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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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Sayed Ahmad AM, Skiadopoulos A, Knikou M. Interactions between arm and leg neuronal circuits following paired cervical and lumbosacral transspinal stimulation in healthy humans. Exp Brain Res 2024; 242:2229-2239. [PMID: 39034329 DOI: 10.1007/s00221-024-06891-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 07/06/2024] [Indexed: 07/23/2024]
Abstract
Transspinal (or transcutaneous spinal cord) stimulation is a promising noninvasive method that may strengthen the intrinsic spinal neural connectivity in neurological disorders. In this study we assessed the effects of cervical transspinal stimulation on the amplitude of leg transspinal evoked potentials (TEPs), and the effects of lumbosacral transspinal stimulation on the amplitude of arm TEPs. Control TEPs were recorded following transspinal stimulation with one cathode electrode placed either on Cervical 3 (21.3 ± 1.7 mA) or Thoracic 10 (23.6 ± 16.5 mA) vertebrae levels. Associated anodes were placed bilaterally on clavicles or iliac crests. Cervical transspinal conditioning stimulation produced short latency inhibition of TEPs recorded from left soleus (ranging from - 6.11 to -3.87% of control TEP at C-T intervals of -50, -25, -20, -15, -10, 15 ms), right semitendinosus (ranging from - 11.1 to -4.55% of control TEP at C-T intervals of -20, -15, 15 ms), and right vastus lateralis (ranging from - 13.3 to -8.44% of control TEP at C-T intervals of -20 and - 15 ms) (p < 0.05). Lumbosacral transspinal conditioning stimulation produced no significant effects on arm TEPs. We conclude that in the resting state, cervical transspinal stimulation affects the net motor output of leg motoneurons under the experimental conditions used in this study. Further investigations are warranted to determine whether this protocol may reactivate local spinal circuitry after stroke or spinal cord injury and may have a significant effect in synchronization of upper and lower limb muscle synergies during rhythmic activities like locomotion or cycling.
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Affiliation(s)
- Abdullah M Sayed Ahmad
- Klab4Recovery Research Program (aka Knikou Lab), The City University of New York, New York, NY, USA
- Department of Physical Therapy, College of Staten Island, The City University of New York, 2800 Victory Blvd, 5N-207, Staten Island, NY, 10314, USA
| | - Andreas Skiadopoulos
- Klab4Recovery Research Program (aka Knikou Lab), The City University of New York, New York, NY, USA
- Department of Physical Therapy, College of Staten Island, The City University of New York, 2800 Victory Blvd, 5N-207, Staten Island, NY, 10314, USA
| | - Maria Knikou
- Klab4Recovery Research Program (aka Knikou Lab), The City University of New York, New York, NY, USA.
- Department of Physical Therapy, College of Staten Island, The City University of New York, 2800 Victory Blvd, 5N-207, Staten Island, NY, 10314, USA.
- Biology PhD Program, CUNY Graduate Center, 365 5th Ave, New York, NY, 10016, USA.
- Collaborative Neuroscience Program, College of Staten Island, 2800 Victory Blvd, 5N-207, Staten Island, NY, 10314, USA.
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Steele AG, Vette AH, Martin C, Masani K, Sayenko DG. Synergistic effects of transcutaneous spinal stimulation and neuromuscular electrical stimulation on lower limb force production: Time to deliver. PLoS One 2024; 19:e0296613. [PMID: 39213293 PMCID: PMC11364223 DOI: 10.1371/journal.pone.0296613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 08/09/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Transcutaneous spinal stimulation (TSS) and neuromuscular electrical stimulation (NMES) can facilitate self-assisted standing in individuals with paralysis. However, individual variability in responses to each modality may limit their effectiveness in generating the necessary leg extension force for full body weight standing. To address this challenge, we proposed combining TSS and NMES to enhance leg extensor muscle activation, with optimizing timing adjustment to maximize the interaction between the two modalities. METHODS To assess the effects of TSS and NMES on knee extension and plantarflexion force, ten neurologically intact participants underwent three conditions: (1) TSS control, (2) NMES control, and (3) TSS + NMES. TSS was delivered between the T10 and L2 vertebrae, while NMES was delivered to the skin over the right knee extensors and plantarflexors. TSS and NMES were administered using a 15 Hz train of three 0.5 ms biphasic pulses. During the TSS + NMES condition, the timing between modalities was adjusted in increments of ¼ the interval within a 15 Hz frequency, i.e., 66, 49.5, 33, 16.5, and 1 ms. RESULTS NMES combined with TSS, produced synergistic effects even on non-targeted muscle groups, thereby promoting leg extension across multiple joints in the kinematic chain. The sequence of NMES or TSS trains relative to each other did not significantly impact motor output. Notably, a delay of 16.5 to 49.5 ms between interleaved TSS and NMES pulses, each delivered at 15 Hz, results in more robust and synergistic responses in knee extensors and plantarflexors. CONCLUSIONS By adjusting the timing between TSS and NMES, we can optimize the combined use of these modalities for functional restoration. Our findings highlight the potential of integrated TSS and NMES protocols to enhance motor function, suggesting promising avenues for therapeutic applications, particularly in the rehabilitation of individuals with SCI.
