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Scheffler MS, Martin CA, Dietz V, Faraji AH, Sayenko DG. Synergistic implications of combinatorial rehabilitation approaches using spinal stimulation on therapeutic outcomes in spinal cord injury. Clin Neurophysiol 2024; 165:166-179. [PMID: 39033698 PMCID: PMC11325878 DOI: 10.1016/j.clinph.2024.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 06/07/2024] [Accepted: 06/26/2024] [Indexed: 07/23/2024]
Abstract
OBJECTIVE The objective of this narrative review was to locate and assess recent articles employing a combinatorial approach of transcutaneous spinal cord stimulation or epidural spinal cord stimulation with additional modalities. We sought to provide relevant knowledge of recent literature and advance understanding on outcomes reported, to better equip those working in neurorehabilitation and neuromodulation. METHODS Articles were selected and analyzed based on study approach, stimulation parameters, outcome measures, and presence of neurophysiological data to support findings. RESULTS This narrative review analyzed 44 recent articles employing a combinatorial approach of transcutaneous spinal cord stimulation or epidural spinal cord stimulation with additional modalities. Our findings showed that limited research exists regarding such combinatorial approaches, particularly when considering modalities beyond activity-based training. There is also limited consistency in neurophysiological and quality of life outcomes. CONCLUSION Articles involving transcutaneous spinal cord stimulation or epidural spinal cord stimulation with other modalities are limited in the current body of literature. Authors noted variety in approach, sample size, and use of participant perspective. Opportunities are present to add high quality research to this body of literature. SIGNIFICANCE Transcutaneous spinal cord stimulation and epidural spinal cord stimulation are emerging in research as viable avenues for targeting improvement of function after traumatic spinal cord injury, particularly when combined with activity-based training. This body of literature demonstrates viable areas for growth from both neurophysiological and functional perspectives. Further, exploration of novel combinatorial approaches holds potential to offer enhanced contributions to clinical and neurophysiological rehabilitation and research.
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Affiliation(s)
- Michelle S Scheffler
- Department of Neurosurgery, Houston Methodist Research Institute, 6670 Bertner Ave, Houston, TX, 77030, USA
| | - Catherine A Martin
- Department of Neurosurgery, Houston Methodist Research Institute, 6670 Bertner Ave, Houston, TX, 77030, USA
| | - Valerie Dietz
- Department of Neurosurgery, Houston Methodist Research Institute, 6670 Bertner Ave, Houston, TX, 77030, USA
| | - Amir H Faraji
- Department of Neurosurgery, Houston Methodist Research Institute, 6670 Bertner Ave, Houston, TX, 77030, USA
| | - Dimitry G Sayenko
- Department of Neurosurgery, Houston Methodist Research Institute, 6670 Bertner Ave, Houston, TX, 77030, USA.
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Pallavi, Mitra S, Palermo AE. Functional Sitting Balance and Anthropometric Measures Are Related to Inspiratory Muscle Performance in People with Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2024; 30:41-49. [PMID: 39139776 PMCID: PMC11317645 DOI: 10.46292/sci23-00052] [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: 08/15/2024]
Abstract
Background Respiratory complications are a leading cause of mortality post spinal cord injury (SCI). Along with breathing, respiratory muscles have a role in maintaining seated balance. Postinjury breathing influences respiratory muscle function. Preliminary evidence indicates a relation between respiratory muscle function and seated balance in people with chronic SCI dwelling in the community, but the relationship between balance and body habitus has not been explored. Objectives To explore the relationships among inspiratory muscle function, functional seated balance (FSB), and body habitus in people with SCI. Methods A convenience sample of inpatients with SCI (C5-T12) aged 18 to 60 years who were using a wheelchair was recruited from November 2022 to March 2023. Those with additional neurological disorders or respiratory support were excluded. Respiratory muscle function measures included maximal inspiratory pressure (MIP), sustained MIP (SMIP), and Fatigue Index Test (FIT). FSB was scored using the Function in Sitting Test (FIST). Body habitus was assessed using the axillary: umbilical (A:U) ratio. Spearman correlations explored the relationships. Results Thirty-eight of 42 screened participants were eligible and participated (male, 32). Levels of injury ranged from C5 to T12. The mean (SD) age and duration of injury of the sample was 25.61 (6.68) years and 31.03 (28.69) months, respectively. SMIP and FIT correlated significantly with FSB (r s= .441, p = .01, and r s= .434, p = .006, respectively). A significant correlation between SMIP and A:U ratio (r s= -.330, p = .043) was observed. Conclusion We observed a significant correlation between inspiratory pressure parameters and both functional seated balance and body habitus, adding to evidence on postural role of respiratory muscles.
