Combined Transcutaneous Electrical Spinal Cord Stimulation and Task-Specific Rehabilitation Improves Trunk and Sitting Functions in People with Chronic Tetraplegia

Abstract

The aim of this study was to examine the effects of transcutaneous electrical spinal cord stimulation (TSCS) and conventional task-specific rehabilitation (TSR) on trunk control and sitting stability in people with chronic tetraplegia secondary to a spinal cord injury (SCI). Five individuals with complete cervical (C4–C7) cord injury participated in 24-week therapy that combined TSCS and TSR in the first 12 weeks, followed by TSR alone for another 12 weeks. The TSCS was delivered simultaneously at T11 and L1 spinal levels, at a frequency ranging from 20–30 Hz with 0.1–1.0 ms. pulse width biphasically. Although the neurological prognosis did not manifest after either treatment, the results show that there were significant increases in forward reach distance (10.3 ± 4.5 cm), right lateral reach distance (3.7 ± 1.8 cm), and left lateral reach distance (3.0 ± 0.9 cm) after the combinational treatment (TSCS+TSR). The stimulation also significantly improved the participants’ trunk control and function in sitting. Additionally, the trunk range of motion and the electromyographic response of the trunk muscles were significantly elevated after TSCS+TSR. The TSCS+TSR intervention improved independent trunk control with significantly increased static and dynamic sitting balance, which were maintained throughout the TSR period and the follow-up period, indicating long-term sustainable recovery.

Neuromodulation for recovery of trunk and sitting functions following spinal cord injury: a comprehensive review of the literature

“…Additionally, trunk instability could lead to various secondary health issues such as pressure injuries (Tharu et al 2022a ), spinal deformities (Friederich et al 2020 ), and pulmonary dysfunction (Patel et al 2017 ). Approximately 70–80% of SCI survivors have decreased or no trunk control (Rahimi et al 2020 ), and are wheelchair-bound (Tharu et al 2022b ). Paralysis of trunk muscles is one of the most significant factors affecting sitting balance in individuals with SCI (Bergmann et al 2019 ; Friederich et al 2020 ), which limit their capacity to perform transfers, propel their manual wheelchairs, and reach for objects (Triolo et al 2009 ).…”

“…As such, the quality of life in people with SCI depends on their dynamic sitting balance and the ability to sit unsupported (Bergmann et al 2019 ), which becomes more important as the post-injury time increases (Friederich et al 2020 ). Therefore, trunk recovery is an essential factor for those with sitting difficulties (Tharu et al 2022b ). Unfortunately, only a few studies have investigated the sitting balance or trunk stability in people with SCI (Bergmann et al 2019 ).…”

“…Neuromodulation is an emerging viable treatment option for paralysis following SCI (Seáñez and Capogrosso, 2021 ; Rahman et al 2022 ). Various forms of neuromodulation have been used to treat SCI, such as functional electrical stimulation (FES) (Wilkenfeld et al 2006b ), electrical stimulation (ES) (Momeni et al 2016 ), functional neuromuscular stimulation (FNS) (Friederich et al 2022 ), transcutaneous electrical spinal cord stimulation (TSCS) (Tharu et al 2022b ), and epidural spinal electrical stimulation (EES) (Gill et al 2020 ). FES, ES and FNS can be delivered both invasively and non-invasively.…”

“…Motor functions modulated by TSCS and EES could restore trunk and sitting impairments (Laskin et al 2022 ). However, only a limited number of studies have examined the possibility of trunk recovery after SCI (Rath et al 2018 ; Chiou and Strutton 2020 ; Tharu et al 2022b ), but due to their small sample size the effects remain uncertain and even fewer have examined the effects of TSCS (Rath et al 2018 ; Tharu et al 2022b ) or EES (Triolo et al 2009 ) for trunk and sitting improvement.…”

A Pilot Study of the Effect of Transcutaneous Spinal Cord Stimulation on Micturition-Related Brain Activity and Lower Urinary Tract Symptoms After Stroke

“…Although TSCS is a relatively new neuromodulation modality, its effect on restoration of diverse bodily functions has been assessed by various authors and studies. 6,7,[10][11][12][13] However, the neural mechanisms underlying the potential benefits of TSCS are yet to be explored. In this pilot study, we investigate the effects of TSCS on neuroimaging outcomes during urodynamic events in patients with LUTS due to stroke.…”