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Affiliation(s)
- Alexander G. Steele
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, Houston, Texas, United States of America
| | - Albert H. Vette
- Department of Mechanical Engineering, Donadeo Innovation Centre for Engineering, University of Alberta, Edmonton, Alberta, Canada
- Glenrose Rehabilitation Hospital, Alberta Health Services, Edmonton, Alberta, Canada
| | - Catherine Martin
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, Houston, Texas, United States of America
| | - Kei Masani
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- KITE Research Institute–University Health Network, Toronto, ON, Canada
| | - Dimitry G. Sayenko
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, Houston, Texas, United States of America
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Tran K, Steele A, Crossnoe R, Martin C, Sayenko DG. Multi-site lumbar transcutaneous spinal cord stimulation: When less is more. Neurosci Lett 2024; 820:137579. [PMID: 38096973 PMCID: PMC10872491 DOI: 10.1016/j.neulet.2023.137579] [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: 08/16/2023] [Revised: 11/15/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Transcutaneous spinal stimulation (TSS) has become a valuable tool for facilitating rehabilitation in individuals with neurological deficits. A significant constraint arises from the need for precise knowledge of stimulation locations to effectively apply TSS for targeted functional enhancement. METHODS In this study, we investigate whether single-site or simultaneous multi-site stimulation over the lumbar spinal cord is advantageous for recruitment of specific motor pools projecting to lower limb muscles and generates higher leg extensor forces in neurologically intact individuals. Tests were performed in a supine position. TSS was delivered at T10-T11, T11-T12, T12-L1, and L1-L2 intervertebral spaces individually, then through all four locations simultaneously. The peak-to-peak amplitude of spinally evoked motor potentials and the forces generated by lower limb muscles were compared at the common motor threshold intensity level across all stimulation conditions. RESULTS Recruitment of motor pools projecting to proximal and distal lower limb muscles followed their topographical rostro-caudal arrangement along the lumbosacral enlargement. Single-site stimulation, apart from the T10-T11 location, resulted in larger responses in both proximal and distal muscles while also generating higher knee-extension and plantarflexion forces when compared to multi-site stimulation. CONCLUSIONS Both motor response and force generation were reduced when using multi-site TSS when compared to single-site stimulation. This demonstrates that the segmental effects of TSS are important to consider when performing multi-site TSS.
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Affiliation(s)
- Khue Tran
- School of Engineering Medicine, Texas A&M University, Houston, TX, USA
| | - Alexander Steele
- Department of Neurosurgery, Houston Methodist Research Institute, Houston, TX, USA
| | - Remington Crossnoe
- Department of Neurosurgery, Houston Methodist Research Institute, Houston, TX, USA
| | - Catherine Martin
- Department of Neurosurgery, Houston Methodist Research Institute, Houston, TX, USA
| | - Dimitry G Sayenko
- Department of Neurosurgery, Houston Methodist Research Institute, Houston, TX, USA.
