital Medical University, Beijing, China
| | - Hanming Wang
- Department of Rehabilitation Diagnosis and Treatment Center, Beijing Rehabilitation Hospital Affiliated to Capital Medical University, Beijing, China
| | - Yafeng Xue
- Department of Rehabilitation Treatment Center, Beijing Rehabilitation Hospital Affiliated to Capital Medical University, Beijing, China
| | - Sen Bai
- Department of Rehabilitation Treatment Center, Beijing Rehabilitation Hospital Affiliated to Capital Medical University, Beijing, China
| | - Yuanyuan Zhou
- Department of Rehabilitation Treatment Center, Beijing Rehabilitation Hospital Affiliated to Capital Medical University, Beijing, China
| | - Yunxin Duan
- Department of Rehabilitation Treatment Center, Beijing Rehabilitation Hospital Affiliated to Capital Medical University, Beijing, China
| | - Yue Zhao
- Department of Urology and Metabolic Rehabilitation Center, Beijing Rehabilitation Hospital Affiliated to Capital Medical University, Beijing, China
| | - Kefu Sha
- Department of Urology and Metabolic Rehabilitation Center, Beijing Rehabilitation Hospital Affiliated to Capital Medical University, Beijing, China
| | - Chunhu Yu
- Department of Urology and Metabolic Rehabilitation Center, Beijing Rehabilitation Hospital Affiliated to Capital Medical University, Beijing, China
| | - Huan Wang
- Department of Rehabilitation Treatment Center, Beijing Rehabilitation Hospital Affiliated to Capital Medical University, Beijing, China
| | - Yanping Peng
- Department of Urology and Metabolic Rehabilitation Center, Beijing Rehabilitation Hospital Affiliated to Capital Medical University, Beijing, China
| | - Ying Wang
- Department of Urology and Metabolic Rehabilitation Center, Beijing Rehabilitation Hospital Affiliated to Capital Medical University, Beijing, China
| | - Shuyan Qie
- Department of Rehabilitation Diagnosis and Treatment Center, Beijing Rehabilitation Hospital Affiliated to Capital Medical University, Beijing, China
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22
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Finn HT, Bye EA, Elphick TG, Boswell-Ruys CL, Gandevia SC, Butler JE, Héroux ME. Transcutaneous spinal stimulation in people with and without spinal cord injury: Effect of electrode placement and trains of stimulation on threshold intensity. Physiol Rep 2023; 11:e15692. [PMID: 37269156 PMCID: PMC10238786 DOI: 10.14814/phy2.15692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 05/03/2023] [Indexed: 06/04/2023] Open
Abstract
Transcutaneous spinal cord stimulation (TSS) is purported to improve motor function in people after spinal cord injury (SCI). However, several methodology aspects are yet to be explored. We investigated whether stimulation configuration affected the intensity needed to elicit spinally evoked motor responses (sEMR) in four lower limb muscles bilaterally. Also, since stimulation intensity for therapeutic TSS (i.e., trains of stimulation, typically delivered at 15-50 Hz) is sometimes based on the single-pulse threshold intensity, we compared these two stimulation types. In non-SCI participants (n = 9) and participants with a SCI (n = 9), three different electrode configurations (cathode-anode); L1-midline (below the umbilicus), T11-midline and L1-ASIS (anterior superior iliac spine; non-SCI only) were compared for the sEMR threshold intensity using single pulses or trains of stimulation which were recorded in the vastus medialis, medial hamstring, tibialis anterior, medial gastrocnemius muscles. In non-SCI participants, the L1-midline configuration showed lower sEMR thresholds compared to T11-midline (p = 0.002) and L1-ASIS (p < 0.001). There was no difference between T11-midline and L1-midline for participants with SCI (p = 0.245). Spinally evoked motor response thresholds were ~13% lower during trains of stimulation compared to single pulses in non-SCI participants (p < 0.001), but not in participants with SCI (p = 0.101). With trains of stimulation, threshold intensities were slightly lower and the incidence of sEMR was considerably lower. Overall, stimulation threshold intensities were generally lower with the L1-midline electrode configuration and is therefore preferred. While single-pulse threshold intensities may overestimate threshold intensities for therapeutic TSS, tolerance to trains of stimulation will be the limiting factor in most cases.
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Affiliation(s)
- Harrison T Finn
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Biomedical Sciences, University of New South Wales, New South Wales, Kensington, Australia
| | - Elizabeth A Bye
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Biomedical Sciences, University of New South Wales, New South Wales, Kensington, Australia
- Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Thomas G Elphick
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Biomedical Sciences, University of New South Wales, New South Wales, Kensington, Australia
| | - Claire L Boswell-Ruys
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Biomedical Sciences, University of New South Wales, New South Wales, Kensington, Australia
- Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Simon C Gandevia
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- Prince of Wales Hospital, Randwick, New South Wales, Australia
- School of Clinical Medicine, University of New South Wales, New South Wales, Kensington, Australia
| | - Jane E Butler
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Biomedical Sciences, University of New South Wales, New South Wales, Kensington, Australia
| | - Martin E Héroux
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Biomedical Sciences, University of New South Wales, New South Wales, Kensington, Australia
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23
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Fallahi MS, Azadnajafabad S, Maroufi SF, Pour-Rashidi A, Khorasanizadeh M, Sattari SA, Faramarzi S, Slavin KV. Application of Vagus Nerve Stimulation in Spinal Cord Injury Rehabilitation. World Neurosurg 2023; 174:11-24. [PMID: 36858292 DOI: 10.1016/j.wneu.2023.02.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 02/19/2023] [Accepted: 02/20/2023] [Indexed: 03/02/2023]
Abstract
Spinal cord injury (SCI) is a prevalent devastating condition causing significant morbidity and mortality, especially in developing countries. The pathophysiology of SCI involves ischemia, neuroinflammation, cell death, and scar formation. Due to the lack of definitive therapy for SCI, interventions mainly focus on rehabilitation to reduce deterioration and improve the patient's quality of life. Currently, rehabilitative exercises and neuromodulation methods such as functional electrical stimulation, epidural electrical stimulation, and transcutaneous electrical nerve stimulation are being tested in patients with SCI. Other spinal stimulation techniques are being developed and tested in animal models. However, often these methods require complex surgical procedures and solely focus on motor function. Vagus nerve stimulation (VNS) is currently used in patients with epilepsy, depression, and migraine and is being investigated for its application in other disorders. In animal models of SCI, VNS significantly improved locomotor function by ameliorating inflammation and improving plasticity, suggesting its use in human subjects. SCI patients also suffer from nonmotor complications, including pain, gastrointestinal dysfunction, cardiovascular disorders, and chronic conditions such as obesity and diabetes. VNS has shown promising results in alleviating these conditions in non-SCI patients, which makes it a possible therapeutic option in SCI patients.
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Affiliation(s)
- Mohammad Sadegh Fallahi
- Neurosurgical Research Network (NRN), Universal Scientific Education and Research Network (USERN), Tehran, Iran; School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Sina Azadnajafabad
- Neurosurgical Research Network (NRN), Universal Scientific Education and Research Network (USERN), Tehran, Iran; Department of Surgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Farzad Maroufi
- Neurosurgical Research Network (NRN), Universal Scientific Education and Research Network (USERN), Tehran, Iran; Department of Neurosurgery, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Pour-Rashidi
- Neurosurgical Research Network (NRN), Universal Scientific Education and Research Network (USERN), Tehran, Iran; Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - MirHojjat Khorasanizadeh
- Department of Neurosurgery, Mount Sinai Hospital, Icahn School of Medicine, New York, New York, USA
| | - Shahab Aldin Sattari
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sina Faramarzi
- School of Biological Sciences, University of California, Irvine, Irvine, California, USA
| | - Konstantin V Slavin
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA.
