The Effects of Adding Transcutaneous Spinal Cord Stimulation (tSCS) to Sit-To-Stand Training in People with Spinal Cord Injury: A Pilot Study

Spinal cord stimulation may enable recovery of volitional motor control in people with chronic Spinal Cord Injury (SCI). In this study we explored the effects of adding SCS, applied transcutaneously (tSCS) at vertebral levels T10/11, to a sit-to-stand training intervention in people with motor complete and incomplete SCI. Nine people with chronic SCI (six motor complete; three motor incomplete) participated in an 8-week intervention, incorporating three training sessions per week. Participants received either tSCS combined with sit-to-stand training (STIM) or sit-to-stand training alone (NON-STIM). Outcome measures were carried out before and after the intervention. Seven participants completed the intervention (STIM N = 5; NON-STIM N = 2). Post training, improvements in International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) motor scores were noted in three STIM participants (range 1.0–7.0), with no change in NON-STIM participants. Recovery of volitional lower limb muscle activity and/or movement (with tSCS off) was noted in three STIM participants. Unassisted standing was not achieved in any participant, although standing with minimal assistance was achieved in one STIM participant. This pilot study has shown that the recruitment of participants, intervention and outcome measures were all feasible in this study design. However, some modifications are recommended for a larger trial.

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An interview based approach to the anorectal portion of the International Standards of Neurological Classification of Spinal Cord Injury Exam (I-A-ISNCSCI): a pilot study

Spinal Cord ◽

10.1038/s41393-019-0399-5 ◽

2019 ◽

Vol 58 (5) ◽

pp. 553-559

Author(s):

Audrey Chun ◽

Andrew D. Delgado ◽

Chung-Ying Tsai ◽

Lisa Spielman ◽

Kristell Taylor ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Pilot Study ◽

International Standards ◽

Cord Injury

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Theoretical and practical training improves knowledge of the examination guidelines of the International Standards for Neurological Classification of Spinal Cord Injury

Spinal Cord ◽

10.1038/s41393-020-00578-1 ◽

2020 ◽

Author(s):

Steffen Franz ◽

Laura Heutehaus ◽

Sina Weinand ◽

Norbert Weidner ◽

Rüdiger Rupp ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Reliability And Validity ◽

International Standards ◽

Practical Training ◽

Cord Injury ◽

Hands On ◽

Before And After ◽

Correct Execution

Abstract Study design Prospective pre–post study. Objectives International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) represents the most frequently used assessment to determine the level and severity of a spinal cord injury (SCI). The guidelines for ISNCSCI are complex and challenging. Knowledge of its correct execution needs to be imparted precisely. The aim of this study was to investigate whether hands-on instructional courses can increase the knowledge of the ISNCSCI examination guidelines. Setting European Multicenter Study about SCI. Methods Before and after the instructional courses, participants were asked to complete questionnaires. The set of questions covered the most important aspects of the examination guidelines. Attendees were asked to self-rate their occupation and experience in ISNCSCI. Results The comparison of pretest and posttest results of 164 attendees from 2014 to 2018 revealed an improvement of knowledge reflected by an increase of correct answers from 66 ± 17% before to 89 ± 11% after the course (p < 0.01). The improvement was not associated with occupation (p > 0.1). However, the correctness of pretest results differed concerning both the period of experience with ISNCSCI (p < 0.05) and the course language (p < 0.01), while the frequency of execution resulted in differences in the posttest (p = 0.01). Conclusions Instructional courses substantially improve knowledge of the ISNCSCI examination guidelines. Differences in knowledge present before the course leveled off after the course. Comprehensive theoretical training is strongly recommended to ensure reliability and validity of ISNCSCI examinations in clinical routine and research. Albeit being practiced in the instructional courses, the benefit of hands-on training still needs to be systematically evaluated in future studies.

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International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) *

50 Landmark Papers ◽

10.1201/9781315154053-16 ◽

2018 ◽

pp. 83-86

Author(s):

Sukhvinder Kalsi-Ryan

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

International Standards ◽

Cord Injury

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International Standards for Neurological Classification of Spinal Cord Injury: Cases With Classification Challenges

Topics in Spinal Cord Injury Rehabilitation ◽

10.1310/sci2002-81 ◽

2014 ◽

Vol 20 (2) ◽

pp. 81-89 ◽

Cited By ~ 10

Author(s):

S. Kirshblum ◽

F. Biering-Sørensen ◽

R. Betz ◽

S. Burns ◽

W. Donovan ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

International Standards ◽

Cord Injury

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International Standards for the Neurological Classification of Spinal Cord Injury

Encyclopedia of Clinical Neuropsychology ◽

10.1007/978-0-387-79948-3_5034 ◽

2011 ◽

pp. 1347-1347

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

International Standards ◽

Cord Injury

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The effects of FES cycling combined with virtual reality racing biofeedback on voluntary function after incomplete SCI: a pilot study

Journal of NeuroEngineering and Rehabilitation ◽

10.1186/s12984-019-0619-4 ◽

2019 ◽

Vol 16 (1) ◽

Cited By ~ 2

Author(s):

Lynsey D. Duffell ◽

Sue Paddison ◽

Ahmad F. Alahmary ◽

Nick Donaldson ◽

Jane Burridge

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Virtual Reality ◽

Electrical Stimulation ◽

Pilot Study ◽

Controlled Trial ◽

Training Programme ◽

International Standards ◽

Motor Score ◽

Cord Injury

Abstract Background Functional Electrical Stimulation (FES) cycling can benefit health and may lead to neuroplastic changes following incomplete spinal cord injury (SCI). Our theory is that greater neurological recovery occurs when electrical stimulation of peripheral nerves is combined with voluntary effort. In this pilot study, we investigated the effects of a one-month training programme using a novel device, the iCycle, in which voluntary effort is encouraged by virtual reality biofeedback during FES cycling. Methods Eleven participants (C1-T12) with incomplete SCI (5 sub-acute; 6 chronic) were recruited and completed 12-sessions of iCycle training. Function was assessed before and after training using the bilateral International Standards for Neurological Classification of SCI (ISNC-SCI) motor score, Oxford power grading, Modified Ashworth Score, Spinal Cord Independence Measure, the Walking Index for Spinal Cord Injury and 10 m-walk test. Power output (PO) was measured during all training sessions. Results Two of the 6 participants with chronic injuries, and 4 of the 5 participants with sub-acute injuries, showed improvements in ISNC-SCI motor score > 8 points. Median (IQR) improvements were 3.5 (6.8) points for participants with a chronic SCI, and 8.0 (6.0) points for those with sub-acute SCI. Improvements were unrelated to other measured variables (age, time since injury, baseline ISNC-SCI motor score, baseline voluntary PO, time spent training and stimulation amplitude; p > 0.05 for all variables). Five out of 11 participants showed moderate improvements in voluntary cycling PO, which did not correlate with changes in ISNC-SCI motor score. Improvement in PO during cycling was positively correlated with baseline voluntary PO (R2 = 0.50; p < 0.05), but was unrelated to all other variables (p > 0.05). The iCycle was not suitable for participants who were too weak to generate a detectable voluntary torque or whose effort resulted in a negative torque. Conclusions Improved ISNC-SCI motor scores in chronic participants may be attributable to the iCycle training. In sub-acute participants, early spontaneous recovery and changes due to iCycle training could not be distinguished. The iCycle is an innovative progression from existing FES cycling systems, and positive results should be verified in an adequately powered controlled trial. Trial registration ClinicalTrials.gov, NCT03834324. Registered 06 February 2019 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03834324. Protocol V03, dated 06.08.2015.

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