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Steele AG, Faraji AH, Contreras-Vidal JL. Electrospinography for non-invasively recording spinal sensorimotor networks in humans. J Neural Eng 2024; 20:066043. [PMID: 38118169 DOI: 10.1088/1741-2552/ad1782] [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: 06/12/2023] [Accepted: 12/20/2023] [Indexed: 12/22/2023]
Abstract
Objective. Currently, few non-invasive measures exist for directly measuring spinal sensorimotor networks. Electrospinography (ESG) is one non-invasive method but is primarily used to measure evoked responses or for monitoring the spinal cord during surgery. Our objectives were to evaluate the feasibility of ESG to measure spinal sensorimotor networks by determining spatiotemporal and functional connectivity changes during single-joint movements at the spinal and cortical levels.Approach. We synchronously recorded electroencephalography (EEG), electromyography, and ESG in ten neurologically intact adults while performing one of three lower-limb tasks (no movement, plantar-flexion and knee flexion) in the prone position. A multi-pronged approach was applied for removing artifacts usingH∞filtering, artifact subspace reconstruction and independent component (IC) analysis. Next, data were segmented by task and ICs of EEG were clustered across participants. Within-participant analysis of ICs and ESG data was conducted, and ESG was characterized in the time and frequency domains. Generalized partial directed coherence analysis was performed within ICs and between ICs and ESG data by participant and task.Results.K-means clustering resulted in five clusters of ICs at Brodmann areas (BAs) 9, BA 8, BA 39, BA 4, and BA 22. Areas associated with motor planning, working memory, visual processing, movement, and attention, respectively. Time-frequency analysis of ESG data found localized changes during movement execution when compared to no movement. Lastly, we found bi-directional changes in functional connectivity (p < 0.05, adjusted for multiple comparisons) within IC's and between IC's and ESG sensors during movement when compared to the no movement condition.Significance. To our knowledge this is the first report using high density ESG for characterizing single joint lower limb movements. Our findings provide support that ESG contains information about efferent and afferent signaling in neurologically intact adults and suggests that we can utilize ESG to directly study the spinal cord.
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Affiliation(s)
- Alexander G Steele
- Laboratory for Noninvasive Brain-Machine Interfaces, IUCRC BRAIN, University of Houston, N308 Engineering Building I, Houston, TX 77204, United States of America
- Center for Neuroregeneration, Department of Neurosurgery, Houston Methodist Research Institute, Houston, TX 77030, United States of America
| | - Amir H Faraji
- Center for Neuroregeneration, Department of Neurosurgery, Houston Methodist Research Institute, Houston, TX 77030, United States of America
- Center for Translational Neural Prosthetics and Interfaces, Houston Methodist Research Institute, Houston, TX 77030, United States of America
- Clinical Innovations Laboratory, Houston Methodist Research Institute, Houston, TX 77030, United States of America
- Department of Neurological Surgery, Houston Methodist Hospital, Houston, TX 77030, United States of America
| | - Jose L Contreras-Vidal
- Laboratory for Noninvasive Brain-Machine Interfaces, IUCRC BRAIN, University of Houston, N308 Engineering Building I, Houston, TX 77204, United States of America
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Steele AG, Vette AH, Martin C, Masani K, Sayenko DG. Combining transcutaneous spinal stimulation and functional electrical stimulation increases force generated by lower limbs: When more is more. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.12.22.573119. [PMID: 38187778 PMCID: PMC10769419 DOI: 10.1101/2023.12.22.573119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
Background Transcutaneous Spinal Stimulation (TSS) has been shown to promote activation of the lower limb and trunk muscles and is being actively explored for improving the motor outcomes of people with neurological conditions. However, individual responses to TSS vary, and often the muscle responses are insufficient to produce enough force for self-supported standing. Functional electrical stimulation (FES) can activate individual muscles and assist in closing this functional gap, but it introduces questions regarding timing between modalities. Methods To assess the effects of TSS and FES on force generation, ten neurologically intact participants underwent (1) TSS only, (2) FES only, and (3) TSS + FES. TSS was delivered using four electrodes placed at T10-T11 through the L1-L2 intervertebral spaces simultaneously, while FES was delivered to the skin over the right knee extensors and plantarflexors. For all conditions, TSS and FES were delivered using three 0.5 ms biphasic square-wave pulses at 15 Hz. During the TSS + FES condition, timing between the two modalities was adjusted in increments of ¼ time between pulses (16.5 ms). Results When TSS preceded FES, a larger force production was observed. We also determined several changes in muscle activation amplitude at different relative stimulus intervals, which help characterize our finding and indicate the facilitating and inhibitory effects of the modalities. Conclusions Utilizing a delay ranging from 15 to 30 ms between stimuli resulted in higher mean force generation in both the knee and ankle joints, regardless of the selected FES location (Average; knee: 112.0%, ankle: 103.1%).