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24
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Jo HJ, Kizziar E, Sangari S, Chen D, Kessler A, Kim K, Anschel A, Heinemann AW, Mensh BD, Awadalla S, Lieber RL, Oudega M, Perez MA. Multisite Hebbian Plasticity Restores Function in Humans with Spinal Cord Injury. Ann Neurol 2023; 93:1198-1213. [PMID: 36843340 PMCID: PMC10268028 DOI: 10.1002/ana.26622] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 12/29/2022] [Accepted: 02/06/2023] [Indexed: 02/28/2023]
Abstract
OBJECTIVE Spinal cord injury (SCI) damages synaptic connections between corticospinal axons and motoneurons of many muscles, resulting in devastating paralysis. We hypothesized that strengthening corticospinal-motoneuronal synapses at multiple spinal cord levels through Hebbian plasticity (i.e., "neurons that fire together, wire together") promotes recovery of leg and arm function. METHODS Twenty participants with chronic SCI were randomly assigned to receive 20 sessions of Hebbian or sham stimulation targeting corticospinal-motoneuronal synapses of multiple leg muscles followed by exercise. Based on the results from this study, in a follow-up prospective study, 11 more participants received 40 sessions of Hebbian stimulation targeting corticospinal-motoneuronal synapses of multiple arm and leg muscles followed by exercise. During Hebbian stimulation sessions, 180 paired pulses elicited corticospinal action potentials by magnetic (motor cortex) and/or electrical (thoracic spine) stimulation allowing volleys to arrive at the spinal cord 1-2 milliseconds before motoneurons were activated retrogradely via bilateral electrical stimulation (brachial plexus, ulnar, femoral, and common peroneal nerves) for biceps brachii, first dorsal interosseous, quadriceps femoris, and tibialis anterior muscles as needed. RESULTS We found in our randomized study that participants receiving Hebbian stimulation improved their walking speed and corticospinal function to a greater extent than individuals receiving sham stimulation. In agreement, prospective study participants improved their grasping and walking, corticospinal function, and quality of life metrics, exhibiting greater improvements with more sessions that persisted 9-month post-therapy. INTERPRETATION Our findings suggest that multisite Hebbian stimulation, informed by the physiology of the corticospinal system, represents an effective strategy to promote functional recovery following SCI. ANN NEUROL 2023;93:1198-1213.
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Affiliation(s)
- Hang Jin Jo
- Shirley Ryan AbilityLab, Chicago, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, USA
| | - Ethan Kizziar
- Shirley Ryan AbilityLab, Chicago, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, USA
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, USA
| | - Sina Sangari
- Shirley Ryan AbilityLab, Chicago, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, USA
| | - David Chen
- Shirley Ryan AbilityLab, Chicago, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, USA
| | - Allison Kessler
- Shirley Ryan AbilityLab, Chicago, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, USA
| | - Ki Kim
- Shirley Ryan AbilityLab, Chicago, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, USA
| | - Alan Anschel
- Shirley Ryan AbilityLab, Chicago, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, USA
| | - Allen W. Heinemann
- Shirley Ryan AbilityLab, Chicago, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, USA
| | - Brett D. Mensh
- Janelia Research Campus, Howard Hughes Medical Institute, Ashburn, Virginia, USA
| | - Saria Awadalla
- Division of Epidemiology & Biostatistics, University of Illinois at Chicago, Chicago, USA
| | - Richard L. Lieber
- Shirley Ryan AbilityLab, Chicago, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, USA
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, USA
- Edward Jr. Hines VA Hospital, Chicago, USA
| | - Martin Oudega
- Shirley Ryan AbilityLab, Chicago, USA
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, USA
- Edward Jr. Hines VA Hospital, Chicago, USA
| | - Monica A. Perez
- Shirley Ryan AbilityLab, Chicago, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, USA
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, USA
- Edward Jr. Hines VA Hospital, Chicago, USA
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25
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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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26
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de Sire A, Moggio L, Marotta N, Curci C, Lippi L, Invernizzi M, Mezian K, Ammendolia A. Impact of rehabilitation on volumetric muscle loss in subjects with traumatic spinal cord injury: A systematic review. NeuroRehabilitation 2023; 52:365-386. [PMID: 36806523 DOI: 10.3233/nre-220277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
BACKGROUND Spinal cord injury (SCI) leads to spinal nerve fiber tract damage resulting in functional impairments. Volumetric muscle loss (VML), a skeletal muscle volume abnormal reduction, is represented by atrophy below the injury level. The strategies for VML management included personalized approaches, and no definite indications are available. OBJECTIVE To identify the rehabilitation effects of VML in subjects with SCI (humans and animals). METHODS PubMed, Scopus, and Web of Science databases were systematically searched to identify longitudinal observational studies with individuals affected by traumatic SCI as participants; rehabilitation treatment as intervention; no control, sham treatment, and electrical stimulation programs as control; total lean body and lower limb lean mass, cross-sectional area, functional gait recovery, muscle thickness, and ultrasound intensity, as outcome. RESULTS Twenty-four longitudinal observational studies were included, evaluating different rehabilitation approaches' effects on the VML reduction in subjects affected by SCI. The data showed that electrical stimulation and treadmill training are effective in reducing the VML in this population. CONCLUSION This systematic review underlines the need to treat subjects with traumatic SCI (humans and animals) with different rehabilitation approaches to prevent VML in the subacute and chronic phases. Further clinical observations are needed to overcome the bias and to define the intervention's timing and modalities.
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Affiliation(s)
- Alessandro de Sire
- Department of Medical and Surgical Sciences, Physical Medicine and Rehabilitation Unit, University of CatanzaroMagna Graecia, Catanzaro, Italy.,Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Lucrezia Moggio
- Department of Medical and Surgical Sciences, Physical Medicine and Rehabilitation Unit, University of CatanzaroMagna Graecia, Catanzaro, Italy.,Rehabilitation Unit, Ospedale degliInfermi, Biella, Italy
| | - Nicola Marotta
- Department of Medical and Surgical Sciences, Physical Medicine and Rehabilitation Unit, University of CatanzaroMagna Graecia, Catanzaro, Italy
| | - Claudio Curci
- Department of Neurosciences, Physical Medicine and Rehabilitation Unit, ASST CarloPoma, Mantova, Italy
| | - Lorenzo Lippi
- Department of Health Sciences, University of Eastern Piedmont "A. Avogadro", Novara, Italy.,Translational Medicine, DipartimentoAttività Integrate Ricerca e Innovazione (DAIRI), AziendaOspedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Marco Invernizzi
- Department of Health Sciences, University of Eastern Piedmont "A. Avogadro", Novara, Italy.,Translational Medicine, DipartimentoAttività Integrate Ricerca e Innovazione (DAIRI), AziendaOspedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Kamal Mezian
- Department of Rehabilitation Medicine, First Faculty of Medicine, Charles University and General UniversityHospital in Prague, Prague, Czech Republic
| | - Antonio Ammendolia
- Department of Medical and Surgical Sciences, Physical Medicine and Rehabilitation Unit, University of CatanzaroMagna Graecia, Catanzaro, Italy
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27
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First Use of Non-Invasive Spinal Cord Stimulation in Motor Rehabilitation of Children with Spinal Muscular Atrophy. Life (Basel) 2023; 13:life13020449. [PMID: 36836806 PMCID: PMC9966619 DOI: 10.3390/life13020449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/21/2023] [Accepted: 02/03/2023] [Indexed: 02/09/2023] Open
Abstract
Spinal muscular atrophy (SMA) is characterized by the degeneration of spinal alpha motorneurons. Nusinersen demonstrated good efficacy in the early disease phases. The feasibility of transcutaneous spinal cord stimulation (tSCS) in motor rehabilitation of patients with spinal cord injury has been demonstrated. We hypothesize that tSCS may activate intact and restored by nusinersen motorneurons and slow down the decline in motor activity, and may contribute to the development of motor skills in children with SMA. A case series is presented. Five children (6-13 years old) with SMA type II or III participated in the study. They were treated with nusinersen for ~2 years. Application of tSCS was carried out during physical therapy for 30-40 min per day in the course of 10-14 days. Outcome measures were goniometry of joints with contracture, forced vital capacity (FVC), RULM and HFMSE scales. The participants tolerated the stimulation well. The reduction of the contracture was ≥5 deg. RULM and HFMSE increased by ~1-2 points. Predicted FVC increased by 1-7% in three participants. Each participant expanded their range of active movements and/or learned new motor skills. Spinal cord stimulation may be an effective rehabilitation method in patients treated with nusinersen. More research is needed.
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28
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Dorrian RM, Berryman CF, Lauto A, Leonard AV. Electrical stimulation for the treatment of spinal cord injuries: A review of the cellular and molecular mechanisms that drive functional improvements. Front Cell Neurosci 2023; 17:1095259. [PMID: 36816852 PMCID: PMC9936196 DOI: 10.3389/fncel.2023.1095259] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 01/16/2023] [Indexed: 02/05/2023] Open
Abstract
Spinal cord injury (SCI) is a devastating condition that causes severe loss of motor, sensory and autonomic functions. Additionally, many individuals experience chronic neuropathic pain that is often refractory to interventions. While treatment options to improve outcomes for individuals with SCI remain limited, significant research efforts in the field of electrical stimulation have made promising advancements. Epidural electrical stimulation, peripheral nerve stimulation, and functional electrical stimulation have shown promising improvements for individuals with SCI, ranging from complete weight-bearing locomotion to the recovery of sexual function. Despite this, there is a paucity of mechanistic understanding, limiting our ability to optimize stimulation devices and parameters, or utilize combinatorial treatments to maximize efficacy. This review provides a background into SCI pathophysiology and electrical stimulation methods, before exploring cellular and molecular mechanisms suggested in the literature. We highlight several key mechanisms that contribute to functional improvements from electrical stimulation, identify gaps in current knowledge and highlight potential research avenues for future studies.
