scholarly journals Functional electrical stimulation therapy improves grasping in chronic cervical spinal cord injury: Two case studies

2008 ◽  
Vol 18 (2) ◽  
pp. 53-61 ◽  
Author(s):  
Rosalynn Miller ◽  
Milos Popovic ◽  
Adam Thrasher ◽  
Molly Verrier
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Electrical Stimulation ◽  
Case Studies ◽  
Functional Electrical Stimulation ◽  
Cervical Spinal Cord ◽  
Hand Function ◽  
Hand Movement ◽  
Cervical Spinal Cord Injury ◽  
Cord Injury

OBJECTIVE AND IMPORTANCE: To present case studies of two individuals with chronic cervical spinal cord injury (SCI) who participated in functional electrical stimulation (FES) therapy with the objective to restore voluntary grasp function. CLINICAL PRESENTATION: Both individuals (right hand dominant males, age 24 and 31) had a sustained a cervical SCI (C6 and C4-5, respectively) at least 8 years prior to participation in this study. INTERVENTION: Both individuals participated in an individualized FES therapy program for 6 weeks. FES therapy was administered through a regimen of three, one-hour sessions, per week for three months. A single arm of each participant (n = 2) was treated. FES therapy is an integrative intervention strategy combining muscle strengthening, functional movement training and stretching. The participant's hand movement abilities were assessed pre and post FES therapy using the Manual Muscle Test (MMT), a modified Sollerman Hand Function Test (mSHFT), and the Reach, Grasp, Transport and Release Task (RGTR). DISCUSSION: As the injuries of participants in the current study were chronic and thus neurologically stable, no spontaneous improvements/recovery in hand function was expected. However, FES as part of an integrated therapeutic approach affected restoration and improvement of hand function in both participants. CONCLUSION: The concurrent improvement in strength, integrated motor function and object contact following FES therapy, demonstrated that there is potential for affecting change in hand function of individuals with chronic SCI.

A critical reappraisal of corticospinal tract somatotopy and its role in traumatic cervical spinal cord syndromes

2021 ◽  
pp. 1-7
Author(s):  
Allan D. Levi ◽  
Jan M. Schwab
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Upper Extremity ◽  
Corticospinal Tract ◽  
Cervical Spinal Cord ◽  
Hand Function ◽  
Cervical Spinal Cord Injury ◽  
Pathophysiological Mechanism ◽  
Cord Injury ◽  
Central Cord Syndrome

The corticospinal tract (CST) is the preeminent voluntary motor pathway that controls human movements. Consequently, long-standing interest has focused on CST location and function in order to understand both loss and recovery of neurological function after incomplete cervical spinal cord injury, such as traumatic central cord syndrome. The hallmark clinical finding is paresis of the hands and upper-extremity function with retention of lower-extremity movements, which has been attributed to injury and the sparing of specific CST fibers. In contrast to historical concepts that proposed somatotopic (laminar) CST organization, the current narrative summarizes the accumulated evidence that 1) there is no somatotopic organization of the corticospinal tract within the spinal cord in humans and 2) the CST is critically important for hand function. The evidence includes data from 1) tract-tracing studies of the central nervous system and in vivo MRI studies of both humans and nonhuman primates, 2) selective ablative studies of the CST in primates, 3) evolutionary assessments of the CST in mammals, and 4) neuropathological examinations of patients after incomplete cervical spinal cord injury involving the CST and prominent arm and hand dysfunction. Acute traumatic central cord syndrome is characterized by prominent upper-extremity dysfunction, which has been falsely predicated on pinpoint injury to an assumed CST layer that specifically innervates the hand muscles. Given the evidence surveyed herein, the pathophysiological mechanism is most likely related to diffuse injury to the CST that plays a critically important role in hand function.

scholarly journals Electrical Stimulation Of The Cervical Dorsal Roots Enables Functional Arm And Hand Movements In Monkeys With Cervical Spinal Cord Injury

2020 ◽  
Author(s):  
B. Barra ◽  
S. Conti ◽  
M.G. Perich ◽  
K. Zhuang ◽  
G. Schiavone ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Electrical Stimulation ◽  
Motor Control ◽  
Cervical Spinal Cord ◽  
Three Dimensional ◽  
Arm Movements ◽  
Cervical Spinal Cord Injury ◽  
Cord Injury ◽  
Stimulation Of

SUMMARYRegaining arm motor control is a high priority for people with cervical spinal cord injury1. Unfortunately, no therapy can reverse upper limb paralysis. Promising neurotechnologies stimulating muscles to bypass the injury enabled grasping in humans with SCI2,3 but failed to sustain whole arm functional movements that are necessary for daily living activities. Here, we show that electrical stimulation of the cervical spinal cord enabled three monkeys with cervical SCI to execute functional, three-dimensional, arm movements. We designed a lateralized epidural interface that targeted motoneurons through the recruitment of sensory afferents within the dorsal roots and was adapted to the specific anatomy of each monkey. Simple stimulation bursts engaging single roots produced selective joint movements. We then triggered these bursts using movement-related intracortical signals, which enabled monkeys with arm motor deficits to perform an unconstrained, three-dimensional reach and grasp task. Our technology increased muscle activity, forces, task performance and quality of arm movements. Finally, analysis of intra-cortical neural data showed that a synergistic interaction between spared descending pathways and electrical stimulation enabled this restoration of voluntary motor control. Spinal cord stimulation is a mature clinical technology4–7, which suggests a realistic path for our approach to clinical applications.

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