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Moon Y, Yang C, Veit NC, McKenzie KA, Kim J, Aalla S, Yingling L, Buchler K, Hunt J, Jenz S, Shin SY, Kishta A, Edgerton VR, Gerasimenko YP, Roth EJ, Lieber RL, Jayaraman A. Noninvasive spinal stimulation improves walking in chronic stroke survivors: a proof-of-concept case series. Biomed Eng Online 2024; 23:38. [PMID: 38561821 PMCID: PMC10986021 DOI: 10.1186/s12938-024-01231-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 03/21/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND After stroke, restoring safe, independent, and efficient walking is a top rehabilitation priority. However, in nearly 70% of stroke survivors asymmetrical walking patterns and reduced walking speed persist. This case series study aims to investigate the effectiveness of transcutaneous spinal cord stimulation (tSCS) in enhancing walking ability of persons with chronic stroke. METHODS Eight participants with hemiparesis after a single, chronic stroke were enrolled. Each participant was assigned to either the Stim group (N = 4, gait training + tSCS) or Control group (N = 4, gait training alone). Each participant in the Stim group was matched to a participant in the Control group based on age, time since stroke, and self-selected gait speed. For the Stim group, tSCS was delivered during gait training via electrodes placed on the skin between the spinous processes of C5-C6, T11-T12, and L1-L2. Both groups received 24 sessions of gait training over 8 weeks with a physical therapist providing verbal cueing for improved gait symmetry. Gait speed (measured from 10 m walk test), endurance (measured from 6 min walk test), spatiotemporal gait symmetries (step length and swing time), as well as the neurophysiological outcomes (muscle synergy, resting motor thresholds via spinal motor evoked responses) were collected without tSCS at baseline, completion, and 3 month follow-up. RESULTS All four Stim participants sustained spatiotemporal symmetry improvements at the 3 month follow-up (step length: 17.7%, swing time: 10.1%) compared to the Control group (step length: 1.1%, swing time 3.6%). Additionally, 3 of 4 Stim participants showed increased number of muscle synergies and/or lowered resting motor thresholds compared to the Control group. CONCLUSIONS This study provides promising preliminary evidence that using tSCS as a therapeutic catalyst to gait training may increase the efficacy of gait rehabilitation in individuals with chronic stroke. Trial registration NCT03714282 (clinicaltrials.gov), registration date: 2018-10-18.
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Affiliation(s)
- Yaejin Moon
- Shirley Ryan AbilityLab, 355 E. Erie St, Chicago, IL, 60611, USA
- Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
- Department of Exercise Science, Syracuse University, Syracuse, NY, 13057, USA
| | - Chen Yang
- Shirley Ryan AbilityLab, 355 E. Erie St, Chicago, IL, 60611, USA
- Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Nicole C Veit
- Shirley Ryan AbilityLab, 355 E. Erie St, Chicago, IL, 60611, USA
- Biomedical Engineering Department, McCormick School of Engineering, Northwestern University, Evanston, IL, 60208, USA
| | - Kelly A McKenzie
- Shirley Ryan AbilityLab, 355 E. Erie St, Chicago, IL, 60611, USA
| | - Jay Kim
- Shirley Ryan AbilityLab, 355 E. Erie St, Chicago, IL, 60611, USA
| | - Shreya Aalla
- Shirley Ryan AbilityLab, 355 E. Erie St, Chicago, IL, 60611, USA
| | - Lindsey Yingling
- Shirley Ryan AbilityLab, 355 E. Erie St, Chicago, IL, 60611, USA
| | - Kristine Buchler
- Shirley Ryan AbilityLab, 355 E. Erie St, Chicago, IL, 60611, USA
| | - Jasmine Hunt
- Shirley Ryan AbilityLab, 355 E. Erie St, Chicago, IL, 60611, USA
| | - Sophia Jenz
- Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Sung Yul Shin
- Shirley Ryan AbilityLab, 355 E. Erie St, Chicago, IL, 60611, USA
- Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Ameen Kishta
- Shirley Ryan AbilityLab, 355 E. Erie St, Chicago, IL, 60611, USA
| | - V Reggie Edgerton
- Rancho Los Amigos National Rehabilitation Center, Broccoli Impossible-to-Possible Lab, Rancho Research Institute, Downy, CA, 90242, USA
- Neurorestoration Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033, USA
| | - Yury P Gerasimenko
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, 40202, USA
- Pavlov Institute of Physiology, St. Petersburg, Russia
| | - Elliot J Roth
- Shirley Ryan AbilityLab, 355 E. Erie St, Chicago, IL, 60611, USA
- Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Richard L Lieber
- Shirley Ryan AbilityLab, 355 E. Erie St, Chicago, IL, 60611, USA
- Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
- Hines VA Medical Center, Maywood, IL, 60141, USA
| | - Arun Jayaraman
- Shirley Ryan AbilityLab, 355 E. Erie St, Chicago, IL, 60611, USA.
- Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA.