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Affiliation(s)
- Ryan M. Dorrian
- Spinal Cord Injury Research Group, School of Biomedicine, The University of Adelaide, Adelaide, SA, Australia,*Correspondence: Ryan M. Dorrian,
| | | | - Antonio Lauto
- School of Science, Western Sydney University, Penrith, NSW, Australia
| | - Anna V. Leonard
- Spinal Cord Injury Research Group, School of Biomedicine, The University of Adelaide, Adelaide, SA, Australia
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29
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Neuromodulation with transcutaneous spinal stimulation reveals different groups of motor profiles during robot-guided stepping in humans with incomplete spinal cord injury. Exp Brain Res 2023; 241:365-382. [PMID: 36534141 PMCID: PMC10278039 DOI: 10.1007/s00221-022-06521-5] [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: 08/16/2022] [Accepted: 12/03/2022] [Indexed: 12/23/2022]
Abstract
Neuromodulation via spinal stimulation has been investigated for improving motor function and reducing spasticity after spinal cord injury (SCI) in humans. Despite the reported heterogeneity of outcomes, few investigations have attempted to discern commonalities among individual responses to neuromodulation, especially the impact of stimulation frequencies. Here, we examined how exposure to continuous lumbosacral transcutaneous spinal stimulation (TSS) across a range of frequencies affects robotic torques and EMG patterns during stepping in a robotic gait orthosis on a motorized treadmill. We studied nine chronic motor-incomplete SCI individuals (8/1 AIS-C/D, 8 men) during robot-guided stepping with body-weight support without and with TSS applied at random frequencies between 1 and up to 100 Hz at a constant, individually selected stimulation intensity below the common motor threshold for posterior root reflexes. The hip and knee robotic torques needed to maintain the predefined stepping trajectory and EMG in eight bilateral leg muscles were recorded. We calculated the standardized mean difference between the stimulation conditions grouped into frequency bins and the no stimulation condition to determine changes in the normalized torques and the average EMG envelopes. We found heterogeneous changes in robotic torques across individuals. Agglomerative clustering of robotic torques identified four groups wherein the patterns of changes differed in magnitude and direction depending mainly on the stimulation frequency and stance/swing phase. On one end of the spectrum, the changes in robotic torques were greater with increasing stimulation frequencies (four participants), which coincided with a decrease in EMG, mainly due to the reduction of clonogenic motor output in the lower leg muscles. On the other end, we found an inverted u-shape change in torque over the mid-frequency range along with an increase in EMG, reflecting the augmentation of gait-related physiological (two participants) or pathophysiological (one participant) output. We conclude that TSS during robot-guided stepping reveals different frequency-dependent motor profiles among individuals with chronic motor incomplete SCI. This suggests the need for a better understanding and characterization of motor control profiles in SCI when applying TSS as a therapeutic intervention for improving gait.
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30
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Rehman MU, Sneed D, Sutor TW, Hoenig H, Gorgey AS. Optimization of Transspinal Stimulation Applications for Motor Recovery after Spinal Cord Injury: Scoping Review. J Clin Med 2023; 12:854. [PMID: 36769503 PMCID: PMC9917510 DOI: 10.3390/jcm12030854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 01/25/2023] Open
Abstract
Spinal cord injury (SCI) is a debilitating condition that can significantly affect an individual's life, causing paralysis, autonomic dysreflexia, and chronic pain. Transspinal stimulation (TSS) is a non-invasive form of neuromodulation that activates the underlying neural circuitries of the spinal cord. Application of TSS can be performed through multiple stimulation protocols, which may vary in the electrodes' size or position as well as stimulation parameters, and which may influence the response of motor functions to the stimulation. Due to the novelty of TSS, it is beneficial to summarize the available evidence to identify the range of parameters that may provide the best outcomes for motor response. The PubMed and Google Scholar databases were searched for studies examining the effects of TSS on limb motor function. A literature search yielded 34 studies for analysis, in which electrode placement and stimulation parameters varied considerably. The stimulation protocols from each study and their impact on limb motor function were summarized. Electrode placement was variable based on the targeted limb. Studies for the upper limbs targeted the cervical enlargement with anatomical placement of the cathode over the cervical vertebral region. In lower-limb studies, the cathode(s) were placed over the thoracic and lumbar vertebral regions, to target the lumbar enlargement. The effects of carrier frequency were inconclusive across the studies. Multisite cathodal placements yielded favorable motor response results compared to single-site placement. This review briefly summarized the current mechanistic evidence of the effect of TSS on motor response after SCI. Our findings indicate that optimization of stimulation parameters will require future randomized controlled studies to independently assess the effects of different stimulation parameters under controlled circumstances.
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Affiliation(s)
- Muhammad Uzair Rehman
- Spinal Cord Injury and Disorders, Hunter Holmes McGuire VA Medical Center, Richmond, VA 23249, USA
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Dustin Sneed
- Department of Physical Medicine and Rehabilitation, School of Medicine, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Tommy W. Sutor
- Spinal Cord Injury and Disorders, Hunter Holmes McGuire VA Medical Center, Richmond, VA 23249, USA
| | - Helen Hoenig
- Physical Medicine & Rehabilitation Service, Durham VA Health Care System, Durham, NC 27705, USA
- Geriatrics Division, Department of Medicine, Duke University, Durham, NC 27710, USA
| | - Ashraf S. Gorgey
- Spinal Cord Injury and Disorders, Hunter Holmes McGuire VA Medical Center, Richmond, VA 23249, USA
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA 23284, USA
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Xu X, Talifu Z, Zhang CJ, Gao F, Ke H, Pan YZ, Gong H, Du HY, Yu Y, Jing YL, Du LJ, Li JJ, Yang DG. Mechanism of skeletal muscle atrophy after spinal cord injury: A narrative review. Front Nutr 2023; 10:1099143. [PMID: 36937344 PMCID: PMC10020380 DOI: 10.3389/fnut.2023.1099143] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 02/20/2023] [Indexed: 03/06/2023] Open
Abstract
Spinal cord injury leads to loss of innervation of skeletal muscle, decreased motor function, and significantly reduced load on skeletal muscle, resulting in atrophy. Factors such as braking, hormone level fluctuation, inflammation, and oxidative stress damage accelerate skeletal muscle atrophy. The atrophy process can result in skeletal muscle cell apoptosis, protein degradation, fat deposition, and other pathophysiological changes. Skeletal muscle atrophy not only hinders the recovery of motor function but is also closely related to many systemic dysfunctions, affecting the prognosis of patients with spinal cord injury. Extensive research on the mechanism of skeletal muscle atrophy and intervention at the molecular level has shown that inflammation and oxidative stress injury are the main mechanisms of skeletal muscle atrophy after spinal cord injury and that multiple pathways are involved. These may become targets of future clinical intervention. However, most of the experimental studies are still at the basic research stage and still have some limitations in clinical application, and most of the clinical treatments are focused on rehabilitation training, so how to develop more efficient interventions in clinical treatment still needs to be further explored. Therefore, this review focuses mainly on the mechanisms of skeletal muscle atrophy after spinal cord injury and summarizes the cytokines and signaling pathways associated with skeletal muscle atrophy in recent studies, hoping to provide new therapeutic ideas for future clinical work.
