Effects of cortical intermittent theta burst stimulation combined with precise root stimulation on motor function after spinal cord injury: a case series study

Synchronous visuotactile stimulation on the own hidden hand and a visible fake limb can alter bodily self-perception and influence spontaneous neuroplasticity. The rubber hand illusion (RHI) paradigm experimentally produces an illusion of rubber hand ownership and arm shift by simultaneously stroking a rubber hand in view and a participant’s visually occluded hand. The aim of this cross-over, placebo-controlled, single-blind study was to assess whether RHI, in combination with high-frequency repetitive transcranial magnetic stimulation (rTMS) given as intermittent (excitatory) theta burst stimulation (iTBS) applied over the hand area of the primary sensory region (S1) can enhance tactile sensation in a group of 21 healthy subjects and one patient with cervical spinal cord injury. Four sessions covered all combinations of real and sham stimulations of the RHI and the TBS: real TBS and real RHI, real TBS and sham RHI, sham TBS and real RHI, and both conditions sham. The condition sham TBS and real RHI shows the greatest effect on the proprioceptive drift (median 2.3 cm, IQR 2) and on the score of RHI questionnaires (median 3, IQR 2) in the control group as well as in the real-real condition (median 2, IQR 2). The sham TBS and real RHI condition also shows the best results in the electrical perception test of the patient (median 1.9 mA). Conversely, the upregulation of the cortical excitability of S1 via TBS seems to impair the effect of the RHI. This might be due to a strengthening of the top-down connection between the central nervous system and the periphery, diminishing the RHI. This finding helps in understanding the mechanisms of top-down and bottom-up mechanisms in healthy subjects and patients with spinal cord injury. The RHI paradigm could represent an interesting therapeutic approach in improving tactile sensation and rTMS techniques could modulate these effects. Yet, further studies are needed, to examine the direction of the interaction effect of TMS and RH.

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Transcranial Magnetic Stimulation with Intermittent Theta Burst Stimulation Alters Corticospinal Output in Patients with Chronic Incomplete Spinal Cord Injury

Frontiers in Neurology ◽

10.3389/fneur.2017.00380 ◽

2017 ◽

Vol 8 ◽

Cited By ~ 3

Author(s):

Hunter J. Fassett ◽

Claudia V. Turco ◽

Jenin El-Sayes ◽

Tea Lulic ◽

Steve Baker ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Transcranial Magnetic Stimulation ◽

Magnetic Stimulation ◽

Incomplete Spinal Cord Injury ◽

Theta Burst Stimulation ◽

Burst Stimulation ◽

Cord Injury ◽

Theta Burst

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Intermittent theta-burst stimulation for upper-limb dysfunction and spasticity in spinal cord injury: a single-blind randomized feasibility study

Spinal Cord ◽

10.1038/s41393-018-0152-5 ◽

2018 ◽

Vol 56 (8) ◽

pp. 762-768 ◽

Cited By ~ 2

Author(s):

Aref-Ali Gharooni ◽

Krishnan Padmakumari Sivaraman Nair ◽

Debby Hawkins ◽

Ian Scivill ◽

Daniel Hind ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Feasibility Study ◽

Upper Limb ◽

Theta Burst Stimulation ◽

Burst Stimulation ◽

Cord Injury ◽

Upper Limb Dysfunction ◽

Single Blind ◽

Theta Burst

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Demographic characteristics and functional outcomes in patients with traumatic and nontraumatic spinal cord injuries

Vojnosanitetski pregled ◽

10.2298/vsp1212061m ◽

2012 ◽

Vol 69 (12) ◽

pp. 1061-1066 ◽

Cited By ~ 6

Author(s):

Sasa Milicevic ◽

Zoran Bukumiric ◽

Aleksandra Karadzov-Nikolic ◽

Rade Babovic ◽

Slobodan Jankovic

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Functional Outcomes ◽

Spinal Cord Injuries ◽

Case Series ◽

Functional Independence ◽

Demographic Characteristics ◽

Case Series Study ◽

Cord Injury ◽

Detailed Medical History

Background/Aim. Spinal cord injuries (SCI) could be associated with a significant functional impairment in the areas of mobility, self-care, bowel and bladder emptying and sexuality. The aim of this study was to compare demographic characteristics and functional outcomes of nontraumatic and traumatic spinal cord injury patients. Methods. This study was designed as retrospective case series study. A detailed medical history including sex, age, mode of trauma, and clinical and radiological examination was taken for all patients. Hospital records were used to classify the patients according to the following: mechanism of injury, neurological level of injury, functional outcomes, associated injuries, method of treatment, secondary complications and length of stay. The following clinical scores were measured in the patients: American Spinal Injury Association standards (CASTA), Functional Independence Measure (FIM), and Modified Aschworth score (MAS). Results. Out of totally 441 patients with spinal cord injury, 279 were traumatic patients (TSCI) and 162 nontraumatic patients (NTSCI); 322 men and 119 women. The mean age of the patients was 46.1 ? 19.9 years. Traumatic and nontraumatic populations showed several significant differences with regard to age, level and severity of lesion. When adjusted for these factors patients with traumatic injuries showed a significantly lower FIM score at admission and significantly better improvement in the FIM score at discharge. The two populations were discharged with similar functional outcome. Conclusions. The NTSCI patients in our study were younger, more frequently female, with less complications before rehabilitation and less frequently treated operatively than the TSCI patients. Hospital rehabilitation of the TSCI patients was longer than that of the NTSCI patients, but their functional gain from admission was also higher, so at discharge. Traumatic and nontraumatic spinal cord lesion patients achieved similar results in regard to neurological and functional status.

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Neurological Recovery in Traumatic Spinal Cord Injury Patient with Delayed Surgical Intervention

Neurologico Spinale Medico Chirurgico ◽

10.15562/nsmc.v1i2.112 ◽

2018 ◽

Vol 1 (2) ◽

pp. 34

Author(s):

Mochamad Targib Alatas

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Surgical Intervention ◽

Case Series ◽

Spinal Cord Injury Patient ◽

Traumatic Spinal Cord Injury ◽

Best Interest ◽

Score Improvement ◽

Cord Injury ◽

Injury Patient

Early surgical treatment for traumatic spinal cord injury (SCI) patients has been proven to yield better improvement on neurological state, and widely practiced among surgeons in this field. However, it is not always affordable in every clinical setting. It is undeniable that surgery for chronic SCI has more challenges as the malunion of vertebral bones might have initiated, thus requires more complex operating techniques. In this case series, we report 7 patients with traumatic SCI whose surgical intervention is delayed due to several reasons. Initial motoric scores vary from 0 to 3, all have their interval periods supervised between outpatient clinic visits. On follow up they demonstrate significant neurological development defined by at least 2 grades motoric score improvement. Physical rehabilitation also began before surgery was conducted. These results should encourage surgeons to keep striving for the patient’s best interest, even when the injury has taken place weeks or even months before surgery is feasible because clinical improvement for these patients is not impossible.

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