Cortical vs. afferent stimulation as an adjunct to functional task practice training: a randomized, comparative pilot study in people with cervical spinal cord injury

Gomes‐Osman, Joyce; Field-Fote, Edelle C.

doi:10.1177/0269215514556087

Cited by 51 publications

(63 citation statements)

References 34 publications

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“…The finding that FTP + PNSS was associated with improvements in precision grip strength confirms the conclusions of prior smaller studies in persons with tetraplegia that have assessed the effects of this intervention on precision grip strength, but only in the weaker hand (12, 19). Imaging studies in neurologically healthy participants have shown that precision grip is associated with bihemispheric activation of numerous motor and sensory cortical regions, while power grip is associated primarily with activation of contralateral activation of the primary motor and sensory cortices (51).…”

Section: Discussionsupporting

confidence: 85%

Priming for Improved Hand Strength in Persons with Chronic Tetraplegia: A Comparison of Priming-Augmented Functional Task Practice, Priming Alone, and Conventional Exercise Training

et al. 2017

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Many everyday tasks cannot be accomplished without adequate grip strength, and corticomotor drive to the spinal motoneurons is a key determinant of grip strength. In persons with tetraplegia, damage to spinal pathways limits transmission of signals from motor cortex to spinal motoneurons. Corticomotor priming, which increases descending drive, should increase corticospinal transmission through the remaining spinal pathways resulting in increased grip strength. Since the motor and somatosensory cortices share reciprocal connections, corticomotor priming may also have potential to influence somatosensory function. The purpose of this study was to assess changes in grip (precision, power) force and tactile sensation associated with two different corticomotor priming approaches and a conventional training approach and to determine whether baseline values can predict responsiveness to training. Participants with chronic (≥1 year) tetraplegia (n = 49) were randomized to one of two corticomotor priming approaches: functional task practice plus peripheral nerve somatosensory stimulation (FTP + PNSS) or PNSS alone, or to conventional exercise training (CET). To assess whether baseline corticospinal excitability (CSE) is predictive of responsiveness to training, in a subset of participants, we assessed pre-intervention CSE of the thenar muscles. Participants were trained 2 h daily, 5 days/week for 4 weeks. Thirty-seven participants completed the study. Following intervention, significant improvements in precision grip force were observed in both the stronger and weaker hand in the FTP + PNSS group (effect size: 0.51, p = 0.04 and 0.54, p = 0.03, respectively), and significant improvements in weak hand precision grip force were associated with both PNSS and CET (effect size: 0.54, p = 0.03 and 0.75, p = 0.02, respectively). No significant changes were observed in power grip force or somatosensory scores in any group. Across all groups, responsiveness to training as measured by change in weak hand power grip force was correlated with baseline force. Change in precision grip strength was correlated with measures of baseline CSE. These findings indicate that corticomotor priming with FTP + PNSS had the greatest influence on precision grip strength in both the stronger and weaker hand; however, both PNSS and CET were associated with improved precision grip strength in the weaker hand. Responsiveness to training may be associated with baseline CSE.

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Section: Discussionsupporting

confidence: 85%

Priming for Improved Hand Strength in Persons with Chronic Tetraplegia: A Comparison of Priming-Augmented Functional Task Practice, Priming Alone, and Conventional Exercise Training

et al. 2017

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“…[15][16][17][18] Studies of rTMS and transcranial direct cortical stimulation are also based on patients with preserved voluntary activity in the muscles under investigation. 11,12,18 PAS induces plasticity in humans without concomitant effort by the subject; 4 we thus hypothesized that long-term PAS could be a technique that could affect also those muscles which are fully paralyzed.…”

Section: Introductionmentioning

confidence: 99%

Long-term paired associative stimulation can restore voluntary control over paralyzed muscles in incomplete chronic spinal cord injury patients