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Affiliation(s)
- Xin Xu
- School of Rehabilitation, Capital Medical University, Beijing, China
- Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center, Beijing, China
- Chinese Institute of Rehabilitation Science, Beijing, China
- Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China
| | - Zuliyaer Talifu
- School of Rehabilitation, Capital Medical University, Beijing, China
- Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center, Beijing, China
- Chinese Institute of Rehabilitation Science, Beijing, China
- Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China
- School of Rehabilitation Sciences and Engineering, University of Health and Rehabilitation Sciences, Qingdao, Shandong, China
| | - Chun-Jia Zhang
- School of Rehabilitation, Capital Medical University, Beijing, China
- Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center, Beijing, China
- Chinese Institute of Rehabilitation Science, Beijing, China
- Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China
| | - Feng Gao
- School of Rehabilitation, Capital Medical University, Beijing, China
- Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center, Beijing, China
- Chinese Institute of Rehabilitation Science, Beijing, China
- Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China
| | - Han Ke
- School of Rehabilitation, Capital Medical University, Beijing, China
- Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center, Beijing, China
- Chinese Institute of Rehabilitation Science, Beijing, China
- Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China
- School of Rehabilitation Sciences and Engineering, University of Health and Rehabilitation Sciences, Qingdao, Shandong, China
| | - Yun-Zhu Pan
- School of Rehabilitation, Capital Medical University, Beijing, China
- Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center, Beijing, China
- Chinese Institute of Rehabilitation Science, Beijing, China
- Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China
- School of Rehabilitation Sciences and Engineering, University of Health and Rehabilitation Sciences, Qingdao, Shandong, China
| | - Han Gong
- School of Rehabilitation, Capital Medical University, Beijing, China
- Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center, Beijing, China
- Chinese Institute of Rehabilitation Science, Beijing, China
- Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China
| | - Hua-Yong Du
- School of Rehabilitation, Capital Medical University, Beijing, China
- Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center, Beijing, China
- Chinese Institute of Rehabilitation Science, Beijing, China
- Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China
| | - Yan Yu
- School of Rehabilitation, Capital Medical University, Beijing, China
- Chinese Institute of Rehabilitation Science, Beijing, China
- Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China
| | - Ying-Li Jing
- School of Rehabilitation, Capital Medical University, Beijing, China
- Chinese Institute of Rehabilitation Science, Beijing, China
- Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China
| | - Liang-Jie Du
- School of Rehabilitation, Capital Medical University, Beijing, China
- Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center, Beijing, China
- Chinese Institute of Rehabilitation Science, Beijing, China
- Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China
| | - Jian-Jun Li
- School of Rehabilitation, Capital Medical University, Beijing, China
- Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center, Beijing, China
- Chinese Institute of Rehabilitation Science, Beijing, China
- Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China
- School of Rehabilitation Sciences and Engineering, University of Health and Rehabilitation Sciences, Qingdao, Shandong, China
- *Correspondence: Jian-Jun Li
| | - De-Gang Yang
- School of Rehabilitation, Capital Medical University, Beijing, China
- Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center, Beijing, China
- Chinese Institute of Rehabilitation Science, Beijing, China
- Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China
- De-Gang Yang
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Shandybina ND, Kuropatenko MV, Moshonkina TR. Regulation of Human Respiration by Electrical Stimulation. J EVOL BIOCHEM PHYS+ 2022; 58:1879-1891. [PMID: 36573159 PMCID: PMC9773692 DOI: 10.1134/s0022093022060175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/28/2022] [Accepted: 09/29/2022] [Indexed: 12/24/2022]
Abstract
The review addresses modern methods of electrical stimulation used to regulate the function of external respiration in humans. The methods include abdominal functional stimulation of respiratory muscles, diaphragmatic stimulation, phrenic nerve stimulation, epidural and transcutaneous spinal cord stimulation. The physiological rationale of their application is described along with the examples of their use in clinical practice, including stimulation parameters and electrode placement diagrams for each of the methods. We analyze the effectiveness of each of the methods in patients with respiratory muscle paresis and the features of their use depending on the level of spinal cord injury. Special attention is paid to the method of epidural spinal cord stimulation because this technique is widely used in electrophysiological studies on animal models, providing deeper insight into the spinal levels of the functional control of external respiration. The review substantiates the great potential of using the method of transcutaneous electrical spinal cord stimulation both in fundamental studies of external respiration and in clinical practice.
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Affiliation(s)
- N. D. Shandybina
- Pavlov Institute of Physiology, Russian Academy of Sciences, St. Petersburg, Russia
- Institute of Experimental Medicine, St. Petersburg, Russia
| | | | - T. R. Moshonkina
- Pavlov Institute of Physiology, Russian Academy of Sciences, St. Petersburg, Russia
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Insausti-Delgado A, López-Larraz E, Nishimura Y, Ziemann U, Ramos-Murguialday A. Non-invasive brain-spine interface: Continuous control of trans-spinal magnetic stimulation using EEG. Front Bioeng Biotechnol 2022; 10:975037. [PMID: 36394044 PMCID: PMC9659618 DOI: 10.3389/fbioe.2022.975037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 09/23/2022] [Indexed: 08/22/2023] Open
Abstract
Brain-controlled neuromodulation has emerged as a promising tool to promote functional recovery in patients with motor disorders. Brain-machine interfaces exploit this neuromodulatory strategy and could be used for restoring voluntary control of lower limbs. In this work, we propose a non-invasive brain-spine interface (BSI) that processes electroencephalographic (EEG) activity to volitionally control trans-spinal magnetic stimulation (ts-MS), as an approach for lower-limb neurorehabilitation. This novel platform allows to contingently connect motor cortical activation during leg motor imagery with the activation of leg muscles via ts-MS. We tested this closed-loop system in 10 healthy participants using different stimulation conditions. This BSI efficiently removed stimulation artifacts from EEG regardless of ts-MS intensity used, allowing continuous monitoring of cortical activity and real-time closed-loop control of ts-MS. Our BSI induced afferent and efferent evoked responses, being this activation ts-MS intensity-dependent. We demonstrated the feasibility, safety and usability of this non-invasive BSI. The presented system represents a novel non-invasive means of brain-controlled neuromodulation and opens the door towards its integration as a therapeutic tool for lower-limb rehabilitation.
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Affiliation(s)
- Ainhoa Insausti-Delgado
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
- International Max Planck Research School (IMPRS) for Cognitive and Systems Neuroscience, Tübingen, Germany
- IKERBASQUE, Basque Foundation for Science, Bilbao, Spain
- TECNALIA, Basque Research and Technology Alliance (BRTA), Donostia-San Sebastián, Spain
| | - Eduardo López-Larraz
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
- Bitbrain, Zaragoza, Spain
| | - Yukio Nishimura
- Neural Prosthetics Project, Department of Brain and Neuroscience, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Ulf Ziemann
- Department of Neurology and Stroke, University of Tübingen, Tübingen, Germany
- Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Ander Ramos-Murguialday
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
- TECNALIA, Basque Research and Technology Alliance (BRTA), Donostia-San Sebastián, Spain
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Song XZ, Chu XL, Liu T, Cao YT, Li RX, Gao MW, Li QW, Gu XS, Ming D. Case report: Ultrasound-guided multi-site electroacupuncture stimulation for a patient with spinal cord injury. Front Neurol 2022; 13:903207. [PMID: 36090881 PMCID: PMC9448914 DOI: 10.3389/fneur.2022.903207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 08/02/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Spinal cord injury causes permanent neurological deficits, which have devastating physical, social, and vocational consequences for patients and their families. Traditional Chinese medicine uses acupuncture to treat neuropathic pain and improve nerve conduction velocity. This treatment can also reduce peripheral nerve injury joint contracture and muscle atrophy in affected patients. And it's got a remarkable restoration when electrical stimulation therapy on impaired peripheral nerves in animal models and clinical trials. Case description A 48-year-old woman was hit by a heavy object that injured her lower back. The patient had a T12-L1 vertebral flexion and stretch fracture with traumatic spinal stenosis. The patient was transferred to the rehabilitation department after posterior T12-L2-segment pedicle screw system distraction and reduction, internal fixation, decompression, and bone graft fusion. Ultrasound-guided electroacupuncture was used to stimulate the sacral nerve, the spinal nerve, and the head of the patient, accompanied by spinal joint loosening training, respiratory training, lumbar comprehensive sports training, paraplegic limbs comprehensive training, and other manipulative treatment. Outcomes After the intervention, the patient showed significant improvements in sensory and motor scores, resulting in functional recovery according to ASIA and FIM. The patient gradually showed reasonable functional remission. Discussion The sacral nerve, the spinal cord, and the head were electrically stimulated by ultrasound-guided electroacupuncture in terms of intervention, and various functions of the patient were alleviated to a certain extent. The efficacy of ultrasound-guided electroacupuncture stimulation in treating neurologic symptoms should be validated in future clinical trials.
