scholarly journals Transcutaneous Electrical Spinal Cord Stimulation to Promote Recovery in Chronic Spinal Cord Injury

2022 ◽  
Vol 2 ◽  
Author(s):  
Candace Tefertiller ◽  
Meghan Rozwod ◽  
Eric VandeGriend ◽  
Patricia Bartelt ◽  
Mitch Sevigny ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Adverse Events ◽  
Upper Extremity ◽  
Spinal Cord Stimulation ◽  
Walk Test ◽  
Motor Score ◽  
Outpatient Therapy ◽  
Chronic Spinal Cord Injury ◽  
Cord Injury

Objective: To evaluate the impact of using transcutaneous electrical spinal cord stimulation (TSCSTSCS) on upper and lower extremity function in individuals with chronic spinal cord injury (SCI).Design: Prospective case series.Setting: SCI specific rehabilitation hospital.Participants: A convenience sample (N = 7) of individuals with tetraplegia who had previously been discharged from outpatient therapy due to a plateau in progress.Interventions: Individuals participated in 60 min of upper extremity (UE) functional task-specific practice (FTP) in combination with TSCS and 60 min of locomotor training in combination with TSCS 5x/week.Main Outcome Measures: The primary outcome for this analysis was the Capabilities of Upper Extremity Test (CUE-T). Secondary outcomes include UE motor score (UEMS), LE motor score (LEMS), sensation (light touch and pin prick), Nine-Hole Peg Test, 10 meter walk test, 6 min walk test, and 5 min stand test.Results: Seven individuals (four motor complete; three motor incomplete) completed 20–80 sessions UE and LE training augmented with TSCS and without any serious adverse events. Improvements were reported on the CUE-T in all seven individuals. Two individuals improved their ASIA impairment scale (AIS) classification (B to C; C to D) and two individuals improved their neurologic level of injury by one level (C4–C5; C5–C6). Sensation improved in five individuals and all four who started out with motor complete SCIs were able to voluntarily activate their LEs on command in the presence of stimulation.Conclusion: Individuals with chronic SCI who had previously demonstrated a plateau in function after an intensive outpatient therapy program were able to improve in a variety of UE and LE outcomes in response to TSCS without any adverse events. This was a small pilot study and future fully powered studies with comparative interventions need to be completed to assess efficacy.

scholarly journals Feasibility and utility of transcutaneous spinal cord stimulation combined with walking-based therapy for people with motor incomplete spinal cord injury

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Liza V. McHugh ◽  
Ashley A. Miller ◽  
Kristan A. Leech ◽  
Cynthia Salorio ◽  
Rebecca H. Martin
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Adverse Events ◽  
Spinal Cord Stimulation ◽  
Walking Speed ◽  
Minimal Detectable Change ◽  
Walk Test ◽  
Incomplete Spinal Cord Injury ◽  
Cord Injury ◽  
Transcutaneous Spinal Cord Stimulation

Abstract Study design Prospective case series. Objectives To evaluate the feasibility and preliminary efficacy of combining transcutaneous spinal cord stimulation (TSCS) with walking-based physical therapy. Setting Hospital-based outpatient center in Maryland, United States. Methods Ten individuals with chronic (>1 year) motor incomplete spinal cord injury (iSCI) completed 23 sessions of 2-h therapy over 8 weeks. TSCS was delivered for the first 30 min of each session using a clinically available device with adjustable current. To assess feasibility of the intervention, we tracked pain, adverse events, and participant retention. Preliminary efficacy was assessed by evaluating changes in walking speed, endurance, and quality following the intervention with select functional outcome measures (10-m walk test (10MWT), 6-min walk test (6MWT), timed up and go, and walking index for spinal cord injury II). Results We found that the combined intervention was feasible in an outpatient clinical setting. Participants tolerated the TSCS well, with no reports of significant adverse events or other issues (e.g., skin irritation or pain that disrupted training). None of the participants elected to discontinue the study. Participants also showed significant improvements in each measure of walking function following the intervention. Changes in walking speed, as measured by the 10MWT (0.56 ± 0.29 m/s to 0.72 ± 0.36 m/s), exceeded the minimal clinically important difference for individuals with iSCI. Changes in walking quality and endurance, as measured by the 6MWT (149.88 ± 99.87 m to 194.53 ± 106.56 m), exceeded the minimal detectable change for individuals with iSCI. Conclusions These results indicate that TSCS is clinically feasible and may be useful as an adjunct to walking-based therapy for adults with iSCI.

EFFECT OF LOWER EXTREMITY EXOSKELETON ROBOT IMPROVING WALKING FUNCTION AND ACTIVITY IN PATIENTS WITH COMPLETE SPINAL CORD INJURY

2019 ◽  
Vol 19 (08) ◽  
pp. 1940060
Author(s):  
XINGANG BAI ◽  
XIANG GOU ◽  
WENCHUN WANG ◽  
CHAO DONG ◽  
FANGXU QUE ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Adverse Events ◽  
Lower Extremity ◽  
Controlled Trial ◽  
Walking Ability ◽  
Walk Test ◽  
Exoskeleton Robot ◽  
Cord Injury ◽  
Complete Spinal Cord Injury