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Affiliation(s)
- Pallavi
- Indian Spinal Injury Center, Institute of Rehabilitation Sciences
| | - Shambhovi Mitra
- Associate Professor, Indian Spinal Injury Center, Institute of Rehabilitation Sciences
| | - Anne E. Palermo
- Research Fellow, Neuroscience Research Australia, Associate Lecturer, University of New South Wales, Australia
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Rejc E, Zaccaron S, Bowersock C, Pisolkar T, Ugiliweneza B, Forrest GF, Agrawal S, Harkema SJ, Angeli CA. Effects of Robotic Postural Stand Training with Epidural Stimulation on Sitting Postural Control in Individuals with Spinal Cord Injury: A Pilot Study. J Clin Med 2024; 13:4309. [PMID: 39124576 PMCID: PMC11313204 DOI: 10.3390/jcm13154309] [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: 07/01/2024] [Revised: 07/18/2024] [Accepted: 07/22/2024] [Indexed: 08/12/2024] Open
Abstract
(1) Background. High-level spinal cord injury (SCI) disrupts trunk control, leading to an impaired performance of upright postural tasks in sitting and standing. We previously showed that a novel robotic postural stand training with spinal cord epidural stimulation targeted at facilitating standing (Stand-scES) largely improved standing trunk control in individuals with high-level motor complete SCI. Here, we aimed at assessing the effects of robotic postural stand training with Stand-scES on sitting postural control in the same population. (2) Methods. Individuals with cervical (n = 5) or high-thoracic (n = 1) motor complete SCI underwent approximately 80 sessions (1 h/day; 5 days/week) of robotic postural stand training with Stand-scES, which was performed with free hands (i.e., without using handlebars) and included periods of standing with steady trunk control, self-initiated trunk and arm movements, and trunk perturbations. Sitting postural control was assessed on a standard therapy mat, with and without scES targeted at facilitating sitting (Sit-scES), before and after robotic postural stand training. Independent sit time and trunk center of mass (CM) displacement were assessed during a 5 min time window to evaluate steady sitting control. Self-initiated antero-posterior and medial-lateral trunk movements were also attempted from a sitting position, with the goal of covering the largest distance in the respective cardinal directions. Finally, the four Neuromuscular Recovery Scale items focused on sitting trunk control (Sit, Sit-up, Trunk extension in sitting, Reverse sit-up) were assessed. (3) Results. In summary, neither statistically significant differences nor large Effect Size were promoted by robotic postural stand training for the sitting outcomes considered for analysis. (4) Conclusions. The findings of the present study, together with previous observations, may suggest that robotic postural stand training with Stand-scES promoted trunk motor learning that was posture- and/or task-specific and, by itself, was not sufficient to significantly impact sitting postural control.
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Affiliation(s)
- Enrico Rejc
- Tim and Caroline Reynolds Center for Spinal Stimulation, Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ 07052, USA; (G.F.F.); (C.A.A.)
- Department of Medicine, University of Udine, P.le Kolbe 4, 33100 Udine (UD), Italy;
- Kentucky Spinal Cord Injury Research Center, University of Louisville, 220 Abraham Flexner Way, Louisville, KY 40202, USA; (C.B.); (T.P.); (B.U.); (S.J.H.)
| | - Simone Zaccaron
- Department of Medicine, University of Udine, P.le Kolbe 4, 33100 Udine (UD), Italy;
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37129 Verona, Italy
| | - Collin Bowersock
- Kentucky Spinal Cord Injury Research Center, University of Louisville, 220 Abraham Flexner Way, Louisville, KY 40202, USA; (C.B.); (T.P.); (B.U.); (S.J.H.)
- Biomechatronics Lab, Department of Mechanical Engineering, Northern Arizona University, S San Francisco St, Flagstaff, AZ 86011, USA
| | - Tanvi Pisolkar
- Kentucky Spinal Cord Injury Research Center, University of Louisville, 220 Abraham Flexner Way, Louisville, KY 40202, USA; (C.B.); (T.P.); (B.U.); (S.J.H.)
| | - Beatrice Ugiliweneza
- Kentucky Spinal Cord Injury Research Center, University of Louisville, 220 Abraham Flexner Way, Louisville, KY 40202, USA; (C.B.); (T.P.); (B.U.); (S.J.H.)