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Affiliation(s)
- Xi-Zi Song
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
| | - Xiao-Lei Chu
- Department of Rehabilitation, Tianjin University Tianjin Hospital, Tianjin, China
| | - Tao Liu
- College of Exercise & Health Sciences, Tianjin University of Sport, Tianjin, China
| | - Yu-Tong Cao
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
| | - Rui-Xin Li
- College of Exercise & Health Sciences, Tianjin University of Sport, Tianjin, China
| | - Ming-Wei Gao
- College of Exercise & Health Sciences, Tianjin University of Sport, Tianjin, China
| | - Qing-Wen Li
- College of Exercise & Health Sciences, Tianjin University of Sport, Tianjin, China
| | - Xiao-Song Gu
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
- *Correspondence: Xiao-Song Gu
| | - Dong Ming
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
- College of Precision Instruments and Optoelectronics Engineering, Tianjin University, Tianjin, China
- Dong Ming
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Chen M, Chen Z, Xiao X, Zhou L, Fu R, Jiang X, Pang M, Xia J. Corticospinal circuit neuroplasticity may involve silent synapses: Implications for functional recovery facilitated by neuromodulation after spinal cord injury. IBRO Neurosci Rep 2022; 14:185-194. [PMID: 36824667 PMCID: PMC9941655 DOI: 10.1016/j.ibneur.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 08/15/2022] [Indexed: 10/15/2022] Open
Abstract
Spinal cord injury (SCI) leads to devastating physical consequences, such as severe sensorimotor dysfunction even lifetime disability, by damaging the corticospinal system. The conventional opinion that SCI is intractable due to the poor regeneration of neurons in the adult central nervous system (CNS) needs to be revisited as the CNS is capable of considerable plasticity, which underlie recovery from neural injury. Substantial spontaneous neuroplasticity has been demonstrated in the corticospinal motor circuitry following SCI. Some of these plastic changes appear to be beneficial while others are detrimental toward locomotor function recovery after SCI. The beneficial corticospinal plasticity in the spared corticospinal circuits can be harnessed therapeutically by multiple contemporary neuromodulatory approaches, especially the electrical stimulation-based modalities, in an activity-dependent manner to improve functional outcomes in post-SCI rehabilitation. Silent synapse generation and unsilencing contribute to profound neuroplasticity that is implicated in a variety of neurological disorders, thus they may be involved in the corticospinal motor circuit neuroplasticity following SCI. Exploring the underlying mechanisms of silent synapse-mediated neuroplasticity in the corticospinal motor circuitry that may be exploited by neuromodulation will inform a novel direction for optimizing therapeutic repair strategies and rehabilitative interventions in SCI patients.
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Key Words
- AMPARs, α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptors
- BDNF, brain-derived neurotrophic factor
- BMIs, brain-machine interfaces
- CPG, central pattern generator
- CST, corticospinal tract
- Corticospinal motor circuitry
- DBS, deep brain stimulation
- ESS, epidural spinal stimulation
- MEPs, motor-evoked potentials
- NHPs, non-human primates
- NMDARs, N-methyl-d-aspartate receptors
- Neuromodulation
- Neuroplasticity
- PSNs, propriospinal neurons
- Rehabilitation
- SCI, spinal cord injury
- STDP, spike timing-dependent plasticity
- Silent synapses
- Spinal cord injury
- TBS, theta burst stimulation
- TMS, transcranial magnetic stimulation
- TrkB, tropomyosin-related kinase B
- cTBS, continuous TBS
- iTBS, intermittent TBS
- mTOR, mammalian target of rapamycin
- rTMS, repetitive TMS
- tDCS, transcranial direct current stimulation
- tcSCS, transcutaneous spinal cord stimulation
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Affiliation(s)
- Mingcong Chen
- Department of Orthopedics and Traumatology, Shenzhen University General Hospital, Shenzhen, Guangdong 518055, China
| | - Zuxin Chen
- Shenzhen Key Laboratory of Drug Addiction, Shenzhen Neher Neural Plasticity Laboratory, the Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences (CAS); Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen, Guangdong 518055, China
| | - Xiao Xiao
- Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Ministry of Education; Behavioral and Cognitive Neuroscience Center, Institute of Science and Technology for Brain-Inspired Intelligence; MOE Frontiers Center for Brain Science, Fudan University, Shanghai 200433, China
| | - Libing Zhou
- Guangdong-Hongkong-Macau CNS Regeneration Institute of Jinan University, Key Laboratory of CNS Regeneration (Jinan University)-Ministry of Education, Guangzhou, Guangdong 510632, China
| | - Rao Fu
- Department of Anatomy, School of Medicine, Sun Yat-sen University, Shenzhen, Guangdong 518100, China
| | - Xian Jiang
- Institute of Neurological and Psychiatric Disorder, Shenzhen Bay laboratory, Shenzhen, Guangdong 518000, China
| | - Mao Pang
- Department of Spine Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangzhou, Guangdong 510630, China
| | - Jianxun Xia
- Department of Basic Medical Sciences, Yunkang School of Medicine and Health, Nanfang College, Guangzhou, Guangdong 510970, China,Corresponding author.
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Fan X, Ren H, Bu C, Lu Z, Wei Y, Xu F, Fu L, Ma L, Kong C, Wang T, Zhang Y, Liu Q, Huang W, Bu H, Yuan J. Alterations in local activity and functional connectivity in patients with postherpetic neuralgia after short-term spinal cord stimulation. Front Mol Neurosci 2022; 15:938280. [PMID: 36034501 PMCID: PMC9405669 DOI: 10.3389/fnmol.2022.938280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 07/13/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionThe efficacy of short-term spinal cord stimulation (stSCS) as a treatment for neuropathic pain in patients with postherpetic neuralgia (PHN) has already been validated. However, the potential alterations in brain functionality that are induced by such treatment have yet to be completely elucidated.MethodsThis study use resting-state functional magnetic resonance imaging (rs-fMRI) to detect the changes in regional homogeneity (ReHo) and degree centrality (DC) related to stimulator-induced pain relief in patients with PHN. A total of 10 patients with PHN underwent an MRI protocol at baseline and after stSCS. Alterations in ReHo and DC were then compared between baseline and after stSCS. We investigated the relationship between clinical parameters and functional changes in the brain.ResultsClinical parameters on pain, emotion, and sleep quality were correlated with ReHo and DC. ReHo and DC were significantly altered in the middle temporal gyrus, precuneus, superior frontal gyrus, supramarginal gyrus, inferior parietal lobule, rolandic operculum, middle occipital gyrus, superior parietal gyrus, and the precentral gyrus after stSCS. A significant correlation was detected between ReHo changes in the middle occipital gyrus, precuneus, inferior parietal gyrus, and changes in pain, emotion, and sleep quality. A significant negative correlation was detected between DC changes in the middle temporal gyrus, rolandic operculum, supramarginal gyrus, precuneus, inferior parietal gyrus, and changes in pain, emotion, and sleep quality.ConclusionThis study found that stSCS is able to induce ReHo and DC changes in patients with PHN, thus suggesting that stSCS can change brain function to alleviate pain, sleep, and emotional disorder.
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Affiliation(s)
- Xiaochong Fan
- Department of Pain Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Xiaochong Fan
| | - Huan Ren
- Department of Pain Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chunxiao Bu
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhongyuan Lu
- Department of Pain Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yarui Wei
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Fuxing Xu
- Department of Pain Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lijun Fu
- Department of Pain Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Letian Ma
- Department of Pain Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Cunlong Kong
- Department of Pain Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Tao Wang
- Department of Pain Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yong Zhang
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qingying Liu
- Department of Pain Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wenqi Huang
- Department of Anesthesiology, The First Affiliated Hospital Sun Yat-sen University, Guangzhou, China
| | - Huilian Bu
- Department of Pain Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jingjing Yuan
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- *Correspondence: Jingjing Yuan
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Mahan E, Dunkelberger N, Oh J, Simmons M, Varghese B, Sayenko D, O'Malley MK. Measuring Torque Production with a Robotic Exoskeleton during Cervical Transcutaneous Spinal Stimulation. IEEE Int Conf Rehabil Robot 2022; 2022:1-5. [PMID: 36176117 DOI: 10.1109/icorr55369.2022.9896477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Spinal cord injury (SCI) affects a large number of individuals in the United States. Unfortunately, traditional neurorehabilitation therapy leaves out clinical populations with limited motor function, such as severe stroke or spinal cord injury, as they are incapable of engaging in movement therapy. To increase the numbers of individuals who may be able to participate in robotic therapy, our long-term goal is to combine two validated interventions, transcutaneous spinal stimulation (TSS) and robotics, to elicit upper limb movements during rehabilitation following SCI. To achieve this goal, it is necessary to quantify the contributions of each intervention to realizing arm movements. Electromyography is typically used to assess the response to TSS, but the robot itself offers an additional source of data since the available sensors on the robot can be used to directly assess resultant actions of the upper limb after stimulation. We explore this approach in this paper. We showed that the effects of cutaneous TSS can be observed by measuring the holding torque required by the exoskeleton to keep a user's arm in a neutral position. Further, we can identify differences in resultant action based on the location of the stimulation electrodes with respect to the dorsal roots of the spinal cord. In the future, we can use measurements from the robot to guide the action of the robot and TSS intervention.
