[The regulation of balance in the children presenting with severe cerebral palsy following the treatment with the use of the locomotor training in combination with the electrical stimulation of leg muscles and spinal cord]

Safety and Feasibility of Cervical and Thoracic Transcutaneous Spinal Cord Stimulation to Improve Hand Motor Function in Children With Chronic Spinal Cord Injury

OBJECTIVE

In adults with cervical spinal cord injury (SCI), transcutaneous spinal stimulation (scTS) has improved upper extremity strength and control. This novel noninvasive neurotherapeutic approach combined with training may modulate the inherent developmental plasticity of children with SCI, providing even greater improvements than training or stimulation alone. Because children with SCI represent a vulnerable population, we first must establish the safety and feasibility of any potential novel therapeutic approach. The objectives of this pilot study were to determine the safety, feasibility, and proof of principle of cervical and thoracic scTS for short-term effect on upper extremity strength in children with SCI.

MATERIALS AND METHODS

In this nonrandomized, within-subject repeated measure design, seven participants with chronic cervical SCI performed upper extremity motor tasks without and with cervical (C3-C4 and C6-C7) and thoracic (T10-T11) site scTS. Safety and feasibility of using cervical and thoracic sites scTS were determined by the frequency count of anticipated and unanticipated risks (eg, pain, numbness). Proof-of-principle concept was tested via change in force production during hand motor tasks.

RESULTS

All seven participants tolerated cervical and thoracic scTS across the three days, with a wide range of stimulation intensities (cervical sites = 20-70 mA and thoracic site = 25-190 mA). Skin redness at the stimulation sites was observed in four of 21 assessments (19%) and dissipated in a few hours. No episode of autonomic dysreflexia was observed or reported. Hemodynamic parameters (systolic blood pressure and heart rate) remained within stable limits (p > 0.05) throughout the assessment time points at baseline, with scTS, and after the experiment. Hand-grip and wrist-extension strength increased (p < 0.05) with scTS.

CONCLUSIONS

We indicated that short-term application of scTS via two cervical and one thoracic site is safe and feasible in children with SCI and resulted in immediate improvements in hand-grip and wrist-extension strength in the presence of scTS.

CLINICAL TRIAL REGISTRATION

The Clinicaltrials.gov registration number for the study is NCT04032990.

Utility and Feasibility of Transcutaneous Spinal Cord Stimulation for Patients With Incomplete SCI in Therapeutic Settings: A Review of Topic

Transcutaneous Spinal Cord Stimulation (TSCS) has been shown to enhance the excitability of spinal neural circuits. This excitation is associated with enhanced voluntary performance in patients with incomplete SCI (iSCI). Though there is much we do not know, combining this altered state of exciability with therapy has the potential to enhance the outcomes associated with activity-based interventions. It is a promising tool to augment the work being done in therapeutic settings with the potential to expedite recovery. There is, however, a lag in assimilating the science for clinical practice. This article will examine current literature related to the application of TSCS in combination with therapeutic interventions for motor recovery and aims to elucidate trends in waveform selection, duration and frequency, and combinatorial therapies that may inform clinical practice. With specific consideration for therapeutic settings, potential benefits, applications, and pitfalls for clinical use are considered. Finally, the next steps in research to move toward wider clinical utility are discussed.