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Muter WM, Mansson L, Tuthill C, Aalla S, Barth S, Evans E, McKenzie K, Prokup S, Yang C, Sandhu M, Rymer WZ, Edgerton VR, Gad P, Mitchell GS, Wu SS, Shan G, Jayaraman A, Trumbower RD. A Research Protocol to Study the Priming Effects of Breathing Low Oxygen on Enhancing Training-Related Gains in Walking Function for Persons With Spinal Cord Injury: The BO 2ST Trial. Neurotrauma Rep 2023; 4:736-750. [PMID: 38028272 PMCID: PMC10659019 DOI: 10.1089/neur.2023.0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
Brief episodes of low oxygen breathing (therapeutic acute intermittent hypoxia; tAIH) may serve as an effective plasticity-promoting primer to enhance the effects of transcutaneous spinal stimulation-enhanced walking therapy (WALKtSTIM) in persons with chronic (>1 year) spinal cord injury (SCI). Pre-clinical studies in rodents with SCI show that tAIH and WALKtSTIM therapies harness complementary mechanisms of plasticity to maximize walking recovery. Here, we present a multi-site clinical trial protocol designed to examine the influence of tAIH + WALKtSTIM on walking recovery in persons with chronic SCI. We hypothesize that daily (eight sessions, 2 weeks) tAIH + WALKtSTIM will elicit faster, more persistent improvements in walking recovery than either treatment alone. To test our hypothesis, we are conducting a placebo-controlled clinical trial on 60 SCI participants who randomly receive one of three interventions: tAIH + WALKtSTIM; Placebo + WALKtSTIM; and tAIH + WALKtSHAM. Participants receive daily tAIH (fifteen 90-sec episodes at 10% O2 with 60-sec intervals at 21% O2) or daily placebo (fifteen 90-sec episodes at 21% O2 with 60-sec intervals at 21% O2) before a 45-min session of WALKtSTIM or WALKtSHAM. Our primary outcome measures assess walking speed (10-Meter Walk Test), endurance (6-Minute Walk Test), and balance (Timed Up and Go Test). For safety, we also measure pain levels, spasticity, sleep behavior, cognition, and rates of systemic hypertension and autonomic dysreflexia. Assessments occur before, during, and after sessions, as well as at 1, 4, and 8 weeks post-intervention. Results from this study extend our understanding of the functional benefits of tAIH priming by investigating its capacity to boost the neuromodulatory effects of transcutaneous spinal stimulation on restoring walking after SCI. Given that there is no known cure for SCI and no single treatment is sufficient to overcome walking deficits, there is a critical need for combinatorial treatments that accelerate and anchor walking gains in persons with lifelong SCI. Trial Registration ClinicalTrials.gov, NCT05563103.
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Affiliation(s)
- William M. Muter
- Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
| | - Linda Mansson
- Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher Tuthill
- Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
| | - Shreya Aalla
- Shirley Ryan AbilityLab, Max Nader Center for Rehabilitation Technologies and Outcomes Research, Chicago, Illinois, USA
| | - Stella Barth
- Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
- UMass Chan Medical School, University of Massachusetts, Worcester, Massachusetts, USA
| | - Emily Evans
- Department of Physical Therapy, Boston University, Boston, Massachusetts, USA
| | - Kelly McKenzie
- Shirley Ryan AbilityLab, Max Nader Center for Rehabilitation Technologies and Outcomes Research, Chicago, Illinois, USA
| | - Sara Prokup
- Shirley Ryan AbilityLab, Max Nader Center for Rehabilitation Technologies and Outcomes Research, Chicago, Illinois, USA
| | - Chen Yang
- Shirley Ryan AbilityLab, Max Nader Center for Rehabilitation Technologies and Outcomes Research, Chicago, Illinois, USA
| | - Milap Sandhu
- Shirley Ryan AbilityLab, Max Nader Center for Rehabilitation Technologies and Outcomes Research, Chicago, Illinois, USA
| | - W. Zev Rymer
- Shirley Ryan AbilityLab, Max Nader Center for Rehabilitation Technologies and Outcomes Research, Chicago, Illinois, USA
| | - Victor R. Edgerton
- Department of Integrative Biology and Physiology, University of California–Los Angeles, Los Angeles, California, USA
- SpineX Inc., Northridge, California, USA
| | - Parag Gad
- Department of Integrative Biology and Physiology, University of California–Los Angeles, Los Angeles, California, USA
- SpineX Inc., Northridge, California, USA
| | - Gordon S. Mitchell
- Department of Physical Therapy, University of Florida, Gainesville, Florida, USA
| | - Samuel S. Wu
- Department of Biostatistics, University of Florida, Gainesville, Florida, USA
| | - Guogen Shan
- Department of Biostatistics, University of Florida, Gainesville, Florida, USA
| | - Arun Jayaraman
- Shirley Ryan AbilityLab, Max Nader Center for Rehabilitation Technologies and Outcomes Research, Chicago, Illinois, USA
| | - Randy D. Trumbower
- Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
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