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Transcutaneous spinal cord stimulation combined with locomotor training to improve walking ability in people with chronic spinal cord injury: study protocol for an international multi-centred double-blinded randomised sham-controlled trial (eWALK). Spinal Cord 2022; 60:491-497. [PMID: 35013547 DOI: 10.1038/s41393-021-00734-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 11/23/2021] [Accepted: 11/25/2021] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN An international multi-centred, double-blinded, randomised sham-controlled trial (eWALK). OBJECTIVE To determine the effect of 12 weeks of transcutaneous spinal stimulation (TSS) combined with locomotor training on walking ability in people with spinal cord injury (SCI). SETTING Dedicated SCI research centres in Australia, Spain, USA and Scotland. METHODS Fifty community-dwelling individuals with chronic SCI will be recruited. Participants will be eligible if they have bilateral motor levels between T1 and T11, a reproducible lower limb muscle contraction in at least one muscle group, and a Walking Index for SCI II (WISCI II) between 1 and 6. Eligible participants will be randomised to one of two groups, either the active stimulation group or the sham stimulation group. Participants allocated to the stimulation group will receive TSS combined with locomotor training for three 30-min sessions a week for 12 weeks. The locomotor sessions will include walking on a treadmill and overground. Participants allocated to the sham stimulation group will receive the same locomotor training combined with sham stimulation. The primary outcome will be walking ability with stimulation using the WISCI II. Secondary outcomes will record sensation, strength, spasticity, bowel function and quality of life. TRIAL REGISTRATION ANZCTR.org.au identifier ACTRN12620001241921.
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Huang R, Nikooyan AA, Moore LD, Zdunowski S, Morikawa E, Sierro T, Sayenko D, Gad P, Homsey T, Le T, Madhavan MA, Abdelshahid M, Abdelshahid M, Zhou Y, Nuwer MR, Sarrafzadeh M, Edgerton VR, Leiter JC, Lu DC. Minimal handgrip force is needed for transcutaneous electrical stimulation to improve hand functions of patients with severe spinal cord injury. Sci Rep 2022; 12:7733. [PMID: 35545644 PMCID: PMC9095635 DOI: 10.1038/s41598-022-11306-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 04/14/2022] [Indexed: 11/09/2022] Open
Abstract
Spinal cord stimulation enhanced restoration of motor function following spinal cord injury (SCI) in unblinded studies. To determine whether training combined with transcutaneous electrical spinal cord stimulation (tSCS), with or without systemic serotonergic treatment with buspirone (busp), could improve hand function in individuals with severe hand paralysis following SCI, we assessed ten subjects in a double-blind, sham-controlled, crossover study. All treatments-busp, tSCS, and the busp plus tSCS-reduced muscle tone and spasm frequency. Buspirone did not have any discernible impact on grip force or manual dexterity when administered alone or in combination with tSCS. In contrast, grip force, sinusoidal force generation and grip-release rate improved significantly after 6 weeks of tSCS in 5 out of 10 subjects who had residual grip force within the range of 0.1-1.5 N at the baseline evaluation. Improved hand function was sustained in subjects with residual grip force 2-5 months after the tSCS and buspirone treatment. We conclude that tSCS combined with training improves hand strength and manual dexterity in subjects with SCI who have residual grip strength greater than 0.1 N. Buspirone did not significantly improve the hand function nor add to the effect of stimulation.
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Affiliation(s)
- Ruyi Huang
- Neurosurgery Department, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA
- Neuroplasticity and Repair Laboratory, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Ali A Nikooyan
- Neurosurgery Department, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA
- School of Information, University of California, Berkeley, Berkeley, CA, 94720, USA
| | - Lisa D Moore
- Neurosurgery Department, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA
- Neuroplasticity and Repair Laboratory, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Sharon Zdunowski
- Department of Neurobiology, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Erika Morikawa
- Neurosurgery Department, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA
- Neuroplasticity and Repair Laboratory, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Tiffany Sierro
- Neurosurgery Department, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | | | - Parag Gad
- Department of Neurobiology, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Tali Homsey
- Neurosurgery Department, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA
- Neuroplasticity and Repair Laboratory, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Timothy Le
- Neurosurgery Department, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA
- Neuroplasticity and Repair Laboratory, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Meghna A Madhavan
- Neurosurgery Department, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA
- Neuroplasticity and Repair Laboratory, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Marina Abdelshahid
- Neurosurgery Department, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Martina Abdelshahid
- Neurosurgery Department, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Yan Zhou
- Neurosurgery Department, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA
- Neuroplasticity and Repair Laboratory, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Mark R Nuwer
- Neurosurgery Department, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA
- Brain Research Institute, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Majid Sarrafzadeh
- Department of Computer Science, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - V Reggie Edgerton
- Brain Research Institute, University of California, Los Angeles, Los Angeles, CA, 90095, USA
- Department of Integrative Biology and Physiology, University of California, Los Angeles, Los Angeles, CA, 90095, USA
- Department of Neurobiology, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - James C Leiter
- White River Junction VA Medical Center, White River Junction, VT, 05009, USA
| | - Daniel C Lu
- Neurosurgery Department, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA.
- Neuroplasticity and Repair Laboratory, University of California, Los Angeles, Los Angeles, CA, 90095, USA.
- Brain Research Institute, University of California, Los Angeles, Los Angeles, CA, 90095, USA.
- Department of Orthopedic Surgery, University of California, Los Angeles, Los Angeles, CA, 90095, USA.
- Neuromotor Recovery and Rehabilitation Center, University of California, Los Angeles, Los Angeles, CA, 90095, USA.
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40
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Hawkins KA, DeMark LA, Vistamehr A, Snyder HJ, Conroy C, Wauneka C, Tonuzi G, Fuller DD, Clark DJ, Fox EJ. Feasibility of transcutaneous spinal direct current stimulation combined with locomotor training after spinal cord injury. Spinal Cord 2022; 60:971-977. [PMID: 35477745 PMCID: PMC9606142 DOI: 10.1038/s41393-022-00801-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 03/30/2022] [Accepted: 04/01/2022] [Indexed: 11/16/2022]
Abstract
Study Design: Feasibility study, consisting of random-order, cross-over study of a single intervention session, followed by a parallel-arm study of 16 sessions Objectives: To investigate the feasibility of a novel combinatorial approach with simultaneous delivery of transcutaneous spinal direct current stimulation (tsDCS) and locomotor training (tsDCS+LT) after spinal cord injury, compared to sham stimulation and locomotor training (sham+LT), and examine preliminary effects on walking function. Setting: Clinical research center in the southeastern United States Methods: Eight individuals with chronic incomplete spinal cord injury (ISCI) completed the two-part protocol. Feasibility was assessed based on safety (adverse responses), tolerability (pain, spasticity, skin integrity), and protocol achievement (session duration, intensity). Walking function was assessed with the 10-meter and 6-minute walk tests. Results: There were no major adverse responses. Minimal reports of skin irritation and musculoskeletal pain were consistent between groups. Average training peak heart rate as percent of maximum (mean(SD); tsDCS+LT: 66(4)%, sham+LT: 69(10)%) and Borg ratings of perceived exertion (tsDCS+LT: 17.5(1.2), sham+LT: 14.4(1.8)) indicate both groups trained at high intensities. Walking speed gains exceeded the minimal clinically important difference (MCID) in three of four who received tsDCS+LT (0.18(0.29) m/s) and one of four in sham+LT (−0.05(0.23) m/s). Gains in walking endurance exceeded the MCID in one of four in each group (tsDCS+LT: 36.4(69.0) m, sham+LT: 4.9(56.9) m). Conclusions: Combinatorial tsDCS and locomotor training is safe and feasible for individuals with chronic ISCI, even those with considerable walking impairment. Study outcomes support the need to investigate the efficacy of this approach.
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Affiliation(s)
- Kelly A Hawkins
- Department of Physical Therapy, University of Florida, Gainesville, FL, USA
| | | | | | | | | | | | | | - David D Fuller
- Department of Physical Therapy, University of Florida, Gainesville, FL, USA
| | - David J Clark
- Brain Rehabilitation Research Center of Excellence, North Florida/South Georgia Veterans Health System, Gainesville, FL, USA.,Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, USA
| | - Emily J Fox
- Department of Physical Therapy, University of Florida, Gainesville, FL, USA. .,Brooks Rehabilitation, Jacksonville, FL, USA.
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41
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Electroacupuncture for Spinal Cord Injury: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:8040555. [PMID: 35280510 PMCID: PMC8916891 DOI: 10.1155/2022/8040555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 11/29/2021] [Indexed: 11/28/2022]
Abstract
Background Previous studies have shown that electroacupuncture (EA) has a positive effect on motor and sensory function in patients with spinal cord injury (SCI). This review evaluated the effectiveness of EA for improvement in activities of daily living in patients with SCI. Methods We searched the Cochrane Library, PubMed, Web of Science, CNKI, WanFang Data, and VIP databases using a search strategy according to the guidelines of the Cochrane Handbook for Systematic Review of Interventions up to 30th September 2020. Only randomized controlled trials (RCTs) of EA in patients with SCI were included. We analyzed the data using RevMan (version 5.3) and graded the quality of evidence using GRADE profiler 3.6.1. Results This meta-analysis included 10 RCTs with 712 patients. Three studies revealed that the functional independence measure score for SCI patients in the EA group was higher than that in the control group (mean difference [MD] = 13.46, 95% CI: 8.00 to 18.92, P < 0.00001). Five studies showed that the modified Barthel index in the EA group was higher than that in the control group (MD = 6.92, 95% CI: 4.96 to 8.89, P < 0.00001). Five studies showed that the American Spinal Injury Association-motor score (ASIA-motor score) in the EA group was higher than that in the control group (standard MD = 0.96, 95% CI: 0.75 to 1.18, P < 0.00001). Three studies reported the ASIA-tactile and pain scores and also reported that the scores in the EA group were higher than those in the control group, with high homogeneity (tactile I2 = 86%, P = 0.0008; pain I2 = 54%, P = 0.11). The quality of evidence for the use of EA for improvement in motor and sensory function in SCIs was moderate according to the GRADE system. Conclusion This review suggested that EA improves activities of daily living and motor function in patients with SCI, with a moderate level of evidence.