- Department of Neurological Surgery, University of Louisville, Louisville, KY 40202, USA
| | - Gail F. Forrest
- Tim and Caroline Reynolds Center for Spinal Stimulation, Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ 07052, USA; (G.F.F.); (C.A.A.)
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ 07103, USA
| | - Sunil Agrawal
- Department of Mechanical Engineering, Columbia University, 220 S. W. Mudd Building, 500 West 120th Street, New York, NY 10027, USA;
- Department of Rehabilitation and Regenerative Medicine, Columbia University, New York, NY 10032, USA
| | - Susan J. Harkema
- Kentucky Spinal Cord Injury Research Center, University of Louisville, 220 Abraham Flexner Way, Louisville, KY 40202, USA; (C.B.); (T.P.); (B.U.); (S.J.H.)
- Department of Neurological Surgery, University of Louisville, Louisville, KY 40202, USA
| | - Claudia A. Angeli
- Tim and Caroline Reynolds Center for Spinal Stimulation, Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ 07052, USA; (G.F.F.); (C.A.A.)
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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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Guérout N. Combined Treatments and Therapies to Cure Spinal Cord Injury. Biomedicines 2024; 12:1095. [PMID: 38791057 PMCID: PMC11118184 DOI: 10.3390/biomedicines12051095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 05/14/2024] [Indexed: 05/26/2024] Open
Abstract
Traumatic injuries of the spinal cord (SCIs) are still pathologies with a disastrous outcome [...].
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Affiliation(s)
- Nicolas Guérout
- Saints Pères Paris Institute for the Neurosciences, Université Paris Cité, CNRS UMR8003, 75006 Paris, France
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6
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van Helden JFL, Alexander E, Cabral HV, Strutton PH, Martinez-Valdes E, Falla D, Chowdhury JR, Chiou SY. Home-based arm cycling exercise improves trunk control in persons with incomplete spinal cord injury: an observational study. Sci Rep 2023; 13:22120. [PMID: 38092831 PMCID: PMC10719287 DOI: 10.1038/s41598-023-49053-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023] Open
Abstract
Arm cycling is used for cardiorespiratory rehabilitation but its therapeutic effects on the neural control of the trunk after spinal cord injury (SCI) remain unclear. We investigated the effects of single session of arm cycling on corticospinal excitability, and the feasibility of home-based arm cycling exercise training on volitional control of the erector spinae (ES) in individuals with incomplete SCI. Using transcranial magnetic stimulation, we assessed motor evoked potentials (MEPs) in the ES before and after 30 min of arm cycling in 15 individuals with SCI and 15 able-bodied controls (Experiment 1). Both groups showed increased ES MEP size after the arm cycling. The participants with SCI subsequently underwent a 6-week home-based arm cycling exercise training (Experiment 2). MEP amplitudes and activity of the ES, and movements of the trunk during reaching, self-initiated rapid shoulder flexion, and predicted external perturbation tasks were measured. After the training, individuals with SCI reached further and improved trajectory of the trunk during the rapid shoulder flexion task, accompanied by increased ES activity and MEP amplitudes. Exercise adherence was excellent. We demonstrate preserved corticospinal drive after a single arm cycling session and the effects of home-based arm cycling exercise training on trunk function in individuals with SCI.