The objective of this research was to evaluate the effectiveness and safety of Lower Extremity Exoskeleton Robot improving walking function and activity in patients with complete spinal cord injury. A prospective, open and self-controlled trial was conducted which include eight patients with complete spinal cord injury accepted Lower Extremity Exoskeleton Robot training with Aider 1.0 and Aider 1.1 for 2 weeks. The 6[Formula: see text]min Walk Test (6MWT), 10[Formula: see text]m Walk Test (10 MWT), Hoffer walking ability rating, Lower Extremity Motor Score (LEMS), Spinal Cord Independence Motor (SCIM), Walking Index for Spinal Cord Injury Version II (WISCI II) were recorded before, 1 week and 2 weeks after training. During the training, the incidence of adverse events (AE), the incidence of serious adverse events (SAE), the incidence of device defects and other safety indicators were observed. Compared with the pre-training, indicators (6MWT, 10MWT, Hoffer walking ability rating, WISCI II) were significantly different after 1 week of training and after 2 weeks of training. Four adverse events occurred during the training period and the incidence of adverse events was 50%. And there was no SAE or device defects. Therefore, it is safe and effective to use the lower extremity exoskeleton robot to complete the walking ability of patients with complete spinal cord injury.

Spinal Cord Stimulation for the Control of Spasticity in Patients with Chronic Spinal Cord Injury: I. Clinical Observations

1986 ◽  
Vol 3 (2) ◽  
pp. 129-143 ◽  
Author(s):  
M.M. DIMITRIJEVIC ◽  
M.R. DIMITRIJEVIC ◽  
L.S. ILLIS ◽  
K. NAKAJIMA ◽  
P.C. SHARKEY ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Cord Stimulation ◽  
Chronic Spinal Cord Injury ◽  
Clinical Observations ◽  
Cord Injury

scholarly journals Against the odds: what to expect in rehabilitation of chronic spinal cord injury with a neurologically controlled Hybrid Assistive Limb exoskeleton. A subgroup analysis of 55 patients according to age and lesion level

2017 ◽  
Vol 42 (5) ◽  
pp. E15 ◽  
Author(s):  
Dennis Grasmücke ◽  
Amrei Zieriacks ◽  
Oliver Jansen ◽  
Christian Fisahn ◽  
Matthias Sczesny-Kaiser ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Motor Behavior ◽  
Treadmill Training ◽  
Walk Test ◽  
Chronic Spinal Cord Injury ◽  
Training Tool ◽  
Cord Injury ◽  
Lesion Level ◽  
Hybrid Assistive Limb

ObjectiveAge and lesion level are believed to represent outcome predictors in rehabilitation of patients with chronic spinal cord injury (SCI). The Hybrid Assistive Limb (HAL) exoskeleton enables patients to perform a voluntary controlled gait pattern via an electromyography-triggered neuromuscular feedback system, and has been introduced as a temporary gait training tool in patients with SCI. The aim of this prospective pre- and postintervention study was to examine functional outcomes as a function of age and lesion level in patients with chronic incomplete SCI (iSCI) or chronic complete SCI (cSCI) with zones of partial preservation (ZPP) by using the HAL as a temporary training tool.MethodsFifty-five participants with chronic iSCI or cSCI (mean time since injury 6.85 ± 5.12 years) were classified according to the American Spinal Injury Association (ASIA) Impairment Scale (AIS) and divided by age (< 50 or ≥ 50 years), independent of lesion level, and also into 4 homogeneous groups according to lesion level. The subgroups were as follows: Subgroup 1, tetraplegic iSCI (n = 13) (C2–8, AIS C [n = 8] and AIS D [n = 5]); Subgroup 2, paraplegic iSCI with spastic motor behavior (n = 15) (T2–12, AIS C [n = 8] and AIS D [n = 7]); Subgroup 3, paraplegic cSCI with complete motor paraplegia and absence of spastic motor behavior (n = 18) (T11–L4 [AIS A], and ZPP from L-3 to S-1); and Subgroup 4, paraplegic iSCI with absence of spastic motor behavior (n = 9) (T12–L3, AIS C [n = 8] and AIS D [n = 1]). The training paradigm consisted of 12 weeks of HAL-assisted treadmill training (5 times/week). Baseline status was documented prior to intervention by using the AIS grade, Walking Index for SCI II (WISCI II) score, the 10-meter walk test (10MWT), and the 6-minute walk test (6MinWT). Training effects were assessed after 6 and 12 weeks of therapy, without HAL assistance.ResultsOverall, a time reduction of 47% in the 10MWT, self-selected speed (10MWTsss) (< 50 years = 56% vs ≥ 50 years = 37%) and an increase of 50% in the 6MinWT were documented. The WISCI II scores showed a mean gain of 1.69 levels. At the end of the study, 24 of 55 patients (43.6%) were less dependent on walking aids. Age had a nonsignificant negative influence on the 10MWTsss. Despite a few nonsignificant subgroup differences, participants improved across all tests. Namely, patients with iSCI who had spastic motor behavior improved to a nonsignificant, lesser extent in the 6MinWT.ConclusionsThe HAL-assisted treadmill training leads to functional improvements in chronic iSCI or cSCI, both in and out of the exoskeleton. An improvement of approximately 50% in the 10MWTsss and in gait endurance (6MinWT) can be expected from such training. The influences of SCI lesion level and age on functional outcome were nonsignificant in the present study. Older age (≥ 50 years) may be associated with smaller improvements in the 10MWTsss. An iSCI in paraplegic patients with spastic motor behavior may be a nonsignificant negative predictor in gait endurance improvements.Clinical trial registration no.: DRKS00010250 (https://drks-neu.uniklinik-freiburg.de/drks_web/setLocale_DE.do)

Sign in / Sign up

Export Citation Format

Share Document