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Rahman MA, Tharu NS, Gustin SM, Zheng YP, Alam M. Trans-Spinal Electrical Stimulation Therapy for Functional Rehabilitation after Spinal Cord Injury: Review. J Clin Med 2022; 11:1550. [PMID: 35329875 PMCID: PMC8954138 DOI: 10.3390/jcm11061550] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/04/2022] [Accepted: 03/09/2022] [Indexed: 01/25/2023] Open
Abstract
Spinal cord injury (SCI) is one of the most debilitating injuries in the world. Complications after SCI, such as respiratory issues, bowel/bladder incontinency, pressure ulcers, autonomic dysreflexia, spasticity, pain, etc., lead to immense suffering, a remarkable reduction in life expectancy, and even premature death. Traditional rehabilitations for people with SCI are often insignificant or ineffective due to the severity and complexity of the injury. However, the recent development of noninvasive electrical neuromodulation treatments to the spinal cord have shed a ray of hope for these individuals to regain some of their lost functions, a reduction in secondary complications, and an improvement in their life quality. For this review, 250 articles were screened and about 150 were included to summarize the two most promising noninvasive spinal cord electrical stimulation methods of SCI rehabilitation treatment, namely, trans-spinal direct current stimulation (tsDCS) and trans-spinal pulsed current stimulation (tsPCS). Both treatments have demonstrated good success in not only improving the sensorimotor function, but also autonomic functions. Due to the noninvasive nature and lower costs of these treatments, in the coming years, we expect these treatments to be integrated into regular rehabilitation therapies worldwide.
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Affiliation(s)
- Md. Akhlasur Rahman
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China; (M.A.R.); (N.S.T.); (Y.-P.Z.)
- Centre for the Rehabilitation of the Paralysed (CRP), Savar Union 1343, Bangladesh
| | - Niraj Singh Tharu
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China; (M.A.R.); (N.S.T.); (Y.-P.Z.)
| | - Sylvia M. Gustin
- NeuroRecovery Research Hub, School of Psychology, University of New South Wales, Sydney, NSW 2052, Australia;
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW 2031, Australia
| | - Yong-Ping Zheng
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China; (M.A.R.); (N.S.T.); (Y.-P.Z.)
| | - Monzurul Alam
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China; (M.A.R.); (N.S.T.); (Y.-P.Z.)
- NeuroRecovery Research Hub, School of Psychology, University of New South Wales, Sydney, NSW 2052, Australia;
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW 2031, Australia
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43
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Zhou X, Zhang L, Gao W. Partial recovery from severe trauma-induced paralysis after lumbar disc herniation. Asian J Surg 2022; 45:1169-1171. [PMID: 35221180 DOI: 10.1016/j.asjsur.2022.01.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 08/12/2021] [Accepted: 01/07/2022] [Indexed: 11/02/2022] Open
Affiliation(s)
- Xiaozhe Zhou
- Affiliated Hospital of Hebei University, Baoding, Hebei, 071000, China
| | - Lingnan Zhang
- Affiliated Hospital of Hebei University, Baoding, Hebei, 071000, China
| | - Wenshan Gao
- Affiliated Hospital of Hebei University, Baoding, Hebei, 071000, China.
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44
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Mutepfa AR, Hardy JG, Adams CF. Electroactive Scaffolds to Improve Neural Stem Cell Therapy for Spinal Cord Injury. FRONTIERS IN MEDICAL TECHNOLOGY 2022; 4:693438. [PMID: 35274106 PMCID: PMC8902299 DOI: 10.3389/fmedt.2022.693438] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 01/10/2022] [Indexed: 12/14/2022] Open
Abstract
Spinal cord injury (SCI) is a serious condition caused by damage to the spinal cord through trauma or disease, often with permanent debilitating effects. Globally, the prevalence of SCI is estimated between 40 to 80 cases per million people per year. Patients with SCI can experience devastating health and socioeconomic consequences from paralysis, which is a loss of motor, sensory and autonomic nerve function below the level of the injury that often accompanies SCI. SCI carries a high mortality and increased risk of premature death due to secondary complications. The health, social and economic consequences of SCI are significant, and therefore elucidation of the complex molecular processes that occur in SCI and development of novel effective treatments is critical. Despite advances in medicine for the SCI patient such as surgery and anaesthesiology, imaging, rehabilitation and drug discovery, there have been no definitive findings toward complete functional neurologic recovery. However, the advent of neural stem cell therapy and the engineering of functionalized biomaterials to facilitate cell transplantation and promote regeneration of damaged spinal cord tissue presents a potential avenue to advance SCI research. This review will explore this emerging field and identify new lines of research.
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Affiliation(s)
- Anthea R. Mutepfa
- Neural Tissue Engineering Keele, School of Life Sciences, Keele University, Keele, United Kingdom
| | - John G. Hardy
- Department of Chemistry, Lancaster University, Lancaster, United Kingdom
- Materials Science Institute, Lancaster University, Lancaster, United Kingdom
| | - Christopher F. Adams
- Neural Tissue Engineering Keele, School of Life Sciences, Keele University, Keele, United Kingdom
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45
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Laskin JJ, Waheed Z, Thorogood NP, Nightingale TE, Noonan VK. Spinal cord stimulation research in the restoration of motor, sensory and autonomic function for individuals living with spinal cord injuries: A scoping review. Arch Phys Med Rehabil 2022; 103:1387-1397. [PMID: 35202581 DOI: 10.1016/j.apmr.2022.01.161] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/26/2022] [Accepted: 01/28/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To describe the status of spinal cord stimulation (SCS) research for the improvement of motor, sensory and autonomic function for individuals living with a spinal cord injury (SCI). DATA SOURCES This scoping review identified original research published prior to March 31, 2021, via literature searches using Medline, EMBASE, PubMed, Science Direct, CINAHL, Sport Discus, Web of Science, as well as a targeted search for well-known principal investigators. Search terms included permutations of "spinal cord stimulation", "epidural spinal cord stimulation", "transcutaneous spinal cord stimulation", "magnetic spinal cord stimulation" and "neuromodulation". STUDY SELECTION Studies were included if they: 1) were in English, 2) presented original research on humans living with a SCI, and 3) investigated at least one of the three forms of SCS. DATA EXTRACTION Extracted data included: authors, publication year, participant characteristics, purpose, study design, stimulation (device, location, parameters,) primary outcomes, and adverse events. DATA SYNTHESIS As a scoping review the extracted data was tabulated and presented descriptively. Themes and gaps in the literature were identified and reported. Of the 5,754 articles screened, 103 articles were included (55 epidural, 36 transcutaneous and 12 magnetic). The primary research design was a case study or series with only a single randomized clinical trial. Motor recovery was the most common primary outcome for epidural and transcutaneous SCS studies whereas bowel and bladder outcomes were most common for magnetic. Seventy percent of the studies included 10 or fewer participants, and 18 articles documented at least one adverse event. Incomplete stimulation parameter descriptions were noted across many studies. No articles mentioned direct engagement of consumers or advocacy groups. CONCLUSION This review identified a need for more robust study designs, larger sample sizes, comparative studies, improved reporting of stimulation parameters, adverse event data, and alignment of outcomes with the priorities of the SCI community.
