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      Multisite Transcutaneous Spinal Stimulation for Walking and Autonomic Recovery in Motor-Incomplete Tetraplegia: A Single-Subject Design

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          Abstract

          Objective

          This study investigated the effect of cervical and lumbar transcutaneous spinal cord stimulation (tSCS) combined with intensive training to improve walking and autonomic function after chronic spinal cord injury (SCI).

          Methods

          Two 64-year-old men with chronic motor incomplete cervical SCI participated in this single-subject design study. They each underwent 2 months of intensive locomotor training and 2 months of multisite cervical and lumbosacral tSCS paired with intensive locomotor training.

          Results

          The improvement in 6-Minute Walk Test distance after 2 months of tSCS with intensive training was threefold greater than after locomotor training alone. Both participants improved balance ability measured by the Berg Balance Scale and increased their ability to engage in daily home exercises. Gait analysis demonstrated increased step length for each individual. Both participants experienced improved sensation and bowel function, and 1 participant eliminated the need for intermittent catheterization after the stimulation phase of the study.

          Conclusion

          These results suggest that noninvasive spinal cord stimulation might promote recovery of locomotor and autonomic functions beyond traditional gait training in people with chronic incomplete cervical SCI.

          Impact

          Multisite transcutaneous spinal stimulation may induce neuroplasticity of the spinal networks and confer functional benefits following chronic cervical SCI.

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          Most cited references75

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          OpenSim: open-source software to create and analyze dynamic simulations of movement.

          Scott L. Delp, Frank Anderson, Allison Arnold … (2007)
          Dynamic simulations of movement allow one to study neuromuscular coordination, analyze athletic performance, and estimate internal loading of the musculoskeletal system. Simulations can also be used to identify the sources of pathological movement and establish a scientific basis for treatment planning. We have developed a freely available, open-source software system (OpenSim) that lets users develop models of musculoskeletal structures and create dynamic simulations of a wide variety of movements. We are using this system to simulate the dynamics of individuals with pathological gait and to explore the biomechanical effects of treatments. OpenSim provides a platform on which the biomechanics community can build a library of simulations that can be exchanged, tested, analyzed, and improved through a multi-institutional collaboration. Developing software that enables a concerted effort from many investigators poses technical and sociological challenges. Meeting those challenges will accelerate the discovery of principles that govern movement control and improve treatments for individuals with movement pathologies.
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            Targeted neurotechnology restores walking in humans with spinal cord injury

            Fabien Wagner, Jean-Baptiste Mignardot, Camille Le Goff-Mignardot … (2018)
            Spinal cord injury leads to severe locomotor deficits or even complete leg paralysis. Here we introduce targeted spinal cord stimulation neurotechnologies that enabled voluntary control of walking in individuals who had sustained a spinal cord injury more than four years ago and presented with permanent motor deficits or complete paralysis despite extensive rehabilitation. Using an implanted pulse generator with real-time triggering capabilities, we delivered trains of spatially selective stimulation to the lumbosacral spinal cord with timing that coincided with the intended movement. Within one week, this spatiotemporal stimulation had re-established adaptive control of paralysed muscles during overground walking. Locomotor performance improved during rehabilitation. After a few months, participants regained voluntary control over previously paralysed muscles without stimulation and could walk or cycle in ecological settings during spatiotemporal stimulation. These results establish a technological framework for improving neurological recovery and supporting the activities of daily living after spinal cord injury.
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              Targeting recovery: priorities of the spinal cord-injured population.

              Kim D Anderson (2004)
              In the United States alone, there are more than 200,000 individuals living with a chronic spinal cord injury (SCI). Healthcare for these individuals creates a significant economic burden for the country, not to mention the physiological, psychological, and social suffering these people endure everyday. Regaining partial function can lead to greater independence, thereby improving quality of life. To ascertain what functions are most important to the SCI population, in regard to enhancing quality of life, a novel survey was performed in which subjects were asked to rank seven functions in order of importance to their quality of life. The survey was distributed via email, postal mail, the internet, interview, and word of mouth to the SCI community at large. A total of 681 responses were completed. Regaining arm and hand function was most important to quadriplegics, while regaining sexual function was the highest priority for paraplegics. Improving bladder and bowel function was of shared importance to both injury groups. A longitudinal analysis revealed only slight differences between individuals injured 3 years. The majority of participants indicated that exercise was important to functional recovery, yet more than half either did not have access to exercise or did not have access to a trained therapist to oversee that exercise. In order to improve the relevance of research in this area, the concerns of the SCI population must be better known and taken into account. This approach is consistent with and emphasized by the new NIH roadmap to discovery.
              Article 0 comments Cited 278 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Phys Ther
                Journal ID (iso-abbrev): Phys Ther
                Journal ID (publisher-id): ptj
                Title: Physical Therapy
                Publisher: Oxford University Press
                ISSN (Print): 0031-9023
                ISSN (Electronic): 1538-6724
                Publication date Collection: January 2022
                Publication date (Electronic): 24 January 2022
                Publication date PMC-release: 24 January 2022
                Volume: 102
                Issue: 1
                Electronic Location Identifier: pzab228
                Affiliations
                [1 ] Department of Rehabilitation Medicine, University of Washington , Seattle, Washington, USA
                [2 ] Center for Neurotechnology , University of Washington, Seattle, Washington, USA
                [3 ] Department of Electrical and Computer Engineering, University of Washington , Seattle, Washington, USA
                [4 ] Department of Mechanical Engineering, University of Washington , Seattle, Washington, USA
                [5 ] Department of Neurological Surgery, University of Washington , Seattle, Washington, USA
                [6 ] Department of Physiology and Biophysics, University of Washington , Seattle, Washington, USA
                Author notes
                Address all correspondence to Dr Moritz at: ctmoritz@ 123456uw.edu
                Author information
                https://orcid.org/0000-0003-3796-8085
                Article
                Publisher ID: pzab228
                DOI: 10.1093/ptj/pzab228
                PMC ID: 8788019
                PubMed ID: 35076067
                SO-VID: 4d4e3f39-56f3-4d10-a7d7-a02f0ddf39bc
                Copyright © © The Author(s) 2022. Published by Oxford University Press on behalf of the American Physical Therapy Association.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution NonCommercial-NoDerivs licence ( https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

                History
                Date received : 20 January 2021
                Date revision received : 7 June 2021
                Date accepted : 23 August 2021
                Page count
                Pages: 00
                Funding
                Funded by: funder-nameCenter for Neurotechnology, the National Science Foundation-Engineering Research Center;
                Award ID: EEC-1028725
                Funded by: Washington State Spinal Cord Injury Consortium;
                Funded by: Christopher and Dana Reeve Foundation, DOI 10.13039/100001305;
                Funded by: University of Washington Institute for Neuroengineering;
                Funded by: Washington Research Foundation, DOI 10.13039/100001906;
                Categories
                Subject: Original Research
                Subject: AcademicSubjects/MED00110

                Keywords: autonomic function,chronic cervical spinal cord injury,locomotor training,noninvasive electrical spinal stimulation
                Data availability:
                Keywords: autonomic function, chronic cervical spinal cord injury, locomotor training, noninvasive electrical spinal stimulation

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