Shulga

Lioumis

Zubareva

et al. 2016

Spinal Cord Ser Cases

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Emerging therapeutic strategies for spinal cord injury aim at sparing or restoring at least part of the corticospinal tract at the acute stage. Hence, approaches that strengthen the weak connections that are spared or restored are crucial. Transient plastic changes in the human corticospinal tract can be induced through paired associative stimulation, a noninvasive technique in which transcranial magnetic brain stimulation is synchronized with electrical peripheral nerve stimulation. A single paired associative stimulation session can induce transient plasticity in spinal cord injury patients. It is not known whether paired associative stimulation can strengthen neuronal connections persistently and have therapeutic effects that are clinically relevant. We recruited two patients with motor-incomplete chronic (one para-and one tetraplegic) spinal cord injuries. The patients received paired associative stimulation for 20-24 weeks. The paraplegic patient, previously paralyzed below the knee level, regained plantarflexion and dorsiflexion of the ankles of both legs. The tetraplegic patient regained grasping ability. The newly acquired voluntary movements could be performed by the patients in the absence of stimulation and for at least 1 month after the last stimulation session. In this unblinded proof-of-principle demonstration in two subjects, long-term paired associative stimulation induced persistent and clinically relevant strengthening of neural connections and restored voluntary movement in previously paralyzed muscles. Further study is needed to confirm whether long-term paired associative stimulation can be used in rehabilitation after spinal cord injury by itself and, possibly, in combination with other therapeutic strategies.

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“…The use of tDCS has led to improvements in pinch force, manual dexterity, and force modulation when combined with repetitive practice [18]. Other study reported that stimulation intensity affects functional outcomes when tDCS was delivered at rest: increased corticospinal excitability to affected muscles was obtained when using 2 mA stimulation, but not 1 mA, in nine chronic SCI patients [19].…”

Section: Transcranial Direct Current Stimulation (Tdcs)mentioning

confidence: 98%

“…This technique is still in the early stage. To our knowledge, just seven studies have examined improvements in motor function after SCI related to the use of tDCS: four studies evaluated its effect on upper limb function [18][19][20][21] and three studies evaluated the tDCS effect on lower limb function and gait [22][23][24]. All these studies used anodal stimulation and showed improvements in upper and lower limb motor function.…”

Section: Transcranial Direct Current Stimulation (Tdcs)mentioning

confidence: 99%

Noninvasive Modalities Used in Spinal Cord Injury Rehabilitation

Barroso¹,

Pascual-Valdunciel²,

Torricelli³

et al. 2019

Spinal Cord Injury Therapy [Working Title]

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In the past three decades, research on plasticity after spinal cord injury (SCI) has led to a gradual shift in SCI rehabilitation: the former focus on learning compensatory strategies changed to functional neurorecovery, that is, promoting restoration of function through the use of affected limbs. This paradigm shift contributed to the development of technology-based interventions aiming to promote neurorecovery through repetitive training. This chapter presents an overview of a range of noninvasive modalities that have been used in rehabilitation after SCI. Among others, we present repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), surface electrical stimulation tools such as transcutaneous electrical spinal cord stimulation (tcSCS), transcutaneous electrical nerve stimulation (TENS), and functional electrical stimulation (FES), as well as its integration with cycling training and assistive robotic devices. The most recent results attained and the potential relevance of these new techniques to strengthen the efficacy of the residual neuronal pathways and improve spasticity are also presented. Future efforts toward the widespread clinical application of these modalities include more advances in the technology, together with the knowledge obtained from basic research and clinical trials. This can ultimately lead to novel customized interventions that meet specific needs of SCI patients.

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Cortical vs. afferent stimulation as an adjunct to functional task practice training: a randomized, comparative pilot study in people with cervical spinal cord injury

Abstract: Meaningful improvements in aspects of hand-related function that persisted at least 30 minutes after intervention were observed with transcutaneous electrical nerve stimulation and transcranial direct current stimulation, when combined with functional task practice.

Cited by 51 publications

References 34 publications

Priming for Improved Hand Strength in Persons with Chronic Tetraplegia: A Comparison of Priming-Augmented Functional Task Practice, Priming Alone, and Conventional Exercise Training

Priming for Improved Hand Strength in Persons with Chronic Tetraplegia: A Comparison of Priming-Augmented Functional Task Practice, Priming Alone, and Conventional Exercise Training

Long-term paired associative stimulation can restore voluntary control over paralyzed muscles in incomplete chronic spinal cord injury patients

Noninvasive Modalities Used in Spinal Cord Injury Rehabilitation

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