Combining spinal neuromodulation and activity based neurorehabilitation therapy improves sensorimotor function in cerebral palsy

Abstract

Motor dysfunction in individuals with cerebral palsy (CP) such as the inability to initiate voluntary movements, walking with compensatory movement patterns, and debilitating spasticity is due to the aberrant neural connectivity between the brain and spinal cord. We tested the efficacy of noninvasive spinal cord neuromodulation (SCiP™, SpineX Inc.) with activity-based neurorehabilitation therapy (ABNT) in improving the sensorimotor function in six children with CP. Children received 8 weeks of either SCiP™ or sham therapy with ABNT (n = 3 per group). At the end of 8 weeks, all participants received 8 weeks of SCiP™ therapy with ABNT. Follow up assessments were done at week 26 (10 weeks after the last therapy session). Sensorimotor function was measured by the Gross Motor Function Measure 88 (GMFM88) test. We observed minimal change in sham group (mean 6% improvement), however, eight weeks of SCiP™ therapy with ABNT resulted in statistically and clinically relevant improvement in GMFM88 scores (mean 23% increase from baseline). We also observed reduced scores on the modified Ashworth scale only with SCiP™ therapy (−11% vs. +5.53% with sham). Similar improvements were observed in sham group but only after the cross over to SCiP™ therapy group at the end of the first eight weeks. Finally, sixteen weeks of SCiP™ therapy with ABNT resulted in further improvement of GMFM88 score. The improvement in GMFM88 scores were maintained at week 26 (10 weeks after the end of therapy), suggesting a sustained effect of SCiP™ therapy.

Transcutaneous Spinal Stimulation and Short-burst Interval Treadmill Training in Children with Cerebral Palsy: A Pilot Study

“…Our findings build on prior studies of tSCS for children with CP. There have now been evaluations of tSCS with more than 50 children with CP across several research groups [14], [15], [16], [17]. Most prior studies have not evaluated impacts on spasticity or long-term training.…”

“…Most prior studies have not evaluated impacts on spasticity or long-term training. In the one prior study that evaluated spasticity, however, no effect of tSCS on spasticity was reported for the two GMFCS Level I-II children included in the study when tSCS was combined with activity-based neurorehabilitation therapy [15]. They applied tSCS to the cervical and thoracic spine at lower amplitudes (12-18 mA at C5-6 and 10-16 mA at T11-12) All rights reserved.…”

“…This further leads to a disruption of inhibitory and excitatory inputs, manifesting as spasticity [50] and impacting mobility [51]. We theorize that the combination of tSCS and motor training promotes reorganization of the spinal-supraspinal connectivity by amplifying sensory signals at the level of the spinal cord during functional activities [11], [15]. Motor practice during this amplified state of sensory feedback may result in improved sensorimotor integration at both spinal and supraspinal levels that is maintained for at least several months following treatment [11].…”

“…Transcutaneous spinal cord stimulation (tSCS) is a novel, non-invasive neuromodulation technique that can modulate spinal and supraspinal circuits [10], [11] especially when implemented with physical therapy [12]. Use of tSCS with physical therapy has reduced spasticity and improved motor function in people with spinal cord injury and CP [12], [13], [14], [15]. In children with CP, a single session of tSCS improved coordination of walking and muscle activation [16], while repeated sessions with bodyweight supported treadmill training or activity-based neurorehabilitation therapy improved walking biomechanics and gross motor function, respectively [14], [15], [17].…”

Effects of spinal stimulation and short-burst treadmill training on gait biomechanics in children with cerebral palsy

“…Prior work has hypothesized that tSCS supports neuroplasticity by inducing reorganization of the central nervous system [8]. Repeated delivery of the combination of tSCS and physical therapy has led to improvements in gross motor function for children with CP [6,7,9]. Understanding the neuromechanical response to therapeutic tSCS is critical in defining the mechanisms by which spinal stimulation may improve gross motor function.…”