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Affiliation(s)
- Alexander G Steele
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, 6550 Fannin Street, Houston, Texas, 77030, United States of America
| | - Albert H Vette
- Department of Mechanical Engineering, University of Alberta, Donadeo Innovation Centre for Engineering, 9211-116 Street NW, Edmonton, Alberta T6G 1H9, Canada
- Glenrose Rehabilitation Hospital, Alberta Health Services, 10230 111 Avenue NW, Edmonton, Alberta T5G 0B7, Canada
| | - Catherine Martin
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, 6550 Fannin Street, Houston, Texas, 77030, United States of America
| | - Kei Masani
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON M5S 3G9, Canada
- KITE Research Institute - University Health Network, Toronto, ON M4G 3V9, Canada
| | - Dimitry G Sayenko
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, 6550 Fannin Street, Houston, Texas, 77030, United States of America
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Oh J, Steele AG, Varghese B, Martin CA, Scheffler MS, Markley RL, Lo YK, Sayenko DG. Cervical transcutaneous spinal stimulation for spinal motor mapping. iScience 2022; 25:105037. [PMID: 36147963 PMCID: PMC9485062 DOI: 10.1016/j.isci.2022.105037] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 07/29/2022] [Accepted: 08/25/2022] [Indexed: 12/02/2022] Open
Abstract
Transcutaneous spinal stimulation (TSS) is a promising approach to restore upper-limb (UL) functions after spinal cord injury (SCI) in humans. We sought to demonstrate the selectivity of recruitment of individual UL motor pools during cervical TSS using different electrode placements. We demonstrated that TSS delivered over the rostrocaudal and mediolateral axes of the cervical spine resulted in a preferential activation of proximal, distal, and ipsilateral UL muscles. This was revealed by changes in motor threshold intensity, maximum amplitude, and the amount of post-activation depression of the evoked responses. We propose that an arrangement of electrodes targeting specific UL motor pools may result in superior efficacy, restoring more diverse motor activities after neurological injuries and disorders, including severe SCI.
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Affiliation(s)
- Jeonghoon Oh
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, 6550 Fannin Street, Houston, TX 77030, USA
| | - Alexander G. Steele
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, 6550 Fannin Street, Houston, TX 77030, USA
- Department of Electrical and Computer Engineering, University of Houston, N308 Engineering Bldg 1, 4726 Calhoun Rd., Houston, TX 77204, USA
| | - Blesson Varghese
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, 6550 Fannin Street, Houston, TX 77030, USA
| | - Catherine A. Martin
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, 6550 Fannin Street, Houston, TX 77030, USA
| | - Michelle S. Scheffler
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, 6550 Fannin Street, Houston, TX 77030, USA
| | - Rachel L. Markley
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, 6550 Fannin Street, Houston, TX 77030, USA
| | | | - Dimitry G. Sayenko
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, 6550 Fannin Street, Houston, TX 77030, USA
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Hofstoetter US, Minassian K. Transcutaneous Spinal Cord Stimulation: Advances in an Emerging Non-Invasive Strategy for Neuromodulation. J Clin Med 2022; 11:jcm11133836. [PMID: 35807121 PMCID: PMC9267622 DOI: 10.3390/jcm11133836] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 06/30/2022] [Indexed: 12/04/2022] Open
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Steele AG, Manson GA, Horner PJ, Sayenko DG, Contreras-Vidal JL. Effects of transcutaneous spinal stimulation on spatiotemporal cortical activation patterns: A proof-of-concept EEG study. J Neural Eng 2022; 19. [PMID: 35732141 DOI: 10.1088/1741-2552/ac7b4b] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 06/22/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Transcutaneous spinal cord stimulation (TSS) has been shown to be a promising non-invasive alternative to epidural spinal cord stimulation (ESS) for improving outcomes of people with spinal cord injury (SCI). However, studies on the effects of TSS on cortical activation are limited. Our objectives were to evaluate the spatiotemporal effects of TSS on brain activity, and determine changes in functional connectivity under several different stimulation conditions. As a control, we also assessed the effects of functional electrical stimulation (FES) on cortical activity. APPROACH Non-invasive scalp electroencephalography (EEG) was recorded during TSS or FES while five neurologically intact participants performed one of three lower-limb tasks while in the supine position: (1) A no contraction control task, (2) a rhythmic contraction task, or (3) a tonic contraction task. After EEG denoising and segmentation, independent components were clustered across subjects to characterize sensorimotor networks in the time and frequency domains. Independent components of the event related potentials (ERPs) were calculated for each cluster and condition. Next, a Generalized Partial Directed Coherence (gPDC) analysis was performed on each cluster to compare the functional connectivity between conditions and tasks. RESULTS Independent Component analysis of EEG during TSS resulted in three clusters identified at Brodmann areas (BA) 9, BA 6, and BA 4, which are areas associated with working memory, planning, and movement control. Lastly, we found significant (p < 0.05, adjusted for multiple comparisons) increases and decreases in functional connectivity of clusters during TSS, but not during FES when compared to the no stimulation conditions. SIGNIFICANCE The findings from this study provide evidence of how TSS recruits cortical networks during tonic and rhythmic lower limb movements. These results have implications for the development of spinal cord-based computer interfaces, and the design of neural stimulation devices for the treatment of pain and sensorimotor deficit.
