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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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2
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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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Malik RN, Samejima S, Shackleton C, Miller T, Pedrocchi ALG, Rabchevsky AG, Moritz CT, Darrow D, Field-Fote EC, Guanziroli E, Ambrosini E, Molteni F, Gad P, Mushahwar VK, Sachdeva R, Krassioukov AV. REPORT-SCS: minimum reporting standards for spinal cord stimulation studies in spinal cord injury. J Neural Eng 2024; 21:016019. [PMID: 38271712 DOI: 10.1088/1741-2552/ad2290] [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: 09/11/2023] [Accepted: 01/25/2024] [Indexed: 01/27/2024]
Abstract
Objective.Electrical spinal cord stimulation (SCS) has emerged as a promising therapy for recovery of motor and autonomic dysfunctions following spinal cord injury (SCI). Despite the rise in studies using SCS for SCI complications, there are no standard guidelines for reporting SCS parameters in research publications, making it challenging to compare, interpret or reproduce reported effects across experimental studies.Approach.To develop guidelines for minimum reporting standards for SCS parameters in pre-clinical and clinical SCI research, we gathered an international panel of expert clinicians and scientists. Using a Delphi approach, we developed guideline items and surveyed the panel on their level of agreement for each item.Main results.There was strong agreement on 26 of the 29 items identified for establishing minimum reporting standards for SCS studies. The guidelines encompass three major SCS categories: hardware, configuration and current parameters, and the intervention.Significance.Standardized reporting of stimulation parameters will ensure that SCS studies can be easily analyzed, replicated, and interpreted by the scientific community, thereby expanding the SCS knowledge base and fostering transparency in reporting.
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Affiliation(s)
- Raza N Malik
- International Collaboration on Repair Discoveries, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Soshi Samejima
- International Collaboration on Repair Discoveries, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Claire Shackleton
- International Collaboration on Repair Discoveries, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tiev Miller
- International Collaboration on Repair Discoveries, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alessandra Laura Giulia Pedrocchi
- Nearlab, Department di Electronics, Information and Bioengineering, and We-Cobot Laboratory, Polo Territoriale di Lecco, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milan, Italy
| | - Alexander G Rabchevsky
- Spinal Cord & Brain Injury Research Center, Department of Physiology, University of Kentucky, Lexington, KY, United States of America
| | - Chet T Moritz
- Departments of Electrical & Computer Engineering, Rehabilitation Medicine, and Physiology & Biophysics, and the Center for Neurotechnology, University of Washington, Seattle, WA, United States of America
| | - David Darrow
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, United States of America
- Department of Neurosurgery, Hennepin County Medical Center, Minneapolis, MN, United States of America
| | - Edelle C Field-Fote
- Shepherd Center, Crawford Research Institute, Atlanta, Georgia, United States of America
- Emory University School of Medicine, Division of Physical Therapy, Atlanta, Georgia, United States of America
- Georgia Institute of Technology, School of Biological Sciences, Program in Applied Physiology, Atlanta, Georgia, United States of America
| | - Eleonora Guanziroli
- Villa Beretta Rehabilitation Center, Valduce Hospital, Costa Masnaga, Lecco, Italy
| | - Emilia Ambrosini
- Nearlab, Department di Electronics, Information and Bioengineering, and We-Cobot Laboratory, Polo Territoriale di Lecco, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milan, Italy
| | - Franco Molteni
- Villa Beretta Rehabilitation Center, Valduce Hospital, Costa Masnaga, Lecco, Italy
| | - Parag Gad
- SpineX Inc., Los Angeles, Los Angeles, CA, United States of America
| | - Vivian K Mushahwar
- Department of Medicine and Sensory Motor Adaptive Rehabilitation Technology (SMART) Network, University of Alberta, Edmonton, Alberta, Canada
| | - Rahul Sachdeva
- International Collaboration on Repair Discoveries, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrei V Krassioukov
- International Collaboration on Repair Discoveries, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Spinal Cord Research Program, G.F. Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, British Columbia, Canada
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Pradat PF, Hayon D, Blancho S, Neveu P, Khamaysa M, Guerout N. Advances in Spinal Cord Neuromodulation: The Integration of Neuroengineering, Computational Approaches, and Innovative Conceptual Frameworks. J Pers Med 2023; 13:993. [PMID: 37373982 DOI: 10.3390/jpm13060993] [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] [Revised: 06/07/2023] [Accepted: 06/11/2023] [Indexed: 06/29/2023] Open
Abstract
Spinal cord stimulation (SCS) is an approved treatment for intractable pain and has recently emerged as a promising area of research for restoring function after spinal cord lesion. This review will focus on the historical evolution of this transition and the path that remains to be taken for these methods to be rigorously evaluated for application in clinical practice. New developments in SCS are being driven by advances in the understanding of spinal cord lesions at the molecular, cellular, and neuronal levels, as well as the understanding of compensatory mechanisms. Advances in neuroengineering and the computational neurosciences have enabled the development of new conceptual SCS strategies, such as spatiotemporal neuromodulation, which allows spatially selective stimulation at precise time points during anticipated movement. It has also become increasingly clear that these methods are only effective when combined with intensive rehabilitation techniques, such as new task-oriented methods and robotic aids. The emergence of innovative approaches to spinal cord neuromodulation has sparked significant enthusiasm among patients and in the media. Non-invasive methods are perceived to offer improved safety, patient acceptance, and cost-effectiveness. There is an immediate need for well-designed clinical trials involving consumer or advocacy groups to evaluate and compare the effectiveness of various treatment modalities, assess safety considerations, and establish outcome priorities.