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Affiliation(s)
- Joeri F L van Helden
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Emma Alexander
- The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Hélio V Cabral
- Department of Clinical and Experimental Sciences, Università degli Studi di Brescia, Brescia, Italy
| | - Paul H Strutton
- Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Eduardo Martinez-Valdes
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Joy Roy Chowdhury
- Midland Centre for Spinal Injuries, The Robert Jones and Agnes Hunt Orthopaedic Hospital NHSFT, Oswestry, UK
| | - Shin-Yi Chiou
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
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Evancho A, Tyler WJ, McGregor K. A review of combined neuromodulation and physical therapy interventions for enhanced neurorehabilitation. Front Hum Neurosci 2023; 17:1151218. [PMID: 37545593 PMCID: PMC10400781 DOI: 10.3389/fnhum.2023.1151218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 06/30/2023] [Indexed: 08/08/2023] Open
Abstract
Rehabilitation approaches for individuals with neurologic conditions have increasingly shifted toward promoting neuroplasticity for enhanced recovery and restoration of function. This review focuses on exercise strategies and non-invasive neuromodulation techniques that target neuroplasticity, including transcranial magnetic stimulation (TMS), vagus nerve stimulation (VNS), and peripheral nerve stimulation (PNS). We have chosen to focus on non-invasive neuromodulation techniques due to their greater potential for integration into routine clinical practice. We explore and discuss the application of these interventional strategies in four neurological conditions that are frequently encountered in rehabilitation settings: Parkinson's Disease (PD), Traumatic Brain Injury (TBI), stroke, and Spinal Cord Injury (SCI). Additionally, we discuss the potential benefits of combining non-invasive neuromodulation with rehabilitation, which has shown promise in accelerating recovery. Our review identifies studies that demonstrate enhanced recovery through combined exercise and non-invasive neuromodulation in the selected patient populations. We primarily focus on the motor aspects of rehabilitation, but also briefly address non-motor impacts of these conditions. Additionally, we identify the gaps in current literature and barriers to implementation of combined approaches into clinical practice. We highlight areas needing further research and suggest avenues for future investigation, aiming to enhance the personalization of the unique neuroplastic responses associated with each condition. This review serves as a resource for rehabilitation professionals and researchers seeking a comprehensive understanding of neuroplastic exercise interventions and non-invasive neuromodulation techniques tailored for specific diseases and diagnoses.
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Affiliation(s)
- Alexandra Evancho
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - William J. Tyler
- Department of Biomedical Engineering, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
- Department of Physical Medicine and Rehabilitation, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Keith McGregor
- Department of Clinical and Diagnostic Studies, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
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Sharma P, Panta T, Ugiliweneza B, Bert RJ, Gerasimenko Y, Forrest G, Harkema S. Multi-Site Spinal Cord Transcutaneous Stimulation Facilitates Upper Limb Sensory and Motor Recovery in Severe Cervical Spinal Cord Injury: A Case Study. J Clin Med 2023; 12:4416. [PMID: 37445450 DOI: 10.3390/jcm12134416] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/19/2023] [Accepted: 06/24/2023] [Indexed: 07/15/2023] Open
Abstract
Individuals with cervical spinal cord injury (SCI) rank regaining arm and hand function as their top rehabilitation priority post-injury. Cervical spinal cord transcutaneous stimulation (scTS) combined with activity-based recovery training (ABRT) is known to effectively facilitate upper extremity sensorimotor recovery in individuals with residual arm and hand function post SCI. However, scTS effectiveness in facilitating upper extremity recovery in individuals with severe SCI with minimal to no sensory and motor preservation below injury level remains largely unknown. We herein introduced a multimodal neuro-rehabilitative approach involving scTS targeting systematically identified various spinal segments combined with ABRT. We hypothesized that multi-site scTS combined with ABRT will effectively neuromodulate the spinal networks, resulting in improved integration of ascending and descending neural information required for sensory and motor recovery in individuals with severe cervical SCI. To test the hypothesis, a 53-year-old male (C2, AIS A, 8 years post-injury) received 60 ABRT sessions combined with continuous multi-site scTS. Post-training assessments revealed improved activation of previously paralyzed upper extremity muscles and sensory improvements over the dorsal and volar aspects of the hand. Most likely, altered spinal cord excitability and improved muscle activation and sensations resulted in observed sensorimotor recovery. However, despite promising neurophysiological evidence pertaining to motor re-activation, we did not observe visually appreciable functional recovery on obtained upper extremity motor assessments.