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Affiliation(s)
- Alexander G Steele
- Department of Neurosurgery, Houston Methodist Research Institute, 6670 Bertner Ave, Houston, Texas, 77030-2707, UNITED STATES
| | - Gerome A Manson
- Department of Neurosurgery, Houston Methodist Research Institute, 6670 Bertner Ave, Houston, Texas, 77030-2707, UNITED STATES
| | - Philip J Horner
- Department of Neurosurgery, Houston Methodist Research Institute, 6670 Bertner Ave, Houston, Texas, 77030-2707, UNITED STATES
| | - Dimitry G Sayenko
- Department of Neurosurgery, Houston Methodist Research Institute, 6670 Bertner Ave, Houston, Texas, 77030-2707, UNITED STATES
| | - Jose L Contreras-Vidal
- Electrical and Computer Engineering, University of Houston, N308 Engineering Building I, Houston, Texas, 77204-4005, UNITED STATES
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Transcutaneous spinal stimulation alters cortical and subcortical activation patterns during mimicked-standing: A proof-of-concept fMRI study. NEUROIMAGE: REPORTS 2022; 2. [DOI: 10.1016/j.ynirp.2022.100090] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Atkinson DA, Steele AG, Manson GA, Sheynin J, Oh J, Gerasimenko YP, Sayenko DG. Characterization of interlimb interaction via transcutaneous spinal stimulation of cervical and lumbar spinal enlargements. J Neurophysiol 2022; 127:1075-1085. [PMID: 35320019 PMCID: PMC8993515 DOI: 10.1152/jn.00456.2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 03/17/2022] [Accepted: 03/21/2022] [Indexed: 11/22/2022] Open
Abstract
The use of transcutaneous electrical spinal stimulation (TSS) to modulate sensorimotor networks after neurological insult has garnered much attention from both researchers and clinicians in recent years. Although many different stimulation paradigms have been reported, the interlimb effects of these neuromodulation techniques have been little studied. The effects of multisite TSS on interlimb sensorimotor function are of particular interest in the context of neurorehabilitation, as these networks have been shown to be important for functional recovery after neurological insult. The present study utilized a condition-test paradigm to investigate the effects of interenlargement TSS on spinal motor excitability in both cervical and lumbosacral motor pools. Additionally, comparison was made between the conditioning effects of lumbosacral and cervical TSS and peripheral stimulation of the fibular nerve and ulnar nerve, respectively. In 16/16 supine, relaxed participants, facilitation of spinally evoked motor responses (sEMRs) in arm muscles was seen in response to lumbosacral TSS or fibular nerve stimulation, whereas facilitation of sEMRs in leg muscles was seen in response to cervical TSS or ulnar nerve stimulation. The decreased latency between TSS- and peripheral nerve-evoked conditioning implicates interlimb networks in the observed facilitation of motor output. The results demonstrate the ability of multisite TSS to engage interlimb networks, resulting in the bidirectional influence of cervical and lumbosacral motor output. The engagement of interlimb networks via TSS of the cervical and lumbosacral enlargements represents a feasible method for engaging spinal sensorimotor networks in clinical populations with compromised motor function.NEW & NOTEWORTHY Bidirectional interlimb modulation of spinal motor excitability can be evoked by transcutaneous spinal stimulation over the cervical and lumbosacral enlargements. Multisite transcutaneous spinal stimulation engages spinal sensorimotor networks thought to be important in the recovery of function after spinal cord injury.
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Affiliation(s)
- D. A. Atkinson
- Doctor of Physical Therapy program, University of St. Augustine for Health Sciences, Austin, Texas
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, Houston, Texas
| | - A. G. Steele
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, Houston, Texas
- Department of Electrical and Computer Engineering, University of Houston, Houston, Texas
| | - G. A. Manson
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, Houston, Texas
- School of Kinesiology and Health Studies, Queen’s University, Kingston, Ontario, Canada
| | - J. Sheynin
- Department of Psychiatry and Behavioral Science, Texas A&M University Health Science Center, Houston, Texas
| | - J. Oh
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, Houston, Texas
| | - Y. P. Gerasimenko
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky
- Department of Physiology, University of Louisville, Louisville, Kentucky
- Pavlov Institute of Physiology, St. Petersburg, Russia
| | - D. G. Sayenko
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, Houston, Texas
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