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Affiliation(s)
- Pierre-François Pradat
- Laboratoire d'Imagerie Biomédicale, Sorbonne Université, CNRS, INSERM, 75013 Paris, France
- APHP, Département de Neurologie, Hôpital Pitié-Salpêtrière, Centre Référent SLA, 75013 Paris, France
- Northern Ireland Centre for Stratified Medicine, Biomedical Sciences Research Institute Ulster University, C-TRIC, Altnagelvin Hospital, Derry/Londonderry BT47 6SB, UK
- Institut Pour la Recherche Sur la Moelle Epiniere et l'Encéphale (IRME), 25 Rue Duranton, 75015 Paris, France
| | - David Hayon
- Clinique Saint-Roch, Service d'Anesthésie, 56 Rue de Lille, 59223 Roncq, France
| | - Sophie Blancho
- Institut Pour la Recherche Sur la Moelle Epiniere et l'Encéphale (IRME), 25 Rue Duranton, 75015 Paris, France
| | - Pauline Neveu
- Saints Pères Paris Institute for the Neurosciences, Université Paris Cité, CNRS UMR8003, 75006 Paris, France
| | - Mohammed Khamaysa
- Laboratoire d'Imagerie Biomédicale, Sorbonne Université, CNRS, INSERM, 75013 Paris, France
| | - Nicolas Guerout
- Saints Pères Paris Institute for the Neurosciences, Université Paris Cité, CNRS UMR8003, 75006 Paris, France
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D’hondt N, Marcial KM, Mittal N, Costanzi M, Hoydonckx Y, Kumar P, Englesakis MF, Burns A, Bhatia A. A Scoping Review of Epidural Spinal Cord Stimulation for Improving Motor and Voiding Function Following Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2023; 29:12-30. [PMID: 37235192 PMCID: PMC10208259 DOI: 10.46292/sci22-00061] [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] [Indexed: 05/28/2023]
Abstract
Objectives To identify and synthesize the existing evidence on the effectiveness and safety of epidural spinal cord stimulation (SCS) for improving motor and voiding function and reducing spasticity following spinal cord injury (SCI). Methods This scoping review was performed according to the framework of Arksey and O'Malley. Comprehensive serial searches in multiple databases (MEDLINE, Embase, Cochrane Central, Cochrane Database of Systematic Reviews, LILACS, PubMed, Web of Science, and Scopus) were performed to identify relevant publications that focused on epidural SCS for improving motor function, including spasticity, and voiding deficits in individuals with SCI. Results Data from 13 case series including 88 individuals with complete or incomplete SCI (American Spinal Injury Association Impairment Scale [AIS] grade A to D) were included. In 12 studies of individuals with SCI, the majority (83 out of 88) demonstrated a variable degree of improvement in volitional motor function with epidural SCS. Two studies, incorporating 27 participants, demonstrated a significant reduction in spasticity with SCS. Two small studies consisting of five and two participants, respectively, demonstrated improved supraspinal control of volitional micturition with SCS. Conclusion Epidural SCS can enhance central pattern generator activity and lower motor neuron excitability in individuals with SCI. The observed effects of epidural SCS following SCI suggest that the preservation of supraspinal transmission is sufficient for the recovery of volitional motor and voiding function, even in patients with complete SCI. Further research is warranted to evaluate and optimize the parameters for epidural SCS and their impact on individuals with differing degrees of severity of SCI.