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Affiliation(s)
- James J Laskin
- Praxis Spinal Cord Institute, Vancouver, British Columbia, Canada; School of Physical Therapy and Rehabilitation Science, University of Montana, Missoula, Montana.
| | - Zeina Waheed
- Praxis Spinal Cord Institute, Vancouver, British Columbia, Canada
| | | | - Tom E Nightingale
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada; School of Sport, Exercise, and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom; Centre for Trauma Sciences Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Vanessa K Noonan
- Praxis Spinal Cord Institute, Vancouver, British Columbia, Canada; International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
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Kiyotake EA, Martin MD, Detamore MS. Regenerative rehabilitation with conductive biomaterials for spinal cord injury. Acta Biomater 2022; 139:43-64. [PMID: 33326879 DOI: 10.1016/j.actbio.2020.12.021] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/24/2020] [Accepted: 12/09/2020] [Indexed: 02/07/2023]
Abstract
The individual approaches of regenerative medicine efforts alone and rehabilitation efforts alone have not yet fully restored function after severe spinal cord injury (SCI). Regenerative rehabilitation may be leveraged to promote regeneration of the spinal cord tissue, and promote reorganization of the regenerated neural pathways and intact spinal circuits for better functional recovery for SCI. Conductive biomaterials may be a linchpin that empowers the synergy between regenerative medicine and rehabilitation approaches, as electrical stimulation applied to the spinal cord could facilitate neural reorganization. In this review, we discuss current regenerative medicine approaches in clinical trials and the rehabilitation, or neuromodulation, approaches for SCI, along with their respective translational limitations. Furthermore, we review the translational potential, in a surgical context, of conductive biomaterials (e.g., conductive polymers, carbon-based materials, metallic nanoparticle-based materials) as they pertain to SCI. While pre-formed scaffolds may be difficult to translate to human contusion SCIs, injectable composites that contain blended conductive components and can form within the injury may be more translational. However, given that there are currently no in vivo SCI studies that evaluated conductive materials combined with rehabilitation approaches, we discuss several limitations of conductive biomaterials, including demonstrating safety and efficacy, that will need to be addressed in the future for conductive biomaterials to become SCI therapeutics. Even so, the use of conductive biomaterials creates a synergistic opportunity to merge the fields of regenerative medicine and rehabilitation and redefine what regenerative rehabilitation means for the spinal cord. STATEMENT OF SIGNIFICANCE: For spinal cord injury (SCI), the individual approaches of regenerative medicine and rehabilitation are insufficient to fully restore functional recovery; however, the goal of regenerative rehabilitation is to combine these two disparate fields to maximize the functional outcomes. Concepts similar to regenerative rehabilitation for SCI have been discussed in several reviews, but for the first time, this review considers how conductive biomaterials may synergize the two approaches. We cover current regenerative medicine and rehabilitation approaches for SCI, and the translational advantages and disadvantages, in a surgical context, of conductive biomaterials used in biomedical applications that may be additionally applied to SCI. Furthermore, we identify the current limitations and translational challenges for conductive biomaterials before they may become therapeutics for SCI.
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47
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Barss TS, Parhizi B, Porter J, Mushahwar VK. Neural Substrates of Transcutaneous Spinal Cord Stimulation: Neuromodulation across Multiple Segments of the Spinal Cord. J Clin Med 2022; 11:639. [PMID: 35160091 PMCID: PMC8836636 DOI: 10.3390/jcm11030639] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/17/2022] [Accepted: 01/18/2022] [Indexed: 02/01/2023] Open
Abstract
Transcutaneous spinal cord stimulation (tSCS) has the potential to promote improved sensorimotor rehabilitation by modulating the circuitry of the spinal cord non-invasively. Little is currently known about how cervical or lumbar tSCS influences the excitability of spinal and corticospinal networks, or whether the synergistic effects of multi-segmental tSCS occur between remote segments of the spinal cord. The aim of this review is to describe the emergence and development of tSCS as a novel method to modulate the spinal cord, while highlighting the effectiveness of tSCS in improving sensorimotor recovery after spinal cord injury. This review underscores the ability of single-site tSCS to alter excitability across multiple segments of the spinal cord, while multiple sites of tSCS converge to facilitate spinal reflex and corticospinal networks. Finally, the potential and current limitations for engaging cervical and lumbar spinal cord networks through tSCS to enhance the effectiveness of rehabilitation interventions are discussed. Further mechanistic work is needed in order to optimize targeted rehabilitation strategies and improve clinical outcomes.
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Affiliation(s)
- Trevor S. Barss
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB T6G 2R3, Canada; (T.S.B.); (B.P.)
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Alberta, Edmonton, AB T6G 2R3, Canada;
- Sensory Motor Adaptive Rehabilitation Technology (SMART) Network, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Behdad Parhizi
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB T6G 2R3, Canada; (T.S.B.); (B.P.)
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Alberta, Edmonton, AB T6G 2R3, Canada;
- Sensory Motor Adaptive Rehabilitation Technology (SMART) Network, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Jane Porter
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Alberta, Edmonton, AB T6G 2R3, Canada;
- Sensory Motor Adaptive Rehabilitation Technology (SMART) Network, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Vivian K. Mushahwar
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB T6G 2R3, Canada; (T.S.B.); (B.P.)
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Alberta, Edmonton, AB T6G 2R3, Canada;
- Sensory Motor Adaptive Rehabilitation Technology (SMART) Network, University of Alberta, Edmonton, AB T6G 2R3, Canada
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48
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Karamian BA, Siegel N, Nourie B, Serruya MD, Heary RF, Harrop JS, Vaccaro AR. The role of electrical stimulation for rehabilitation and regeneration after spinal cord injury. J Orthop Traumatol 2022; 23:2. [PMID: 34989884 PMCID: PMC8738840 DOI: 10.1186/s10195-021-00623-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 12/27/2021] [Indexed: 12/26/2022] Open
Abstract
Electrical stimulation is used to elicit muscle contraction and can be utilized for neurorehabilitation following spinal cord injury when paired with voluntary motor training. This technology is now an important therapeutic intervention that results in improvement in motor function in patients with spinal cord injuries. The purpose of this review is to summarize the various forms of electrical stimulation technology that exist and their applications. Furthermore, this paper addresses the potential future of the technology.
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Affiliation(s)
- Brian A Karamian
- Rothman Orthopaedic Institute at Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA, 19107, USA.
| | - Nicholas Siegel
- Rothman Orthopaedic Institute at Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA, 19107, USA
| | - Blake Nourie
- Rothman Orthopaedic Institute at Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA, 19107, USA
| | | | - Robert F Heary
- Department of Neurological Surgery, Hackensack Meridian School of Medicine, Nutley, NJ, 07110, USA
| | - James S Harrop
- Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Alexander R Vaccaro
- Rothman Orthopaedic Institute at Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA, 19107, USA
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49
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Carrera RM, Omofuma I, Yasin B, Agrawal SK. The Effect of Transcutaneous Spinal Cord Stimulation on Standing Postural Control in Healthy Adults. IEEE Robot Autom Lett 2022. [DOI: 10.1109/lra.2022.3185370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Robert M. Carrera
- Department of Biomedical Engineering, Columbia University,, New York, NY, USA
| | - Isirame Omofuma
- Department of Biomedical Engineering, Columbia University,, New York, NY, USA
| | - Bushra Yasin
- Mechanical Engineering Department, Columbia University, New York, NY, USA
| | - Sunil K. Agrawal
- Departments of Mechanical Engineering and Rehabilitation and, Regenerative Medicine, New York, NY, USA
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50
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Flores Á, López-Santos D, García-Alías G. When Spinal Neuromodulation Meets Sensorimotor Rehabilitation: Lessons Learned From Animal Models to Regain Manual Dexterity After a Spinal Cord Injury. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:755963. [PMID: 36188826 PMCID: PMC9397786 DOI: 10.3389/fresc.2021.755963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 11/16/2021] [Indexed: 12/22/2022]
Abstract
Electrical neuromodulation has strongly hit the foundations of spinal cord injury and repair. Clinical and experimental studies have demonstrated the ability to neuromodulate and engage spinal cord circuits to recover volitional motor functions lost after the injury. Although the science and technology behind electrical neuromodulation has attracted much of the attention, it cannot be obviated that electrical stimulation must be applied concomitantly to sensorimotor rehabilitation, and one would be very difficult to understand without the other, as both need to be finely tuned to efficiently execute movements. The present review explores the difficulties faced by experimental and clinical neuroscientists when attempting to neuromodulate and rehabilitate manual dexterity in spinal cord injured subjects. From a translational point of view, we will describe the major rehabilitation interventions employed in animal research to promote recovery of forelimb motor function. On the other hand, we will outline some of the state-of-the-art findings when applying electrical neuromodulation to the spinal cord in animal models and human patients, highlighting how evidences from lumbar stimulation are paving the path to cervical neuromodulation.
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Affiliation(s)
- África Flores
- Department of Cell Biology, Physiology and Immunology, Institute of Neuroscience, Universitat Autònoma de Barcelona and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain
| | - Diego López-Santos
- Department of Cell Biology, Physiology and Immunology, Institute of Neuroscience, Universitat Autònoma de Barcelona and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain
| | - Guillermo García-Alías
- Department of Cell Biology, Physiology and Immunology, Institute of Neuroscience, Universitat Autònoma de Barcelona and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain
- Institut Guttmann de Neurorehabilitació, Badalona, Spain
- *Correspondence: Guillermo García-Alías
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