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Affiliation(s)
- Pawan Sharma
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY 40202, USA
| | - Tudor Panta
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY 40202, USA
- Frazier Rehabilitation Institute, University of Louisville Health, Louisville, KY 40202, USA
| | - Beatrice Ugiliweneza
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY 40202, USA
- Department of Health Management and Systems Science, University of Louisville, Louisville, KY 40202, USA
- Department of Neurological Surgery, University of Louisville, Louisville, KY 40202, USA
| | - Robert J Bert
- Department of Radiology, University of Louisville, Louisville, KY 40202, USA
| | - Yury Gerasimenko
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY 40202, USA
- Department of Physiology, University of Louisville, Louisville, KY 40292, USA
- Pavlov Institute of Physiology, Russian Academy of Sciences, 199034 Saint Petersburg, Russia
| | - Gail Forrest
- Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ 07052, USA
- Kessler Foundation, Newark, NJ 07052, USA
| | - Susan Harkema
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY 40202, USA
- Frazier Rehabilitation Institute, University of Louisville Health, Louisville, KY 40202, USA
- Department of Neurological Surgery, University of Louisville, Louisville, KY 40202, USA
- Department of Bioengineering, University of Louisville, Louisville, KY 40202, USA
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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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Tharu NS, Lee TTY, Lai KKL, Lau TE, Chan CY, Zheng YP. Sagittal Spinal Alignment in People with Chronic Spinal Cord Injury and Normal Individual: A Comparison Study Using 3D Ultrasound Imaging. J Clin Med 2023; 12:jcm12113854. [PMID: 37298049 DOI: 10.3390/jcm12113854] [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: 02/15/2023] [Revised: 05/16/2023] [Accepted: 06/01/2023] [Indexed: 06/12/2023] Open
Abstract
The aim of this study was to compare the sagittal spinal alignment of people with chronic spinal cord injury (SCI) with normal individuals and to determine whether transcutaneous electrical spinal cord stimulation (TSCS) could cause a change in the thoracic kyphosis (TK) and lumbar lordosis (LL) to re-establish normal sagittal spinal alignment. A case series study was conducted, wherein twelve individuals with SCI and ten neurologically intact subjects were scanned using 3D ultrasonography. In addition, three people with SCI having complete tetraplegia participated further to receive a 12-week treatment (TSCS with task-specific rehabilitation) after evaluation of sagittal spinal profile. Pre- and post-assessments were conducted to evaluate the differences in sagittal spinal alignment. The results showed that the TK and LL values for a person with SCI in a dependent seated posture were greater than those of normal subjects for: standing (by TK: 6.8° ± 1.6°; LL: 21.2° ± 1.9°), sitting straight (by TK: 10.0° ± 4.0°; LL: 1.7° ± 2.6°), and relaxed sitting (by TK: 3.9° ± 0.3°; LL: 7.7° ± 1.4°), respectively, indicating an increased risk for spinal deformity. In addition, TK decreased by 10.3° ± 2.3° after the TSCS treatment, showing a reversible change. These results suggest that the TSCS treatment could be used to restore normal sagittal spinal alignment for individuals with chronic SCI.
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Affiliation(s)
- Niraj Singh Tharu
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Timothy Tin-Yan Lee
- 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
| | - Kelly Ka-Lee Lai
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Ting-Er Lau
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Chui-Yi Chan
- Department of Biomedical Engineering, 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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11
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Tharu NS, Wong AYL, Zheng YP. Neuromodulation for recovery of trunk and sitting functions following spinal cord injury: a comprehensive review of the literature. Bioelectron Med 2023; 9:11. [PMID: 37246214 DOI: 10.1186/s42234-023-00113-6] [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: 04/13/2023] [Accepted: 05/16/2023] [Indexed: 05/30/2023] Open
Abstract
Trunk stability is crucial for people with trunk paralysis resulting from spinal cord injuries (SCI), as it plays a significant role in performing daily life activities and preventing from fall-related accidents. Traditional therapy used assistive methods or seating modifications to provide passive assistance while restricting their daily functionality. The recent emergence of neuromodulation techniques has been reported as an alternative therapy that could improve trunk and sitting functions following SCI. The aim of this review was to provide a broad perspective on the existing studies using neuromodulation techniques and identify their potentials in terms of trunk recovery for people with SCI. Five databases were searched (PubMed, Embase, Science Direct, Medline-Ovid, and Web of Science) from inception to December 31, 2022 to identify relevant studies. A total of 21 studies, involving 117 participants with SCI, were included in this review. According to these studies, neuromodulation significantly improved the reaching ability, restored trunk stability and seated posture, increased sitting balance, as well as elevated activity of trunk and back muscles, which were considered early predictors of trunk recovery after SCI. However, there is limited evidence regarding neuromodulation techniques on the improvement of trunk and sitting functions. Therefore, future large-scale randomized controlled trials are warranted to validate these preliminary findings.
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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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