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Affiliation(s)
- Nina D’hondt
- Department of Pain Medicine, Multidisciplinary Pain Center, VITAZ, Sint-Niklaas, Belgium
| | - Karmi Margaret Marcial
- Department of Anesthesiology, Philippine General Hospital, University of Philippines, Philippines
| | - Nimish Mittal
- Department of Physical Medicine and Rehabilitation, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Matteo Costanzi
- Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Yasmine Hoydonckx
- Department of Anesthesiology and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Pranab Kumar
- Department of Anesthesiology and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Marina F. Englesakis
- MLIS Library & Information Services, University Health Network, Toronto, Ontario, Canada
| | - Anthony Burns
- Department of Physical Medicine and Rehabilitation, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Anuj Bhatia
- Department of Anesthesiology and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
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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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Oh J, Steele AG, Varghese B, Martin CA, Scheffler MS, Markley RL, Lo YK, Sayenko DG. Cervical transcutaneous spinal stimulation for spinal motor mapping. iScience 2022; 25:105037. [PMID: 36147963 PMCID: PMC9485062 DOI: 10.1016/j.isci.2022.105037] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 07/29/2022] [Accepted: 08/25/2022] [Indexed: 12/02/2022] Open
Abstract
Transcutaneous spinal stimulation (TSS) is a promising approach to restore upper-limb (UL) functions after spinal cord injury (SCI) in humans. We sought to demonstrate the selectivity of recruitment of individual UL motor pools during cervical TSS using different electrode placements. We demonstrated that TSS delivered over the rostrocaudal and mediolateral axes of the cervical spine resulted in a preferential activation of proximal, distal, and ipsilateral UL muscles. This was revealed by changes in motor threshold intensity, maximum amplitude, and the amount of post-activation depression of the evoked responses. We propose that an arrangement of electrodes targeting specific UL motor pools may result in superior efficacy, restoring more diverse motor activities after neurological injuries and disorders, including severe SCI. Cervical spinal motor maps are created by transcutaneous spinal stimulation Upper limb muscle-specific stimulation coincides with segmental motor pool locations Lateral stimulation can be advantageous depending on rostral or caudal sites Site-specific stimulation can help determine therapeutic outcomes after SCI
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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: 13] [Impact Index Per Article: 6.5] [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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Taylor C, McHugh C, Mockler D, Minogue C, Reilly RB, Fleming N. Transcutaneous spinal cord stimulation and motor responses in individuals with spinal cord injury: A methodological review. PLoS One 2021; 16:e0260166. [PMID: 34793572 PMCID: PMC8601579 DOI: 10.1371/journal.pone.0260166] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 11/03/2021] [Indexed: 11/18/2022] Open
Abstract
Background Transcutaneous spinal cord stimulation (tSCS) is a non-invasive modality in which electrodes can stimulate spinal circuitries and facilitate a motor response. This review aimed to evaluate the methodology of studies using tSCS to generate motor activity in persons with spinal cord injury (SCI) and to appraise the quality of included trials. Methods A systematic search for studies published until May 2021 was made of the following databases: EMBASE, Medline (Ovid) and Web of Science. Two reviewers independently screened the studies, extracted the data, and evaluated the quality of included trials. The electrical characteristics of stimulation were summarised to allow for comparison across studies. In addition, the surface electromyography (EMG) recording methods were evaluated. Results A total of 3753 articles were initially screened, of which 25 met the criteria for inclusion. Studies were divided into those using tSCS for neurophysiological investigations of reflex responses (n = 9) and therapeutic investigations of motor recovery (n = 16). The overall quality of evidence was deemed to be poor-to-fair (10.5 ± 4.9) based on the Downs and Black Quality Checklist criteria. The electrical characteristics were collated to establish the dosage range across stimulation trials. The methods employed by included studies relating to stimulation parameters and outcome measurement varied extensively, although some trends are beginning to appear in relation to electrode configuration and EMG outcomes. Conclusion This review outlines the parameters currently employed for tSCS of the cervicothoracic and thoracolumbar regions to produce motor responses. However, to establish standardised procedures for neurophysiological assessments and therapeutic investigations of tSCS, further high-quality investigations are required, ideally utilizing consistent electrophysiological recording methods, and reporting common characteristics of the electrical stimulation administered.
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Affiliation(s)
- Clare Taylor
- Department of Anatomy, School of Medicine, Trinity College, The University of Dublin, Dublin, Ireland
- * E-mail:
| | - Conor McHugh
- Department of Anatomy, School of Medicine, Trinity College, The University of Dublin, Dublin, Ireland
| | - David Mockler
- John Stearne Medical Library, Trinity Centre for Health Sciences, School of Medicine, St. James’s Hospital, Dublin, Ireland
| | - Conor Minogue
- Department of Anatomy, School of Medicine, Trinity College, The University of Dublin, Dublin, Ireland
| | - Richard B. Reilly
- Trinity Centre for Biomedical Engineering, Trinity College, The University of Dublin, Dublin, Ireland
- School of Engineering, Trinity College, The University of Dublin, Dublin, Ireland
- School of Medicine, Trinity College, The University of Dublin, Dublin, Ireland
| | - Neil Fleming
- Department of Anatomy, School of Medicine, Trinity College, The University of Dublin, Dublin, Ireland
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